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" docx

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<0.01) and length-for-age
(r=0.108, p<0.05). Conclusion: Physical, psychomotor development of children should be
assessed and monitored regularly, using WHO Anthro software and Denver 2 test.
Key words: physical, psychomotor development, breastfeeding, complementary feeding

1. Introduction
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 the physical, psychomotor development in the future.
Brain cells increase the most rapidly before birth and during the first 5 or 6 months of a
baby. To achieve maximum brain growth, the baby needs optimal nutrition. Severe
protein- energy malnutrition in the last trimester of pregnant mother may decrease the

number of brain cells by as much as 20 percent in the first 6 months of life of a baby.
Nutrition for children in the first years play an important role in the development
process and quality of life of each individual. Lack of breast-feeding, especially in the
first 6 months of the life, and inadequate complementary feeding are common causes of
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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:
2
n  Z
2

p (1  p )
e2

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 80110 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.
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- 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 20092010
4.1.1. Physical development
Table 1. Classification of undernutrition

Classification

n

%

Underweight

8

25.81

Stunting

6

51.61

Wasting

17

22.58

Total

31

p

<0.0001

100.0

There were 31 (8.01%) infants were malnutrition of 3 classifications, detailed as
table 5.1.
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4.1.2. Psychomotor development
Table 2. Psychomotor development of infants

Classification

n

%

Normal

355

91.73

Delayed

32

8.27

Total

387

p

100.0

< 0.0001

Table 3. Number of delayed domains of psychomotor development by gender

Male (1)

Gender

Female (2)

Total

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

355

91.73

25

6.46

7

1.81

Total

387

100.0

Vaginal delivery

255

65.89

Interventional birth

132

34.11

Total

Diseases during neonatal

Full-term

Post-term

Way of delivery

%

Pre-term

Term

n

387

100.0

Yes

41

10.59

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period

No

89.41

Total

387

100.0

Severe jaundice

10

22.73

Neonatal infection

7

15.91

Others

24

61.36

Total

Which disease

346

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

8

2.07

Sugar

6

1.55

Infant formula

152

39.28

16

4.13

Total

387

100.00

Yes

378

97.67

No

9

2.33

Total

387

100.00

Insufficient supply of milk

7

77.78

Mother using Insulin

1

11.11

Non – protractile nipple

1

11.11

Total
Time of first breast
feeding

52.97

Others

Reasons for not breast
feeding

205

Liquorice

Breast feeding

%

Breast milk

The first food after
birth

n

9

100.00

<30 minutes

36

9.52

30-60 minutes

72

19.05

60 minutes - <1 day

137

36.24

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>1 day

133

35.19

Total

378

100.00

On demand

318

84.13

On clock

60

15.87

Total

378

100.00

<4

342

90.48

4-6

36

9.52

Total

378

100.00

Yes

21

5.56

Not yet

357

94.44

Total

378

100.00

<4

10

47.63

4–6

6

28.57

>6

5

23.81

Total

21

100.0

Mother do not know feeding
technique

1

4.76

Infants stopped themselves

12

57.14

Insufficient breast milk

7

33.33

Mother gone away

1

4.76

Total

21

100.00

Feeding time

Duration of exclusive
breastfeeding (month)

Stopping of breast
feeding

Time of stopping
(months)

Reasons for stopping
breast feeding

- Prevalence of breastfeeding and exclusive breast feeding for the first 4-6
months for the children according to head of Huong Long and Phu Hoi CHCs’
estimation were 95% - 40% and 30% - 0%, respectively. The results from quantitative
data was 97.67% and 9.52%.

- There were some local conceptions that can be barriers to breastfeeding such as
early complementary feeding, and hard-work of mother, as reported by head of CHCs.
- Time of first breast feeding was within 2 hours after birth (females, 36,39,23
years old -Huong Long; female, 24 years old, Phu Hoi), “I breastfed my daughter right
after I came back to postnatal room, I did not care the time” (female, 34 years old,
Huong Long), “ Breastfeeding after 2 hours because the mother is very tired after
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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

%

<4

40

15.27

4-6

208

79.38

>6

14

5.35

Total

262

100.0

Rice powder

1

0.38

Cereals

167

64.23

Rice water

3

1.15

Fruit water

2

0.77

Grind gruel

60

23.08

Others

27

10.37

Total

260

100.0

Grind gruel

144

57.83

Un-grind gruel

45

18.07

Cereals

59

23.69

Others

1

0.40

Total

249

100.0

By bottle

11

4.44

When (month)

First
complementary
food

Current food

How to feed

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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,
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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 mỏnitoring 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

No

384

99.22

Total

387

100.0

Yes

371

95.87

No

16

4.13

Total

387

100.0

Yes

286

77.09

No

66

17.79

Do not care

19

5.12

Total

371

100.0

Happy

226

59.79

Sad, disappointed

17

4.50

Discriminating between boy
and girl

Know gender of fetal before
birth

Gender of fetal as desired

Family’s reaction

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<0.05; respectively)
There was relationship between weight-for-age and weight-for-length, lengthfor-age (p<0.001).
The time of introducing complementary food was significantly correlated with
weight-for-length (r= - 0.156,; p<0.01), and length-for-age (r=0.108’ p<0.05).
A negative statistically significant correlation between mother’s level of
education and breastfeeding practice was found (r=-0.15; p<0.01).
There were no significant differences between:
-

