PREVALENCE AND RISK FACTORS FOR ANEMIA AMONG FEMALE STUDENTS OF ETHNIC MINORITIES IN THAI NGUYEN PROVINCE, VIETNAM MISS HOA THI HONG HANH A THESIS FOR DEGREE OF MASTER OF SCIENCE KHON KAEN UNIVERSITY 2018 PREVALENCE AND RISK FACTORS FOR ANEMIA AMONG FEMALE STUDENTS OF ETHNIC MINORITIES IN THAI NGUYEN PROVINCE, VIETNAM MISS HOA THI HONG HANH A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE GRADUATED SCHOOL KHON KAEN UNIVERSITY 2018 THESIS APPROVAL KHON KAEN UNIVERSITY FOR MASTER OF SCIENCE IN MEDICAL SCIENCE Thesis title: Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen province, Vietnam Author: Miss Hoa Thi Hong Hanh Thesis Examination committee Prof Dr Sastri Saowakhontha Chairperson Assoc Prof Dr Kanokwan Sanchaisuriya Member Assist Prof Dr Pattara Sanchaisuriya Member Prof Dr Supan Fucharoen Member Assoc Prof Goonnapa Fucharoen Member Prof Dr Arunee Jetsrisuparp Member Thesis Advisers ………………………………………………… Advisor (Assoc Prof Dr Kanokwan Sanchaisuriya) ………………………………………………… Co-Advisor (Assist Prof Dr Pattara Sanchaisuriya ) ………………………………………… ………………………………………………… (Prof Dr Surasukdi Wongratanacheewin) (Assoc Prof Dr Patcharee Jearanaikoon) Dean, Graduated School Dean, Faculty of Associated medical Science Copyright of Khon Kaen University i Hoa Thi Hong Hanh ่ ่ นชน ความชุกและปั จจัยเสียงภาวะเลื อดจางในนักศึกษาหญิงทีเป็ กลุ่มน้อยในจังหวด ั ไทเหงียน ประเทศเวียดนาม วิทยานิ พนธ ์ปริญญาวิทยาศาสตรมหาบัณฑิต สาขาวิทยาศาสตร ์การแพทย ์ คณะเทคนิ คการแพทย ์ มหาวิยาลัยขอนแก่น ่ กษาวิทยานิ พนธ ์: รศ.ดร.กนกวรรณ แสนไชยุรยิ า อาจารย ์ทีปรึ ่ กษาร่วม: ผศ.ดร.ภัทระ แสนไชยสุรยิ า อาจารย ์ทีปรึ บทคัดย่อ ภ า ว ะ เ ลื อ ด จ า ง เ ป็ น ห นึ่ ง ใ น ปั ญ ห า สุ ข ภ า พ ข อ ง ช น ก ลุ่ ม น้ อ ย ป ร ะ เ ท ศ เ วี ย ด น า ม เ ป็ น ป ร ะ เ ท ศ ที่ มี ช น ก ลุ่ ม น้ อ ย ม า ก ถึ ง ช น เ ผ่ า ก า ร ศึ ก ษ า ค ร ั้ ง นี ้ ่ ่ มีวต ั ถุประสงค ์เพือประเมิ นความชุกและหาปัจจัยเสียงของการเกิ ดภาวะเลือดจางในหญิงวัยเจริญพันธุ ์ชนกลุ่มน้อยในตอ ่ าลังศึกษา ณ มหาวิทยาลัยไทเหงียน จานวน นเหนื อของประเทศ อาสาสมัครเป็ นนักศึกษาแพทย ์กลุ่มชาติพน ั ธุ ์ต่างทีก ร า ย ท า ก า ร เ ก็ บ ข ้ อ มู ล พื ้ น ฐ า น ทั่ ว ไ ป แ ล ะ ข ้ อ มู ล สุ ข ภ า พ โ ด ย ก า ร สั ม ภ า ษ ณ์ ้ น และเก็ บตัวอย่างเลือดหลังจากอาสาสมัครลงนามในแบบคายินยอม ในเบืองต ้ ตัวอย่างเลือดทุกรายถูกนาไปตรวจ complete blood count ณ โ ร ง พ ย า บ า ล ป ร ะ จ า จั ง ห วั ด ไ ท เ ห งี ย น เ พื่ อ คั ด ตั ว อ ย่ า ง เ ลื อ ด ที่ ต ร ว จ พ บ ภ า ว ะ เ ลื อ ด จ า ง ไ ป ต ร ว จ วั ด ร ะ ดั บ เ ฟ อ ร ์ ไ ร ทิ น ใ น ซี ร ั ม หลัง จากนั้ นจึง น าตัว อย่ า งเลือดที่เหลือ ทุ ก รายมาตรวจวินิ จฉั ย ธาลัสซีเมีย ณ ประเทศไทย จากตัว อย่า ง 275 ราย พบความชุก ภาวะเลือ ดจาง และ ภาวะเลือ ดจางจากการขาดธาตุเหล็ ก เท่ ากับ ร ้อยละ 31.6 (95% CI = 26-37%) และร ้อยละ (95% CI = 4-11%) ตามล าดับ ผลการตรวจวินิ จ ฉั ย ธาลัส ซีเ มีย ผลการตรวจวินิ จ ฉั ย ธาลัส ซีเมีย ่ ความสาคัญทางคลินิก ชนิ ด ไดแ้ ก่ 0-thalassemia ( 0-thal), -thalassemia พบพาหะของธาลัสซีเมียทีมี ้ น ้ 57 ราย (ร ้อยละ 20.7) และพบว่ า ในกลุ่ ม ผู ท ( -thal) และ hemoglobin E (Hb E) รวมทังสิ ้ ี่มี ภ าวะเลือ ดจาง มี ผู ้ เ ป็ น พ า ห ะ ธ า ลั ส ซี เ มี ย ร ้ อ ย ล ะ 42.5 มี ภ า ว ะ ข า ด ธ า ตุ เ ห ล็ ก ร ้ อ ย ล ะ 17.2 ่ เคราะห ์ข ้อมูลโดยใช ้สมการถดถอยโลจิสติก พบว่า เป็ นพาหะธาลัสซีเมียร่วมกับภาวะขาดธาตุเหล็ก ร ้อยละ 8.1 เมือวิ ่ มพันธ ์กับภาวะเลือดจางอย่างมีนัยสาคัญ คือ -thal [adjusted Odd ratio (AOR) = 66.4; 95% ธาลัสซีเมียทีสั CI = 8.3-533.7] แ ล ะ พ า ห ะ -thal (AOR = 25.3; 95% CI = 8.9-72.5) ่ ่ สด