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  1. JOURNAL OF SCIENCE, Hue University, N0 61, 2010 ANEMIA IN PRIMARY SCHOOL-CHILDREN OF TWO HIGHLAND COMMUNES IN NAM DONG DISTRICT, THUA THIEN HUE PROVINCE Dang Thij Anh Thu, Hoang Trong Sy, Nguyen Van Hoa College of Medicine and Pharmacy, Hue University SUMMARY A survey carried out in 2007 of 336 highland school children in Nam Dong district, Thua Thien Hue Province showed that the total rate of anemia was 28.9%, in which it was almost all at mild level (26.2%) and moderate level (2.7%), there were no cases at the serious level; The malnutrition rate of children was 39%. According to the stool tests, the rate of children getting hookworm was the highest with 18.2%. There was a significant difference between anemia and ethnic groups (the anemia rate of the Kinh children was lower than that of the Catu ones). Moreover, there were other significant differences between anemia and biological factors, including: age, nutritional status, and hookworm infection. Factors relating to anemia were geography, household economic levels, the number of days eating meat and fish a week, having parents working as farmers, educational levels of mothers and mother’s practice in feeding children. 1. Introduction In recent decades, although there has been a considerable change of socio- economic conditions, anemia is still an important health issue in many rural and highland areas in Vietnam. Particularly for school-age children, it is dangerous, and not only related to their physical and mental health but also affects the long-term development of the community. Thuong Nhat commune and Khe Tre town are two poor highland areas of Nam Dong district. Basically, people in both areas have a low education level, poor income, traditional customs and habits, topography and so on, which restricts living environment, hygienic conditions, and children’s health. Therefore, objectives of this study are to Determine the rate of anemia of primary school children in Thuong Nhat commune and Khe Tre Town of Nam Dong district, Thua Thien Hue province, compare this rate of the Katu ethnic group to the Kinh and Find out the relationships between anemia and some factors on this group. 449
  2. 2. Methodology 2.1. Participants The study was conducted in primary schools of Thuong Nhat commune and Khe Tre town of Nam Dong district, Thua Thien Hue province. 336 pupils randomly selected by EPI INFO statistical software were evaluated, included 164 pupils of Thuong Nhat commune primary school and 172 Khe Tre Town primary pupils. The study was conducted from June to September, 2007. 2.2. Research method This was a cross-sectional survey. Children’s weight and height was measured to examine the nutritional condition. Blood samples were collected for the measurement of hemoglobin concentration, using the KX-21 machine (Symex, Japan). Formalin ether technique was used to test stool samples to look for helminthes eggs. Mothers of those children were directly interviewed for more information relating to anemia, the answers were written down using questionnaires. Assessment indicators - Evaluating children’s anemia status based on the hemoglobin concentration standard (g/dl) of the World Health Organization (Mild anemia: 9.0-11.9g/dl, moderate anemia: 7-8.9g/dl, serious anemia: lower than 7g/dl). - Evaluating helminthes infection status by whether children had helminthes eggs (including Hookworm’s, Ascaris’or Trichuris’s eggs) in stool samples or not. - Weight and height were used for evaluating nutrition condition of children (If the children are younger than 9 years old, the index of weights over heights based on the conferential population was calculated: - Lower than -2SD was considered malnutrition - Equal to or over -2SD was considered normal For 9 year old children and the older, whose height was over the upper boundary’s height, a BMI indicator was applied. Weight BMI = Height2 Assessment: under 5th centigrade of the conferential population was considered malnutrition, equal and over 5th centigrade of conferential population was considered 450
  3. normal. - Some other factors were also evaluated, including: children’s infectious status as well as blood lost status in the six weeks before the study was conducted, household economic levels, the number of days eating meat and fish a week, having parents working as farmers, educational levels of mothers and mother’s practices regarding feeding children. Statistical analysis All data were coded and entered into EPI INFO version 6.04b and SPSS 15.0 for analysis. 3. Results and discussion 3.1. The social- demographic characteristics of the sample Table 3.1. The social- demographic characteristics of participants. Characteristics n % p Kinh 220 65.5 Ethnic p>0.05 Catu 116 34.5 Males 186 55.4 Sex p>0.05 Females 150 44.6 Khe Tre 172 51.2 Demography p>0.05 Thuong Nhat 164 48.8 6 45 13.4 7 52 15.5 8 49 14.6 Ages p>0.05 9 43 12.8 10 64 19.0 >10 83 24.7 Total 336 100 There was no significant difference between the two ethnic groups, number of males and females, number of people living in Thuong Nhat commune and Khe Tre town, as well as in ages of participants ( p>0.05). 451
