Tình trạng thiếu máu dinh dưỡng ở phụ nữ có thai bà mẹ cho con bú và trẻ dưới 5 tuổi tại thành phố hồ chí minh

TC.DD & TP6 (3+4) - 2010

TINH TRANG THIEU MAU D|NH D U Q N G 6 PHU NX? CO THAJ,
BA ME CHO CON BU VA T;11E Dir6l 5 TUOI TAI THANH PHO
HO c m MINH
Nguyen Nhan Thanli', Trdn Thi Minti Hanh\ Phan Nguyen Thanh Binh',
Le Nguyen Trung Due Son^, Pham Ngoc Oanh', Do Thi Ngoc Diep\ Le Thi Kim Qui •'
Khao sat tinh trang thilu mau d phu nii' cd thai (PNCT) nam 2006, tinh trang thieu mau d phu nii'
cho con bii va tre em < 5 hili nam 2008 tai thanh pho Ho Chi Minh (TP.HCM). Muc tieu; Xac dinh
ti le thilu mau, thieu sat va cac yeu to lien quan vdi tinh trang thieu vi chat nay d PNMT, phu nii
cho con bu va tre em < 5 tuoi. Phuong phap; Dieu tra cat ngang; 776 PNCT, 711 ba me cho con
bii (2-12 thang) va 644 tre < 5 tuoi tai TP.HCM. PNCT dugc liy mau xet nghiem Hb, fenitin,
CRP; Ba me cho con bii va tre < 5 tuoi dugc lay mau xet nghiem cong thiic mau; Bang cau hoi
soan sin dugc dung de phong van kien thiic & thuc hanh cua PNCT, ba me cho con bii va tre < 5
tuli vl phong chong thieu vi chat. Ket qua; Hb & ferritin huyet thanh tmng binh cua PNCT lan
lugt la ll,9g/dl & 46ng/ml. Ti le thieu mau & thieu sat va du trii sat thap lan lugt la 17,5%, 7.9%
va 34,7%. PNCT uong sat it nhat 3 thang trong thai ky co ti le thieu mau thap hon PNCT khong
uIng sit du 3 thang (14,5% so vdi 21,0%, p<0,05). PNCT uong sat it nhat 2 thang trong thai ky
COtile thieu sat thap hon PNCT khong uong sat du 2 thang (6,0% so vdi 10,6%, p<0,05). Ti le
PNCT biet each phong ngira thieu mau (an du dinh duong ket hgp uong sat bo sung) la 26,6%. Ti
le PNCT biet tac hai cua thieu mau la 41,3%. Ti le thieu mau ciia ba me cho con bu va tre < 5 tuoi
lin lugt la 9,6% va 11,6%.
Tir khoa: Thieu mdu, hemoglobin (Hb),ferritn huyet thanh
L DAT VAN DE
Thieu mlu thieu sat la van de su'c
khoe cdng ddng anh hudng den >50%
PNMT d cic nudc Ddng Nam Chau A [1 ],
llm tang nguy ea tie cham phat trien ngay
tu trong bung me, sinh ra nhe can, sinh
non, suy dinh dudng, hole tu vong chu
sinh d me & con [2,3]. Theo kit qua dilu

tra do Vien Dinh Dudng tien hanh nam
1988-1990 tren 2471 phu nii taoi sinh de
thi ti le thieu mau d thai phu vung ndng
thdn la 49% (3 thing cudi 11 59%), va d
Ha Ngi 1141% (3 thing culi la 48%) [ 46]. Ti le thieu mlu d PNCT toan qudc nim
2000 la 32,2%, d vung Ddng Nam Bg la
' BS - Tmng tam dinh duong TPHCM
^ TS, BS - Trung tam dmh duong TPHCM
' BSCKII - Trung tam dinh duong TPHCM
" BSCKI - Trung tam dmh duo'ng TPHCM
56

34,3% [7]. Ket qua dieu tra do Vien Dinh
Dudng thuc hien nam 2006 cho thay ti le
thieu mau d PNCT, phu nii tadi sinh de
va tre < 5 tadi van cd y nghia sue khoe
cdng ddng d muc do trung binh, lan lugt
la 37,6%, 26,7% va 36,7%.
Chuang tiinh phdng chdng thieu mlu
dinh dudng la chuang trinh qudc gia,
dugc trien khai tren toln TP.HCM tu' nim
2005 vdi boat ddng chu yeu 11 bd sung
vien sat & truyen thdng ve kien thuc
phdng chdng thieu mlu cho thai phu. Tuy
nhien, den nay van chua cd sd lieu cu the
vl tinh trang thieu mau & kiln thuc vl
phdng chdng thieu mau ctia PNCT, phu


