Eating habits _ _ _ _ 11
Many school-aged children globally consume inadequate amounts of fruits and vegetables while overindulging in unhealthy snacks high in sugar, saturated fats, sodium, and salts, including items like bread, cookies, ice cream, and sweetened beverages that are often marketed to them A Brazilian study found that no children aged 7 to 8 years met the diet quality index for vegetables In developing countries, especially among poorer families and in rural areas, children's diets primarily consist of a limited range of staples such as cereals, roots, and tubers, with minimal protein intake.
Breakfast patterns are crucial for children's health, yet many school-aged children worldwide skip or delay this important meal, which is particularly detrimental to cognitive function, especially in undernourished children Research indicates that children who postpone breakfast tend to have a higher Body Mass Index (BMI) compared to their peers A 2007 study in New Zealand revealed that those who skipped breakfast were more likely to consume calorie-dense snacks, such as chocolate, cakes, chips, and sugary beverages, which are low in nutritional value.
A study conducted by Al-Domi HA et al involving 977 students aged 7-18 in three major cities of Jordan (Amman, Irbid, and Al-Zarqa) identified regular meals and snacks from school cafeterias as risk factors for overweight and obesity Additionally, research by Tran Thi Xuan Ngoc highlighted a link between eating patterns and disordered eating behaviors, such as gluttony and the consumption of junk food.
Consumption of thermogenic nutrients, sugary soft beverages, and high-sugar foods, along with inadequate parental regulation of children's sugar intake, significantly increases the risk of overweight and obesity Research by Le Thi Hop et al highlights that sugary snacks do not supply essential nutrients for children's healthy growth while contributing to excess calorie intake for mothers, as noted by Egyptian researchers.
Physical activities - - - —
In 2008, the American Physical Activity Advisory and Guidance Committee advised that children under 18 should participate in 60 minutes of physical activity daily, ranging from mild to vigorous intensity, to help reduce the rates of overweight and obesity.
Only 48.99% of boys and 34.7% of girls aged 6 to 11 meet physical activity recommendations, with a significant decline of approximately 37.6 minutes in activity time observed between ages 9 and 15 Longitudinal studies reveal that only 11.9% of boys and 3.4% of girls aged 12-15 are aware of these guidelines Sedentary behavior and engaging in less than 30 minutes of daily exercise are identified as risk factors for overweight and obesity, as shown in a study involving 977 students aged 7 to 18 in Jordan Additionally, research by Blanco et al indicates that children with obesity are less physically active compared to their normal-weight peers, highlighting the need for increased awareness and intervention in physical activity levels among children.
In Can Tho, a study involving 1,000 students revealed that 9% of those who engaged in physical activities or sports experienced stunting, a percentage notably lower than the 25% observed among their peers who did not participate in such activities.
The most critical causes for malnutrition according to several reports, were the economic andsocial conditions
A family's income significantly influences a child's health and nutrition, with children from low-income households more likely to be overweight In the United States, the prevalence of childhood obesity decreases as family education and income levels rise Similarly, in Europe, a link has been established between obesity and socioeconomic deprivation, highlighting the relationship between parental socioeconomic status and children's education in countries like Czechia, Portugal, and Sweden, as reported by the WHO Childhood Obesity Surveillance Initiative in 2008.
Geographic isolation significantly impacts families' access to essential food, healthcare, and nutrition services in countries like Burundi, Honduras, and Mali In these regions, the prevalence of stunted children is notably higher, with Honduras and Mali reporting twice the rates compared to metropolitan areas, while Peru shows three times the incidence.
Obesity and overweight are more prevalent among wealthier families, particularly in urban areas, where schoolchildren show significantly higher rates, although the disparity is decreasing in some affluent regions Research indicates that children in urban settings tend to be taller than their rural peers, and factors such as spatial disparity play a crucial role in health outcomes Urban children, regardless of gender, experience higher obesity rates compared to those in rural areas, primarily due to urban lifestyles that promote sedentary behavior and reduced physical activity.
In the United States, research has shown that race and ethnicity significantly influence dietary habits, with malnutrition identified as being overweight Studies indicate that children of African descent are at a greater risk of obesity compared to their peers Notably, African girls are 6% to 7% more likely to be overweight than Mexican-American boys.
Socioeconomic factors significantly influence children's nutrition, with gender, father's occupation, and mother's education playing key roles A 2016 survey in Bangladesh identified additional critical factors, including age, mother's BMI, both parents' educational levels, place of residence, socioeconomic status, community status, religion, and region, all contributing to childhood malnutrition.
