Báo cáo nghiên cứu khoa học: "Nghiên cứu về phát triển thể chất và tâm thần và một số yếu tố liên quan của trẻ sơ sinh ở thành phố Huế - Việt Nam, 2009-2010"

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Nội dung Text: Báo cáo nghiên cứu khoa học: "Nghiên cứu về phát triển thể chất và tâm thần và một số yếu tố liên quan của trẻ sơ sinh ở thành phố Huế - Việt Nam, 2009-2010"

JOURNAL OF SCIENCE, Hue University, N0 61, 2010 STUDY ON PHYSICAL AND PSYCHOMOTOR DEVELOPMENT AND SOME RELATED FACTORS OF INFANTS IN HUE CITY - VIETNAM, 2009-2010 Hoang Thi Bach Yen, Hoang Anh Tien , Nguyen Van Dat, Dinh Thanh Hue College of Medicine and Pharmacy, Hue University SUMMARY Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. For children, good health is very important because it is the foundation for physical, psychomotor development. Nutrition for children in the first years plays an important role in the development process and quality of life of each individual. Insufficient nutrition in this period can lead to poor physical and mental development, and even diseases. This study was conducted with two objectives: To assess the physical, psychomotor development of infants in Hue City in 2009-2010; and to identify factors relating to physical, psychomotor development of infants. Methodology: A cross-sectional study was implemented with a combination of quantitative and qualitative methods. Results: The prevalence of underweight, stunting, and wasting malnutrition were 2.07%, 1.55% and 4.39%, respectively. Prevalence of delayed psychomotor development was 8.27%. There was a correlation between the time of having complementary feeding and weight-for-length (r= - 0.156, p
diseases and death of infants. Long-term consequences include bad results at school, low working productivity and delayed mental development. Moreover, during the first year of life, the immune system has not been fully developed. Insufficient nutrition in this period can lead to poor physical and mental development and even diseases. The Denver test has been applied in community in Vietnam. But in Hue city, it was just used to assess and follow the psychomotor development for children with health problems, not in community. The objectives of study are to assess the physical, psychomotor development of infants in Hue City in 2009-2010 and to identify factors in the relation with physical, psychomotor development of infants. 2. Methodology 2.1. Study design: This is a cross- sectional study with a combination of quantitative and qualitative methods. 2.2. The setting: Hue city -Vietnam 2.3. Study subjects: Infants live in Hue city and their mothers. 2.3.1. Sample size: p (1  p ) 2 n  Z e2 2 With the 95% confidence level, Z  / 2 =1.96 p =0.9: Estimated prevalence of normal physical and psychomotor development of infants. e = 0.03 Then n = 385. The sample size in this study is 387 infants and 387 mothers. 2.3.2. Sampling method: cluster random sampling Classify 27 precints of Hue city into North and South of Perfume River, then select randomly 4 clusters for sampling (2 precints from the North and 2 precints from the South). The selected four precints were Huong Long, Phu Thuan from the North and Phu Hoi, Thuy Xuan from the South. All of the infants within each cluster (about 80- 110 infants/precint) were study subjects. 2.4. Measurement procedures - Quantitative method: Interview mothers using questionnaire, measuring weight, length, head circumference of the infants. Assess psychomotor development by Denver 2 test. 540
- Qualitative method: 2 focus group discussions of mothers and 2 key informant interviews of head of commune health center were implemented at Huong Long and Phu Hoi. 2.5. Statistical methods Using SPSS 15.0 and Medcal to calculate p, 2,mean. Using WHO Anthro software for assessment of physical development. To assess breast feeding practice of mothers, we used a score scale with 1 mark for each right practice. The criteria of right practices were - Using breast milk as the first food after birth - The child is breast-fed - Breast feeding begin within the first hour of birth - Feeding a baby "on demand" - Technique of feeding is right (observed and assessed by investigator) - Exclusive breast feeding from 4-6 months. 3. Ethical issues Respondents will be informed the aims of the study and the results will be published anonymously. 4. Results This study was conducted on 387 infants (208 males (53.7%), 179 females (46.3%)) and 387 mothers. All of them were Kinh. 4.1. Physical and psychomotor development of infants in Hue City in 2009- 2010 4.1.1. Physical development Table 1. Classification of undernutrition Classification n % p Underweight 8 25.81 Stunting 6 51.61