  4. Table 3.2. Anemia rate, malnutrition rate and helminthes infection rate of participants. Characteristics n % Moderate 9 2. 7 Anemia Mild 88 26.2 Normal 239 71.1 Malnutrition 131 39.0 Nutritional status Normal 205 61.0 Hookworm 61 18.2 Helminthes infection Ascaris 14 4. 2 Trichuris 5 1. 5 The total anemia rate of primary school children in Thuong Nhat commune and Khe Tre town in 2007 was 28.9%. All cases were at mild and moderate levels. There was no serious anemia. This result was similar to the ones of Cao Ba Loi ‘s study and Youssef A. ‘s survey (in which, the anemia total rate of primary school children in Lang Son Cit y and Morocco were 29.4% and 31.6%, respectively). Also, it was acceptable according to the rate given by the WHO, the anemia rate of children from 5 to 12 years old is around 37%. The rate of malnutrition was 39.0%. In the stool samples, the rate of samples having Hookworm ‘s eggs were highest (18.2%). The stool samples containing other worm ‘s eggs were low. This might result from nation collective helminthes worming program for primary school children which are carrying out in Nam Dong district. 3.2. Some factors linking to anemia’s status 3.2.1. Biological factors Table 3.3. Relationships between anemic status and sex, ethnic, age of studied group Anemia 2, p Characteristics Total n % 2 = 3.13 Male 186 61 32.8 Sex p > 0.05 Female 150 36 24.0 2 = 11.71 Catu 116 47 40.5 Ethnic groups p < 0.01 Kinh 220 50 22.7 2 = 23.20 Age (years) 6 45 22 48.9 452
  5. 7 52 21 40.4 p < 0.01 8 49 14 28.6 9 43 14 32.6 10 64 15 23.4 >10 83 11 13.3 Total 336 97 28.9 The results showed that there was a significant difference in anemia status between males and females in the studied group. Yet, there were significant links between the anemia status and ethnic groups (the rate of anemia in the Katu children was higher than that of the Kinh children, p 0.05 No 322 92 28.6 2 = 1.10 Yes 5 3 60.0 Trichuris infection No 331 94 28.4 p > 0.05 Total 336 97 28.9 453
  6. A significant difference between anemia and children’s nutritional status was found in this study (p>0.05). According to many other surveys, there was a high anemia rate in malnourished children (over 80%). Anemia and malnutrition have a strong link with each other, the more seriously malnourished children get, the worse their anemia is. Evaluating the relationships between helminthes infection and anemia showed that there was a link between Hookworm infection and anemia. The research of Ta Thi Tinh also reported that there was no connection between anemia and Ascaris infection as well as Trichuris infection, but a significant relationship between anemia and Hookworm infection was found. Table 3.5. Relationships between Anemia and infectious or blood lost status in 6 months before the study was conducted. Anemia 2, p Characteristics Total N % 2 = 0.45 Yes 9 4 44.4 Blood lost status p > 0.05 No 327 93 28.4 Yes 26 10 38.5 2 = 1.26 Infectious status No 310 87 28.1 p > 0.05 Sum 336 97 28.9 Although there was no relationship between anemia’s status and blood lost status as well as infectious status in the six months before the study was conducted, chronic infection and bleeding are factors relating to anemia. Therefore, children with chronic infections or who have serious bleeding have had chronic bleeding in the past need to be looked after carefully. It is necessary for them to supplement their iron levels with tablest to prevent anemia. 3.2.2. Environmental factors Table 3.6. Relationships between anemia status and demography, household economic levels and the number of days eating meat and fish a week Anemia 2, p Characteristics Total n % 2 = 18.08 Thuong Nhat 164 65 39.6 Demography p < 0.01 Khe Tre 172 32 18.6 Household Under the 2 = 17.66 193 73 37.8 economic levels average 454
  7. p < 0.01 Equal or over the 143 24 16.8 average 0 - 3 days 163 67 41.1 Number of days 2 = 23.08 eating meat and 4 - 7 days 173 30 17.3 fish a week p < 0.01 Total 336 97 28.9 Demography is one of the factors relating to anemia in our study. According to the results in the survey of Nguyen Cong Khanh on the anemia status of Vietnamese children in 1987, there was a significant difference in the rate of anemic children between rural areas and urban areas; that was also similar to the results of the study of Adewuji JO (1992). There was a considerable link between household economic levels and anemia status. It is reasonable that economic factors influence many other elements, including children nutrition status. The research of Ali, on the relationship between demographic- social factors and anemia status in 2001 found the difference between household economic levels and anemia’s status. The children who ate more meat and fish a week have lower rate of anemia. Compared with results of the study of Nguyen PH, it also reported that there was a relationship between anemia status and the number of days children ate fish and meat a week. Additionally, the survey of Nguyen Chi Tam mentioned that the low frequency of fish and meat intake was a risk factor of anemia among members in family, including the adult. Table 3.7. Relationships between anemia‘s status and having parents working as farmers Anemia 2, p Characteristics Total n % Farmer 203 76 37.4 2 = 18.29 Mother ’s Other 133 21 15.8 occupation p < 0.01 Total 336 97 28.9 Farmer 205 75 36.6 2 = 16.36 Father ‘s Other 126 20 15.9 occupation p < 0.01 Total 331 95 28.7 There was a relationship between anemia status and parents who were farmers. The possible reason is that if parents work as farmers their children have more occasions to play in the fields, combined with other factors such as habits of walking 455
