JOURNAL OF SCIENCE, Hue University, N 0 61, 2010 MALNUTRITION STATUS AND RELATIVE FACTORS IN CHILDREN UNDER 5 YEARS OLD IN KON TUM PROVINCE, 2008 Pham Thi Hai College of Medicine and Ph
Trang 1JOURNAL OF SCIENCE, Hue University, N 0 61, 2010
MALNUTRITION STATUS AND RELATIVE FACTORS IN CHILDREN
UNDER 5 YEARS OLD IN KON TUM PROVINCE, 2008
Pham Thi Hai College of Medicine and Pharmacy, Hue University
SUMMARY
In 2008, a study was conducted in a population of 1500 Children under 5 years old and their mothers in Kon Tum Province using a cross-sectional method with two objectives: identify the malnutrition rate in children under 5 years old in Kon Tum province, 2008 and find out the factors related to the malnutrition situation in children under 5 years old in Kon tum province Results showed that the malnutrition rate was 30.2%, including 24.2% of malnutrition level I; 5.5% of level II and the remaining of level III In terms of relative factors of malnutrition in Children There are many different factors contributing to malnutrition such as low birth-weight (< 2500 gram); children with a history of diarrhea and acute respiratory infections; mothers with low BMI (< less than 18.5); mothers with a poor diet and low weight of the mothers during pregnancy; low education level of the mothers; mother’ age from 36-49 when being pregnant; having a family of more than 3 children; and low family income Other factors regarding breastfeeding and complementary feeding were: a complete lack of breastfeeding in the first six months of age; early weaning time (< 12 months); early initiation of complementary diet (< 6 months); and a poor complementary diet consisting of only gruel with rice flour and salt The relationship between malnutrition in children and the factors such as breastfeeding time after giving birth, and mother’s occupation has not been found
Key words: malnutrition, weight, height, breast milk, weaning, related
1 Introduction
Vietnam is not only internationally recognised in the effort to prevent malnutrition, but is also the sole country which has achieved success in reducing the acute malnutrition rate However, the malnutrition rate in children is still high, this is one of the barriers to the development and integration process of the country
Kon Tum is a highland province in the northern central area The ethnic minority group makes up more than 54% of the population They often have low education levels and follow traditional customs For this reason, the high risk level of malnutrition in children here would be unavoidable Weight malnutrition rate in children under 5 according to an investigation in 2007 was 31%, which was relatively high in
Trang 2comparison with other provinces There is a considerable gap between this figure and the required target of national nutrition strategy to be reached by late 2010 Monitoring the annual malnutrition rate along with investigating and evaluating associated risk factors are important activities develop appropriate solutions for preventing malnutrition
in the future As a result, we conduct the study: “Malnutrition status and relative factors
in children under 5 years old in Kon Tum province, 2008”
Study objectives is to identify the malnutrition rate in Children under 5 years old in Kon Tum province, 2008 and investigate the factors related to the malnutrition situation in Children under 5 years old in Kon Tum province
2 Methodology
2.1 Subjects and Research Time
Study participants were all under 5-year-old children born from 01/11/2003 to 31/10/2008 and their mothers in Kon Tum
The study was conducted between July 2008 and October 2008 in all 9 suburban districts of the province
2.2 Research method: The study used a cross-sectional descriptive method
2.2.1 Sample size:
The sample size is calculated based on the formula, as following:
2 2 /
2 ( 1 )
d
p p Z
Where:
n: Number of researched children Confident interval: 95%, Z /2 =1,96 p: Estimated malnutrition rate, p = 31,5% is malnutrition rate of the year
2007 in Kon Tum3
d: Standard error, d = 0,25 Therefore, the minimum sample size is 1326 children
Adding 15% for refusals and attrition, the study sample size is 1500 children
2.2.2 Selecting the sample:
The study used a multi–stage random sampling method
2.2.3 Collecting data:
- Children: date of birth, gender, birth-weight, breastfeeding status,
Trang 3complementary diet, disease status, and anthropometric measurements
