Micronutrient deficiencies and anemia among preschool children in rural Vietnam

The prevalence of trace elements deficiencies, vitamin A deficiency, anemia, and their relationships were investigated in a cross sectional study involving 243 children aged from 12 to 72 months in rural Vietnam. Serum levels of copper, zinc, selenium and magnesium were determined by inductively coupled plasma mass spectrometer and that of retinol by high performance liquid chromatography. Hemoglobin concentration in whole blood was measured by the cyanmethemoglobin method. The prevalence of deficiencies in zinc, selenium, magnesium, and copper was 86.9%, 62.3%, 51.9%, and 1.7%, respectively. On the other hand, 55.6% were anemic and 11.3% had vitamin A deficiency. Deficiency in two or more micronutrient was found in 79.4% of the children. Parameters associated significantly with anemia were selenium deficiency (OR 2.80 95% CI 1.63-4.80, p=0.0002) and serum retinol<1.05 micromol/L (OR 1.83, 95% CI 1.10-3.05, p=0.021). Magnesium deficiency (OR 3.09 95% CI 1.36-7.03) was found to be a risk factor for zinc deficiency and vice versa. The results indicate that micronutrient deficiencies are prevalent among preschool children in Vietnam. In addition, the results also demonstrate a strong relationship between selenium deficiency and anemia. Clearly, sustainable strategies are urgently required to overcome the problems in the country.     

潍坊市城乡儿童口腔健康及窝沟封闭项目实施状况

了解潍坊市城乡儿童口腔健康状况及对适宜儿童实施窝沟封闭项目状况,为更好地开展口腔教育和防龋干预提供参考.方法 对潍坊市19所城乡小学二年级儿童共2 967名进行口腔健康检查和口腔卫生知识问卷调查,对适宜儿童实施第一恒磨牙窝沟封闭术.结果 乡村儿童乳牙患龋率和第一恒磨牙患龋率均高于城区儿童(P值均<0.05),第一恒磨牙窝沟封闭率城区高于乡村(x2=41.622,P<0.01).城区儿童对引起龋齿的不良行为和牙齿的自我保护方法知识掌握程度高于乡村儿童;将口腔卫生保健教育纳入学生课堂教育学校的儿童口腔卫生知识掌握程度高于未开展口腔卫生保健教育的学校,差异均有统计学意义(P值均<0.05);城区儿童刷牙行为较农村儿童明显规范(P值均<0.01).结论 儿童口腔健康状况形势严峻,学校教育对儿童口腔健康行为影响较大.学校、社会和家长应共同努力,积极实施窝沟封闭项目,预防儿童第一恒磨牙龋齿的发生.     

湖南省农村贫困地区14082名6～24月龄婴幼儿贫血状况分析

目的了解湖南省农村贫困地区婴幼儿营养性贫血情况,为制定农村贫困地区婴幼儿贫血综合防控措施提供依据。方法采用概率比例规模抽样(PPS)、系统抽样相结合的方法,调查2012-2015年湖南省贫困地区6~24月龄婴幼儿家庭基本情况,并测量其血红蛋白含量、体重和身长。结果 14 082名6~24月龄婴幼儿总贫血患病率32.7%,2012-2015年6~24月龄婴幼儿贫血患病率分别为39.6%、31.4%、36.4%、30.8%,随时间推移逐渐下降(P0.05)。男童贫血患病率高于女童(P0.05)。6~、12~、18~24月龄婴幼儿贫血患病率分别为42.7%、33.6%、24.5%,患病率随年龄增大逐渐下降(P0.05)。低体重婴幼儿贫血患病率高于非低体重婴幼儿,低体质指数婴幼儿贫血患病率高于非低体质指数婴幼儿(P0.05);消瘦婴幼儿贫血患病率高于非消瘦婴幼儿,生长迟缓婴幼儿贫血患病率高于非生长迟缓婴幼儿,但差异均无统计学意义(P0.05)。父亲学历高低对婴幼儿贫血患病率无影响(P0.05),母亲学历高者贫血患病率低于母亲学历低者(P0.05)。结论湖南省农村贫困地区6~24月龄婴幼儿贫血患病率较高,有必要采取综合性措施改善婴幼儿营养状况,降低婴幼儿贫血患病率。     

Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families

BACKGROUND: Iron deficiency (ID) is the most common nutritional deficiency in the world and remains relatively common in at-risk groups in the United States. The actual prevalence of anemia, ID, and iron deficiency anemia (IDA) in California remains unclear. OBJECTIVE: The objective was to determine the prevalence of anemia, low iron stores, ID, and IDA in children participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) population, and to assess the value of using hemoglobin to predict ID. DESIGN: This was a cross-sectional study of a convenience sample of 12-36-mo-old children from WIC clinics in 2 California counties. RESULTS: The prevalence of anemia was 11.1% (hemoglobin <110 g/L at 12-24 mo or <111 g/L at 24-36 mo). Study- and literature-determined abnormal values for iron measures were as follows: serum ferritin or=8.4 or >10.0 microg/mL, and transferrin saturation or=2 abnormal iron measures) were 16.2% and 8.8%, and of IDA (ID with low hemoglobin) were 3.4% and 3.2% on the basis of study- and literature-determined cutoffs, respectively. Hemoglobin concentration was used to predict study- and literature-determined ID on the basis of receiver operating characteristic curves. The sensitivity of low hemoglobin in predicting study- and literature-determined ID was low (23.2% and 40.0%, respectively). CONCLUSIONS: Anemia and ID were prevalent in this WIC sample, but IDA was uncommon. Low hemoglobin is a poor predictor of ID.     

广西农村小学一年级儿童口腔健康促进效果分析

了解口腔健康促进活动对促进学龄儿童掌握口腔健康知识的效果,为建立良好口腔卫生行为和饮食习惯提供依据.方法 抽取广西15所农村小学一年级学生745名作为调查对象,对其进行为期1年的口腔健康干预,以问卷调查方式评价其促进效果.结果 口腔健康知识方面,刷牙时间、每天刷牙次数、含氟牙膏可预防龋齿、刷牙出血说明牙龈不健康、白开水最适合解渴、常吃甜食对牙齿有害等知晓率活动前分别为35.70%,37.99%,28.86%,54.50%,76.24%,78.39%,活动后分别提高6.98,23.35,27.38,12.88,13.56,10.07百分点(x2值分别为7.62,81.28,114.26,25.98,48.57,36.25,P值均<0.01).口腔卫生行为方面,早晚刷牙、每天刷牙2~3 min、使用含氟牙膏等形成率活动前分别为25.91%,44.43%,23.62%,活动后分别提高了12.61,12.89,14.90百分点(x2值分别为25.16,24.75,30.61,P值均<0.01).饮食习惯方面,每天进食可乐或雪碧≥1次、每天进食饼干或蛋糕面包等甜点心≥1次、每天进食糖果或巧克力≥1次等形成率活动前分别为81.34%,77.18%,83.22%,活动后分别降低了4.29,9.26,12.08百分点,差异均有统计学意义(x2值分别为4.17,16.05,30.87,P值均<0.05).结论 口腔健康促进活动使学生的口腔健康知识明显提高,口腔卫生行为和饮食习惯明显改善.     