  8. barefoot and so on, leading to good conditions for hookworm infection. Therefore, it can cause anemia. Table 3.8. Relationships between anemia‘s status and educational levels of mothers and mother’s practice in feeding children Anemia 2, p Characteristics Total n % Illiterature 135 51 37.8 Primary 129 29 22.5 2 = 8.75 Educational levels of school mothers p < 0.05 Higher than primary 72 17 23.6 schools No 204 70 34.3 Mother’s practice in 2 = 7.50 feeding children Yes 132 27 20.5 p < 0.01 Total 336 97 28.9 Generally, the results showed that the higher the educational levels o f mothers, the lower anemia rate found in their children. According to the results of a study of Cao Duc Hanh on the anemia status of children from six months to under 15 years old, there was also a link between anemia ‘s status and educational levels of mothers, some other research had a similar conclusion. In addition, the connection between anemia status and the mother’s practices of feeding children was found by our study. 4. Conclusions The total anemia rate of primary school children in Thuong Nhat commune and Khe Tre town was 28.9%, all of them were at the mild level (26.2%) and moderate level (2.7%), there were no serious cases of anemia. The rate of malnutrition was 39.0%. In the stool samples, the rate of samples having hookworm‘s eggs were highest (18.2%). There was a significant difference between anemia rate of different ethnical groups. The rate of anemia in the Katu children was higher than that of the Kinh. Moreover, biological factors relating to anemia were ages, nutritional status, hookworm infection. Environmental factors which have a relationship with anemia status included demography, household economic levels, the number of days eating meat and fish a week, parents working as farmers, educational levels of mothers and the mother’s practice in feeding children. 456
  9. 5. Recommendations Katu children in Nam Dong should supplement their diet with iron tablets and cured for normal reasons of anemia. Suitable solutions should be given to improve malnutrition and hookworm infections among these primary school children. The knowledge of mothers and awareness about anemia should be strengthened. Further research needs to be conducted in Nam Dong about anemia to get the correct assessment and detect its relating factors for improving community health. REFERENCES 1. Wilson JD , Braunwald E, Isselbacher KJ. Principles of internal medicine. vol.1. Ha Noi: Medical Publishing House 1999:466-471. 2. Loi Cao Ba et al. Relationships between anemia with intestinal parasitic infection in school children (6-14 years old) in Quang Lac, Mai Pha, Chi Lang communes of Lang Son city, Lang Son province. Malarial and Parasitic diseases preventive Magazine 2005, vol.1: 77-82. 3. Nguyen Chi Tam. Nutritional anemia and some relating factors in 11 to 14 year old children in a rural commune [Master ‘s thesis of community nutrition], Hanoi Medical University 1996. 4. Ta Thi Tinh et al. The relationship between anemia‘s status of primary school children and worm infection in a highland commune of Thanh Hoa Province. Studies reported at National Conference in Malaria – Parasitology – Insects in 2001-2005, Ha noi Medical Publishing House 2006:126-133. 5. Quizhpe E. et al., Prevalence of Anaemia in Schoolchildren in the Amazon Area of Ecuador. Rev Panam Salud Publica 2003; 13(6):355-361. 6. Nguyen PH et al. Risk Factors for Anemia in Vietnam. Southeast Asian J Trop Med Public Health 2006; 37(6):1213-1223. 7. Nguyen Cong Khanh et al. Anemia in Vietnamese Children in 1987. 20 years of Prevention and Control of Micronutrient Deficiencies in Vietnam. Hanoi Medical Publishing House 2001:102-103. 8. Nguyen Thi Ngoc Phuong et al. Effects of Anemia on Physical and Behavioral-mental Development of Children in Budang District Binh Phuoc Province in 2000. 20 years of Prevention and Control of Micronutrient Deficiencies in Vietnam. Hanoi Medical Publishing House 2001:146-162. 457
  10. 9. World health Organization. School-age Children. Helminthes Control in School-age Children. Genever: World Health Organization Press 2002:9-10. 10. Youssef A. et al. Prévalence de L’ Anémie Chez les Préadolescents Scolaires dans La Province de Kénitra au Maroc. Cahiers Santé 2004 ;14 :37-42. 458
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