4.1.2. Psychomotor development Table 2. Psychomotor development of infants Classification n % p Normal 355 91.73 < 0.0001 Delayed 32 8.27 Total 387 100.0 Table 3. Number of delayed domains of psychomotor development by gender Male (1) Female (2) Total Gender p (1,2) Number n % n % n % 1 12 37.50 12 37.50 24 75.00 >0.05 2 3 9.38 2 6.25 5 15.63 >0.05 3 2 6.24 1 3.13 3 9.37 >0.05 Total 17 53.12 15 46.88 32 100.0 Among 4 domains, gross motor and language accounted for the highest prevalence of the delay (51.16% and 23.26% respectively). Except for the personal – social domain, the rest ones showed the delay on male rather than female. A statistically-significant difference was observed between genders for all delayed domains. 4.2. Factors relating to physical and psychomotor development of infants 4.2.1. Characteristics of the infants during neonatal period Table 4. Characteristics of the infants during the neonatal period Characteristics n % Full-term 355 91.73 Term Pre-term 25 6.46 Post-term 7 1.81 Total 387 100.0 Vaginal delivery 255 65.89 Way of delivery Interventional birth 132 34.11 Total 387 100.0 Yes 41 10.59 Diseases during neonatal 542
period No 346 89.41 Total 387 100.0 Severe jaundice 10 22.73 Which disease Neonatal infection 7 15.91 Others 24 61.36 Total 41 100.0 Weight at birth There were 24 (6.20%) of infants with a birth weight under 2500gr. Among of them 9 (2.33%) was pre-term. The weight at birth was 3100 ± 400 grams. 4.2.2. Feeding practice 4.2.2.1. Breastfeeding Table 5. Breastfeeding practice Breastfeeding practice n % Breast milk 205 52.97 Liquorice 8 2.07 Sugar 6 1.55 The first food after birth Infant formula 152 39.28 Others 16 4.13 Total 387 100.00 Yes 378 97.67 Breast feeding No 9 2.33 Total 387 100.00 Insufficient supply of milk 7 77.78 Mother using Insulin 1 11.11 Reasons for not breast feeding Non – protractile nipple 1 11.11 Total 9 100.00
>1 day 133 35.19 Total 378 100.00 On demand 318 84.13 Feeding time On clock 60 15.87 Total 378 100.00
delivery, she need time to rest before giving breastfeeding” (female, 35 years old, Huong Long). “Infants of mothers who had caesareans were often breast-fed after 1 day as the mother was isolated from the child” (females, 22, 32 years old, Phu Hoi). During that day, the child was fed by infant formula milk. Time of stopping breastfeeding for most mothers was from 1.5 to 2 years “normally 2 years as theory but it is not always true in reality because of work and the child” (female, 35 years old, Huong Long). “My two children stopped breastfeeding after 1.5 years because of my work and their starting of kindergarten. I had to work in the field,under the sun directly, so I thought that my breast milk was not good enough for my baby. therefore I stopped early. After stopping breastfeeding, my baby accepted to have complementary food and formula milk” (female, 34 years old, Huong Long). 4.2.3. Complementary feeding Table 6. Complementary feeding Complementary feeding practice n % 6 14 5.35 Total 262 100.0 Rice powder 1 0.38 Cereals 167 64.23 Rice water 3 1.15 First Fruit water 2 0.77 complementary food Grind gruel 60 23.08 Others 27 10.37 Total 260 100.0 Grind gruel 144 57.83 Un-grind gruel 45 18.07 Current food Cereals 59 23.69 Others 1 0.40 Total 249 100.0 How to feed By bottle 11 4.44 545
By spoon, cup 237 95.56 Total 248 100.0 About the half of mothers introduced complementary food when their infants were 4-5 month-of age (Huong Long, Phu Hoi). Some others were at 6 month-age as suggested by mothers-in-law (Huong Long). A few infants were fed with complementary food before 3 months because “my baby cried all day and all night because he was starved” (female, 22 years old, Huong Long; female, 29 years old, Phu Hoi) or “The economical status of family did not allow us to buy infant formula milk, we have to feed him complementary food when breast milk is not enough for him” (female, 24 years old, Phu Hoi). - Most of mothers used cereals as the first complementary food. - Preparation of complementary foods: stewing bones, beef, pork or boiling fish and mixing with rice; most of mothers added salt, red onion, fish sauce, and oil. Some of them also added monosodium glutamate, or dehydrated broth . However, some other mothers were against adding monosodium glutamate as “the food will be taste enough if we stew many things, the only thing to do is to add some salt” (female, 34 years old, Huong Long) 4.2.4. Knowledge of mothers about delayed psychomotor development Some mothers gave attention to the psychomotor development of their baby. “The delay means not to pronounce as fluently as usual. It will be good if the baby can repeat what the mother said” (female, 28 years old, Phu Hoi) or “The delay means not to reach some standards, based on the time. For instance, if a one year old baby can not walk, he is considered as having delayed development. These are applied for the height, weight, and intelligence” (male, 36 years old, Phu Hoi). “If a child can fight over the toys of other children, it will be good because he is active” (female, 35 years old, Huong Long). Addressing psychomotor development was a new area for even heads of the CHCs. Hence the CHCs do not have any activities for this. Some factors relating to infant’s development In term of factors relating to infant’s development, mothers gave the opinions of “everyday caring”, “many influenced factors such as genes, hygiene, nutrition, teaching environment; for example, inadequate diet in quantity and quality will affect the child’s development” (male, 36 years old, Phu Hoi), “enough and timely sleeping” (female, 27 years old, Phu Hoi). Some mothers thought that the child had delayed development because of adults’ thinking. “They did not allow their children to go out in order to avoid wind and dust, 546