我国城乡婴幼儿营养健康状况及差异分析

目的 了解我国城乡婴幼儿营养健康变化情况及城乡差异,为国家制定相关政策、提高国民素质提供科学依据。方法 以历次全国营养普查数据为主,分析我国城乡婴幼儿营养健康状况的变化规律及城乡差距。结果 我国出生婴儿的死亡率不断下降、出生体质明显改善;0~3岁婴幼儿身高、体重明显增加,生长迟缓率和低体重率明显下降,但缺铁性贫血患病率显著增加;我国婴幼儿营养健康状况的城乡差距进一步加大,农村婴幼儿的生长迟缓率、低体重率和贫血患病率均显著高于城市。结论 我国婴幼儿营养健康状况不断改善,但营养不良问题仍相当突出,特别是农村应引起足够重视。     

Enhancements to nutrition program in Indian integrated child development services increased growth and energy intake of children

The Indian Integrated Child Development Services (ICDS) provides supplemental food to children aged 6 mo to 6 y. This study assessed the impact of enhancements to the existing Supplemental Nutrition Program of local production of supplemental food, home fortification with a micronutrient powder, and improved program monitoring. A quasi-experimental longitudinal design was used. Data were collected from 15 Anganwadi centers randomly selected from the enhanced program and 15 from the usual program. Multilevel linear regression was used to examine changes over time between the 2 groups accounting for village-level variation in intent-to-treat analysis. Children in the enhanced program initially aged 12-18 mo gained 0.72 (P = 0.02) greater height-for-age Z-score. Significant differences were observed in gain in weight-for-age Z-score among those initially aged 9-11 (2.48; P = 0.01), 12-18 (0.76; P = 0.01), and 19-24 mo old (0.73; P = 0.01), and gain in weight-for-height Z-score among 9-11 (2.66; P = 0.04) and 19-24 mo old (0.99; P = 0.01). For these age groups, the prevalence of stunting, underweight, or wasting averted ranged from 20.3 to 33.4%. Energy intake in the enhanced program was significantly greater for boys initially aged 12-18 mo (575.1 kJ/d; P = 0.03). Results from a qualitative substudy supported the plausibility of observed outcomes. ICDS would be more effective in improving child nutrition if it included these enhancements. The enhancements studied may be useful in improving program delivery and uptake of other similar programs.     

Impact of nutrition counselling on nutrition knowledge and nutrient intake of 7- to 9-y-old children in an atherosclerosis prevention project

OBJECTIVE: To assess the impact of nutrition counselling given to 7.5- to 9-y-old children and their parents on children's nutrition knowledge and nutrient intakes. DESIGN AND SUBJECTS: The study children are participants in a prospective, randomised STRIP study (Special Turku Coronary Risk Factor Intervention Project for Children), whose aim was to decrease the intakes of saturated fat and cholesterol while increasing the intake of unsaturated fat in the intervention children from the age of 7 months onwards. Nutrition counselling was given only to the parents until the child's age of 7 y. Nutrition knowledge and nutrient intakes (total energy, total fat, saturated fat, unsaturated fat and sodium) were studied in a time-restricted cohort of 47, 7-y-old intervention and 51 control children. Thereafter, nutrition counselling was given both to the children and parents. Children's nutrition knowledge and nutrient intakes were measured again at the age of 9 y. RESULTS: Biannual nutrition counselling given to the intervention children and the parents maintained the differences in saturated fatty acid intake attained during the intervention given to the parents alone (11.5 vs 13.3 E% (percent of energy intake), at the age of 7 y, P<0.01; 11.1 vs 13.4 E% at the age of 9 y, respectively; P<0.01). The intervention children used more polyunsaturated fatty acids at the age of 9 y than the control children (5.7 vs 5.1 E%, P=0.05). At 7 y, the intervention and control children had similar nutrition knowledge scores (total knowledge score 12.9 vs 12.0, respectively, P=0.13). After 1.5 y of nutrition intervention, at 9 y, the intervention children's nutrition knowledge was higher than that of the controls (total nutrition score 16.5 vs 13.2, respectively, P<0.001) and the ability to explain the reasons for their picture choices in the nutrition knowledge test had increased. CONCLUSION: This study showed that only a relatively short period of counselling with low input is needed to increase in children's nutrition knowledge and ability to explain nutrition-related subjects if advice has first been given to the parents and if the parents have received reinforcement and concrete help with parent-child communication after their children have been involved in the counselling. The differences attained in nutrient intake could also be maintained.     

