Tình trạng dinh dưỡng và xu hướng tăng trưởng của trẻ lứa tuổi học đường

TC.DD & TP6 (3+4) - 2010<br /> <br /> ton DC, 2/2000. paper.<br /> Vien Dinh Duong, 2006. Vietnam: Tinh 10. UNDP- Ting cue Thing ke: Miic song<br /> hinh dinh duong nam 2006. trong thai ky kinh tl biing no. Nha xuat<br /> UNICEF, 1990. Strategy for improved ban Thing ke 12/2001. trang 73-88.<br /> nutrition of children and women in de- 11. Worid Health Organization (WHO),<br /> veloping countries. New York, pp. 3-4. 2009. Global database on child growth<br /> 9. UNICEF/EAPRO, 2003. Strategy to re- and mahiutrition. WHO, Geneva, pp.<br /> duce matemal and child undemutrition. 75-80.<br /> UNICEF, Health and Nutrition working<br /> Summary<br /> TREND OF STUNTING REDUCTION AND PRIORITIES IN CHILD MALNUTRI-<br /> TION INTERVENTION STRATEGY IN VIETNAM<br /> Reduction in childhood malnutrition in Vietnam between 1985; 2005 and 2009 was examined<br /> using data of some national surveys. The prevalence of mahiutrition, including stunting, reduced<br /> significantly for underweight from 59.7% in 1985 to 31.9% in 2009 with an average reduction of<br /> 1.2 % per year in the period from 1985 to 2009. There were clear differences in the decrease in<br /> malnutrition prevalence between urban, mral and mountainous areas, the reduction being highest<br /> in the urban regions and lowest in the mountainous areas. Regression analysis showed that the nu-<br /> trition status of the child is positively related to better household living condition and educational<br /> level of the fathers, but not the mothers. Stunting is higher in children whose parents are farmers<br /> and higher Ln households with more children. Stunting prevalence is lower in households with<br /> safe water access and hygienic toilets. For the years to come, the dramatic reduction is childhood<br /> mahiutrition as seen in the period 1994 to 2009 might be difficult to match. More comprehensive<br /> actions are needed to lower childhood malnutrition in Vietnam fiirther.<br /> Key words: Malnutrition; Vietnam, Stunting, Poverty.<br /> * Bdi todn vdn se ddng tren tgp chi DD&TP, 2011<br /> <br /> „ TiNHT^tANG^DINHpTr^NGyAXUHird^G<br /> TANG TRlTCfNG CUA TRE LlTA TUOI HOC DUONG<br /> Le Nguyen Bdo Khanh'<br /> <br /> Ba muai nam truac, the giai da tham chi cao ban bat cii giai doan nao<br /> chiing kien cugc vat Ion cua hang trieu tre trong lich sir nhan loai [2]. Dieu nay phan<br /> sa sinh de dugc ky niem sinh nhat dau anh su thanh cong ciia cac chuang trinh<br /> tien tiong cugc dai ciia chiing. Liic do chi "vi sir song ciia tre em", dong thai ciing<br /> khoang 83% tie so sinh sing qua 12 dat ra nhiing nhiem vu cap bach dii vai<br /> thang taoi [1]. Ngay nay, theo thing ke cong tac cham soc dinh duang va siic<br /> cua UNICEF trong mgt thap ky qua co tai khoe doi voi tre em liia taoi hgc duang.<br /> tren 90% tre em tren the giai da song qua C) Viet Nam, tre liia tali hoc ducmg<br /> 5 taoi va dat tai taoi den trucmg. Ty le tre chiem khoang 1/3 dan so. Tre lu'a tali hpc<br /> dugc den truang tang dan bang nam, duang (tir 6-17 taoi) trai qua hai m i c<br /> <br /> 'TS.BS -Vien Dinh duang<br /> <br /> 24<br />  TC.DD & TP6 (3+4) - 2010<br /> <br /> quan trpng trong qua trinh tang trudng va Chieu cao, can nang tre em luon thap<br /> phat trien the luc, do la giai doan tien day ban kich thuac tham khao NCHS. Tuoi<br /> thi va vj thanh nien. Trong giai doan tien cang cao thi khoang each cang ro ret.