BioMed Research International

BioMed Research International / 2019 / Article
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Controlling Noncommunicable Diseases in Transitional Economies

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Research Article | Open Access

Volume 2019 |Article ID 6921312 | 8 pages | https://doi.org/10.1155/2019/6921312

Malnutrition among 6–59-Month-Old Children at District 2 Hospital, Ho Chi Minh City, Vietnam: Prevalence and Associated Factors

Academic Editor: Carl A. Latkin
Received05 Oct 2018
Revised26 Nov 2018
Accepted10 Jan 2019
Published05 Feb 2019

Abstract

Objectives. Childhood malnutrition is major health concern in many low- and middle-income countries, including Vietnam. It was a major risk factor for child mortality and adult ill-health. Malnutrition could increase the risk of serious infections; conversely current diseases also had a negative impact on the growth of child. This study, therefore, examines the prevalence of stunting and underweight among 6–59-month-old outpatient children in District 2 Hospital, Ho Chi Minh City, Vietnam. Methods. A cross-sectional study involved a sample of 225 children aged 6–59 months who were randomly selected from the Outpatient Department in District 2 Hospital. Anthropometric measurements and blood test of children were taken to assess the nutritional status and anaemia. A structured questionnaire was also used to collect mothers’ and children’s characteristics to examine associated risk factors. Results. The prevalence of stunting, underweight, overweight, and anaemia among children aged 6–59 months was 9.8%, 8.4%, 25.8%, and 30.7%, respectively. Underweight significantly correlated only to having breastfeeding in the first hour after birth (RR: 0.02; 95% CI: 0.01-0.17; p<0.001), while stunting was related to age of starting complementary foods from equal to/more than 6 months (RR=0.70, 95%CI=0.50-0.99, p<0.05) and normal birth weight (RR = 0.29, 95%CI = 0.15-0.56, p<0.001). Conclusions. This study emphasized the importance of measuring the overall nutritional status for children, who have coexisting infectious diseases and anaemia. The high prevalence of malnutrition and anaemia underlined the need for routine screening as well as treatment of children. Additionally, health information strategies should be focused on young children feeding practices to minimize stunting and underweight.

1. Introduction

Malnutrition was one of the most significant child health issues in developing countries. In 2012, approximately 19.4% and 29.9% of children aged under 5 years had underweight and stunting, respectively [1], with more than 3.4 million mortality cases among children aged under 5 years related to nutritional status [2]. World Health Organization (WHO) reported that the prevalence of stunting and underweight among children aged under 5 years globally in 2017 decreased; those were 13.5% and 22.2%, respectively. However, more than half of all stunted children under 5 years lived in Asia and Africa [3, 4]. Stunting refers to a child who is too short for his or her age; these children could suffer severe irreversible physical, cognitive damage and these devastating effects can last a lifetime and even affect the next generation [5]. Malnutrition was also one of the important risk factors in the onset of many communicable and noncommunicable diseases in both children and adults worldwide [6]. Therefore, adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential [7]. Malnourished children suffer in higher proportion from respiratory infections, diarrhea, and measles, characterized by a protracted course and exacerbated disease [8]. Stimulation of an immune response by infection increased the demand for metabolically derived anabolic energy and associated substrates, leading to a synergistic vicious cycle of adverse nutritional status and increased susceptibility to infection [9].

Many national surveys showed that Vietnam achieved the target to reduce the prevalence of underweight. However, underweight and stunting remained at the level of moderate to high public health impact in 2010 (17.5%, 29.3%, respectively) and in 2014 (12.0%, 23.3%, respectively) [10, 11], while the percentage of children hospitalized at national hospital of pediatrics in Vietnam having underweight was higher (18.2%) [12]. Population-based information was available on malnutrition in under-5-year-old children in some national surveys; however, data on malnutrition and associated factors at hospital settings were rare. Thus, this study aimed to describe the rates of malnutrition among children aged 6–59 months in the Outpatient Department of District 2 Hospital in Ho Chi Minh City.