- Mother: age, education level, occupation, ethnic group, family income, drinking and eating habit, number of children and anthropometric measurement
2.2.4 Collecting data techniques:
- Identifying children under 5 years of age: estimating their age based on the nearest month and year
- Idetifying athropometric measurements: measuring weight and height as normal rule
- Collect information about relative factors by directly interviewing mothers (or guardians) using a structured questionnaire
2.2.5 Indicators to evaluate nutritional status in children:
Three anthropometric measurements are Weight-for-age, Height-for-age and Weight-for-height The study results were on the basis of reference data of the U.S National Center for Health Statistics (NCHS); A negative standard deviation (-2SD) is considered as malnutrition
2.3 Data analysis method:
The study used EPI INFO and SPSS software to determine the malnutrition rate according to adjusted age and gender Test 2 was used to compare the indicators
3 Results
3.1 Malnutrition rate:
Table 3.1 Underweight- for-age malnutrition rate
Children
Percentage
<0.001
The underweight malnutrition rate of children in Kom Tum, in 2008 is 30.2%, which is still relatively high compared with 19.9% of the national malnutrition rate This figure is also considered as at very high level according to the WHO’s
Trang 4classification Therefore, to achieve the required target of the national nutrition strategy
of 2001-2010, it is necessary for Kon Tum province to improve the economic conditions and education levels in the effort of reducing the malnutrition rate in children to 20% by
2010
Figure 3.1 underweight-for-age malnutrition rate in children
Malnutrition in children often happens in the first year of life (12.7%) and increases in accordance with the age group The highest malnutrition risk was found in children within the age group of 12 to 36 months, which then continues at a high level until under 60 months (29.3%) This finding is comparable with the investigation of the Nutrition Institution and Phan Van Hai but different with the studies which were implemented in plain areas, which showed that the highest malnutrition rate is at the group of 48 to 60-month old
Table 3.2 Stunting-for-age malnutrition rate
Number of Malnutrition case
Percentage
<0.0001
The stunting malnutrition rate in children under 5 years old in Kon Tum is much higher than in the whole country and at a very high level according to the WHO
Trang 5classification1 Stunting in children under 5 years old appears early in the first year of life (24.4%) and booms in the age group of 12 to under 24 months, and is then constantly maintained at high levels until under 60 months; There is a significant difference in the stunting malnutrition rate among age groups (figure 3.2) This outcome
is similar to the study of Phan Van Hai The Nutrition Institution, and some other researchers
Figure 3.2 Stunting-for-age malnutrition rate Table 3.3 Wasting-for-age malnutrition rate
<0.001
The highest wasting-for-age malnutrition rate is in the 12 to under 24-month-old group This figure will gradually decrease when children grow up There is a statistical difference with p<0.001
Trang 6Figure 3.3.Wasting-for-age malnutrition rate
According to Ha Huy Khoi, the wasting malnutrition rate is often at the highest level when children are 2 years old This is an age group which is weaning and switching to the diet of an adult person Therefore, poor diet along with diseases can lead to wasting in children
Table 3.4 Classification of malnutrition according to level
Almost malnourished children is in level 1; Malnutrition level is just 0.5%
Table 3.5 Classification of stunting- for-gender malnutrition rate
malnutrition rate %
Stunting malnutrition rate%
SDD thấp còi %
p>0.05 The difference between boys and girls in all of three type of malnutrition is insignificant This result is comparable to the researchers
Trang 7Table 3.6 Classification of malnutrition rate according to rate
malnutrition rate %
Stunting malnutritio
n rate%
Wasting malnutrition rate %
Minority ethnic
p <0,001 p <0,001 The malnutrition rate in ethnic minority children is much higher than than in Kinh children in all 3 types of malnutrition This difference is statistically significant with p<0.001 This result is similar to Phan Van Hai’s study and other researchers
Table 3.7 Malnutrition rate of the combination of HFA and WFH
There are 2.5% of children in malnutrition status of stunting and wasting symptom
3.2 Factors relative to malnutrition status