<br /> day thi (6-9 taoi), ca the can nhieu chat Chieu cao va can nang ciia tre em Ha<br /> dinh duang de du trii' chuan bi buoc vao Ngi ban ban tre em nong thon: taoi cang<br /> giai doan tang toe phat trien vi thanh nien. lan thi khoang each cang xa.<br /> Cham khai dpng qua trinh tang trucmg<br /> Gan day, mgt cugc dieu tra thu thap<br /> manh trong giai doan nay la nguyen nhan<br /> cac so do nhan trac lan nhat ta' tru'oc tai<br /> chinh dan tai tinh trang kem phat tnen<br /> nay tren 14.000 tre hgc duang nong thon<br /> ciia tre xuat hien sam.<br /> trong cac nuac dang phat tiien, bao gom:<br /> Theo To chiic Y te the giai, vj thanh Ghana, Tazania, Indonesia, An Do va<br /> nien la nhom doi tagng tir 10-19 ta6i[3]. Viet Nam da cho thay: 51%) bi coi cge<br /> Day la giai doan mci dau ca hgi chuan bi (stanting), 48% suy dinh duang the thieu<br /> ve dinh duang cho cugc song tru'ong can (underweight) [5]. Suy dinh duang<br /> thanh khoe manh. Them niia, trong liic the com (wasting) it pho bien han, nhung<br /> giai quyet nhiing van de dinh duang vi Cling CO tai tren 20% tre hgc ducmg dugc<br /> thanh nien, mgt so roi loan dinh duang nghien ciiu a Viet Nam co can nang theo<br /> khai phat trong giai doan dau dai co kha chieu cao thap. Tinh trang thieu dinh<br /> nang ciing dugc khac phuc. duang va be nho a tre em Viet Nam va<br /> I. TINH TRANG DINH Dl/O^G An Do gap nhieu ban so vai ba nuac con<br /> CUA TRE LlTA TUOI HOC D L T O N G lai [6]. Nhiing phan tich nay cho thay sir<br /> Mac du vai tro nen tang cua dinh tang truang kem la rat pho bien trong so<br /> duang doi vai su phat trien the luc, siic tre hgc duang nong thon cr Chau Phi,<br /> khoe, tam voc cua tre, kha nang ban Chau A noi chung va Viet Nam noi rieng.<br /> che qua trinh tien trien ciia tinh '^^<br /> trang beo phi va cac benh man tinh<br /> 1618 162.4 1631<br /> lien quan khac da dugc thira nhan, 157.1<br /> 1G0.4<br /> <br /> 1547 _|?J -> 157,3<br /> song dinh duang cho liia taoi hgc „ 151.5<br /> 149.5..<br /> 1525<br /> .•-<br /> duang va vi thanh nien trong nhiing ."^^^ 151.7<br /> 152.8 153.1 '53.3<br /> 15D<br /> <br /> nam qua khong phai la van de dugc 140<br /> uu tien quan tam ciia xa hg. Tuy 13G.1<br /> — • - NOng thOn (Khanh. 2007)<br /> nhien, nhiing so lieu dugc cong bo<br /> - < — T h i n h phS (HBp, 1999)<br /> tir cac ket qua nghien ciiu tren pham<br /> —•—NCHS<br /> vi hep da chi ra mgt thuc trang dang<br /> lo ngai ve dinh duang va siic khoe ioo Tuoi<br /> ciia quan dan cu nhom tuoi hpc 11 12 13 14 15 16 17 18 19<br /> <br /> duang nay. Chieu cao trung binh theo tuSi ciia nO hoc sinh ph£ th6ng<br /> Cac kich thude nhdn trac vd phdt<br /> Nghien ciiu theo doi chieu sau ve sir<br /> trien the lite kem<br /> phat trien tre em tir so sinh den 18 tuoi<br /> Ket qua ciia cugc dieu tra tren cua vien Dinli duang tien 218 tre Ha Ngi<br /> 11.917 tre tir 0-15 taoi a cac -vung nong cho thay: mii'c tang can cua tre em Viet<br /> thon trong ca nuac va 9.410 hgc sinh Ha<br /> Nam trong 3 thang dau khong khac vai<br /> ngi [4] cho thay:<br /> tieu chuan quoc te, tham chi con cao ban,<br /> nhung sau do kem dan [7]. Co hai thai ky<br /> 25<br />  TC.DD & TP6 (3+4) - 2010<br /> <br /> su thua kem bieu hien cao nliat: tir 6-12 mot hoac hai biia an trong ngay [13]. Ddi<br /> thang va 6-11 taoi (lira taoi tieu hgc) [8]. \ dl rre hgc dudng. dilu na\' thudng xay<br /> Do cham phat trien so vai chuan quoc re ra khi tre khdng cd bira an sang. 6 mgt sd<br /> nen chieu cao nam thanh nien \''iet Nam Niing sau \Ting xa, Ming kho klian. nai<br /> hien nay (chi dat 163,7 cm ) thap hom kliong cd mang ludi "'an hgc duong". tre<br /> 13.1 cm va nii \'iet Nam (trung binh 153 dl hgc CO the m4t ca hai bua, do trudng<br /> cm [9]) thua kem 10,7 cm. Khong chi so qua xa. tre phai di hgc ta rat sdm khdng<br /> vai chuan ma so \csi tam voc cua thanh kip an sang; tan hgc v l din nlia l^i qua<br /> nien cac nuac trong khu \"irc (nhu: Nhat mat biia trua, tre met mdi sau nhieu gid<br /> Ban, Singapore, Thai Lan) tam voc cua hgc tai trudng \-a phai di chang dudng xa<br /> thanh nien Viet Nam deu thua kem. ve nJia nen thudng bd ludn biia thii hai<br /> Ngoai ra, do thieu van dgng nen to chat (biia trua) trong ngay de ngu. Cii nliu \'a}-,<br /> the luc. nhat la siic ben va siic manh cua hang ngay diia tre hau nhu cbi an mgt biia<br /> thanh nien \ i e t Nam dugc xep xko muc chieu tdi lay lai siic hpc bai va chuan bi di<br /> kem va rat kem so vai chuan quoc te, hgc ngay hdm sau.<br /> tham chi so vdi NTiat Ban [10]. Dieu nay Theo Poltitt va cs (1993) [14], nhimg<br /> cho tha}', viec cai thien dinli dudng kliong diia tre nhin ddi di hgc thudng td ra thieu<br /> chi quan trgng a nhiing nam dau, ma do binJi tinh khi gap phai nhiing kinh thich<br /> phai la mgt qua trinh lien tuc, trong do khdng phii hgp, giam sir chii y, gay anh<br /> nhiing nam taoi hgc dudng. nhat la giai hudng tdi ket qua hgc tap. Nguge lai, mgt<br /> doan \"i thanh nien ciing dong vai tro thiet<br /> so nghien ciiu da chiing minh: hanh vi<br /> yeu khong kem taoi tien hgc dudng.<br /> cua tre dugc cai thien rd ret va nic thdi<br /> To chiic Y te the gidi da khang dinh: sau khi tre dugc an hoac uong giiia gid<br /> mgt trong cac ngm'en nhan quan trgng [13]. Ddi tam thdi gay hau qua nhu nhau<br /> nhat gay thieu dinh dudng d tre em hgc ca tren tre suy dinh dudng lan tre co tinli<br /> dudng la do che do an thieu hoac chat trang dinh dudng tot. Tu\' nhien, nliiing<br /> lugng qua kem [11]. 0 Met nam, g4n diia tre suy dinh dudng cd the de bi anh<br /> 80% dan so nudc ta song d nong thon, nai huong cua ddi tam thdi lam mat hoac<br /> chua CO mang ludi nha an hgc dudng cho giam chiic nang nhan thiic. tir do lam<br /> bac hgc nay. Bua an ciia tre lira taoi hgc giam ket qua va thanh tich hgc tap.<br /> dudng phu thugc \'ao biia an gia dinli. Nhiing nam qua. san xuat gao d \'iet<br /> Mac dii biia an cua ngudi dan nong thon Nam da dii cho nhu cau an uong cua<br /> hien nay da co chieu hudng cai thien ban ngudi dan \k cd mgt lugng dang ke xuat<br /> ve mat chat lugng, song nhin chung thirc khau. Tu\' nhien, tinh trang thieu doi d<br /> pham chu yeu van la gao, thiic an dgng mgt sd dia phucmg Ming sau, Ming khd<br /> vat con thap. lugng siia an xko chua dang klian cdn xay ra. Mat khac do dien biin<br /> ke, lugng rau dao dgng theo miia: qua tiiien tai bat thudng. nhieu \'una ciin2<br /> chintieuthu hang nga\- cho biia an rat it [12]. diing trudc nguy ca thieu doi. Tre em tadi<br /> 2. Doi tam th&i di bgc a nhiing Ming na}- gap Uions it<br /> Mac dil so tre tdi trudng hang nga\' klio khan va tinh trang tre em do; bo hoc<br /> bi doi chua dugc xac dinli ro, song doi la mgt ^•an de can quan tam.