TC.DD & TP6 (3+4) - 2010

nu' cho con bu vl tre < 5 tadi tai TP.HCM.
De cd ca sd djnh hudng cho chien lugc
can thiep nham cai thien tinh trang thieu
mlu d thai phu, phu nu' cho con bu vl tre
< 5 tadi gdp phan cai thien tam vdc ctia
gidng ndi bat dau tu sir phat trien cua bao
thai, Trung tam Dinh dudng (TTDD) da
tien hanh "nghien cu'u vdi muc tieu khao
sat tinh trang thieu mlu & thieu sat d
PNCT tai TPHCM nam 2007, tinh trang
thieu mlu d phu nu' cho con bu va tre < 5
tadi nam 2008": vdi muc dich xay dung
chien lugc can thiep phdng chdng thieu
mau hieu qua tai TP.HCM.
II. DOI TLTONG VA P H L T O N G PHAP
NGHIEN Ctru
1. Doi tu'O'ng.
- Phu nir co thai: Tdng sd 776 thai phu
(25-30 thai phu d mdi PX) tham gia dieu
tra. Cac ddi tagng dugc khim tdng quit,
danh gia thieu mau tren lam sang, can
bang can dien ta' TANITA sai sd 200g.
Phdng van mgt sd thdng tin ve kinh te xa
hdi, chieu cao & can nang trudc mang
thai, bd sung sat, khim thai, & kien thuc
phdng ngua thieu mau luc mang thai dua
vao bang cau hdi soan san.
Dinh lugng Ferritin & CRP: Mdi ddi
tagng dugc lay 5 ml mau tinh mach khi
ddi vio luc 6-8h cua budi sing tiong ngay

dieu tra. Mau tTnh mach dugc bao quan
trong thung lanh va dugc quay ly tam vdi
tdc do 3000 vdng/phut trong 5 phut de
tich huyet thanh sau 3 - 4 gid lay mau hi
thuc dia. Mau huyet thanh dugc tach de
cho ket qua cdng thuc mlu, djnh lugng
Ferritin, & CRP. Cdng thuc mlu dugc
djnh lugng bang phuong phip tin xa Inh
sang laser (thude thti' cua hang Abbott,
miy phan tich CellDyn 3500 - 3700).
Ferritin dugc dinh lugng blng phuang
phip boa phat quang miin dich CMIA
(thude thu' cua hang Abbott, may Archi-

tect). CRP dugc dinh lugng bang phuong
phip mien dich do do due Turbidimetric
immunoassay (thude thti Wako ctia hang
Abbott, miy Architect). Cdng thuc mlu,
ferritin va CRP dugc phan tich tai labo
cua Medic.
- Ba me cho con bii va tre < 5 tuoi: chgn
ngau nhien 30 phudng xa (PX), tai mdi
phudng xa da chgn neu tren, chgn 22 tre
tti danh sleh tre dudi 5 tadi & 25 b l me
tti' danh sich ba me cho con bu (2-12
thing) theo phuang phip ngau nhien he
thdng. Cudi cting, tdng sd 644 tre & 711
b l me tham gia nghien ciin cd day dti
thdng tin hgp le.
Lay 1ml mlu tmh mach cua tre va

1 ml mlu tinh mach ctia ba me cho vao 2
dng thuy tinh cd chua chat chdng ddng
EDTA, lac deu nhe tay de tranh vd hdng
cau, blo quin mit (thung da) tai thuc dia
de xet nghiem CTM tai Trung tam Y khoa
Qudc tl (Diag Center) d TPHCM.
2. Phucng phap nghien cu'u
Dieu tia cat ngang dugc thuc hien tai
30 phudng/xa (PX) thugc TPHCM dugc
chgn ngau nhien theo phuang phap PPS.
- Tieu chuan chan doan
Phu nif mang thai: Tinh trang thieu
mau dugc xlc dinh khi Hbsat khi Ferritin<12ng/ml; du trii sat thap
khi Ferritin trong khoang 12-<30ng/ml
[8], va cd tinh trang viem khi
CRP>10mg/l [9]. BMI trudc mang thai
dugc tinh bang can nang (kg)/ binh
phuang chieu cao (m^) (can nang & chieu
cao do ddi tugng cung cap qua phdng
van).
Bd me cho con bu vd tre < 5 tuoi:
Danh gia thieu mau ''°^:
Me : Hb < 120 g/L
T r e < 5 t a o i : H b < 110 g/L
- Xii- ly so lieu. Sd lieu dugc nhap blng
57


TC.DD & TP6 (3+4) - 2010

phin mim EPl-lNFO 6.0 & xu ly blng
phin mim SPSS 11.0. Test Chi binh
phuong dugc sti' dung de sg sanh cic ti le.
General Linear Model (GLM) dugc su
dung de so sinh cic sd trung binh giu'a
cic nhdm dugc phan theo 3 thai ky. Phan
tich cic mdi taong quan bang phep kiem
tuong quan Pearson trudc va sau khi hieu
chinh cho cic yeu td gay nhieu (tadi, BMI

tm'dc mang thai). Hoi qui da bien dugc su
dung de tim cac yiu td lien quan. Gil trj
p<0.05 dugc xem nhu cd y nghia thdng ke.
HL KET QUA
Dac dilm ctia PNCT tham gia dieu tra
dugc md ta trong Blng 1. Han 50%
PNCT tham gia dilu tra d nhdm 20-29
tudi. PNCT d 3 thing cudi & 3 thing giua
thai ky chilm lin lugt la 64%o & 32%.