2. Materials and Methods

2.1. Setting and Study Population

A cross-sectional survey was conducted during January to July 2018 at District 2 Hospital. District 2 Hospital is located in the North East of Ho Chi Minh City. The average number of patients who visit pediatricians at District 2 Hospital was 80 per day. Among them, 50 were children aged 0 to 59 months. Children from 6 to 59 months old were systematically randomly selected from the daily registered list of patients with k=5 until we got 225 children. Besides, children’s mothers or caregivers were also invited to interview session.

2.2. Data Collection

Children length/height and weight were collected by using a pediatric digital scale and pediatric anthropometric rule. Besides, anthropometric data of these children at birth were also obtained with the children’s card of birth. Moreover, a structural questionnaire was also applied to interview children’s mothers or caregivers about associated risk factors. Blood samples were collected after interviews. Hemoglobin (Hb) concentration was measured using blood samples taken from children’s venous blood; two mL of blood was drawn into ethylenediaminetetraacetic acid (EDTA) tubes and analyzed using CELL–DYN Ruby Hematology Analyzer from Abbott.

2.3. Ethical Approval

Informed consent was obtained from all participants. This study was approved by the Ho Chi Minh City University of Medicine and Pharmacy, Vietnam (protocol number 165/UMP-BOARD). Coding was applied to ensure the participant anonymous.

2.4. Data Analysis

Data on height and weight were converted to z-scores of height/length-for-age (HAZ), weight-for-age (WAZ), weight-for-height/length (WHZ), and child body mass index (BMI) using the WHO Anthro software 3.2.2 [13]. The WHO standard reference was adopted to classify children nutritional status such as stunting (HAZ < -2) and underweight (WAZ < -2), and those with BMI-z-score > +1 were considered as at risk of overweight [14]. Hemoglobin (Hb) concentrations were performed using CELL–DYN Ruby Hematology Analyzer at District 2 Hospital, and anaemia was defined as Hb concentrations less than 110 g/L [15, 16].

Data which were collected by questionnaire were entered into EpiData 3.0 by two experienced research assistants. For ensuring data quality, double entry and 10% random check were applied. Stata for Window version 13 was used to analyze data. Descriptive statistics with frequency, percentage, mean scores, and standard deviation were performed. The Chi-square test and t-test were used to determine the relationship between factors and undernutrition status. Multivariate analysis was performed using Poisson regression for variables that had a significance level < 0.20 in the bivariate analysis.

3. Results

3.1. Characteristics of Participants

Table 1 showed the characteristics of 225 participants, including mothers and children aged 6.0–59.0 months. Nearly two-thirds of mothers were 25.0–<35.0 years old. Half of them were sellers (58.3%). Few of them had high school degree (5.8%). Most of them had moderate income (91.6%). In terms of children, most of children (93.3%) had normal birth weight. One-third of children were 36.0–59.0 months old with not much difference between genders. The majority of children (88.4%) had breastfeeding in the first hour after birth, but lower exclusive breastfeeding for the first 6 months of life (34.2%). 81.3% of children were recorded with acute respiratory infections. Besides, 9.8% and 30.6% of children came to hospital because of diarrhea and anaemic, respectively.


Characteristics of mothers N (%)

Mother’s age (years)
 ≥ 18 and <2535 (15.6)
 ≥ 25 and <35151 (67.1)
 ≥ 3539 (17.3)
Occupation
 Housewife39 (17.3)
 Government officer/office worker55 (24.4)
 Seller131 (58.3)
Education
 Primary school101 (44.9)
 Secondary school111 (49.3)
 High school and higher13 (5.8)
Gross household income
 Moderate206 (91.6)
 Poor, near-poor households19 (8.4)
Number of children in household
 187 (38.7)
 2111 (49.3)
 ≥ 327 (12.0)

Characteristics of childrenN (%)

Gender (Male)116 (51.6%)
Age (months)
 6 - 1141 (18.2)
 12 - 2362 (27.6)
 24 - 3547 (20.9)
 36 - 5975 (33.3)
Nutrition history
 Breastfeeding in the first hour after birth (yes)199 (88.4)
 Exclusive breastfeeding for the first 6 months of77 (34.2)
 life (yes)
 Age of starting complementary foods (≥6 months)14 (6.4)
(n=219)
Getting full vaccination (yes)201 (89.3)
Anaemia(n=124)38 (30.6)
Existing diseases
 Acute respiratory infections183 (81.3)
 Diarrhea22 (9.8)
Normal birth weight (≥ 2500 g)210 (93.3)

3.2. Prevalence of Underweight, Stunting, and Associated Risk Factors

Table 2 showed the malnourished children 9.8 % were stunted (low length/height-for-age), while 8.4% were underweight (low weight-for-age), and 25.8 % were at risk of overweight and overweight/obesity.