เมือวิเคราะห ์ความสัมพันธ ์ระหว่างธาลัสซีเมียกับชาติพน ั ธุ ์ พบว่า ชาติพน ั ธุ ์ทีมี ั ส่วนของ 0-thal และ -thal สูง 0 คือ Tay ( -thal ร ้อยละ 12.9 และ -thal ร ้อยละ 6.1), Muong ( -thal ร ้อยละ 10.9 และ -thal ร ้อยละ 2.2), และ Nung ( 0-thal ร ้อยละ 12.5 และ -thal ร ้อยละ 4.5) และชาติ พ ัน ธุ ท ์ ี่พบสัด ส่ ว น Hb E สู ง สุ ด คือ Muong (ร ้ อ ย ล ะ ) ผลการศึกษามีประโยชน์สาหร ับกาหนดมาตรการควบคุมภาวะเลือดจางและป้ องกันการแพร่กระจายของโรคธาลัสซีเมีย ชนิ ดรุนแรงในภูมภ ิ าค ii Hoa Thi Hong Hanh Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen province, Vietnam Master of Science Thesis in Medical Sciences, Graduate School, KhonKaen University Thesis Advisor: Assoc Prof Dr Kanokwan Sanchaisuriya Co-Advisor: Asst Prof Dr Pattara Sanchaisuriya ABSTRACT Anemia is one of the health problems among ethnic minorities In Vietnam, there are up to 54 ethnic minority groups residing in mountainous regions of the country This study aimed to determine the prevalence and risk factors for anemia among reproductive-age women of ethnic minorities in northern Vietnam Participants included 275 medical female students of various minority groups studying at Thai Nguyen University Information on socio-demographic and health status was collected by means of interview After getting written informed-consent, blood samples were collected Complete blood count was measured initially at Thai Nguyen General Hospital Blood samples of anemic individuals were determined further for serum ferritin The remaining blood samples were then carried to Thailand for investigation of thalassemia (thal) Of the 275 women, the prevalence of anemia and iron deficiency anemia (IDA) was 31.6% (95% CI = 26-37%), and 7.6 % (95% CI = 4-11%), respectively The three forms of thalassemia, including α0-thal, β-thal, and Hb E were identified in 57/275 women (20.7%) Amongst anemic women, 42.5% had thalassemia, and 17.2% had ID Coincident of thal with ID was found in women (8.1%) Applying multiple logistic regression revealed that types of thalassemia that associated significantly with anemia were -thal [adjusted OR (AOR) = 66.4 (95% CI 8.3-533.7)] and thal (AOR = 25.3; 95% CI = 8.9-72.5) Additional analysis of thalssemia in relation with ethnicities revealed the high proportions of α0-thal and -thal among the Tay (12.9% 0-thal and 6% -thal), Muong (10.9% 0-thal and 2.2% -thal), and Nung (12.5% 0-thal and 4.2% -thal) A highest proportion of Hb E (26%) was detected in the Muong group The results are useful for implementing appropriate measures to control anemia and prevent the spread of severe thalassemia syndromes in this region iii Goodness portion of the present thesis is dedicated to my parents, my thesis advisory committee and the entire teaching staff iv ACKNOWLEDGEMENTS I would like to express my deepest and sincere gratitude to my research advisor, Associate Professor Kanokwan Sanchaisuriya, and my co-advisor, Assistant Professor Pattara Sanchaisuriya for their kindness to provide me an opportunity to be their advisee and for their valuable motivation, suggestions, and guidance throughout my study I would like to express my greatest appreciation and sincere to Faculty of Associated Medical Sciences, Khon Kaen university and Khon Kaen University for giving me a scholarship for studying here I would like to take this opportunity to thank all the professors in the Faculty of Associated Medical Sciences for providing me