Bang 1. Dac diem dich te, Iam sang ciia doi tuong tham gia dieu tra

Nhom tuoi (nam) < 20
20-29
30-39
>40
3 Ky thai
3 thang dau
3 thang giiia
3 thang cuoi

Noi cu ngu
Npi thanh
Ngoai thanh & ven (ghi chung la "ngoai thanh")
Toan bo
Bdng 2. Dac diem tre < 5 tuoi tham gia nghien cun

Tan so
47
420
299
10
29
248
499
449
327
776

Ti le (%)
6,1
54,1
38,5
1,3
3,7
32,0
64,3
57,9
42,1
100

Bdng 3. Dac diem ba me cho con bii tham gia
nghien ciru

%

So doi tuong
n
%

IjilOl

Trai

322

50,0

Gai

322

50,0

589
122

82,8
17,2

Khac

693
14
4

97,5
2,0
0,6

<25
25-34
>35

: 187
420
104

26,3
59,1
14,6

59
650

8,3
91,7

114
595

16,1
83,9

189
131
116
151
124
711

26,6
18,4
16,3
21,2
17,4
100.0

Noi thanh
Ngoai thanh
Dan toe

Noi cir ngu
Noi thanh

547

84,9

Ngoai thanh

97

15,1

Kinh
Hoa

Nhom tuoi

Nhom tuoi
<6 thang

60

9,3

6-<12 thang
12-<23 thang

101
131

15,7
20,3

24-<36 thang
36-<48 thang

128
107

19,9
16,6

117

18,2

48-<60 thang
Toan bo

Vuns cu ngu

644

100,0

.

•

Miic BMI
<18,5 (gay)
,
>18,5 (khong say)
Trinh do van hoa
< Lop 6
>L6p6
Kinh te gia dinh*
1

2
3
4
5
Toan bo

Kinh ti gia dinh: tu- thdp din cao (tinh theo cde vdt dung
trong gia dinh)

58


TC.DD & TP6 (3+4) - 2010
Ning lugng, dudng chat & cac
nhdm thuc phim tieu thu 24h cua PNCT
d 6 thing sau thai ky dugc trinh biy
trong Blng 5. Do PNCT hay bi nghen
trong 3 thing dau thai ky anh budng den
che do an udng that su nen sd lieu khdng
dugc trinh bay trong bang nay. Nang
lugng, chat sit, vitamin C, thit, rau, &
trai cay tieu thu trong 24h d nhdm
khdng thieu mlu & khdng thieu sat deu
cao ban so vdi nhdm cd thieu mau hole
thieu sat. Tuy nhien, khac biet niy
khdng cd y nghia thdng ke, rieng ddi vdi
nhdm trii cay thi khic biet nay d
ngudng cd y nghia thdng ke (p=0,098)
giua 2 nhdm thieu & khdng thieu mau.
Thai phu tieu thu nang lugng dat gan

80% so vdi RDA. Lugng protein tieu
thu cua PNCT deu dat muc nhu cau
khuyen nghi. Tuy nhien, lugng sat tieu
thu so vdi khuyen nghi d PNCT la rat
thip (chi khoang 40% so vdi RDA).

Tuang quan giu'a ndng do Hb hole
gil tri logarit cua Ferritin huyet thanh
vdi tdng sd ngly udng vien sat tinh den
thdi diem dieu tra theo tung giai doan
thai ky dugc the hien trong Bieu dd 1 -6.
Hb cd khuynh hudng tuong quan nghich
vdi ngay udng vien sat trong 3 thing
dau & 3 thing giua thai ky (lan lugt la r
= -0,25 & r = -0,14), tuy nhien mdi
tuang quan cd y nghTa thdng ke chi
quan sat dugc ddi vdi 3 thing giua thai
ky (p<0,05). Trong 3 thing cudi, viec
udng vien sat lam tang Hb rd ret
(r=0,26, p<0,01). Logarit ctia ferritin
Cling cd khuynh hudng tuang tir nhu Hb
ddi vdi sd ngly udng vien sat. Tuy
nhien, mdi tuong quan yeu ban & chi cd
y nghia thdng ke d 3 thing cudi (r=0,17,
p<0,01). Cac mdi tuang quan nay van
cdn y nghia thdng ke sau khi dugc hieu
chinh cho BMI trudc khi mang thai &
cho tadi.