Nutrition status of childrenN (%)

Underweight (Weight-for-age: WA< -2SD)19 (8.4)
Stunting (Length/height-for-age: HA< -2SD)22 (9.8)
Wasting (Weight-for-length/height: WH< -2SD)10 (4.4)
Overweight (BMI>+1)58 (25.8)

Characteristics of children with and without underweight were similar. However, having breastfeeding in the first hour after birth, getting full vaccination, and having diarrhea, as well as the duration of this disease, all correlated with significantly different underweight rate (p<0.05) (Table 3). Children who had breastfeeding in the first hour after birth had lower underweight rate than children without breastfeeding in the first hour (5.1% vs. 34.6%, p<0.01). Correspondingly, children who were fully vaccinated in EPI had lower underweight rate than those not getting full vaccination (6.5% vs. 25.0%, p<0.05). The rate of children diagnosed with diarrhea was higher than the rate of those who were not (22.7% vs. 6.9%, p<0.05), and the average number of days of this disease (3 days) was significantly correlated with underweight status (p<0.05). This study included 225 mothers; most mothers’ characteristics did not have a statistically significant correlation with underweight rate of infants (p>0.05). The results of Poisson regression of factors associated with underweight status were summarized in Table 4. A statistically significant relationship between underweight rate and characteristics of infants, such as breastfeeding in the first hour after birth, was found. When model was adjusted for all other variables, there was a 0.01–0.17-fold decrease in underweight rate of children for a 1-unit increase in “breastfeeding in the first hour after birth” (p<0.01).


Underweightp-value
Yes (n=19)No (n=206)

Characteristics of children
Gender
 Female8(7.3)101(92.7)
 Male11(9.5)105(90.6)0.563
Age (months)
 6 - 114(9.8)37(90.2)
 12 - 235(8.1)57(91.9)0.873
 24 - 355(10.6)42(89.4)
 36 - 595(6.7)70(93.3)
Weight at birth
 Low (< 2500g)3(20.0)12(80.0)
 Normal (≥ 2500 g)16(7.6)194(92.4)0.121
Breastfeeding in the first hour after birth
 Yes10(5.1)189(94.9)<0.001
 No9(34.6)17(65.4)
Exclusive breastfeeding for the first 6 months
 Yes5(6.5)72(93.5)0.448
 No14(9.5)134(90.5)
Age of starting complementary foods (n=219)
 < 6 months17(8.3)188(91.7)1.00
 ≥6 months1(7.1)13(92.7)
Getting full vaccination
 Yes13(6.5)188(93.5)<0.05
 No6(25.0)18(75.0)
Anemia (n=124) missing 101
 Yes5(13.2)33(86.8)0.057
 No3(3.5)83(96.5)
Acute respiratory infections
 Yes15(8.2)168(91.8)0.761
 No4(9.5)38(90.5)
Diarrhea
 Yes5(22.7)17(77.3)<0.05
 No14(6.9)189(93.1)
Duration of this disease (days)3(2-7)2(2-3)<0.05

Characteristics of mothers
Age (years)
 ≥ 18 and <254(11.4)31(88.6)
 ≥ 25 and <3514(9.3)137(90.7)0.320
 ≥ 351(2.6)38(97.4)
Occupation
 Housewife4(10.3)35(89.7)0.601
 Government officer/office worker6(10.9)49(89.1)
 Seller9(6.9)122(93.1)
Education
 Primary school7(6.9)94(93.1)0.188
 Secondary school9(8.1)102(91.9)
 High school and higher3(23.1)10(76.9)
Gross household income
 Poor, near-poor households2(10.5)17(89.5)
 Moderate17(8.3)189(91.7)0.067
Number of children in household
 111(12.6)76(87.4)
 26(5.4)105(94.6)0.188
 ≥ 32(7.4)25(92.6)

Chi-square and Fisher exact tests used for comparison with and without underweight groups.

