MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH PHOUTHAY SYSOUPHANE PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.R MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH PHOUTHAY SYSOUPHANE PARENTAL DIETARY PRACTICES AND ASSOCIATED FACTORS FOR CHILDREN AGED 3-5 YEARS IN RURAL DISTRICTS, VIENTIANE PROVINCE, LAO P.R MASTER OF PUBLIC HEALTH CODE: 8720701 SUPERVISOR: CHANDAVONE PHOXAY, MD, PhD. DIRECTOR OF NATIONAL NUTRITION CENTER HANOI, 2020 ACKNOWLEDGMENTS I wish to acknowledge the support of the Medical Committeesfrom the Netherlands and Vietnam, the Hanoi University of Public Health, the Lao Tropical Public Health Institute and the University of Health Sciences in producing this work. To my parents: both of you are my first role models. I hope that you will be blessed with a long life.
Your relentless belief in my capabilities has allowed me to dare dream. You have shown me that hard work brings results. Thank you for being my never-ending supporters and also helping me to believe in myself. I would like to express my sincerest gratitude to my supervisors, Professors Chandavone Phoxay, MD, PhD and Nguyen Thi Kim Ngan, MSc for their kindly offered suggestions.
throughout my research and thus helping me to complete this dissertation. Thank you for never letting me quit and for believing that I could obtain a Masters degree. Your professional support and personal friendship have meant more than gold to me. Finally, I would like to acknowledge all the parents who participated in this study and made its findings possible.
May you overcomewith strenght every challenge you face in raising your children. Thanks to all of you who have supported me and given me inspiration in the pursuit of my research goal. iv LIST OF TABLES AND FIGURES 115. 4 CHAPTER 1: REVIEW OF LITERATURE 5 II.
Proper dietary practices for children aged 3-5 years Old. Overview of the problems caused by inadequate parental dietary practices for their 0n 0. Factors associated with dietarY DFAC{IC€S:. Overview of areas intended to implement research.
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Dafa collection metho(.-- ¿+ 6 <5 *x S9 E1 E11 1T 1T T11 TH HT HH 21 PIN). Socio-demographic characteristics OŸ DAT€TIS. Parental dietary practices for children aged 3-5 y€aTS. Parental knowledge of dietary practices for children aged 3-5 years.
Parental perception of fOOd SCCUTILY. Social and neighborhood charaCt€TISẨÏCS. Bivariate analysis for factors associated with parental dietary practices for children Aged 3-5 YEALS. Factors associated with parental dietary practices for children aged 3 to 5 years.
Summary of results and comparison with previous research. HH Tri 43 REFERENCCE. St SE SH 1 TH HH TT nh Tri 44 ANNEX I1: MEASUREMENT OE STUDY VARIABLES.------5 555 5c<ceccc+ 33 ANNEX 2: QUESTIONNAIRE (ENGLISH VERSION).---- 5-5555 c+cscccerercr+ 58 ANNEX 3: QUESTIONNAIRE (LAO VERSION).-- c5 63 ANNEX 4: INFORMATION SHEET FOR PARTICIPANTS.---- 555 5«5+c<c<cec+ 69 ANNEX 5: INFORMED CONSENT FORM FOR PARTICIPANTS. 71 ANNEX 6: ETHICAL APPROVA,.
74 ANNEX §: MINUTES OF EXPLANATION AFTER THESIS DEFENCE. 80 iii BMI CVD CFPQ CUS FS FFQ HESSM LSIS LSB MDG NNS NCCN NHANES SDG UNL US USDA WB WHO ABBREVIATIONS Body Mass Index Cardiovascular Disease Comprehensive Feeding Practices Questionnaire Children Under The Age Of Five Years old Food Security Food Frequency Questionnaire Household Food Security Survey Module Lao Social Indicators Survey Lao Statistics Bureau Millennium Development Gold National Nutrition Strategy National Comprehensive Cancer Network National Health and Nutrition Examination Survey Sustainable Development Goals United Nations Lao United States United States Department of Agriculture World Bank Word Health Organization iv Table 3.10 LIST OF TABLES AND FIGURES Socio-demographic charateristics of parents Parental dietary practices for children aged 3-5 years Level of parental dietary practices for children aged 3-5 years Knowledge of parents about dietary practices for children Level of knowledge about dietary practices Parentsperception about food security Level of perception about food security of parents Social and neigbourhood among parents Bivarite analysis for factors associated with parental dietary practice for children aged 3-5 years Multiple regression analysis for factors associated with parental dietary practices for children aged 3-5 years SUMMARY Nutrition plays an important role in childhood growth and development. Preschool-aged children have nutritional problems due to their environmental preferences and inability to choose healthy food. Good nutrition is thus crucial as the body needs the promotion of growth and development.
Inappropriate and insufficient provision of food and the five food groups will cause a halt in children’s growth, deficient intelligence and frequent illness. Accordingly, children should be given the five food groups with various kinds of food in each group for three meals a day and milk as a supplementary food. Parental dietary practices have been highlighted as an important psychometric factor for improving the nutritional outcomes of children. However, parental dietary practices have not been extensively studied in Laos.