which were considered reasons for sickness of a child. Therefore, we should bring them to the park to play with other children to be more active” (female, 26 years old, Phu Hoi). - According to mothers, “thin and stunting” (female, 32 years old, Phu Hoi), “low weight”, “low weight and short in height” (female, 27 years old, Phu Hoi)., “big head, small bottom, and swelling abdomen” (female, 34 years old, Huong Long) were signs of malnutrition. To prevent malnutrition, they suggested that the babies should be fed well and mỏ nitoring continuously, prevented from illness and immunized as scheduled. 4.2.5. Caring the infant Most mothers fed their child directly. Some infants also were fed by their grandmothers. “The child will eat more if he was fed by his mother because she is patient enough to feed him” (female, 39 years old, Huong Long)., “It is really very hard to feed my baby, it takes me about 1.5 to 2 hours for a meal” (female, 24 years old, Phu Hoi).. Sometimes but it was very rare that the child was fed by his father as “he came home late after work”, “My husband said that I can ask him to do everything except for feeding the baby” (female, 24 years old, Phu Hoi).. Mothers also were the one who played and chatted to the infants. The others sometimes played with them. 4.2.6. Gender issue Table 5.7. Influence of gender issue on caring of the infant Gender issue n % Yes (Male priority) 3 0.78 Discriminating between boy No 384 99.22 and girl Total 387 100.0 Yes 371 95.87 Know gender of fetal before No 16 4.13 birth Total 387 100.0 Yes 286 77.09 No 66 17.79 Gender of fetal as desired Do not care 19 5.12 Total 371 100.0 Happy 226 59.79 Family’s reaction Sad, disappointed 17 4.50 547
No reaction 135 35.72 Total 378 100.0 Most mothers knew the gender of their child before birth. A few of them felt sad knowing having a girl while the others considered that boys or girls was the same. However, most of them cared for girls as much as boys, “Males and female are equal” ((female, 27 years old, Phu Hoi).., “Boys or girl is my child” (female, 24 years old, Phu Hoi)... Many families at Huong Long still wanted to have son, “Males or females are the same but males are preferred in rural areas” (female, 39 years old, Huong Long).., “everybody discriminates in favour of males”. This concept often derived from the husband, “depending on the husband’s family, if the husband is the first son of the family, the gender of infant will be a problem” (female, 24 years old, Phu Hoi)... According to two heads of CHCs, gender discrimination was still.a problem “the elders in feudal, backward or single-sex-child families often consider gender as an important issue” (Female, 52 years old, Huong Long). 4.3. Relationship There was relationship between weight-for-length, length-for-age and psychomotor development (χ2=3.688; p=0.055 and χ2 = 4.57; p
Our results Tu Ngu et al (Phu Tho - Classification p 2006) (n=150) (n=387) Underweight 25.81 27.6 >0.05 Stunting 51.61 41.4 0.05 There was a statistically difference (p
statistically significant difference (p0.05), 1.55% vs 6.3% (p
College of Medicine and Pharmacy, Vietnam). The study was suported by the Project for capacity building for Public Health, Hue College of Medicine and Pharmacy-QUT. REFERENCES 1. WHO. Data sources and inclusion criteria. http://wwwwhoint/nutrition/databases/infantfeeding/data_source_inclusion_criteria/en/ indexhtml 2. Nguyễn Công Khẩn. Cách nhìn mới về nuôi dưỡng trẻ sơ sinh và trẻ nhỏ theo khuyến nghị toàn cầu của WHO/UNICEF (2007). Tạp chí dinh dưỡng & thực phẩm; 2:1-5. 3. WHO. Global strategy for infant and young child feeding, (2003). 4. Đinh Thanh Huề. Phương pháp Dịch tễ học. Nhà xuất bản Y học, (2005). 5. . Lê Đức Hinh – Nguyễn Chương. Đánh giá sự phát triển vận động – thần kinh trẻ em. Thần kinh học, (1994), 66-73. 6. Từ Ngữ, Huỳnh Nam Phương, Hoàng Thu Nga, Phí Ngọc Quyên. Tìm hiểu về thực hành ăn bổ sung và các yếu tố ảnh hưởng đến tình trạng dinh dưỡng ở trẻ 6-23 tháng tại 3 xã nông thôn Phú Thọ. Tạp chí DD-ATTP, tập 3 – số 4 – tháng 12/2007, (2007), 78-87. 7. Hàn Nguyệt Kim Chi và cộng sự. Tìm hiểu sự phát triển tâm vận động của trẻ từ 0 đến 24 tháng bằng phương pháp điều tra dọc. Nhà xuất bản giáo dục, (1999). 8. Đặng Oanh, Đặng Tuấn Đạt, Nguyễn Sơn Nam và cs. Tìm hiểu tập quán nuôi con của bà mẹ dân tộc thiểu số ở Tây Nguyên. Tạp chí DD-ATTP, tập 3 – số 4 – tháng 12/2007, (2007), 23-33. 9. Bộ Y tế, Viện Dinh Dưỡng. Hỏi đáp dinh dưỡng. Nhà xuất bản y học, (2000). 551