VariablesRisk Ratio95CIp-value

Breastfeeding in the first hour after birth0.020.01-0.17<0.001
Getting full vaccination1.340.57 - 3.170.495
Diarrhea0.180.01-5.080.314
Anemia1.770.36 – 8.770.487
Duration of this disease1.040.91 - 1.180.565

Table 5 indicated that characteristics of children and mothers with and without stunting were similar. However, having low birth weight (<2500g), breastfeeding in the first hour after birth, getting full vaccination, having diarrhea disease, and the existence of three or more children in household all correlated with significantly different stunting rate (p<0.05). Children who had low birth weight had higher stunting rate than children with normal weight at birth (33.3% vs. 8.1%, p<0.05). Besides, children breastfeeding in the first hour after birth had lower stunting rate than children without breastfeeding in the first hour (6.5% vs. 34.6%, p<0.001). Children getting full vaccination had lower stunting rate compared with those not getting full vaccination (6.9% vs. 33.3%, p<0.001). Additionally, the rate of children diagnosed with diarrhea was higher than the rate of those who were not (27.3% vs. 7.9%, p<0.05). Characteristics of mothers, including number of children in household, had a significant correlation with stunting (p<0.05).


Stuntingp value
Yes (n=22)No (n=203)

Characteristics of children
Gender
 Female12(11.1)97(88.9)
 Male10(8.6)106(91.4)0.547
Age (months)
 6 - 117(17.1)34(82.9)
 12 - 237(11.3)55(88.7)0.254
 24 - 353(6.4)44(93.6)
 36 - 595(6.7)70(93.3)
Weight at birth
 Low (< 2500g)5(33.3)10(66.7)
 Normal (≥ 2500 g)17(8.1)193(91.9)0.009
Breastfeeding in the first hour after birth
 Yes13(6.5)186(93.5)<0.001
 No9(34.6)17(65.4)
Exclusive breastfeeding for the first 6 months
 Yes5(6.5)72(93.5)0.448
 No14(9.5)134(90.5)
Age of starting complementary foods (n=219)
 < 6 months11(4.5)65(85.5)0.112
 ≥6 months11(7.7)132(92.3)
Getting full vaccination
 Yes8(33.3)16(66.7)
 No14(6.9)187(93.1)<0.001
Anemia (n=124) missing 101
 Yes6(15.8)32(84.2)
 No8(9.3)78(90.7)0.293
Acute respiratory infections
 Yes19(10.4)164(89.6)0.774
 No3(7.1)39(92.9)
Diarrhea
 Yes6(27.3)16(72.7)0,012
 No16(7.9)187(92.1)
Duration of this disease (days)3(2-4)2(2-3)0.089

Characteristics of mothers
Age (years)
 ≥ 18 and <255(14.3)30(85.7)
 ≥ 25 and <3516(10.6)135(89.4)0.200
 ≥ 351(2.6)38(97.4)
Occupation
 Housewife6(15.4)33(84.6)
 Government officer/office worker3(5.5)52(94.6)0.278
 Seller13(9.9)118(90.1)
Education
 Primary school7(6.9)94(93.1)0.188
 Secondary school9(8.1)102(91.9)
 High school and higher3(23.1)10(76.9)
Gross household income
 Poor, near-poor households3(15.8)16(84.2)0.357
 Moderate19(9.2)187(90.8)
Number of children in household
 115(17.2)72(82.8)
 26(5.4)105(94.6)<0.05
 ≥ 31(3.7)26(96.3)

Chi-square, Fisher exact and t- tests used for comparison with and without stunting groups, excluding missing data.

Summarizing the results of Poisson regression model (Table 6), we found statistically significant relationship between characteristics of children such as birth weight and age of starting complementary foods with stunting rate. When the model was adjusted for all other variables, there was a 0.15–0.56-fold decrease in stunting rate of children for a 1-unit increase in “normal birth weight” (RR=0.29, 95%CI=0.15-0.56, p<0.001) and a 0.50–0.99-fold decrease in stunting rate of children for a 1-unit increase in age of starting complementary foods equal to/more than 6 months (RR=0.70, 95%CI=0.50-0.99, p<0.05).


