Sự tăng trưởng thể chất và sức khỏe của trẻ dưới 2 tuổi có mẹ được bổ sung vi chất dinh dưỡng trước và trong quá trình mang thai tại thái nguyên tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING
THAI NGUYEN UNIVERSITY

--------------------------

NGUYEN THI XUAN HUONG
PHYSICAL AND HEALTH GROWTH AMONG UNDER 2-YEAR
CHILDREN BORN TO MOTHERS RECEIVING
MICRONUTRIENT SUPPLEMENTATION BEFORE AND
DURING PREGNANCY IN THAI NGUYEN

Speciality: Pediatrics
Code number: 62720135

MINISTRY OF EDUCATION AND TRAINING
THAI NGUYEN UNIVERSITY

Mã số: 62720135

THAI NGUYEN, 2019


The dissertation was completed at
UNIVERSITY OF MEDICINE AND PHARMACY
THAI NGUYEN UNIVERSITY

Supervisor:
1. Ass.Prof.Ph.D. Nguyen Thanh Trung
2. Ph.D. Nguyen Hong Phuong

Critic 1: …………………………………………

Critic 2: …………………………………………
Critic 3: …………………………………………

The dissertation will be defended nationally to the Evaluation
Committee at University of Medicine and Pharmacy, Thai Nguyen
University at …. on …., 201

The dissertation is available for reference at
- The library of Thai Nguyen University of Medicine and Pharmacy
- Learing resource centre of Thai Nguyen University
- The National Medical Library


3

INTRODUCTION
Growth is a fundamental biological feature of children. Research on
growth is considered the basic science of Pediatrics. Pediatricians, the United
Nations Children's Fund (UNICEF) and the World Health Organization
(WHO) emphasize that the first 1,000 days of life, from conception to the
age of two, is a very important period and considered as “golden days” in
children’s life.
This is a special stage that provides the foundation for lifelong health
and has long term impact on the physical, mental and motor development
later in life. The 1000 golden days are a window of opportunity that provides
up to 60% of children’s potential to increase their height in the future. In
Vietnam, the rate of malnourished children is still high. According to the
2015 statistics of the National Institute of Nutrition, underweight prevalence
accounted for 14.1%, stunting accounted for 24.6%. Undernutrition was
especially high in the mountainous and Central Highlands regions. The

proportion of children under 5 years old with nutritional anemia is 29.2%.
The nutritional status of mothers before and during pregnancy is also poor.
Studies worldwide have shown that maternal nutritional status,
especially micronutrient status during pregnancy, is a major determinant
of birthweight and height development potential. This means that
maternal nutritional status must be prepared before pregnancy and should
be maintained well throughout pregnancy. There are plenty studies that
examined the role of nutrition and micronutrient on child physical
development in the first 1000 golden days. However, evidents on the
effects micronutrient supplement before and during pregnancy on later
period of child physical and health development are limited.
Therefore, we carried out the thesis: "Physical and health growth
among under 2-year children born to mothers receiving micronutrient
supplementation before and during pregnancy in Thai Nguyen".
The objectives are:
1. To evaluate the physical and health growth of under -2 year
children born to mothers receiving micronutrient supplements before
and during pregnancy in Thai Nguyen.
2. To identify factors affecting the physical and health growth of
children under 2 years of age whose mothers receiving micronutrient
supplements before and during pregnancy in Thai Nguyen

1. Necessity of the research


4
Stunting is a public health problem in developing countries. The
World Health Organization has set a goal to reduce stunting by 40% in
children under 5 years old by 2025 compared to the year 2010, and also
proposed many solutions to achieve this goal, including supplement

micronutrients for mothers before and during pregnacy. Thus the title of
this thesis is topical, consistent with the trend of the world and the
national nutrition program.
NEW CONTRIBUTIONS OF THE THESIS
1. The project is the first project in Vietnam to study the growth and
health of children aged 0-24 months whose mothers received
micronutrient supplements before and during pregnancy in Thai Nguyen.
2. The study has provided data on physical and health growth of
children aged 0-24 months in Thai Nguyen and has found a number of
factors affecting physical growth and health of children in Thai Nguyen.
3. Research has shown the important role of multiple micronutrient
supplementation before pregnancy on pregnancy outcomes. Children
born to mothers who received pre-pregnancy multiple micronutrient
supplementation, following by prenatal iron-folic acid supplementation,
had higher birth weight and height and lower neonatal anemia rate
compared to those born to mothers who received folic acid or iron - folic
acid supplementation before pregnancy.
THESIS STRUCTURE
The thesis consists of 143 pages. In addition to the introduction (3
pages), the conclusion (3 pages) and the recommendation (1 page), there are
4 chapters: Chapter 1: Literature review (40 pages); Chapter 2:
Methodology (18 pages); Chapter 3: Results (48 pages); Chapter 4:
Discussion (32 pages). The thesis has 36 tables, 11 figures, 171 references
(Vietnamese: 59; English: 112).


5
Chapter1. LITERATURE REVIEW
1. Physical growth of children
1.1. Growth in weight

Weight is a measure usually carried out in all basic and routine
surveys. It is very important measure to assess physical fitness, nutrition
and growth. It is also universal, simple and easy to measure.
1.2. Growth in height
Height (length) is one of the most basic dimensions in anthropometric
surveys. The height represent the length of the whole body so it is used to
assess the growth of children, the form of adult stature. Height is a faithful
measure of growth, height reflects good past life and is evidence that reflects
nutrition. Long-term malnourished children will slow height development.
1.3. Head circumference (or occipital-forehead circumference)
The head circumference is a measurement used in anthropology,
correlates with brain mass and cognitive function. The measurement of the
head circumference
allows indirect assessment of the secondary
abnormalities of the brain due to pathological processes. Therefore, the
American Society of Pediatrics recommends measuring the head
circumference when visiting children, especially among children under 2
years of age.
1.4. Mid upper arm circumference
Mid upper arm circumference (MUAC) is one of the anthropometric
indicators commonly used in field surveys. It allows to assess the muscle
mass and it also reflects the nutritional status of children. MUAC can be
used to quickly classify nutritional status in the community. WHO has set
a threshold for assessing the nutritional status of children: MUAC ≥
13.5cm: Normal, MUAC 11.5 to less than 12.5cm: moderate acute
malnutrition, MUAC <11.5cm: severe acute malnutrition.
2. Nutritional status and health of children.
Assessing the health of an individual or a community is a challenge,
because health is an abstract concept and difficult to measure. In the
scope of the thesis, we only mention one aspect of child health:

nutritional status and some common acute diseases in children in the
community: undernutrition, anemia, acute respiratory infections and
diarrhea.
Malnutrition is a condition in which the body lacks protein, energy
and micronutrients. The disease is common in children under 5 years old,
manifesting in many different levels, or more or less affecting the