Assessing the success of the WomanKind program: an integrated model of 24-hour health care response to domestic violence

PURPOSE: The WomanKind program, a non-profit health care based program for for victims of domestic/intimate partner violence (IPV), seeks to enable and motivate health care providers to identify victims of such violence and refer them to WomanKind's in-house services. An evaluation designed to assess client referral to WomanKind services and the impact of health care provider training was carried out. METHODS: Data were collected at three intervals over a 2-year period at 3 intervention and 2 comparison hospitals located in Minneapolis, MN. The focus of data collection efforts was to assess the providers' knowledge, attitudes, beliefs, and behaviors (KABB) concerning identification and referral of victims of IPV. Hospital staff and volunteer advocate training programs also were evaluated. Chart reviews were conducted and client referrals assessed. RESULTS: Providers at WomanKind hospitals demonstrated significantly higher knowledge, attitudes, beliefs and behaviors than those at comparison hospitals throughout the study. During the data collection period, 1719 IPV victims were identified and referred to the WomanKind program, while only 27 IPV victims were referred to trained social workers at the comparison hospitals. Chart reviews indicated that emergency staff at the intervention sites provide documentation of IPV in patient records twice as frequently as emergency staff at the comparison sites. CONCLUSION: This research underscores the efficacy of a well-structured, multidisciplinary effort to deliver services to IPV victims. The results demonstrate that specialized training and on-site client services create a significant positive impact on the KABB of health care providers.     

农村4～9年级留守儿童的心理健康状况分析

目的了解农村4~9年级留守儿童的心理状况。方法采用心理健康诊断测验(MHT)的方式,对农村4~9年级512名留守学生进行调查,评估其心理健康状况。结果性别、年级不同的留守儿童,其心理健康的状况也有所差异,父母一方外出务工以及监护人的不同对儿童的心理健康影响存在统计学差异(P0.05)。农村留守儿童表现出读书学习焦虑、对人焦虑和冲动倾向与非留守儿童相比具有明显的统计学差异(P0.05)。结论父母外出务工,造成儿童长期不与父母生活在一起,是影响儿童心理健康的重要因素。     

Fathers' beliefs about parenting and fathers' clubs to promote child health in rural Haiti

Health care providers are challenged to use culturally appropriate, low-technology approaches to improve child health in resource-poor countries. Village fathers' clubs is one approach used in rural Haiti since 1994. Fathers meet regularly for health education and community-building activities. Our aim was to investigate parenting practices and beliefs among Haitian fathers of young children and to explore their views on fathers' clubs. We conducted semistructured interviews with 18 fathers. Themes identified were fathers' involvement in routine care of their children, the close partnerships of fathers and mothers in child care, fathers' responsibilities to their communities, and fathers' clubs as an important supportive institution for the Haitian fathers and their families. Rural Haitian fathers reported taking a very active role in the lives of their families and children. Increased involvement of fathers should be explored as a strategy to improve child health and survival in other parts of Haiti and throughout the world.     

湖北农村地区6~23月龄婴幼儿贫血状况分析

目的 了解湖北省农村地区6~23月龄婴幼儿贫血状况。方法 采用整群随机抽样的方法,对8个农村县的婴幼儿喂养行为进行入户问卷调查,对血红蛋白和身长、体重进行现场测量。结果 813名6~23月龄婴幼儿中,贫血患病率为30.6%,男童为29.2%,女童为32.2%;6~11月龄婴幼儿贫血患病33.6%,高于12~17月龄的31.2%和18~23月龄的24.6%（P<0.05）;母亲贫血的婴幼儿贫血患病率37.6%,高于母亲不贫血婴幼儿的28.8%（P<0.05）;有初乳喂养史的婴幼儿贫血患病率27.4%,低于无初乳喂养者的48%（P<0.01）;产后1~24 h内开奶的婴幼儿贫血患病率18.4%,低于24 h后开奶者的39.9%（P<0.01）;营养不良的婴幼儿贫血患病率32.7%,高于无营养不良婴幼儿的22.2%（P<0.05）。结论 尽早开奶、初乳喂养、改善母亲贫血和儿童营养不良状况有助于降低农村地区婴幼儿贫血患病率。     