VariablesRisk Ratio95CIp-value

Normal birth weight0.290.15-0.56<0.001
Breastfeeding in the first hour after birth0.780.29-2.070.612
Age of starting complementary foods timely0.700.50-0.99<0.05
Duration of this disease1.120.90-1.390.323
Getting full vaccination0.210.04-1.030.055
Diarrhea0.870.10-7.520.902
Number of Children in household
 11
 20.360.14-1.020.055
 30.120.16-1.700.054
Mother’s age (years)
 <251
 ≥ 25 and <351.390.68-2.830.363
 ≥ 350.460.06-3.480.451

4. Discussion

The results of this study suggested that malnutrition remains a problem in outpatient children, who had existing diseases and anaemia. They showed the double burden of malnutrition and disease. This “double burden” occurred in the same individual at different stages of his or her life, with the rates of 8.4% underweight, 9.8% stunting, 4.4% wasting, and 25.8% overweight. Proportions of stunting and underweight in our study were higher than those at Bagamoyo District Hospital in Tanzania, being 8.4% and 5.7%, respectively [17], and among hospitalized children in the Netherlands with 9% chronic malnutrition [18], but lower than that among hospitalized children in Romania with 13.6% stunting [19], as well as children hospitalized at National Hospital of Pediatrics in Vietnam having 18.2% underweight and 22.5% stunting [12]. There could be another subject and outpatient with milder level and shorter duration of current disease (3.2 ± 2.1 days). Therefore, all of these factors affected lower nutritional status than hospitalized children in another study. However, the proportions in our findings were higher than those in healthy children who had the same age (6–59 months) in Ho Chi Minh City in 2015 (7.0% stunting and 4.9% underweight) [20]. Because malnutrition led to a synergistic vicious cycle of adverse nutritional status and increased susceptibility to infection, there was currently different gap between malnutrition proportion in hospital and community populations under five. Our result showed high anaemia rate (30.6%). Prior studies conducted in Vietnam seemed to focus only on assessing frequency of anaemia in the large community; for example, Nguyen PH and Nhien NV’s researches showed the prevalence of anaemia was high among children aged 0 to 59 months in Vietnam in 2006 (45.1%) [21] and 45% among primary school children in rural Vietnam [22]. We were unable to find any studies that evaluate malnutrition accompanied with anaemia in outpatient children. Therefore, we did not have any database for comparison. Because anaemia and malnutrition often had common causes, they indicated that malnutrition, anaemia problems, and infectious diseases would cooccur in the same individuals. Actually, our finding showed that children with anaemia had also higher stunting than those without (15.8% vs. 9.3%) and underweight was similar (13.2% vs. 3.5%). However, the comparison of observed and expected values was not significantly difference, maybe due to loss of power when we categorized Hb, HAZ, and WAZ as dichotomous variables. It was recommended that pediatricians needed a comprehensive screening of nutritional and anaemic status along with current diseases to intervene at the same time. Our result found that children aged 6-12 months had the highest stunting rate (17.1%) (Table 5). However, the comparison of observed and expected values did not show significant difference. De Novaes Oliveira M and Rannan-Eliya RP’s researches on Brazilian children attending daycare centers [23] and Sri Lanka [24] had similar results. However, this was inconsistent with others, such as a study in rural Ethiopia showing that the proportion of child stunting increased as the age of the child increased [25]. There was statistically significant relationship between underweight rate and breastfeeding in the first hour after birth; that is, a decrease in underweight rate of children correlated to an increase in “breastfeeding in the first hour after birth” (Table 4), which was consistent with WHO's recommendation that breastfeeding should be done as soon as possible. Therefore, nutritional counseling to mothers was designed to promote breastfeeding practices. We also found that stunting was associated with a lower birth weight and age of starting complementary foods timely (equal to/more 6 months); that is, a decrease in stunting rate of children correlated to an increase in “normal birth weight”, with low birth weight negatively impacting stunting, and a decrease in stunting rate of children correlated with an increase in age of starting complementary foods timely. Therefore, education programs for mothers had to encourage starting complementary feeding along with breastfeeding for infants aged 6 months or more, and breastfeeding as soon as possible in the first hour after birth. Our study found that there was no association between characteristics of mothers and malnutrition status of children aged 6–59 months. This result was inconsistent with finding of Gwatkin and colleagues, which was high level of malnutrition among children of less educated women in developing countries [26]; in addition, Reed reported that higher level of education is associated with improved child weight-for-age [27].