Bang 4. Mirc tang can, Hb, Het, ferritin huyet thanh trung binh, ti le thieu mau, ti Ie thieu sat & ti Ie

sat dy trir thap cua P N C T theo 3 giai doan cua thai ky.
Bien so

Tang can (kg)

3 thang dau
(n=29)

3 thang giii'a 3 thang cuoi
n=499)
n=248)

Toan bo
(n=776)

Gia tri
P*

1,2 ± 3 , 3

4,5 ± 3 , 3

9,4 ± 3,9

7,5 ± 4 , 5

BMI truoc mang thai

20,2 ± 2,5

19,9 ± 2 , 6

19,7 ± 2 , 4

19,8 ± 2 , 5

NS

Hb (g/dl)

12,5 ± 1,2a

11,8 ± 0 , 9

11,9±1,0

11,9±1,0

<0,01

Het (%)

36,7 ± 3,4a

35,3 ± 2 , 7

35,6 ± 2 , 6

35,6 ± 2 , 7

<0,05

101,0 ± 52,6a

63,0 ± 46,8b

33,7 ±32,1

45,4 ±41,9

<0,01

Ti le thieu mau

2 (6,9%)

44(17,7%)

90(18,0%)

136(17,5%)

NS

Ti le thieu sat

0 (0,0%)

8 (3,4%)

52(10,7%)

60 (8,0%)

<0,01

Ti le du tru' sat thap

1 (3,7%)

38(16,2%)

221 (45,4%)

260 (34,7%)

<0,01

Ferritin huyet thanh (ng/ml)

So liiu trinh bdy: trung binh ± do lich chudn hoac n (%).
', thiec hien bdi GLM (ddi vdi sd trung binh) hogc Chi hinh phuang (doi vdi ti le, chi so 3 thdng giUa & 3
thdng cudi). NS: khdc biet khdng coy nghia thong ke.
', khdc hiet so vdi 3 thdng giiea & 3 thdng cudi: p< 0.01 (Post-hoc t-test).
*, khdc biit so vdi 3 thdng cudi: p<0,01 (Post-hoc t-test).

59


TC.DD & TP6 (3+4) - 2010

Theo Bang 4, mu'c ting can trung
binh ctia PNCT d tung giai doan cua thai
ky diu dat so vdi muc tang can khuyen
nghi (gin 1kg d 3 thing dau, 4kg d 3
thing giiia, & 9 kg d 3 thing cudi).
Khdng cd su khic biet ve BMI trudc
mang thai giiia 3 nhdm theo tadi thai. Hemoglobin (Hb) & ndng do ferritin huyet
thanh trung binh cd su khic biet qua 3 ky
thai. De xac dinh chieu hudng cua su

khic biet niy, so sinh Post-hoc t-test
dugc ap dung, chung tdi nhan thay Hb &
ferritin cua PNCT d 3 thing giua & 3
thing cuoi thai ky diu thip ban bin so
vdi 3 thing diu. Ti le thilu mau PNCT 3
thing giiia & 3 thing cudi cao. Ti le du
tru' sat thap cua PNCT 3 thing cudi cao
gan gap 3 lan so vdi 3 thing giua
(P<0,01).

Bdng 5. So sanh nang lirong, duo'ng chat & cac nhom thye pham tieu thu 24h it 6 thang sau thai ky
giira nhom thieu mau & khong thieu mau va ^iiia nhom thieu sat & khong thieu sat.
Tinh trang thieu mau

Tinh trang thieu sat a

Khong thieu mau
(n=290)

Thieu mau

(n=58)

Khong thieu sat
(n=313)

Thieu sat
(n=27)

2130,2 ±733,3

2083,9 ±799,7

2143,0 ±745,7

1955,3 ±735,7

89,5 ±38,0

89,9 ± 5 1 , 2

90,6 ± 4 0 , 7

81,9 ± 4 0 , 0

18,1 ± 8 , 4

16,8 ±10,5

18,1 ± 8 , 8

16,3 ± 8 , 5

Vitamin C (mg) *•

90,3 (47,5-160,3)

63,8 (43,7-121,1)

89,9 (48,9-155,7)

63,8 (32,9-115,8)

Thit(g)''

107,5 (49,4-207,8)

86,1 (44,0-200,0)

108,0 (47,8-202,8)

93,8 (55,5-238,9)

14,3 (0,0-83,2)

28,4 (0,0-94,7)

16,5(0,0-92,0)

0,0(0-85,7)

Nang luong (kcal)
Protein (g)

sat (mg)

Ca(g)^
Rau(g)''
Trai cay(g)''

205,3 (125,0-317,3) 189,5 (148,3-275,0) 205,4(126,2-313,1) 179,3 (123,4-257,1)
180,0(54,5-401,0)

124,8 (0,0-257,7)

180,0(38,0-400,0)

83,0(0-199,5)

So voi nhu cau khuyen nghi ciia 'Vien Dinh duong (RDA)*^
Nang lugng (%)

78,9 (26,8)

77,3 (30,2)

79,5(27,4)