广西农村6～24月龄婴幼儿生长发育及影响因素

目的 了解广西壮族自治区农村地区6～24月龄婴幼儿的生长发育现状及其影响因素,为改善当地儿童生长发育水平提供参考依据。方法采用分层整群随机抽样方法,抽取广西横县、宾阳县和灵山县8个乡的1 198名6～24月龄婴幼儿家长进行问卷调查,并由经过统一培训的人员测量婴幼儿的身长、体重。结果 广西壮族自治区农村地区6～24月龄婴幼儿体重和身长均低于中国9市标准人群,且随年龄增加,儿童身长、体重差距逐渐增大;广西农村地区6～24月龄婴幼儿营养不良发生率为21.9%(262/1 198),其中低体重和生长迟缓的发生率分别为16.2%(194/1 198)和13.5%(162/1 198);不同月龄婴幼儿比较,生长迟缓和营养不良发生率差异均有统计学意义(P=0.000);多因素Logistic回归分析结果表明,≥12月龄、孩次为第2个及以后和不饮用开水是婴幼儿发生营养不良的危险因素,正常产是婴幼儿发生营养不良的保护因素。结论 广西农村地区婴幼儿低体重和生长迟缓发生率较高;月龄较大、早产儿和孩次靠后的婴幼儿是发生营养不良的高危人群。     

Collaboration, consultation and referral in an integrated health-mental health program at an HMO

The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.     

Risk factors for anemia among 6- to 12-month-old children in Brazil]

OBJECTIVE: To estimate the prevalence of anemia and to determine associated risk factors among infants receiving routine health care in public clinics in Brazil. METHOD: This cross-sectional study included 2,715 infants between 6 and 12 months old in 12 cities, in all five of the geographic regions of Brazil. Information regarding the child and its feeding habits was obtained from the mother or other caregiver, using a questionnaire. Nutritional status was determined based on height and weight measurements. The hemoglobin concentration was measured using the HemoCue portable hemoglobinometer. Anemia was defined as hemoglobin < 11 g/dL. The infants' eating habits were assessed based on what they were eating around the time of the questionnaire interviews. The association between anemia and the different variables was evaluated through bivariate analysis, followed by multiple logistic regression using a hierarchical selection model. RESULTS: The prevalence of anemia for the entire group was 65.4%. Multiple regression analysis identified the following risk factors for anemia: living in the Southeastern Region of Brazil (odds ratio (OR) = 1.57, 95% confidence interval (95% CI) = 1.25- 1.99), maternal age < 20 years (OR = 1.58, 95% CI = 1.21-2.07), birthweight < 2,500 g (OR = 2.09, 95% CI = 1.48-2.95), not being breast-fed (OR = 1.28, 95% CI = 1.02-1.61), receiving both breast milk and other foods (OR = 1.40, 95% CI = 1.10-1.78), and male gender (OR = 1.24, 95% CI = 1.06-1.46). CONCLUSIONS: The high proportion of anemic children indicates the need to emphasize, in prenatal and infant health programs, intervention measures for anemia control. Our results could guide these measures, focusing on the groups at greatest risk, such as low birthweight babies and the children of adolescent mothers.     