4.1. Limitation

This study had limitations that should be considered in interpreting the results. It was difficult to generalize our hospital-based study’s results to the general population. The limitation of a cross-sectional study in teasing out the cause-effect relationship between demographic characteristics of mothers, children, and malnutrition was considered. There was also possibility of social desirability bias; however, interviewers encouraged parents to express their opinions freely. In addition, though being essential to diagnose anaemia, hemoglobin measurement alone could not determine the cause of the anaemia. Future studies could conduct additional measurements of iron status such as serum ferritin or serum transferrin receptor.

5. Conclusion

This study emphasized the importance of measuring the overall nutritional status for children, who have coexisting infectious diseases and anaemia. The high malnutrition and anaemia prevalence underlined the need for routine screening as well as treatment in outpatient children. Additionally, health information strategies should be focused on young children feeding practices to minimize stunting and underweight.

Data Availability

The primary data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

All authors substantially contributed to the drafting and revising of the article, as well as the final approval of the version to be submitted. Huynh Giao, Huynh Ho Ngoc Quynh, and Nguyen Thi Ngoc Han contributed to the conception and design of the study and acquisition of the data. Nguyen Thi Ngoc Han and Do Quang Thanh conducted the data analysis, and Huynh Ho Ngoc Quynh and Tran Van Khanh contributed to data interpretation.

Acknowledgments

We wish to acknowledge the cooperation and support of nurses and laboratory personnel at District 2 Hospital, who facilitated the study. We thank all the families for the time and effort they devoted to the study.