6
physical and health development of children. The first two years after
birth are the fastest growing stages of the body, the period of greatest risk
of malnutrition. The survey results on the nutritional status of children,
the rate of underweight malnutrition children in Vietnam has decreased
but remained high, in 2012 was 16.2%, in 2013 was 15.3%, in 2014 is
14.5% and in 2015 is 14.1%. However, the national rate of stunting
malnutrition remains at 26.7% in 2012, 25.9% in 2013, 24.9% in 2014
and 24.6% in 2015.
According to the nutrition surveillance in 2009 - 2010, the rate of
anemia in the ecological regions remains almost average and seriously in
Northwestern mountain area. The younger the age group was, the higher the
risk of anemia was: the group of 0-12 months and 12-24 months has the
highest anemia rate of 45.3% and 44.4%, respectively; meanwhile, in the
group of 24-35 months, this rate was only 27.5%.
ARI is the leading cause of disease burden, and the third leading
cause of death for children under 5 in Vietnam.
In Vietnam, the regions with the highest prevalence of diarrhea are
the North West, Central Highlands, Red River Delta, and those with the
lowest rate of diarrhea are the South East and the North Central Coast.
3. Factors affecting the physical growth, nutritional status and health
of children under 2 years of age

The growth process of children from the time of pregnancy to birth
and growth is influenced by many factors: nutrition, genetics,
environment and society. Just like growth, there are many weaknesses
affecting the nutritional and health status of children: Nutrition,
socioeconomic, food safety, environment, genetic and biological factors.
The impact of each factor on growth and health varies according to the
developmental stage of the child, with motivating factors, and factors that
cause restriction. These factors do not work separately but they are
closely related and determine the nature of development.


7
Chapter 2: METHODOLOGY
2.1. Research subjects
Subjects of study are mother and child pairs in which mothers are
supplemented with micronutrient before and during pregnancy and divided
into 3 groups:
Group 1: Children who are born by mothers receiving Folic acid (FA)
weekly before pregnancy and receiving iron + folic acid (IFA) daily during
pregnancy.
Group 2: Children who are born by mothers who receive IFA
supplements weekly before becoming pregnant and receive IFA
supplements daily during pregnancy.
Group 3: Children who are children of mothers receive multiple
micronutrient (MM) weekly before pregnancy and daily IFA supplement
during pregnancy.
2.1.1. Selection criteria for research
- Children of mothers who participated in micronutrient intake
before and during pregnancy, we followed children from birth to 24
months of age.

- The families who agree to allow the children to participate in the
study and sign the agreement to participate in the study
2.1.2. Exclusion criteria from research
- Children with birth defects
- Die before 24 months
- Parents who do not agree to accept the study or refuse to
continue to participate at any time.
2.2. Location and time
2.2.1. Location
The study was conducted in 20 communes in 4 districts: Dai Tu, Phu
Luong, Dinh Hoa and Vo Nhai of Thai Nguyen province.
2.2.2. Time: From October 2013 to April 2016
2.3. Research Methodology
2.3.1 Study design
Cohort studies monitor the physical and health growth of babies born
by women who have been fortified with micronutrients before and during
pregnancy until they are 24 months old
2.3.2. Sample size, sample selection
Sample size:
Applying the formula for estimating relative risk in cohort studies
n  Z 2 / 2

(1  p1 ) / p1   (1  p0 ) / p0 
[ln(1   )]2


8
Inside:
p1: The rate of malnutrition is estimated in children of children of
mothers who are supplemented with micronutrients, P1 = (RR) .p0

p0: The rate of malnutrition is estimated among children of mothers
in the general population. According to the results of the Nutrition
Institute in 2012, the rate of malnourished children in the northern
mountainous region is 20.9%. .
: Expected accuracy (allowable difference between relative risk RR
of population with RR obtained from sample), select  = 0.2
RR: Relative risk, it is estimated that the child group of mothers
with micronutrient supplementation is less malnourished than 50% of
mothers with micronutrient supplement, choose RR = 0.5
Instead of the formula, calculate the sample size of 953
The minimum sample size required in the study is 953 children. In
fact, we investigated 1151 children, during the data collection process,
there were 90 children excluded from the study, 32 children gave up, 15
children roamed, 43 children did not participate fully. The number of
eligible children included in the data analysis was 1061 children.

Sample.
Step 1: Selecting districts: the four districts: Vo Nhai, Dinh Hoa, Dai Tu
and Phu Luong were secleted.
Step 2: Selecting communes: 5 communes in each district were randomly
for the study
Step 3: Select the research object:
The mothers and children of mothers who have micronutrient
supplements before and during pregnancy were selected. We made a list
and matched the number of children and mothers to carry out vertical
monitoring from birth to 24 months of age.
2.4. Research indicators and variables
2.4.1. Research indicators
Research indicators for goal 1:
- Weight of children aged 0-24 months by age and gender, according to the

group of micronutrient supplements.
- Length of children aged 0-24 months by age and gender, according to the
group of micronutrient supplements.
- Head and arm rings of children from 0 to 24 months by age and gender,
according to the group of micronutrient supplements.
- The rate of malnutrition: being underweight, stunting, and lean by age,
according to the group of micronutrients.