Weight at birth and weight-for-age, weight-for-length, length-for-age

-

Diseases of infants during neonatal period and psychomotor development

-

Breast feeding and psychomotor development

-

Gender discrimination and psychomotor development

5. Discussions
5.1. Physical, psychomotor development of infants in Hue City in 2009-2010
5.1.1. Physical development
Comparing our results to other study

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Our results

p

(n=387)

Tu Ngu et al (Phu Tho 2006) (n=150)

Underweight

25.81

27.6

>0.05

Stunting

51.61

41.4

<0.05

Wasting

22.58

15.1

>0.05

Classification

There was a statistically difference (p<0.05) of stunting between our study and
Tu Ngu et al.
5.1.2. Psychomotor development
Prevalence of delayed psychomotor development in our study was 8.27%. A
statistically significant difference (p< 0.0001) was showed between normal and delayed
infants. Among 4 domains, gross motor and language accounted for the highest
prevalence of the delay (51.16% and 23.26%).
According to Han Nguyet Kim Chi et al (1999), the psychomotor development
of children from 0 to 24 months follows common rules but is not the same for all
children and all domains. During the first year, the infants had delayed gross motor and
language but the development of all 4 domains would be good in the second year. Our
study showed the same characteristics as this author for the first year.
5.2. Factors in the relation with physical and psychomotor development of
infants
91.73% infants of our study were delivered at full-term and 6.46 % were
delivered pre-term. Low birth weight of pre-term infants might be a risk factor for
physical development because the development of their bodies would not be completed.
However, our study showed no relationship between birth weight and physical
development. It is possible our sample size was not sufficient.
Within 34.11% of intervened birth, 7.58% of mothers wanted to deliver their
babies by active Cesarean because of traditional perceptions that girls who were born in
the year of the Tiger (lunar calendar) will be miserable, so they wanted to have them
earlier.
There were 9 infants (2.33%) who were fed by breast milk. The estimation of

breastfeeding and exclusive breastfeeding prevalence from heads of CHCs did not fit
well with the actual number founded by our study. The CHCs should strengthen their
roles to promote breastfeeding for all children as suggested.
Our study showed only 9.52% of infants were exclusive breastfed within the
first 4-6 months. Mean duration of exclusive breastfeeding in our study was 3.25± 1.25
months. This number according to Tu Ngu et al (2006) was 2.94 ± 1.52. There was a
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statistically significant difference (p<0.05) between two studies.
The first foods after birth in our study compared with Dang Oanh et al were
breast milk and sugar or infant formula were 52.97% vs 57.8% (p>0.05), 1.55% vs
6.3% (p<0.01), 39.28% vs 32.5% (p<0.05), respectively.
The study showed that 5.56% of infants had stopped breastfeeding. According to
Han Nguyet Kim Chi et al. (1999) ceasing breastfeeding early also influenced the both
physical and mental development of children
We found the prevalence of having complementary food at 4-6 month-age and
before 4 months were 79.38% and 15.27%, respectively. The two heads of CHCs
confirmed that early introduction of complementary food still occurs in their areas.
Dang Oanh et al studied on 1170 under 36 month-age children founded that 34.1% had
complementary food before 3 months (8.8% at the first month; 25.3% at the second or
third month), 65.9% from the fourth month.
Some of the mothers who attended focus group discussions added monosodium
glutamate when preparing food for infants. The National Institute of Nutrition suggest
that monosodium glutamate should not be added to the food of children under 3 as it
artificially sweetens the food, the infants will depend on that sweet and deny other foods
that are necessary for their development. Moreover, toxicity can occur with overuse.
There were 0.78% of families who discriminated between boy and girl children
(son preference). A few of mothers felt sad knowing that they were having a girl. The
two heads of CHCs confirm that gender discrimination was still a problem. According

to Han Nguyet Kim Chi et al, gender discrimination, especially from mothers will
affects psychomotor development of the child.
6. Conclusion
This study showed the prevalence of undernutrition was 31 (8.01%) and delayed
psychomotor was 32 (8.27%). A negative statistically significant correlation between
mother’s level of education and breastfeeding practice was found (r=-0.15; p<0.01).
The time of introducing complementary food was significantly correlated with weightfor-length (r= - 0.156,; p<0.01), and length-for-age (r=0.108’ p<0.05). There were no
significant differences between: Weight at birth and physical development, diseases of
infants during neonatal period, breast feeding, gender discrimination and psychomotor
development
WHO Anthro and Denver 2 test are useful tools for detecting and following
physical, psychomotor development of children that should be used widely.
Acknowledgement
This paper is one part of the results of a Master of Public Health thesis (Hue
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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.

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