71,5(26,5)

Protein (%)

101,8 (43,0)

102,5 (59,1)

103,2 (46,3)

92,3 (44,4)

S5t(%)

40,3(18,6)

37,3(23,3)

40,2(19,5)

36,1(18,9)

.S'o lieu trinh bdy: trung binh (do lech chudn) hogc trung vi (25''' - 75''' bdch phdn vi).
" Sd lieu phdn tich sau khi logi trie 27 trudng hap co tinh trgng viem.
* .S'o lieu duac phdn tich bdng gid tri logarit ciia biin qua t-test.
'' Nhu cdu khuyin nghi ndng luang & protein cho thai phu theo tieng giai dogn thai ky & hogt ddng thi liec
viea. Nhu cdu khuyin nghi chdt sat cho thai phu vdi chi do sdt gid tri sinh hoc cao [10]

60


TC.DD & TP6 (3+4) - 2010
Cac thdng tin ve noi khim thai & kien

thuc phdng chdng thieu mlu kliong trinh
bay d day Han 50% PNCT khu vuc ndi
thanh chgn benh vien la noi kham thai.
Trong khi dd, PNCT d vung ngoai thanh
di khim thai chu yeu d tram y te
(56,4%). Chi cd 41,3% PNCT bilt dugc
tic hai cua thieu mlu ddi vdi thai ky. Ti
le PNCT biet cleh phdng ngua thieu mlu
day du (an dti dinh dudng ket hgp udng

sit bd sung) la 26,6%. Ti le PNCT biet
thuc pham giau chat sat 11 64,0%. Gan
50% PNCT biet dugc nhu'ng thdng tin
tren 11 tu benh vien, Trung tam y te hole
phdng mach. Ti le PNCT biet thdng tin
niy tii tram y te la 38,0%. Khdng quan
sit dugc mdi taang quan giu'a kien thuc
phdng ngua thieu mlu vdi tinh trang
thieu mau cua PNCT.

Bang 6. Hemoglobin huyet thanh trung binh & ti Ie thieu mau ciia tre theo nhom thang tuoi
n

Hb huyet thanh
(X ± SD)

Thieu mau
n (%)a

Thieu mau

%b

<6 thang

60

11,4 ±0,9

30,0% [18]

30,2

6-< 12 thang

101

11,5 ±1,1

31,7% [32]

12-<23 thang

131

12,1 ± 1 , 2 *

16,8% [22]**

3U
16,6

24-<36 thang

128

12,4 ±1,0*

7,8% [10]**

7,8

Nhom thang tuoi

36-<48 thang

107

12,6 ±0,9*

3,7% [4]**

3,6

48-<60 thang

117

12,8 ± 0 , 9 *

3,4% [4]**

3,4

Toan bo

644

12,2 ±1,1

14,0% [90]

11,6

" Sd lieu thd
' Hiiu chinh theo tudi & gidi (theo ddn sd thvec ndm 2004)
'p< 0,001 vs. nhdm < 6 thdng & 6-<12 thdng, t-test
"p<0,001 vs. nhdm < 6 thdng & 6-<12 thdng, x2 test

Tinh trang thieu mdu cua tre
Bang 6 cho thay Hemoglobin huyet thanh trung binh & ti le thieu mlu ctia tre theo
nhdm thing tadi. Ti le thieu mlu cua tie tham gia dieu tia la 14,0% (sd lieu thd). Ti le thieu
mlu giam dan theo thing tadi. Hb huyet thanh trung binh & ti le thieu mlu d tiing nhdm
tadi tren 12 thing khic biet cd y nghia thdng ke so vdi nhdm < 6 thing & nhdm 6-12
thing. Ti le thieu mlu cao nhat d nhdm tre dudi 12 thing (30,0% d tie < 6 thing & 31,7%
d tre 6-< 12 thing). Sau khi hieu chinh cho tadi & gidi thi ti le thieu mlu d tie la 11,6%.
Bdng 7. Ti Ie thieu mau cOa ba me cho con bu

%
Kliong thieu mau

643

Phuk luc: Bieu do 1-6. Tuong quan giiira nong do
Hb (Bieu do 1-3) hoac logarit cua Ferritin (Bieu
do 4-6) voi so ngay uong vien sat den luc dieu tra.

90,4

Thieu mau

68

9,6

Tong cong

711

100,0

Ti le thilu mau cua ba me cho con bu la
9,6%), d muc do nhe theo phan loai y
nghia sue khde cdng ddng (blng 7).