9
- Percentage of anemia, ARI, TCC by age, by micronutrient supplement
group.
Research indicators for objective 2: Analysis of a number of factors affecting
the physical and health growth of children under 2 years of age with mothers
receiving micronutrient supplements before and during pregnancy.
- Factors affecting the weight of children at birth, 12 months and 24 months.
- Factors affecting the length of children at birth, 12 months and 24 months
- Factors affecting stunting, underweight of children at birth, 12 months and
24 months.
- Factors affecting anemia, ARI, TCC of babies at birth, at 12 months and at
24 months.
2.4.2. Variables and how to define variables
- Child's age: take the date of investigation except the child's date of birth
and based on WHO 2006 standards
- Child's gender: Boys and girls
- Weight: In kg, take a decimal number after the comma
- Length, head, arm, and chest: In cm, take a decimal number after the
comma.
Classification of nutritional status
Use measurements of the child's age, gender, weight and height to

calculate indicators: weight for age (WAZ), height for age (HZA), weight
for height (WHZ) and Classification of malnutrition according to WHO
2006. Standard children when WAZ, HAZ, WHZ indexes are between -2
and +2.
Malnutrition is recorded when the WAZ, HAZ, WHZ <- 2 indicators
- Underweight: When WAZ <- 2SD
- Stunting: When HZA <- 2SD
- Malnutrition is thin: When WHZ <- 2SD
Criteria for assessing anemia: based on the amount of Hemoglobin (Hb)
Neonatal anemia when Hb <135 g / l
Children under 2 years old anemia when Hb <110 g / l
Pregnant mothers are anemic when Hb <110g / l
The unborn mother is anemic when Hb <120g / l
- Acute diarrhea: Children are considered TCC when they go out of loose
stools splashing water 3 times or more in a day, the time is less than 14 days.
- ARI: Children are diagnosed with acute respiratory infections when
children have 2 or more signs in the following signs: cough, fever, runny nose,
shortness of breath, fast breathing.
Mother's ethnicity: Kinh and other ethnic groups


10
- Education level of mothers: According to the standards of the Ministry
of Education and Training
+ Primary school: finish grade 5
+ Middle school: finish grade 9
+ High school: finish grade 12
+ On high school: apprenticeship or university, postgraduate.
- Height of mother: Normal: 45 1.45m, low <1.45m.
- BMI of the mother before pregnancy: BMI = Weight / Height 2.

Normal BMI ≥ 18.5 kg / m2; BMI <18.5 kg / m2: chronic energy deficiency,
BMI> 25 kg / m2 is overweight, obesity.
- Number of kilograms of weight gain of mothers during pregnancy:
Normal ≥ 9 kg, <9 kg: little increase.
- Maternal occupation: Agricultural or other occupations (Teachers,
workers, accountants, business).
- Maternal micronutrient supplemented before pregnancy: FA, IFA,
MM
- Preterm birth: gestational age at birth <37 weeks
- Low birth weight: Birth weight <2500g
- Light weight for gestational age: Underweight for gestational age is
considered a useful health monitoring indicator for newborns. We use
INTERGROWTH-21st standard in 2014
- Child feeding practices: Evaluated at 8 times of 1,3, 6, 9, 12, 15,18 and
24 months of age, including practice of breastfeeding and complementary
feeding, using criteria WHO.
2.5. Analyzing and processing data
The data was analyzed and processed with Stata10 software. The
statistical tests are selected appropriately to ensure accuracy
2.6. Ethics
The study was approved by the Ethics Council in Biomedical
Research Institute of Sociology and Sociology in Vietnam and agreed by
local authorities. Parents are informed about the purpose, rights and
responsibilities of participating in the study and voluntarily participate in
the study. The study participants received nutritional counseling before
intervention.


11

Chapter 3: RESULTS
3.1. General information about the research sample
The study included 1061 mother and child pairs, of which 338
mothers were supplemented with micronutrients, 342 mothers were
supplemented with iron-acid folic and 380 mothers were supplemented
with folic acid. Farming mothers accounted primary part (82%); ethnic
minority mothers account for nearly half (49.4%). The number of boys
was 544, accounting for 51.27%. Girls were 517, accounting for 48.73%.
The rate of underweight babies under 2500g accounts for 5.1%, the rate
of premature babies under 37 weeks is 9.4%, 12.1% of low birth weight
babies with respect to gestational age. There was no difference in
individual characteristics, child feeding practices and household
characteristics in 3 study groups.
3.2. Physical and health growth of children under 2 years old
3.2.1. Physical growth of children under 2 years old.
Table 3.1. Average weight and length of children from 0-24 months old
Age
(Month)

0
1
3
6
9
12
15
18
24

Average weight of children from

Average length of children from 0
0 – 24 months old (kg)
– 24 months old (cm)
Boy(n = 544) Girl (n =517)
Boy (n =544) Girl(n = 517)
P
p
( X ± SD)
( X ± SD)
( X ± SD)
( X ± SD)
3,10 ± 0,39
3,01 ± 0,38
0,01
3,10 ± 0,39
3,01 ± 0,38
0,01
3,97 ± 0,63
3,79 ± 0,62
0,01
3,97 ± 0,63
3,79 ± 0,62
0,01
5,44 ± 0,98
5,05 ± 0,81
0,01
5,44 ± 0,98
5,05 ± 0,81
0,01
6,62 ± 0,87

6,08 ± 0,77
0,01
6,62 ± 0,87
6,08 ± 0,77
0,01
7,98 ± 0,93
7,41 ± 0,88
0,01
7,98 ± 0,93
7,41 ± 0,88
0,01
8,70 ± 1,02
8,08 ± 0,95
0,01
8,70 ± 1,02
8,08 ± 0,95
0,01
9,47 ± 1,02
8,87 ± 1,03
0,01
9,47 ± 1,02
8,87 ± 1,03
0,01
9,92 ± 1,11
9,36 ± 1,05
0,01
9,92 ± 1,11
9,36 ± 1,05
0,01
10,96 ± 1,13 10,29 ± 1,03 0,01 10,96 ± 1,13 10,29 ± 1,03 0,01

Comment: The development of weight, length of male children is
higher than that of female children in different ages, the difference is
statistically significant (p <0.01).
Table 3.2. Average weight of 3 groups of children from 0 – 24 months old (kg)
Month Group MM
(Age)
( X ± SD)
0
3,29 ± 0,53
1
3,98 ± 0,67
3
5,49 ± 1,02
6
6,69 ± 0,92
9
8,02 ± 0,96

Boy
Group IFA Group FA
( X ± SD)
3,13 ± 0,43
3,95 ± 0,64
5,47 ± 0,99
6,62 ± 0,73
8,01 ± 0,88