<br /> tam thdi la mgt tinh trang kha pho bien a 3. Thieu vi chdt dinh du&no;<br /> cac nudc dang phat trien bao gom ca Viet Cac vi chat dinli dudng co vai tro hit<br /> Nam. Doi tam thdi xav ra khi tre bi riiieu sue quan trgng doi vdi phat trien toan \-en<br /> <br /> 26<br />  TC.DD & TP6 (3+4) - 2010<br /> <br /> ve the luc va tri tae ciia tre tadi liia taoi cao bi thieu vi chat ndi chung va nhat la<br /> hpc dudng, dac biet tre vi thanh nien. Cac thieu mau thieu sat) chua dugc quan tam<br /> thieu hut vi chat dinh dudng phd bien day dii, mac dii gan day da cd mdt sd<br /> nhat va gay anh hudng rd ret len nang luc nghien ciiu thi diem bd sung sat/folat<br /> va thanh tich hpc tap cua tre lira tadi hpc hang taan cho nii thanh nien. Trong mdt<br /> dudng bao gdm: i-dt, sat va vitamin A. nghien ciiu gan day ciia vien Dinh dudng<br /> Thieu iot: dau thap ky 90, thieu idt cho thay 20% hpc sinh gai vi thanh nien<br /> va budu cd d Viet Nam la kha phd bien. da bi thieu mau do thieu sat, trong dd cd<br /> Dieu tra dich te hpc gan day chi ra: ty le tdi 35% tre gai vi thanh nien sdm (10-13<br /> budu cd trong sd hpc sinh Ha Npi la tadi) va gan 20%) vi thanh nien trung binh<br /> 9,9%, Hai phdng la 13,3%, Hai hung (14-16 tadi) da bi thieu mau tii' miic nhe<br /> 20,5%, Thai Binh 16,4% [15] . Nhu vay, den -vu'a [17]. Thieu mau khdng chi gay<br /> mac dii da cd nhiing tien bd vugt bac anh hudng xau tdi su phat trien the lire,<br /> trong nhiing nam qua, thieu idt van con tdi qua trinh day thi binh thudng ciia tre,<br /> la van de sii'c khoe quan trgng d Viet Nam ma cdn lam giam nang luc hpc tap ciia<br /> ma Ilia tadi hgc dudng la nhdm can dugc chiing. Tre liia tadi hpc dudng bi thieu du<br /> quan tam giai quyet. trii sat thudng cd bieu hien kem boat bat,<br /> giam su chii y trong gid hpc dan tdi ket<br /> Thieu mdu thieu sdt: Cugc tdng<br /> qua hpc tap kem. Tre thieu mau thieu sat<br /> dieu tra toan qudc nam 1995 da xac nhan<br /> ciing khd cd the lira chgn nhiing thdng tin<br /> thieu mau thieu sat cd tam quan trgng<br /> can thiet va thich hgp tir cac bai giang<br /> hang dau trong cac benh thieu vi chat<br /> tiong ldp [18]. Tren ca sd cac bang chiing<br /> dinh dudng d nudc ta [16]. Nhiing nd luc<br /> nay, tac gia khang dinh: nhiing noi thieu<br /> phdng chdng thieu mau dinh dudng trong<br /> mau thieu sat phd bien hau qua cua nd<br /> thdi gian qua mdi chi tap trung vao nhdm<br /> dang tac dgng true tiep lam giam siit<br /> tre dudi 5 tadi va ba me cd thai, trong khi<br /> nghiem tigng hieu qua giao due toan dien.<br /> tie liia tadi hgc dudng va vj thanh nien (la<br /> nhiing nhdm ciing dugc coi cd nguy ca<br /> Ty Ie thieu mau dinh duong cua hoc sinh<br /> (cdng bd trong 15 ndm gdn ddy)<br /> <br /> Tac gia Nam Dia diem Doi tu'O'ng Ty le thieu mau<br /> TP 13,2%<br /> N.C.Khanh [19] 1994 HS7-14t<br /> NT 21,3%<br /> N.CKhin [20], [21] 1997 Nu 15-19t 28,1 %<br /> NT<br /> 1999 22,0 %<br /> P.T Hirong [22] 1998 NT HS6-16t 29,9 %<br /> TP HS 6-lot 14,8 %<br /> L.T Huong [23] 1999<br /> NT 18 8%<br /> L.N.B Khanh [17] 2007 Nu hs, 20%<br /> NT<br /> vtn 11-1 St<br /> <br /> Thieu vitamin A Biiu hien nang 6 nudc ta hien nay chua cd mdt cdng bd<br /> nhat ciia nd la gay mu loa va tu vong. nao ve tinh tiang vitamin A ciing nhu anh<br /> Thiiu vitamin A tien lam sang lam giam hudng ciia nd len nhdm tre hpc dudng,<br /> phat trien ca the, giam rniln dieh din