Thus this study was carried out to assess parental dietary practices and the related factors of parental dietary practices among children aged 3-5 years in rural districts, Vientiane province, Lao P. A cross-sectional study was conducted from January to December 2019. A sample of 400 parents who had children aged 3-5 years old and living in four districts in Vientiane Province participated in this study. The data were collected through face-to-face interviews with the parents using a structured questionnaire.
The data were analyzed using STATA software. Descriptive statistics, univariate analysis, and multiple logistic regressions were used. The dietary practices among 72.% of the parents of children aged 3-5 years old were poor, and the practices among 27.2% of them was good. Most parents allowed children to eat candy and cakes.
But they provided cheese less than animal milk to their children. More than 90% of parents prepared green vegetables and fruit, almost 90% prepared eggs, more than 70% prepared meat, but only 16% of parents prepared milk for their children. More than one-third provided for their children three or more meals a day. Factors associated with dietary practices of parents were religion (p-value =0.041), household members (p-value =0.001), monthly allowance (p-value < 0.001) and knowledge (p-value < 0.
vi More than two-third of parents had poor dietary practices for feeding children aged 3-5 years old. Most parents gave children candy and cakesbut little animal milk. Religion, household allowance, household members and knowledge were associated with parental dietary practices for feeding children aged 3-5 years old in rural districts in the Lao P. There is an urgent need to provide a nutrition education program for parents in school and communities to raise their knowledge and awareness about proper dietary practices in order to improve children’s nutrition levels.
Vii INTRODUCTION Nutrition is the most important condition for the preservation of health, normal growth and development of the human body. Nutrition is food intake in accordance with the dietary needs of the organism. The food should contain all the necessary nutrients to maintain the normal functioning and development of the organism, such as proteins, fats, carbohydrates, vitamins, minerals and water in the required quantities. At the same time, the needs are individual and depend on age, type of employment, living conditions and so on.
Proper nutrition is a well-balanced diet combined with regular physical activity, which is the basis of good health (Allagulova, 2016). According to the World Health Organization, in 2018, the mortality rate of children under five years of age (CU5) in low-income countries was 68 per 1000 live births. Half of these CUS deaths took place in sub-Saharan Africa, and another 30% in Southern Asia. The CUS death rate was almost 14 times that in high-income countries (5 per 1000 live births) (WHO, 2018a).
In sub-Saharan Africa, 1 in 13 children died before their fifth birthday. In high-income countries, that number was 1 in 185 (WHO, 2018b). Globally, 85 percent of deaths among children and young adolescents in 2018 occurred in the first five years of life, accounting for 5.3 million deaths, of which 2.5 million (47%) occurred in the first month of life, 1.5 million (29%) at age 1-11 months, and 1.3 million (25%) at age 1-4 years.9 million deaths occurred among children aged 5-14 years (WHO, 2019a).1 million children die from undernutrition each year. Hunger and undernutrition cont ibute to more than half of global child deaths; undernutrition can make children more vulnerable to illness and exacerbate disease (WHO, 2019b).
In 2018, globally there were 149 million CUS who were stunted, 49 million who were wasted and 40 million who were overweight (WHO, 2019c). In the Lao P.R, the stunting rate of CUS was at 44% in 2011 compared with the MDG | target of 37% Lao social indicator survey (LSIS), 2011; (MDG report, 2015). The government of the Lao P.R has been highly committed to overcoming the malnutrition of the Laotian people. As a result, the stunting rate and underweight rate among children under 5 years old had declined to 33% and 21% respectively in 2017 (LSIS II, 2017); however, the wasting rate had increased to 9% compared with the 6% in 2011 (LSIS, 2017).
The stunting rate in the Lao PDR of children under five years old is still one of the highest rates in Southeast Asia. The World Bank collection of development indicators compiled from officially recognized sources reported that the CUS mortality rate was at 47.3 per 1000 live births in 2018; malnutrition was one of the leading causes of CUS deaths in the Lao P. According to the nutrition profile in Vientiane Province 2017, 33% of children under five years of age were stunted, 7% were wasting and 20% were underweight. The Lao Social Indicators Survey 2017 (LSIS) found that children in poor rural households were 3 times more stunted than those in economically more well-to-do families.
One of the major determinants of dietary practices adopted among the children is the nutritional knowledge of the parents (LSB, 2017). According to the district health information system 2 (DHIS2) in Vientiane Province in 2019 the mortality rate of CUS was 81 persons out of 1,000. Parental feeding practices are food or eating-specific behaviours or strategies that parents use to influence what, when and how much their children eat. They, therefore, play an important role in the development of eating behaviors and the subsequent weight status of children (Peters et al, 2012).
As feeding practices are potentially modifiable, they are important candidates for behavior change initiatives aimed at improving children’s diets during the malleable period of early life and, in turn, decrease the risk of overweight and obesity (Anzman et al, 2010). One important determinant of children's eating behaviors is the feeding practices parents use (Gregory et al, 2010). These have been shown to be influenced by both parents and child factors (Haycraft et al, 2012). Parental feeding practices are described as strategies used by parents to get their children to eat.
These may involve parent- centered or child-centered strategies (Xu et al, 2013). Obviously, there is limited information on the nutritional knowledge level among parents and its associated dietary practices of children in Vientiane Province and the whole country as well. Thus, the lack of research on dietary practices to assess factors associated with improving the dietary practices of parents or caregivers has led to the need for this study.