( X ± SD)
3,14 ± 0,45

3,98 ± 0,59
5,36 ± 0,94
6,55 ± 0,92
7,92 ± 0,94

P
0,003
0,882
0,264
0,463
0,442

Girl
Group MM Group IFA Group FA
( X ± SD)
3,20 ± 0,40
3,75 ± 0,65
5,04 ± 0,78
6,02 ± 0,79
7,28 ± 0,86

( X ± SD)
3,08 ± 0,48
3,79 ± 0,65
4,98 ± 0,84
6,10 ± 0,73
7,56 ± 0,95

( X ± SD)
3,03 ± 0,42

3,83 ± 0,55
5,12 ± 0,80
6,14 ± 0,80
7,38 ± 0,81

p
0,001
0,524
0,181
0,510
0,040


12
12
15
18
21
24

8,72 ± 1,06 8,75 ± 0,97 8,66 ± 1,02
9,52 ± 1,05 9,49 ± 1,01 9,40 ± 1,02
9,88 ± 1,09 9,85 ± 0.99 10,00 ± 1,22
10,17 ± 1,13 10,16 ± 1,03 10,08 ± 1,03
11,18 ± 1,26 11,07 ± 1,10 10,69 ± 0,99

0,695
0,222
0,739
0,593

0,093

8,01 ± 0,97
8,87 ± 1,09
9,36 ± 1,08
9,50 ± 1,07
10,27 ±1,20

8,19 ± 0,98 8,03 ± 0,90
8,94 ± 1,06 8,81 ± 0,94
9,46 ± 0,97 9,24 ± 1,13
9,58 ± 1,10 9,46 ± 1,12
10,41 ± 0,95 10,16 ± 0,88

0,165
0,247
0,495
0,492
0,547

Comment: The weight of children increases gradually with age, in
the first 6 months, the weight of children increases rapidly, when the
child is 6 months old, the weight is double compared to the time of birth,
after 6 months the weight of the child increases more slowly. Children of
mothers who received multiple micronutrient supplements before
pregnancy had a higher birth weight than those of mothers who received
iron-folic acid supplementation or only iron supplementation (p <0.01),
without differences in the weight of children in 3 study groups at other
ages.
Table 3. 3. Average length of 3 research groups of children from 0 – 24

months old (cm)
Month
(age)
0
1
3
6
9
12
15
18
21
24

Group MM

Boy
Group IFA

Group FA

( X ± SD)
51,23 ± 3,30
53,25 ± 3,02
58,27 ± 3,56
62,27 ± 2,75
68,03 ± 2,55
71,59 ± 2,71
75,65 ± 2,99
77,68 ± 2,88

79,10 ± 2,87
83,01 ± 3,05

( X ± SD)
49,31 ± 2,66
52,84 ± 2,73
58,24 ± 3,77
61,96 ± 2,35
68,05 ± 2,67
71,59 ± 2,18
75,65 ± 2,74
77,79 ± 2,59
79,29 ± 2,92
83,33 ± 2,90

( X ± SD)
49,41 ± 2,92
53,07 ± 3,12
57,74 ± 3,56
61,79 ± 3,03
67,66 ± 2,56
71,35 ± 2,68
75,27 ± 2,86
77,96 ± 2,71
78,80 ± 2,78
81,94 ± 3,14

P
0,001
0,497

0,167
0,412
0,191
0,935
0,074
0,852
0,184
0,091

Group MM

Girl
Group
NhómIFA
FA

( X ± SD)
50,60± 3,01
52,53± 2,46
57,00 ±3,21
60,73 ±2,74
66,34 ±2,62
69,91± 2,48
74,21 ±2,98
76,92 ±2,78
78,04 ±2,99
81,25 ±2,63

( X ± SD)
48,77 ± 3,11

51,99 ± 2,58
56,53 ± 3,73
60,91 ± 4,20
66,60 ± 2,53
69,86 ± 2,54
74,16 ± 2,82
76,52 ± 2,80
77,90 ± 2,86
81,67 ± 2,83

( X ± SD)
48,74 ± 2,74
52,68 ± 2,42
57,14 ± 3,25
60,83 ± 3,02
66,48 ± 2,63
69,81 ± 3,04
74,04 ± 3,02
75,99 ± 3,31
77,93 ± 2,82
80,77 ± 3,49

Comment: The length of children increases gradually with age, in the
first 6 months the length of the child increases rapidly, then the length of
the child increases slowly. Children of mothers who were supplemented
with multiple micronutrient before pregnancy had a longer birth length
than those of mothers who received iron-folic acid supplementation or
only supplemented iron (p <0.01), without differences in the length of
children in 3 research groups at other ages.
3.2. 2. Nutritional status and health of children under 2 years old

Table 3.4. Rate of disease by age
Malnutrition (n= 1061)
Range of
age

Underweight
(%)

Stunting
(%)

Wasting
(%)

Anemia
(%)
(n= 1061)

ARI
(%)
(n= 1061)

Acute
diarrhea
(%)
(n= 1061)

p
0,001
0,058

0,104
0,924
0,587
0,935
0,715
0,254
0,863
0,410


13
1 month
3 months
6 months
9 months
12 months
15 months
18 months
24 months
Age

4,3
3,5
2,3
4,9
6,3
6,9
7,7
8,4
5,5

6,0
5,8
6,0
7,7
9,4
15,8
21,7
28,7
12,2

13,7
6,9
4,0
2,5
3,4
3,5
3,1
2,4
5,4

63,2
59,4
65,9
53,2
52,9
43,2
56,9

9,7

24,9
41,4
29,4
34,0
43,6
29,6
32,5
32,7

3,8
7,9
13,0
14,1
12,1
11,5
9,7
7,0
10,0

Comment: The rate of malnutrition in children of TN appears early from the age
of 1 month of age, tends to increase with age, highest in the age of 15-24 months.
The rate of anemia in children is still high in all ages. Uneven prevalence of acute
respiratory infections at different ages, highest at the age of 15 months. The rate of
acute diarrhea is uneven at different ages and higher in the age group of 6-12
months.