Table 3.8 The relationship between studied factors and malnutrition status
Studied factors
% Malnut rition rate
% nutrition rate
p
Mother’s diet during
pregnancy
<0.001 normal & greater than 27.9 72.1
Weight increase of
mother during
pregnancy
<0.001
Birth-weight
<0.001
Trang 8No 27.6 72.4
Pre-lacteal feed
early ( 1 hour) 29.7 70.3
> 0.05 late (>1 hour ) 31.6 68.4
Breastfeeding in the
first 6 months of age
< 0.05
Initiation of
complementary diet
< 0.05
Weaning time
<12 months 52.2 47.8 <0.001
Malnutrition is associated with diet and the weight increase of mother during pregnancy, birth-weight, completely breastfed within 6 months of age, complementary diet, early weaning (p<0.001) Our outcomes are rational with the researchers
Table 3.9 The relationship between children with medical history of diarrhea and fever along
with bad cough and malnutrition
Diarrhoea
p <0.001
Fever and cough
p <0.001
Malnutrition is notably related to children with a medical history of diarrhea and fever along with bad cough (p < 0.001) This result is in accordance with other research
Table 3.10 Other relative factors and malnutrition rates in Children
on rate %
Nutrition
Education level of
mother
p <0.0001 Primary school 31.9 68.1
Trang 9 second
Occupation of mother
> 0.05
<0.001
<0.05
<0.001
<0.001
There is a correlation between malnutrition in children and other factors such as the education level of the mothers, BMI of the mothers, mothers’ age, their number of children and family income The difference has statistical meaning with p<0.05-0.001 Our results are comparable with other research
The occupation of mothers is statistically linked with malnutrition in children in, which is also reported by other researchers
4 Conclusion
Through the study of a population of 1500 under 5-year-old children and their mothers of in Kon Tum, we found the following results:
Malnutrition status in Children:
The malnutrition rate is 30.2%, including 24.2% of malnutrition level ®, 5.5%
of level II and the remaining of level III
The group of babies from 12 to less than 24 month-old occupies the highest malnutrition rate, consisting of types of stunting, underweight and wasting
The height-for-age malnutrition rate is at a very high level of 44.5% and weight-for-height malnutrition rate is 6.9%; the malnutrition rate of children who contract both stunting and wasting symptom is 2.5%
Trang 10There was indifferences between malnutrition rate of boys and girls (p>0.05) The malnutrition rate was significantly different in statistics between Kinh children and ethnic minority children The underweight malnutrition rate of Kinh children and ethnic minority children is 18.6% and 31.8% respectively (p <0.001) The stunting malnutrition rate is 31.6% for the former and 46.3% for the latter (p<0.001)
Malnutrition-related factors in Children
There are many different factors contributing to malnutrition such as birth-weight of children under 2500 gram; children with history of diarrhea and acute respiratory infection; mothers’ BMI of less than 18.5; poor diet of the mother and low weight of the mothers during pregnancy; low education level of the mothers; mothers’ age from 36-49 when being pregnant; having a family of more than 3 children and low family income Other factors about breastfeeding and complementary diet such as a complete lack of breastfeeding in the first six months of age; weaning time is less than
12 months; initiation of complementary diet is under 6 months; and a poor complementary diet consisting of gruel with rice flour and salt
The relationship between malnutrition in children and the factors such as breastfeeding time after giving birth, and mother’s career has not been found
5 Recommendation
From above results, we propose some of the solutions to improve the malnutrition status in children in the areas of Kon Tum province, as follows:
(1) Strengthen the communication and education about nutrition for the mothers
to improve knowledge of caring and feeding children, especially sick children
(2) Improve health care and nutrition for women of childbearing age, especially for pregnant women, and improvement in household income;
(3) Continue further research on specific risk factors causing malnutrition in under 5-year-old children in Kon Tum particularly and the Central Highlands generally, especially in ethnic minority children From that point, we will have effective solutions
to diminish the rate of child malnutrition
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