61


TC.DD & TP6 (3+4) - 2010

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3 thang cuoi
r=0.17; p<0.01

Bieu d6 6

3 thang giua

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IV. BAN LUAN
Ti le thilu mlu cua PNCT-TP.HCM
nam 2007 la 17,5% (Blng 2), nghia la
thieu mlu cd y nghTa sue khde cdng ddng
theo phan loai ciia Td chuc Y te The gidi
[8]. Ti le nay chi bang khoang mdt nua so
vdi ti le thieu mau PNCT toan qudc nim
2000 (32,2%) & virng Ddng Nam Bg
(34,3%), thap ban so vdi vimg ddng bang
sdng Hdng (23,7%))[7]. So vdi cic nudc
trong khu -vuc thi ti le thieu mlu d PNCTTP.HCM cao ban so vdi ti le nay d Singapore (15,3%)) [12], nhung hai thap ban so
vdi Thii Lan (19,2%) [13], & chi khoing
mgt nira so vdi Malaysia (35%)) [14].

„ . i .k .
3 thang cuoi
S ' « " ' 3 ° f - ' ' ^ . r = -0.26;p<0.01

1 15
i •>

60

200

Ti le thilu sit d PNCT-TP.HCM la
8,0%) (Blng 2), ti le nay d 3 thing cudi
thai ky cao gap 3 lan so vdi 3 thing giira
(10,7% so vdi 3,4%, p<0,01), Khoing 1/3
thai phu (34,7%) cd du trQ' sat thap, ti le
nay kha cao d 3 thing cudi thai ky
(45,4%) (Bang 2). Nhu clu ve chit sit dl
tao mlu thudng tang cao liic mang thai,
nhat 11 trong 3 thing cudi thai ky nham
dap ling sir phat trien nhanh ciia thai nhi,
tuy nhien, che do an thudng khd dip ung
du nen dl dan den thieu mlu trong giai
doan nay. Mac du lugng dam ciia PNCT
tieu thu -vugt RDA & nang lugng dat gin
80% RDA (Bang 3), tuang ung vdi muc
tang can trung binli d cac giai doan thai
ky diu dat kliuyin nghi (Bang 2), lugng
thit tieu thu trung binh cung khdng thip


TC.DD & TP6 (3+4) - 2010
(khoang lOOg/ngay, thugc loai chl do an
cd gil tri sinh hgc cao, sit hip thu khoing
15%) [11], nhung lugng sit tii' chl do In
cGng chi dat khoang 40% so vdi nhu clu
khuyin nghi (Bang 3). Nang lugng tieu
thu, chat dam, sit, vitamin C, thit, rau &
trai cay tieu thu trong 24h d nhdm khdng
thieu mlu cd khuynh hudng cao han

nhdm thieu mau, d nhdm khdng thilu sit
cd khuynh hudng cao ban so vdi nhdm
thieu sat nhung su khic biet chua cd y
nghia thdng ke cd the do chl do an chi thu
thap dugc trong 1 ngly, chua dii dai dien
cho che do an thudng xuyen ciia PNCT.
Ket qua nghien cuu cho thiy bo
sung sit trong thai ky cd tuang quan
nghich trong 3 thing diu (du chua cd y
nghia thing ke) (Biiu dd 1-6) cd thi do
tinh frang Hb & ferritin hr horde khi mang
thai khic biet giira cac PNCT hole do tinh
trang nghen trong 3 thing dau anh hudng
den hieu qui ciia viec udng sit. Tuy
nhien, do so lugng PNCT kha it trong 3
thing dau nen cic ket qua trong giai doan
nay rat khd dien giai. Hb cd tuang quan
nghich vdi tdng sd ngay udng sit trong 3
thing giira (r=-0,14, p<0,05). Mdi tuong
quan theo chieu thuan giira tong so ngay
udng sit vdi Hb (r=0,26, p<0,01) & ferritin (r=0,17, p<0,01) chi quan sit dugc d
ba thing cudi thai ky. Mdi tuang quan
van cdn y nghia thing ke khi hieu chinh
cho tudi & BMI trudc mang thai. Dilu
niy cho thiy thdi dilm bd sung sit thich
hgp cd the nen bit dau tu' 3 thing giiia dl
dat hieu qua trong 3 thing cuoi. Day 11
giai doan thieu mau cao nhit trong thai
ky. Theo Chuang trinh phdng ching
thieu mlu qudc gia, thai phu nen su dung

vien sit ket hgp acid folic rit sdm ngay
tir khi mdi phit hien cd thai. Tuy nhien,
viec bd sung sat sdm tir 3 thing diu thai
ky cd the cdn biy thugc tinh trang sit tir