A study by Hackett et al examined disadvantaged Colombian children in small municipalities and identified household assets as significant determinants of children's nutritional status The research indicated that trained parents and the unavailability of a community piped water network positively impacted child health Similarly, Bassolé's findings in India revealed that access to healthy drinking water reduced stunting, as measured by height-for-age z-scores (HAZ) Furthermore, increased latrine coverage was shown to effectively reduce fecal pathogen exposure and prevent diseases, thereby decreasing long-term malnutrition, as demonstrated in research conducted in Odisha.
Research has extensively examined the relationship between a mother's education and employment status and her child's nutritional health Numerous studies indicate a significant correlation between a mother's educational attainment and the nutritional status of her child.
Children of educated mothers tend to have better nutritional outcomes compared to those of illiterate mothers An analysis conducted in Indonesia indicates that a mother's educational level is a strong predictor of her child's long-term nutritional success This correlation highlights the importance of maternal education in promoting child health and well-being.
Research indicates that higher maternal education offers a modest protective effect against childhood stunting However, if a mother lacks essential health skills, her education may not positively influence her child's nutritional status Consequently, a mother's basic health knowledge plays a more significant role in determining her child's nutrition than her formal education level Additionally, it is important to note that a father's educational attainment also correlates with his child's nutritional outcomes, highlighting the multifaceted nature of parental influence on child health.
RESEARCH SUBJECTS AND ME I 1101)0 LOGY
Study Subjects 2.2 Study location and studs time
Children aged 7-10 years old werestudents from primary schoob in Thai Nguyen and Nghe An provinces
Primary school children aged 7-10 years old residingin the research locationsand attending school at thetime of the study
Children whose parents had giveninformed consent
- Children with physical and mental deformities affecting anthropometric
2.2 Study locationand studyrune: Theresearch tookplace atthree pri mars’schools in Nghe An province and three primary schools in Thai Nguyen province from November 2020 to December 2020.
2-3.1 Study design: Using a cross-sectionalstudy
The formular has been usedto calculate the sample size (Estimating a population proportion with specified relative precision) as follows
Zlo 2 thestandardvariationusually set at 1 96 (whichcorresponds to a 95% confidence interval) p = 0.172 (the stunted prevalence of primary school children of the previous survey) (S3J £ = 0.30 (Relativeprecision).
So,theminimum sample size was n ■ 214
In total, the final sample size forthe study was 262
Samplingmethod: Using multi-stage sampling method
- Province selection purposively select twoprovinces
- School selection randomly select 3 schools each province in Thai Nguyen province:
Tan Lap Primary School Tan Lap Ward Thai Nguyen City
Chau Son PrimarySchool Chau Son Ward Song Cong City
Phuc Linh Primary School, PhueLinhCommune Dai Tu District ỉn Nghe Anprovince-
Tan Xuan Primary School TanXuan Commune.Tan Ky District
Ben Thuy Primary School Ben Thuy Ward Vinh City
Nghia XuanPrimary School Nghia Xiun Commune.Quy Hop District
- Researchsubjects sampling makea list ofall students in each age group from 7 to
10 Randomly select a target sample of 12 studentsper age group in each school
- Nutritional status of students Anthropometric isdiffer bygender andage, thatwhy not only the anthropometric index (Weight, Height, Sitting height Waist circumference, Hip circumference MUAC Tricepsskinfoldthickness Subscapular
-w •* CN ôG skinfold thickness), but also DOB and gender were variables Moreover HaZ and BAZwerecalculated
• Some factors related to nutritional status of students: ethnicity-, parent's details, children’s healthstatus, environmental factors, eating habits andphysicalactivities
• Distributed the designed questionnaires to the parentsof the students in order to collect data.
Measuring Height at ieast 3 times, the resuit would be the average of 3 measumentsfifthereHO5 ’ỈO difference by more than0.3 cm)
To measure students' height accurately, they removed their footwear and headgear, standing on a length measuring board with their feet together, heels against the backboard, and knees straight They were instructed to keep their gaze fixed on the ground, ensuring their eyes and ears were level The investigator gently lowered the measuring arm onto the top of their heads, asking them to breathe in and stand tall, before recording the results with a precision of 0.1 cm.