Figure 3.1. Stunting rate by age of 3 research groups
Comment: Stunting rate increases with age, especially after 18
months. There was no difference in stunting rate between the three study
groups.

14

Figure 3.2. The rate of underweight malnutrition according to the age of
the three study groups
Comment: The rate of underweight malnutrition gradually increases with
age, especially after 12 months of age. There was no difference in the
prevalence of underweight among the three study groups.

Figure 3.3. The prevalence of anemia according to the age of the 3 study
groups
Comment: Children of mothers supplemented with multiple
micronutrient before pregnancy had a lower rate of anemia at birth than
those of mothers who received iron-folic acid supplement or iron


15
supplementation only (p <0, 05). There is no difference in the rate of
anemia in the 3 groups at other ages.
3.3. Factors affecting child growth and health
Table 3.5. Regression analysis of factors related to infant weight,
weight at 12 months and 24 months
Factors

Birthweight

Child weight
at 12 months old
(95% CI) p

(95% CI)
P
Β

Characteristics of mothers
Mothers supplemented with micronutrient
FA
IFA
0,01 0,06; 0,07 0,830 0,08
MM
0,16 0,10 ; 0,23 0,001 -0,04
Occupation
Farmer
Officer and
0,06 0,04; 0,16 0,258 0,04
others
Ethnic
Kinh
Ethinic
-0,17
minorities
Education
Primary
Secondary
0,09 -0,01;0,19 0,084 -0,03
High school
0,09 -0,02;0,20 0,107 -0,01
Collegeor
0,07

0.08;0,23
0,356 0,10
higher
BMI
BMI<18.5
BMI≥18.5
0,12 0,06; 0,18 0,001 0,13
Gestational
weight gain
<9kg
≥9kg
0,14 0,08; 0,20 0,001
Characteristics of children
Birthweight
0,85
Child
weight at12
months old
Gender
Girl
Boy
0,08 0,02; 0,14 0,005 0,58
Birth order
Firstchild
≥ Second
0,19 0,12; 0,27 0,001 -0,32

β

Child weight

at 24 months old
(95% CI)
p

-0,05; 0,22 0,231
-0,18; 0,10 0,535

-0,03 -0,13; 0,07
0,04 -0,05; 0,14

0,523
0,377

-0,17; 0,24 0,729

-0,01 -0,15; 0,14

0,963

-0,29; -0,06 0,004

-0,01 -0,09; 0,08

0,949

-0,24; 0,18 0,748
-0,24; 0,23 0,957
-0,22; 0,41 0,558

0,12 -0,02; 0,27

0,20 0,03; 0,36
0,18 -0,05; 0,40

0,096
0,018
0,120

0,01; 0,26

-0,01 -0,09; 0,09

0,960

0,039

0,72; 0,98 0,001
0,88

0,84; 0,92 0,001

0,46; 0,69

0,001

0,09

0,01; 0,17

0,047

-0,48; -

0,001

0,09

0,01; 0,17

0,047


16
child
ARI
No
Yes
Acute
diarrhea
No
Yes
Household characteristics
Household socio-economic status
Poor
Nearpoor
0,03 0,05; 0,11
Medium
0,07 -0,01; 0,15
Rich
0,07 -0,01; 0,16
Food security

Yes
No

0,17

0,15

0,501
0,094
0,095

0,04; 0,27

0,011

-0,03 -0,11; 0,05

0,490

-0,09 -0,25; 0,08 0,302

-0,14 -0,31; 0,02

0,093

0,06 -0,10; 0,23 0,447
-0,01 -0,18; 0,15 0,878
0,05 -0,13; 0,23 0,601

0,02 -0,09; 0,14

0,16 0,04; 0,23
0,18 0,05; 0,31

0,695
0,010
0,006

-0,07 -0,23; 0,09 0,411

-0,08 -0,20; 0,03

0,160

Comment:
- Factors affecting birth weight are: mothers supplemented with micronutrient
before pregnancy, mother's BMI, maternal weight gain during pregnancy, gender,
child order.
- The factors affecting the weight of children at 12 months of age are: mother's
ethnicity, maternal BMI, gender, birth weight at birth, child order.
- The factors affecting weight of children at 24 months of age are: Weight of
children at 12 months of age, gender, order of children, household economy.
Table 3.6. Regression analysis of factors related to infant length, at 12
months and 24 months
Factors

Birth length

β
95% CI P
Characteristics of mothers

Mothers supplemented with micronutrient
FA
IFA
-0,15 -0,61; 0,30 0,511
MM
1,89 1,43; 2,35 0,001
Occupation
Farmer
Officer andothers -0,32 -1,01; 0,37 0,368
Ethnic
Kinh
Ethinic minorities
Education
Primary

β

Child length
at 12 months old
95% CI
p

β

Child length
at 24 months old
95% CI
p

0,14 -0,24; 0,52 0,465

0,04 -0,35; 0,44 0,837

0,01 -0,32; 0,33 0,964
-0,02 -0,35; 0,30 0,888

-0,98 -0,66; 0,46 0,733

-0,06 -0,53; 0,41 0,792

-0,34 -0,66; -0,17 0,039

-0,14 -0,42; 0,13 0,315


17
Secondary
0,07 -0,62; 0,77
High school
0,54 -0,22; 1,31
Collegeorhigher 0,53 -0,54; 1,59
Height of mother
<145 cm
≥145 cm
1,36 0,51; 2,21
Gestational weight gain
<9kg
≥9kg
0,20 -0,19; 0,60
Characteristics of children
Birth length

Child length at
12 months old
Gender
Girl
Boy
0,58 0,20; 0,96
Premature
birth
No
Yes
Birth order
First child
≥ Second child
1,03 0,51; 1,54
ARI
No
Yes
Acute diarrhea
No
Yes
Household characteristics
Household socio-economic status
Poor
Nearpoor
-0,01 -0,54; 0,54
Medium
- 0,04 -0,58; 0,51
Rich
-0,62 -0,65; 0,53
Food security