trudc khi mang thai. Dilu nay cin dugc
xlc dinh til' cic nghien ciiu sau han ve
hieu qui bd sung sat giUa cic nhdm cd
tinh trang sit khac nhau tir trudc klii
mang thai ddi vdi sir tang Hb & du trQ' sit
trong cic giai doan thai ky, cung nhu la
thdi diem bit dau udng sit. Do thdng tin
thu dugc trong nghien cu'u nay chi 11 tdng
sd ngly udng sit chii khdng cd ham
lugng & lieu thude nen phin bien luan
nay nham dua ra cic gil thuyit &h budng
den cic nghien ciiu sau ban v l thdi dilm,
liiu lugng sat bd sung thich hgp nhit de
phdng ngua dugc thieu mau trong thai ky.
Dac diem tre < 5 tudi va ba me cho
con bii tham gia nghien ciiu dugc trinh
bay d blng 4 vl blng 5. Ti le tre nam : nu
la 1:1, chia llm 6 nhdm tuoi. Ba me cho
con bu cu ngu d ndi thanh chilm ti le
82,8%, d ngoai thinh la 17,2%, chia lam
3 nhdm tuoi < 25 tudi (26,3%), 25-34 tudi
(59,1%), > 35 tuoi (14,6%)
Ti le thieu mlu cua tre < 5 tudi la
11,6%), d muc do nhe theo phan loai y
nghia sii'c khde cdng ddng cua WHO

2001. Ti le tre thieu mlu cao nhit d nhdm
tre < 23 thing, lin lugt la 30,2%, 31,2%
va 16,6%o theo cic nhdm tudi < 6 thing,
6-<12 thing va 12-<23 thing. Nhdm tre <
23 thing thudng cd cac vin dh ve benh ly
va dinh dudng, lugng thiic an tre an vio
khdng du nen khdng cung cip dii vi chit
dinh dudng, dac biet la chit sit cho tre.
Tre trong do tudi nay thudng hay bi
nhiem tning dudng tieu hda va hd hip
dan den tre bieng an vl thilu hut chit sit.
Ti le thieu mlu cua b l me cho con bii
la 9,6%o, d miic do nhe theo phan loai y
nghia siic khde cdng dong ciia WHO
2001. PNCT nen dugc bd sung vien sit
theo phic do cua Vien Dinh Dudng, mdi
ngay 1 vien sit chua 60 mg sit nguyen td
63


TC.DD & TP6 (3+4) - 2010
va 0,4 mg acid folic tu' klii phit hien cd
thai din I thing sau sinli.
V. KET LUAN
Ti le thilu mlu ciia PNCT, b l me cho con
bu vl tre < 5 mdi tai TP.HCM nim 2007,
2008 lin lugt la 17,5%, 9,6% va 11,6%,
vin 11 vin de sire khde cdng ddng tai
TRHCM.
PNCT udng sit it nhat 3 thing trong thai

ky cd ti le thieu mlu thap ban PNCT
khdng uIng sit du 3 thing (14,5% so vdi
21,0%, p=0,024). PNMT uong sit it nhit
2 thing trong thai ky cd ti le thieu sit thap
ban PNCT khdng udng sit du 2 thing
(6,0% so vdi 10,6%, p=0,042). Bd sung
sit tir 3 thing giua se llm tang Hb & ferritin d 3 thing cudi. Lugng sat In vao cua
PNCT d 3 thing giua & 3 thing cudi rat
thap (khoing 40%) so vdi nhu cau
khuyen nghi.

5.

VT, Ninh NX. Mdt vdi dgc diim dich ti hoc
ciia thiiu mdu thiiu sdt tren phu nir cd thai a
:,,
6.

Seshadri, S. Prevalence of micronutrient de-

hiiu qud bd sung sdt/folat tren phu nie cd thai
bj thiiu mdu. Tuyen tap cong trinh nghiin
ciru kJioa hoc dinh dudng. Vien Dinh Dudng,
HdNdi
7.

berth thiiu vitamin A, thiiu mdu dinh dudng
a Viet Nam trong nhieng ndm gdn day, mdt sd
khuyin nghi mdi ve Men phdp phdng chdng.
Tgp chi Y hoc Viet Nam. 2003; 285(6); 2231.

8.

WHO 200L Iron deficiency aneamia; assessment, prevention,

and control. A guide for

programme managers. WHO/NHD /01.3; 1114. http;//www. fda.gov/cdrh

/oivd/guid-

9..

WHO. 2001. Iron Deficiency Anaemia; Assessment. Prevention, and Control. A guide

acid in pregnant women in South East Asia.

10. Bd Yti. Nhu cdu dinh dudng khuyen nghi clio

Rasmussen, K.M. Is there a causal relationand

ngudi Viet Nam. NXB Yhoc. HdNdi 2007.
11. Singh
Anaemia

K, Fong

YF, Arulkumaran

in pregnancy—a

study in Singapore. Eur J Clin Nutr

natal mortality? J Nutr. 2001; 131; 590S-603S

Jan;52(I):65-70.

Scholl, TO. & Hediger, M.L. Anaemia and

12. Chotnopparatpattara
rak S, Charnngam

P,

S.

cross-sectional

weight at birth, length of gestation and peri-

iron deficiency anaemia; compilation of data

1998

Limpongsanu-

P. The prevalence and

on pregnancy outcome. Am. J. Clin. Nutr.

risk factors of anemia in pregnant women. J

1994: 59; 492S-501S

Med Assoc Thai 2003 Nov:86(I I); 1001-7.