To accurately measure weight using a portable electronic weighing scale, ensure the scale is positioned on a firm, flat surface Students should remove their footwear and socks before stepping onto the scale, placing one foot on either side They are instructed to stand still, face forward, and adjust their posture before stepping off The weight results are recorded with a precision of ± 0.1 kg.
Preparing a constant tension tape and a pen Marking the inferior margin (lowest point) ofthe last riband the crest of the ilium (top of the hipbone) with a finepen
To accurately measure students' height, stand to the side and find the midpoint, marking it with a tape measure Wrap the tension tape around the marked midpoint, ensuring it remains horizontal across the student's back and front Instruct students to stand with their feet together, arms at their sides, and gently exhale Record the measurements with a precision of 0.1 cm for reliable results.
.Ifrosuring Hip Cirrumft'rt'Hcr
To measure waist circumference accurately, gather the same equipment as for measuring bullock girth Instruct students to stand with their feet together, arms at their sides, and palms facing inwards while gently exhaling Ensure the measuring tape is positioned horizontally around the body at the largest circumference Record the measurements with a precision of 0.1 cm.
To measure the midpoint of the upper arm in right-handed individuals, bend the left arm at a 90-degree angle and identify the top of the shoulder and the tip of the elbow Position the tape measure at the top of the shoulder, maintaining eye level, and place your right thumb on the tape where it meets the elbow's tip Fold the tape at this endpoint to find the midpoint of the upper arm, marking it with a finger or pen After straightening the arm, wrap the tape around the marked midpoint, adjusting for tension, and record the measurement with an accuracy of 0.1 cm.
* ikinfoldthlckrtfis (back side middle upperarm)
To accurately measure the vertical fold using the Harpenden caliper, assess the triceps skinfold on the posterior surface of the right upper arm, specifically at the pre-marked location for mid-upper arm circumference Ensure the student's shoulders are relaxed during this process for optimal results.
To measure skinfold thickness accurately, stand behind the subject and gently grasp a fold of skin and subcutaneous adipose tissue about 2.0 cm above the marked point using your thumb and index finger Ensure that the skinfold is parallel to the long axis of the arm Position the tips of the caliper jaws at the marked point, perpendicular to the length of the fold, and record the results with a precision of ± 0.1 mm.
Subscapular skinfold thickness is measured under the lowest point of the shoulder blade, utilizing a diagonal fold technique 1 to 2 cm below the inferior angle of the scapula This measurement is taken with a caliper skinfold, and results are recorded with an accuracy of 0.1 mm.
Potential Errors and Solutions
Information gathering errors, interview errors, andrecall errors were allpossibilities in theStudy-
Fix: - Ensured toolstandards Duringthe investigation only one device tvpe was usedfor each measurement.The weighing and measuj ingequipment must bechecked for accuracy after each investigation
Data management and analysis _
Before enteringdata into the softwares simple processing ofinformation fromthe questionnaire wasrequired
• BM1 of parents.- B\n ikg/ntlt criteria for Astons b\ the regional office for rằw n’esrent Pacific Regionof WHO
* Physical activity: The questionnaireincludes 9 questions based on a broad spectrum ofactivities takingplaceduringphysical education, school breaks, days and evenings and over the weekend Physical activity questionnaire forchildren and adolescents cut offpoint [96]
Sufficiently active: > 2.9 forboys and > 2.7 for girls
Low active: 0.05) The highest prevalence of overweight and obesity was observed in 5-year-olds at 29%, followed by 9-year-olds at 26.9% and 10-year-olds at 25.8%, while 7-year-olds had the lowest rate at 21.1% Stunting rates were highest among 7-year-olds at 9.9%, contrasting with the lowest rate of 6.5% in 8-year-olds Additionally, the 10-year-old group experienced the highest rate of wasting at 9.7%, whereas the 9-year-olds had the lowest rate at 4.5%.
3.3 Somefactors related to nutritional status or students
Table 3 7.The association between the nut ritional status of children and the parent's nutritional status
(Father) • Yes No OR(95% CI) p n % n %
•B.\a criteriaforAiicns byrhe regional officefor rhe Ifestern Pacific Region of ÍĨHO
Table 3.7 reveals a significant correlation between maternal nutritional status and stunting rates in children The prevalence of stunting was only 6.1% among children of mothers with a normal BMI, but it increased dramatically to 22.7% for those born to underweight mothers, indicating a statistically significant association (OR 4.5; 95% CI 1.1-15.3; P