Yes
No

0,829
0,165
0,331

0,002

0,13
0,26
0,59

-0,45; 0,70
-0,37; 0,90
-0,33; 1,43

-1,73 -2,46; -1

0,666
0,412
0,220

0,001

-0,07 -0,55; 0,42
0,07 -0,47; 0,60
0,26 -0,48; 1,01

0,791

0,808
0,487

-0,37 -0,97; 0,24 0,234

0,315
0,21 0,16; 0,27

0,001
0,79 0,73; 0,84 0,001

0,003

1,62 1,30; 1,93 0,001

-0,05 -0,33; 0,24 0,748

-0,21 -0,75; 0,33 0,444

0,001

0,996
0,890
0,837

-0,30 -0,73; 0,12 0,163

-0,28 -0,64; 0,08 0,129

0,08 -0,24; 0,04 0,617

0,15 -0,12; 0,42 0,290

0,03 -0,44; 0,49 0,915

0,11 -0,45; 0,66 0,708

0,29 -0,16; 0,73 0,203
0,42 -0,04; 0,88 0,076
0,42 0,08; 0,92 0,100

0,20 -0,18; 0,58 0,305
0,38 -0,17; 0,77 0,060
0,94 0,51; 1,36 0,001

-0,46 -0,92; -0,01 0,048

0,10 -0,29; 0,49 0,604

Comment:
- Factors affecting the length of birth are: mothers supplemented with
micronutrient before pregnancy, mother's height, gender, child order.


18
- Factors affecting the length of children at 12 months of age are: mother's
ethnicity, mother's height, gender, length of birth and food security.
- Factors affecting the length of children at 24 months of age are: Length of
children at 12 months of age, household economy.
Table 3.7. Regression analysis of factors related to low birthweight and

underweight at 12 months and 24 months
Factors

Low birthweight

Underweight
at 12 months old
OR
95% CI
p

Underweight
at 24 months old
OR
95% CI
p

0,88 0,46; 1,66 0,684
1,24 0,67; 2,23 0,492

0,92 0,48; 1,76
1,10 0,59; 2,05

0,799
0,775

0,27; 3,60 0,928

2,14 0,85; 5,41

0,107

1,35 0,54; 3,41

0,523

0,42; 1,59 0,562

1,19 0,70; 2,01

0,516

1,05 0,61; 1,80

0,871

0,25; 2,29 0,626
0,19; 2,41 0,555
0,30-10,54 0,522

0,94 0,40; 2,21
0,78 0,29; 2,08
0,70 0,17; 2,90

0,889
0,624
0,623

0,57 0,26; 1,26
0,37 0,14; 0,97

0,11 0,02; 0,60

0,166
0,042
0,011

0,39; 1,48 0,522

0,56 0,33; 0,94

0,028

0,53 0,31; 0,91

0,021

7,31 3,61; 14,79

0,001

OR
95% CI
p
Characteristic of mothers
Mothers supplemented with micronutrient
FA
IFA
0,64 0,28; 1,47 0,293
MM
1,11 0,54; 2,26 0,777

Occupation
Farmer
Officer and
0,99
others
Ethnic
Kinh
Ethnic
0,82
minorities
Education
Primary
Secondary
0,76
High school
0,69
Collegeor
1,79
higher
BMI
BMI<18.5
BMI≥18.5
0,76
Gestational weight gain
<9kg
≥9kg
0,98
Characteristic
Low birth
weight

Underweight
at 12 months
old
Gender
Girl

0,50; 1,93 0,964

35,54 19,50;64,79 0,001


19
Boy
Premature
birth
No
Yes

0,59

11,56

0,31; 1,12 0,107

4,89;
27,34

Child order
Firstchild
≥ Second child 0,79 0,37; 1,68

ARI
No
Yes
Acute diarrhea
No
Yes
Dietary diversity
Yes
No
Household characteristic
Household socio-economic status
Poor
0,99 0,40; 2,48
Nearpoor
1,46 0,59; 3,60
Medium
1,24 0,45; 3,42
Rich
Food security
Yes
No

0,001

0,532

1,000
0,407
0,675

1,54 0,92; 2,59

0,71

0,102

0,99 0,58; 1,68

0,960

0,30; 1,68

0,433

2,39 1,05; 5,45

0,038

1,14 0,51; 2,52

0,749

0,72 0,42; 1,22 0,221

1,38 0,80; 2,36

0,246

1,38 0,69; 2,76 0,364

0,73 0,23; 2,31

0,588

0,65 0,31; 1,37 0,260

1,00 0,49; 2,05

0,990

0,78 0,39; 1,54 0,474
0,81 0,40; 1,65 0,563
0,33 0,13; 0,82 0,018

0,93 0,46; 1,89
0,90 0,42; 2,03
0,86 0,36; 2,03

0,838
0,783
0,731

2,15 1,13; 4,12 0,020

0,70 0,33; 1,50

0,358

Comment:
- Factors affecting underweight births are premature babies

- Factors affecting underweight children under 12 months of age: BMI of mothers
before pregnancy, child order, low birth weight, household economy, food
security.
- Factors affecting underweight children at 24 months of age: Low birth weight at
12 months of age, mother's education, BMI of the mother before becoming
pregnant.
Table 3.8. Regression analysis of factors related to stunting at birth, at 12
months and 24 months
Factors

Low birthweight
OR
β 95% CI
p
Characteristic of mothers
Mothers supplemented with micronutrient
FA
IFA
0,94 0,55; 1,59 0,810
MM
1,14 0,68; 1,90 0,609

Stunting at 12 months old
OR β 95% CI
P

Stunting at 24 months old
OR
β 95% CI
p

0,86 0,54; 1,37 0,532
0,72 0,44; 1,16 0,176

0,86 0,58; 1,29
0,63 0,41; 0,97

0,468
0,035


20
Occupation
Farmer
Officer and
1,28 0,58; 2,82 0,536
others
Ethnic
Kinh
Ethnic
0,84 0,51; 1,32 0,467
minorities
Education
Primary
Secondary
0,69 0,34; 1,40 0,309
High school
0,44 0,19; 1,00 0,050
Collegeor
0,32 0,095; 1,09 0,069

higher
Height of mothers
≥1,45m
<1,45m
1,58 0,70; 3,57 0,265
Gestational
weight gain
<9kg
≥9kg
0,79 0,51; 1,23 0,294
Charactericstic of children
Low birth
weight
Stunting at
12 months
old
Gender
Girl
Boy
1,16 0,75; 1,79 0,502
Premature birth
No
Yes
1,78 0,89; 3,58 0,102
Low birth weight
No
Yes
Child order
Firstchild
≥Second child 0,67 0,39;1,17 0,162