tdi song chac chan thieu vitamin A, thieu sat<br /> de mSc nliiem tning hd hap cap, tieu chay. va cd the ca thieu kem la cac van de thieu<br /> 27<br />  TC.DD & TP6 (3+4) - 2010<br /> <br /> vi chat dinh dudng rat can quan tam giai cimg mdt liic ta' hai loai giun trd Ien (da<br /> quyet d ddi ta'png nay. nhiim) [26]. Giun dang gay ra rSt nhieu<br /> Thieu can xi: Tre lua tadi hpc tac hai cho tre ma hau qua ciia nd la thieu<br /> dudng cd nhu cau can xi cao, dac biet la dinh dudng, thiiu vi chit dinh dudng, do<br /> tre vi thanh nien nhu cau can xi cdn ldn bi giun chilm doat sinh ch4t dmh dudng<br /> hon, vi day la thdi ky khoi xuong tang len trong CO thi, hut mau, tham cbi gay rdi<br /> din dinh diem. Cd tdi 37% xuong cd the loan hap thu cac ch4t dinh dudng ciia tie.<br /> dugc tdng hgp trong giai doan phat tiien De phdng chdng nhiem giun hgc<br /> tang vgt cua thdi ky vi thanh nien [24]. dudng, ngoai viec diing thude tay giun,<br /> Mdt sd bang chimg xuong tiep tuc phat mdt sd ket qua nghien cim cua Vien Dinh<br /> trien sau giai doan ldn vgt d tie vi thanh Dudng da chiing minh bieu qua rd ret ciia<br /> nien. Sir mat khoang d xumig ciia nhiing giao due truyen thdng ve each phdng<br /> ngudi me do tadi vi thanh nien dang nudi tianh nhiem giun len viec giam ty le tai<br /> con bii la do thieu can xi. Mac dii benh nhiem giun tren tre hgc dudng.<br /> loang xuong trong cac nudc dang phat 5. T/iira cdn vd beo phi<br /> trien khdng dugc coi tigng, song sd lieu<br /> hien nay chi ra rang: van de nay dang gia Mdt trong nhiing van de dinh<br /> tang trong sd phu nii Chau A [24]. dudng mdi nay sinh hien nay la hien<br /> tagng gia tang nhanh chdng cua tinh<br /> Ciing nhu sd lieu ve tinh trang vita- trang thira can, beo phi d liia tudi hgc<br /> min A, cho den nay chua cd mdt cdng bd dudng d khu vuc dd thi nhu Ha Ndi, TP<br /> nao ve tinh trang can xi trong nhdm tie Hd Chi Minh, Hai phdng... Neu nhu trudc<br /> liia tadi hgc dudng ciing nhu nhiing hau 1995, hau nhu thira can, beo phi d hgc<br /> qua cua nd len nhdm taoi nay. sinh khdng dang ke, den nam 2001, ty le<br /> 4. Nhiem giun du&ng mot: beo phi d hgc sinh cac trudng ngi thanh<br /> Nhiem giun dudng mdt, nhit la giun thanh phd Hd chi Minh la 14% [27], d Ha<br /> diia (Ascaris lumbricoides) va giun tdc ngi va Hai phdng la 8-10% [28]. G4n day<br /> (Trichuris trichiura) la rat phi biin tiong ty le thira can, beo phi d TP Hd Chi Minh<br /> nhieu nudc, trong do tre liia taoi hgc tang tren 17% [29]. Day la biic tianh tiai<br /> dudng la nhdm thudng bi nhiem giun diia nguge vdi nhung gi phd bien d cac viing<br /> va giun tdc vdi ty le va cudng do nang ndng thdn, song kliong cd nghia la tie liia<br /> nhat [25], dac biet d cac -vung nliiet ddi tadi hgc dudng d ndng thdn khdng cd<br /> va can nhiet ddi, noi ma ty le suy dinh nguy CO thira can, beo phi. Thiia can, beo<br /> dudng cua tre em kha phd biin. Trong cac phi khdng chi anh huong tdi hgc tap va<br /> vimg dan cu nay, ngudi ta thing ke cd tdi hanh vi cua tre ma con la cua ngd cua cac<br /> tren 80% tre em nhiem giun diia. benh man tinh khdng lay, thira can va beo<br /> phi cang xay ra sdm thi nguy ca mic cac<br /> 6 Viet Nam, ty le nay len tdi 96 %>,<br /> benh nay cang cao.<br /> trong do 30-40%) nhiem tii miic do vua<br /> tdi miic do nang; cd tdi tren 60 %> nhiim<br /> Dien bien ty Ie thiia can beo phi tai 1 so thanh pho Idn va ca nu'dc<br />