Co-existence of anemia, vitamin A deficiency and growth retardation among children 24-84 months old in Maracaibo, Venezuela

Iron deficiency anemia has been associated with alterations in child development and psychomotor function, being myelination and dopaminergic functioning especially vulnerable. Iron deficiency, at different ages, has different reversible and irreversible effects on CNS. Anemia has also been related to vitamin A deficiency (VAD) and growth retardation. The aim of the present paper was to determine the coexistence of micronutrient deficiency, iron and vitamin A, and macronutrient deficiency (growth retardation). The sample consisted of 202 Venezuelan children, aged 24-84 month old, (104 girls, 98 boys); Anemia, VAD and growth retardation was evaluated by means of blood hemoglobin concentration analysis, HPLC serum retinol (values <20 microg/dl reveal VAD) and height/age and weight/age Z scores (< or = - 2 SD express stunting and underweight). Prevalence of anemia was 38.11%; VAD, 21.78%; stunting, 14.36% and underweight, 9.40%. Anemia and VAD clustered in 7.92%; anemia + stunting or + underweight coexisted in 5.94% and 2.97%, respectively. Stunting and underweight clustered with VAD in 2.97% and 1.48%. The three-way combination with anemia was only seen with stunting in 0.99% of the sample. The prevalence of micronutrient deficiencies remain as significant public health problems which should be simultaneously treated as virtually independent, giving priority to infant, toddler and preschool age groups.     

河北省城乡地区6~24月龄婴幼儿喂养状况研究

目的 了解河北省城乡地区6~24月龄婴幼儿的喂养状况,并应用婴幼儿喂养指数(infant and child feeding index,ICFI)评价城乡地区不同月龄组婴幼儿的喂养行为,为指导婴幼儿喂养提供科学的参考依据。 方法 数据来自2015年中国居民食物消费状况调查。选取6~24月龄婴幼儿作为研究对象,应用ICFI对喂养行为(24 h母乳喂养、24 h奶瓶喂养、24 h膳食种类、1周辅食添加天数)进行评分。 结果 本研究共纳入婴幼儿861名,ICFI平均得分为(10.58±3.18)分,不同月龄组间ICFI平均得分的差异有统计学意义(F=141.119,P=0.000),在6~8月龄组中,城市ICFI平均得分为(7.61±3.15)分,显著高于农村的(5.44±3.04)分(F=11.859,P=0.001)。喂养总合格率为54.94%(473/861),各月龄组的喂养合格率分别为14.16%、38.78%、66.56%,不同月龄组间喂养合格率的差异均有统计学意义(χ²=124.181,P=0.000)。婴幼儿辅食添加满分率较高的为蛋类、谷薯类、水果、蔬菜,较低的为豆类及其制品、奶类及其制品。 结论 河北省农村地区的低月龄婴幼儿喂养较差,建议加强对辅食添加时间、种类及添加频率等方面婴幼儿喂养知识的宣传。     

承德市南园社区2～7岁儿童营养与健康状况调查

目的为促进儿童健康发育,了解本地区儿童营养与健康状况情况,探索较为有效干预儿童发育的方法。方法选择2009年1月～2010年12月期间承德市某社区内250名2～7岁儿童。对照分析不同年龄组营养状况、健康状况及饮食行为及结果评分。结果﹤4岁儿童组和≥4岁儿童组严重营养不良者对照显示,差异无统计学意义(P﹥0.05);﹤4岁儿童组低体重率(3.7%)、发育迟缓率(0.9%)及肥胖率(4.6%)比≥4岁儿童组低体重率(12.7%)、发育迟缓率(7.0%)及肥胖率(19.7%)显著低(P﹤0.05)。﹤4岁儿童组龋齿率(0.0%)及缺铁性贫血率(0.9%)比≥4岁儿童组龋齿率(4.9%)及缺铁性贫血率(7.0%)显著低(P﹤0.05);而佝偻病率(7.4%)比≥4岁儿童组佝偻病率(1.4%)显著高(P﹤0.05)。﹤4岁儿童组饮食行为评分[(82.3±8.4)分]及饮食结构评分[(80.3±7.6)分]比≥4岁儿童组饮食行为评分[(76.1±7.3)分]及饮食结构评分[(74.6±5.8)分]显著高(P﹤0.05)。结论该社区在孩子添加辅食的过程中,培养孩子健康的饮食行为方面较为欠缺,需要儿童保健部门加强此方面的宣教,以促进孩子的健康发育。