ARI
No
Yes
Acutediarrhea
No
Yes
Dietarydiversity

1,23 0,58; 2,59 0,590

1,08 0,56; 2,08

0,814

1,18 0,78; 1,77 0,426

1,69 1,18; 2,40

0,004

0,84 0,45; 1,59 0,603
0,69 0,33; 1,45 0,331
0,39 0,12; 1,30 0,125

0,94 0,53; 1,67
0,63 0,33; 1,22
0,28 0,10; 0,84

0,827
0,168

0,023

4,47 2,29; 8,72 0,001

1,85 0,93; 3,68

0,081

9,73 6,40;14,80

0,001

1,20 0,85; 1,69

0,293

2,32 1,46; 3,68

0,001

1,58 0,92; 2,74 0,099

1,12 0,76; 1,66 0,564

1,23 0,63; 2,39 0,534

5,29 3,21; 8,69 0,001

1,04 0,60;1,80

0,885

1,63 0,98;2,69

0,057

0,89 0,59;1,32

0,555

0,77 0,56;0,97

0,145

0,81 0,45;1,46

0,487

0,99 0,48;2,01

0,975


21
Yes
No
Household characteristics
Household socio-economicstatus
Poor
Nearpoor

1,19 0,64;2,23 0,568
Medium
1,60 0,86;2,96 0,137
Rich
1,53 0,77;3,05 0,675
Food security
Yes
No

1,68

1,09;2,60

0,019

0,98 0,59;1,63
0,64 0,35;1,15
0,75 0,40;1,41

0,941
0,137
0,376

0,91 0,57;1,45
1,29 0,79;2,08
0,87 0,50;1,52

0,683
0,307
0,637

1,61 0,96;2,70

0,071

1,12 0,69;1,80

0,640

Comment:
- Factors affecting stunting at 12 months of age: The height of the
mother, light weight compared to the gestational age. In which children
of mothers with height <1.45m are at risk of stunting malnutrition 4.47
times higher than mothers with height ≥ 1.45m. Low birth weight babies
were 5.29 times more likely to be stunted than stunted babies at birth.
- Factors affecting stunting when children 24 months of age: Maternal
ethnicity, underweight compared to gestational age, stunting malnutrition
at 12 months, children can eat diverse foods. In particular, children of
ethnic minority mothers are 1.69 times more likely to be stunted than
those of Kinh mothers. Stunting malnutrition children at 12 months of
age had a risk of stunting malnutrition 9.73 times higher when 24 months
compared to children without stunting. Low birth weight babies are 2.32
times more likely to develop stunting than those without birth weight.
Children who do not eat diverse foods are 1.69 times more likely to be
stunted than children who eat diverse foods.


22
Table 3.9. Regression analysis of factors related to anemia at birth, at 12
months and 24 months

Factors

Anemia at birth
OR 95% CI
p
Characteristic of mothers
Mothers supplemented with micronutrient
FA
IFA
0,91 0,65; 1,28 0,602
MM
0,67 0,48; 0,95 0,022
Occupation
Farmer
Officer andothers
1,25 0,74; 2,11 0,396
Ethnic
Kinh
Ethnicminorities
Education
Primary
Secondary
0,85 0,49; 1,46 0,557
High school
0,90 0,49; 1,62 0,722
Collegeorhigher
0,55 0,24-1,24 0,151
Anemia before pregnancy
No
Yes

1,44 1,01; 2,05 0,042
Anemia during pregnancy
No
Yes
1,36 1,01; 1,82 0,040
Characteristics of children
Gender
Girl
Boy
1,10 0,83; 1,46 0,490
Child order
Firstchild
≥ Second child
0,72 0,49; 1,06 0,095
Birth anemia
No
Yes
Anemia at 12 months old
No
Yes

Anemia at 12 months old
OR 95% CI
p

Anemia at 24 months old
OR
95% CI
p

1,02 0,74; 1,41 0,905
0,79 0,57; 1,10 0,174

1,03 0,76; 1,41 0,825
1,09 0,80; 1,49 0,567

1,15 0,71; 1,87 0,555

0,60 0,38; 0,95 0,030

1,28 0,98; 1,69 0,072

1,21 0,93; 1,56

0,155

0,80 0,48; 1,32 0,385
0,91 0,53; 1,58 0,740
0,51 0,24; 1,09 0,084

0,45 0,29; 0,71
0,68 0,41; 1,11
0,47 0,23; 0,97

0,001
0,127
0,041

1,36 0,97; 1,91 0,069

1,88 1,38; 2,56

0.001

1,34 1,03; 1,75 0,029

1,20 0,85; 1,69

0,293

1,04 0,60; 1,80 0,885

1,63 0,98; 2,69

0,057

1,33 1,03; 1,73

0,029

1,27 0,97; 1,66 0,082

Comment:- Factors affecting anemia at birth: Mothers supplemented with
multiple micronutrient before pregnancy, mothers who are anemic before and
during pregnancy.
- The factors affecting 12-month-old young anemia are: gender, household
economy.
- Factors affecting anemia for 24 months: mother who are anemia before
pregnancy, occupation and education of mothers and anemia at 12 months.