References

  1. G. A. Stevens, M. M. Finucane, C. J. Paciorek et al., “Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: A systematic analysis of population representative data,” The Lancet, vol. 380, no. 9844, pp. 824–834, 2012. View at: Publisher Site | Google Scholar
  2. J. Bongaarts, “Food and Agriculture Organization of the United Nations: the state of food and agriculture: agricultural trade and poverty: can trade work for the poor?” Population and Development Review, vol. 33, no. 1, pp. 197-198, 2007. View at: Google Scholar
  3. World Health Organization, Global and regional trends by WHO Regions, 1990-2025 Stunting: 1990-2025, 2018, http://apps.who.int/gho/data/node.main.NUTWHOREGIONS?lang=en.
  4. World Health Organization, Levels and trends in child malnutrition, 1-15, WHO, Geneva, Switzerland, 2018.
  5. D. L. Pelletier and E. A. Frongillo, “Changes in child survival are strongly associated with changes in malnutrition in developing countries,” Journal of Nutrition, vol. 133, no. 1, pp. 107–119, 2003. View at: Publisher Site | Google Scholar
  6. S. Ashaba, G. Z. Rukundo, F. Beinempaka, M. Ntaro, and J. C. Leblanc, “Maternal depression and malnutrition in children in southwest Uganda: A case control study,” BMC Public Health, vol. 15, no. 1303, pp. 1–6, 2015. View at: Google Scholar
  7. R. Uauy, J. Kain, V. Mericq, J. Rojas, and C. Corvalán, “Nutrition, child growth, and chronic disease prevention,” Annals of Medicine, vol. 40, no. 1, pp. 11–20, 2008. View at: Publisher Site | Google Scholar
  8. D. A. Meira, “Interactions of infection, nutrition, and immunity,” Revista da Sociedade Brasileira de Medicina Tropical, vol. 28, no. 4, pp. 315–319, 1995. View at: Publisher Site | Google Scholar
  9. U. E. Schaible and S. H. Kaufmann, “Malnutrition and infection: Complex mechanisms and global impacts,” PLoS Medicine, vol. 4, no. 5, Article ID e115, 2007. View at: Publisher Site | Google Scholar
  10. Unicef, Điều tra Đánh giá Các Mc tiêu Tr em và Ph nữ 2011, Unicef, Vietnam, 2011, https://www.unicef.org/vietnam/vi/19062012_MICS4__TV.pdf.
  11. UNICEF Viện Dinh Dưỡng, Báo cáo tóm tắt tổng điều tra dinh dưỡng 2009-2010, Viện dinh dưỡng quốc gia: Nhà xuất bản Y học Hà Nội, 2011.
  12. P. T. T. Hương and C. T. T. Hương, “Nutrional status of children hospitalized at national hospital of pediatrics,” Vietnam Journal of Preventive Medicine, vol. 15, no. 3, pp. 162–164, 2015. View at: Google Scholar
  13. World Health Organization, WHO Anthro for Personal Computers, 2011, http://www.who.int/childgrowth/software/en/.
  14. World Health Organization, WHO Child Growth Standards: Training Course on Child Growth Assessment, China, 2008.
  15. World Health Organization, Haemoglobin Concentrations for The Diagnosis of Anaemia And Assessment of Severity, 2011.
  16. World Health Organization, Nutritional Anaemias: Tools for Effective Prevention And Control, Geneva, Switzerland, 2017.
  17. O. A. Juma, Z. O. Enumah, H. Wheatley et al., “Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania,” BMC Public Health, vol. 16, no. 1, article no. 1094, 2016. View at: Publisher Site | Google Scholar
  18. K. F. Joosten, H. Zwart, W. C. Hop, and J. M. Hulst, “National malnutrition screening days in hospitalised children in the Netherlands,” Archives of Disease in Childhood, vol. 95, no. 2, pp. 141–145, 2010. View at: Publisher Site | Google Scholar
  19. O. Marginean, A. M. Pitea, S. Voidazan, and C. Marginean, “Prevalence and assessment of malnutrition risk among hospitalized children in Romania,” Journal of Health, Population and Nutrition, vol. 32, no. 1, pp. 97–102, 2014. View at: Google Scholar
  20. Unicef, “Phân tích tình hình tr em Việt Nam năm 2017 y ban nhân dân Thành phố Hồ Chí Minh2017,” https://www.unicef.org/vietnam/vi/Final_Sitan_HCMC_Viet.pdf. View at: Google Scholar
  21. P. H. Nguyen, K. G. Nguyen, M. B. Le et al., “Risk factors for anemia in Vietnam,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 37, no. 6, pp. 1213–1223, 2006. View at: Google Scholar
  22. N. Van Nhien, N. C. Khan, T. Yabutani et al., “Relationship of low serum selenium to anemia among primary school children living in rural Vietnam,” Journal of Nutritional Science and Vitaminology, vol. 54, no. 6, pp. 454–459, 2008. View at: Publisher Site | Google Scholar
  23. M. De Novaes Oliveira, R. Martorell, and P. Nguyen, “Risk factors associated with hemoglobin levels and nutritional status among Brazilian children attending daycare centers in Sao Paulo city, Brazil,” Archivos Latinoamericanos de Nutrición, vol. 60, no. 1, pp. 23–29, 2010. View at: Google Scholar
  24. R. P. Rannan-Eliya, S. M. Hossain, C. Anuranga, R. Wickramasinghe, R. Jayatissa, and A. T. Abeykoon, “Trends and determinants of childhood stunting and underweight in Sri Lanka,” The Ceylon Medical Journal, vol. 58, no. 1, pp. 10–18, 2013. View at: Publisher Site | Google Scholar
  25. K. Teji Roba, T. P. O’Connor, T. Belachew, and N. M. O’Brien, “Anemia and undernutrition among children aged 6–23 months in two agroecological zones of rural Ethiopia,” Pediatric Health, Medicine and Therapeutics, vol. 7, pp. 131–140, 2016. View at: Publisher Site | Google Scholar
  26. D. R. Gwatkin, S. Rutstein, K. Johnson, E. Suliman, A. Wagstaff, and A. Amouzou, “Socio-economic differences in health, nutrition, and population within developing countries: An overview,” Nigerian Journal of Clinical Practice, vol. 10, no. 4, pp. 272–282, 2007. View at: Google Scholar
  27. B. A. Reed, J.-P. Habicht, and C. Niameogo, “The effects of maternal education on child nutritional status depend on socio-environmental conditions,” International Journal of Epidemiology, vol. 25, no. 3, pp. 585–592, 1996. View at: Publisher Site | Google Scholar

Copyright © 2019 Giao Huynh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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