Gidy T Khdi HH, Nhdn BT Ninh NX. Tinh
hinh thiiu mdu dinh dieang ciia phu nie cd
thai a mot sd vimg ndng thon Viit Nam.
Tuyin tap cong trinh nghiin ciru khoa hoc
dinh dudng.

Viin Dinh Duang, Hd Ndi.

1989; 1:30-34.

64

Ninh NX, Khdn NC. Khuynh hudng thay ddi

for programme managers. P. 33.

weight at birth, length of gestation

4.

1989; 96-101.

jiciancy particularly of iron, zince and folic

ship between iron deficiency anemia and

3.

Klidi HH. Nhdn BT Ninh NX. Thu nghiim

ance/1246.html

Br.J.Nutr 2001; 85: S87-S92.
2.

ndng thdn & thdnh pho Hd Noi. Y hoc thuc
hdnh. 1990; 3; 17-21.

TAI LIEU THAM KHAO
1.

Gidy T Klidi HH. Nhdn BT. Quyen DT Hiin

13. HanijfJ. Das A, Onn LT. Sun CW, Nordin
NM, Rampal S. Bahrin S.
Ganeslingam
M. Kularatnam KJ, Zaher ZM. Anemia in
pregnancy in Malaysia; a cross-sectional
survey
Asia
Pac
J
Clin
Nutr
2007;I6(3);527-36.

TC.DD & TP6 (3+4) - 2010
Summary
IRON DEFICIENCY ANEMIA STATUS OF PREGNANT WOMEN, LACTATING
WOMEN AND CHILDREN UNDER 5 YEARS OLD IN HCMC
A survey on anemia status in pregnant women (PW) in 2006, lactating women and children under
5 years old in 2008 was conducted in HCMC. Objectives: To identify prevalence of anemia, iron
deficiency, low iron storage and related factors to anemia & iron deficiency in PW, lactating women
and children under 5 years to detennine proper intervention approaches. Methods: A cross sectional
survey; 776 PW, 711 lactating women and 644 children under 5 years old were weighted, and collected fasting blood to analyze Hb, ferritin & CRP. Lactating women and children under 5 years
old were weighted, and collected fasting blood to analyze Hb. A stmctured questionnaire was used
to collect information on socio-economic condition, iron supplement and knowledge on anemia
prevention. A sub-group of 406 PW was randomly selected for 24h dietary recall. Results: Mean
values of Hb and Ferritin of PW were 11.9 g/dl and 46ng/ml, respectively; The prevalence of anemia, iron deficiency, low iron storage of PW were 17.5%, 7.9% and 34.7%, respectively. The
prevalence of anemia in PW, who taking iron supplement at least 3 months during pregnancy duration was lower compared with those taking iron supplement less than 3 months (14.5% vs.
21.0%, p<0.05). The prevalence of iron deficiency was also lower in iron supplement PW at least
2 months taking comparing to those taking iron supplement less than 2 months in pregnancy duration (6.0% vs. 10.6%, p<0.05). The prevalence of PW having adequate knowledge on anemia prevention was 26.6%. The prevalence of PW knowing the effects of anemia was 41.3%. The
prevalence of anemia in lactating women and children under 5 years old were 9.6% and 11.6%,
respectively.
K-CyworAs: iron deficiency anemia. Hemoglobin (Hb), ferritin

[•• ,

THIEU VITAMIN A,TIEN LAM SANG, THIEU MAU 6 TRE EM
< 5 TUOI TAI VIET NAM - NAM 2 0 0 8
Nguyen Xudn Ninh', Nguyen Thanh Huffng^,Pham Thi Ngdn \
Nguyen Anh Tudn '', Dang Trw&ng Duy ^, Le Danh Tuyen^
Dieu tra thieu vitamin A tien lam sang va thieu mau d 8152 tre em < 5 tuoi, ciia 56 tinh thanh, dugc
tien hanh vao cuoi nam 2008. Ket qua cho thay ty le thieu vitamin A tien lam sang (retinol huyet

thanh <0,7pmol/L) la 14,2%; ty le thilu mau (Hb<110g/L) la 29,2%, thuoc muc tmng binh vl y
nghia sire khoe cong dong. Ty le thieu vitamin A va thieu mau c6 dao dgng nhieu theo viing sinh
thai, theo tinh trong moi vung sinh thai; nhom tre <24 thang tuoi cd ty le thieu vitamin A va thieu
mau cao nhat. Can co nhung bien phap can thiep dac liieu, nliam ha thap ty le nay ti'ong nhiing nam toi.
Til' khoa: thieu vitamin A, thieu mdu, tre em tien hoc du&ng, retinol, hemoglobin
' PGS, TS - Vien Dinh du-ong
- Cn - Vien Dinh duong
^ KTV - Vien Dinh duong
''BS - Vien Dinh duong
5 TS, BS - Vien Dinh duo'ng

••;.;:,
• >,

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-

65