23

Chapter 4: DISCUSSION
4.1. Physical and health growth of children from 0-24 months in Thai Nguyen
4.1.1. Physical growth of children aged 0-24 months
Immediately after birth, Thai Nguyen children had the same weight and length
as some domestic authors, but lower than WHO standards. The results of Table
3.1 show that in the first year, especially in the first 6 months after birth, children
have the fastest growth in weight and length. From the second year onwards, the
anthropometric indicators of children increased slowly. Boys had a faster growth
rate than girls of all ages. This result is similar to that of Nguyen Thi Yen, Vu Thi
Thanh Huong, studied in Hanoi. When comparing the physical growth of 3 groups
of children participating in the results in Table 3.2 and Table 3.3, the children of
mothers who were supplemented with multiple micronutrient before pregnancy
had high birth weight and length. More children of mothers who received iron folic acid, or only folic acid supplement before pregnancy. At other ages, there
were no differences in the weight and length of the 3 groups of children
participating in the study.
The results of the study in Table 3. 4 show that this is a community with
severity of anemia in children (> 40%) according to the classification of WHO's
public health significance with the lack of the average blood of children is 56.9%,
the rate is higher in boys 58.0%, girls 55.7%. This result is similar to that of Tran
Thanh Do and his partner, 58.6%, by Wenlong Gao et al. (2013) studying anemia
of children under 36 months in rural western China. anemia rate of 52.47%. The
higher research results of Nguyen Anh Tu are 45.8%, the results of the national
census are 45.3%, the Northern mountainous area is 43%, by Tran Thuy Nga and
colleagues ( 2015) in which Viet Nam's anemia rate is 27.8%, higher in
mountainous areas (31.2%) and rural areas (28.4%) and lower than in urban areas
( 22.2%). The study results also show that the rate of anemia in children under 1
year old is higher than that of children over 1 year old, highest in the ages of 3-9

months (63.2% - 65.9%), children over 1 year old have coins the direction
decreases as the age increases. When comparing the prevalence of anemia in the
three study groups, we found that the children of mothers who received multiple
micronutrient before pregnancy had a lower rate of anemia at birth than the
children of iron supplemented mothers. - Folic acid or iron supplement only.
The results of the study in Table 3.4 show that the rate of acute respiratory
infections in children is 32.7%, appearing very early in the first month after giving
birth, the rate is uneven in all ages. The research results are similar to that of the
author Nguyen Dinh Danh (2011) in Dinh Quan, Dong Nai is 34.9%. When
analyzing acute respiratory infections in children by sex, research results show that


24
the common morbidity rate in boys is 33.1% in girls is 31.2% but there is no
difference in the rate of RID according to gender (p> 0.05). The research results
are similar to those in Bac Kan, Bac Giang and Thai Nguyen.
The research results in Table 3.4 show that the rate of acute diarrhea is 10.01%,
uneven at all ages. On doing research on age of diarrhea, we found that the
incidence of diarrhea was high in the age group of 6-12 months. This is the young
age group that started to shift to eating. Passive antibodies from mother lessen and
active antibodies do not yet exist. If mothers process food unreasonably and do not
ensure hygiene, children get diarrhea easily. The study results are similar to that of
Phan Thi Bich Ngoc whose group of children under 12 months old had the highest
rate of diarrhea of 70.97%.
4.2. Factors affecting child growth and health
4.2.1. Factors affecting children's growth
Birth weight and length are closely related to the previous nutritional status of
the mother's pregnancy. In our study, there was an association between CN and
the length of birth of a child with mothers receiving multiple micronutrient before
pregnancy. Results showed that infants of mothers who received multiple

micronutrient before pregnancy had a birth weight greater than 160g and length of
birth at 1.89cm higher than mothers who received folic acid supplementation
before carrying. pregnancy, the difference was significant p <0.01). The study
results of Pham Quoc Hung in Ha Nam, by Nguyen Dang Truong in Hai Phong
also showed that the supplementation of micronutrient for pregnant women
improved weight and average length of birth better than iron supplementation folic acid.
Research shows that maternal weight and height affect children's weight and
length. Children of mothers who were pregnant with BMI ≥ 18.5 had a birth
weight higher than 120g compared to mothers with BMI <18.5. Children of
mothers with a pre-pregnancy height of 45145cm have a birth height of 1.36cm
higher than that of mothers of a height <145cm. This result is similar to the study
by Van Quang Tan in Binh Duong, by Ho Thi Phuong Hoa with the study in Hue.
The results of our study show that children of ethnic minority mothers are lower in
length than those of Kinh mothers. Each ethnic group has its own custom of eating
and raising children. Mothers of ethnic minorities often have low living standards,
lack of knowledge and practices to care for children such as early supplemental
feeding, unreasonable diets, abstinence when children are sick, thus making
children slow-growing.
The results of the research in Table 3.5 and Table 3.6 show that boys and
children who are the second or older have more weight, are taller than girls, and
taller than children of the first. This result is similar to Nguyen Thi Yen's author.


25
Weight and length of birth affect weight and length when children are 12
months and 24 months old. This suggests that the need to improve weight and
length of children should focus on development, weight length in the womb and in
the first year after birth.
The weight and length of birth and in the first year often depend on the
nutritional status, height of the mother, after 1 year of weight and the length of the

child is related to the household economy. Children who live in families with a
medium or rich economy weigh more and are longer than children living in
families with poor economies. Children living in families with rich household
economy, having enough food security, children will be able to eat more fully,
meeting the development needs of children, children will develop physically
better. Conversely, if children are not well fed due to the poor economic condition
of the young family.
4.2.2. Factors affecting the nutritional status and health of children
Factors affecting nutritional status
When analyzing the factors related to the nutritional status of children, we
found that the child's weight at birth affects underweight and stunting malnutrition.
The group of children with birth weight <2500g has the rate of underweight
malnutrition higher than 7.31 times and the rate of stunting malnutrition is 5.29
times higher than the one with birth weight ≥ 2500g when the child is 12 months
old. This result is similar to that of Nguyen Thi Tien, Le Danh Tuyen and Nguyen
Thi Nguyet Nga.
The results of our study also showed that children of mothers with height
<145cm had a stunting rate of 4.47 times higher than that of mothers with a height
of 145 cm. Studies show that the height of mothers is significantly associated with
stunting malnutrition, stunting women will produce low-birth-weight babies at risk
of stunting. Children of mothers who are stunted or underweight tend to be stunted
or underweight. In this way SDD is passed from generation to generation as an
unwanted inheritance.
Ethnicity and educational attainment of mothers also affected stunting
malnutrition, children of ethnic minority mothers had a stunting rate of 1.67 times
higher than their children. Kinh ethnic mother. Children of mothers with higher
education levels are 0.72 times less likely to be stunted than those of mothers with
primary education. This may explain the relationship between mothers'
educational attainment and limitations on child care and nurturing knowledge.
Factors affecting the child's anemia

Regression analysis of factors related to anemia in newborn infants we found that
neonatal anemia is closely related to the mother's anemia before and during
pregnancy. Children who are children of mothers with anemia before pregnancy