valuable knowledge and experience during my study I am also very grateful to Prof Dr Sastri Saowakhontha, Prof Dr Supan Fucharoen, Assoc Prof Goonnapa Fucharoen, Prof Dr Arunee Jetsrisuparp for being as examination committee and for their valuable suggestions as well as encouragement I would like to thank Dr Attawut Chaibunruang, Assist Prof Dr Supawadee Yamsri, Dr Hataichanok Sriwarakun, Miss Jutatip Jamnok, Mr Phongsathorn Wichian, Miss Benchawan Kingchaiyaphum, graduate students of Thalassemia Group and other graduate students Faculty of Associated Medical Sciences, Khon Kaen University as well as my family for the suggestion, support, consolation, helpful, cheerfulness and friendliness Finally, I deeply appreciate the financial support from the Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University Hoa Thi Hong Hanh v TABLE OF CONTENTS ABSTRACT ii LIST OF TABLES vii LIST OF ABBREVIATIONS viii CHAPTER I INTRODUCTION 1 Background and rationale Research questions Objectives Anticipated outcomes CHAPER II LITERATURE REVIEW Part I: General consideration of anemia, ID and IDA Anemia Iron deficiency (ID) and iron deficiency anemia (IDA) Part II: Related research Prevalence and risk factors for anemia in Vietnam Prevalence of thalassemia and hemoglobinopathies in Vietnam Conceptual framework 11 CHAPTER III RESEARCH METHODOLOGY 12 Study design 12 Study population 12 Sample size 12 Data collection & tools 13 Statistical analysis 14 Ethical consideration 14 Scope and limitation of the study 14 CHAPTER IV RESULTS 16 General characteristics of the study population 16 Prevalence of anemia, IDA, and thalassemia among 275 women of ethnic minorities 16 Hematologic features among anemic and non-anemic women 17 Factors associated with anemia among 275 women of ethnic minorities 17 Distribution of thalassemia among different ethnic groups 17 vi CHAPER V DISCUSSION 26 CHAPER VI CONCLUSION 29 REFERENCES 30 APPENDIX A INFORMATION SHEET 34 APPENDIX B QUESTIONNAIRE FORM 39 APPENDIX C ETHICAL APPROVAL FORM 44 APPENDIX D RESEACH PRESENTATION 45 vii LIST OF TABLES Page Table Classification of anemia by age and gender Table Causes of iron deficiency Table Prevalence of anemia in Vietnam Table Prevalence of the three clinically significant thalassemia in Vietnam 10 Table Socio-demographic characteristics of the 275 participants 18 Table Basic information on health status of the 275 participants 19 Table Prevalence of anemia, IDA, and thalassemia among 275 women of 20 ethnic minorities Table Prevalence of the three clinically significant thalassemia among 275 21 reproductive-age women of ethnic minorities Table Proportions of factors explaining anemia among 87 women 22 Table 10 Hematological characteristics of anemic and non-anemic women; 23 categorized by thalassemia and iron status Table 11 Effect of thalassemia types on anemia 24 Table 12 Distribution of the clinically significant thalassemia among 275 25 reproductive-age women with different ethnicities 31 12 Le TH, Le TTX, Le HP, et al Diet and nutritional status among children 24-59 months by seasons in a mountainous area of Northern Vietnam in 2012 Global Health Action 2014; 7: 10.3402/gha.v7.23121 13 Le TH, Vu TTN Nutritional Practices among Ethnic Minorities and Child Malnutrition in Mountainous Areas of Central Vietnam Food and Nutrition Sciences 2013; 4(1): 8289 14 Nguyen PH, Strizich G, Lowe A, et al Food consumption patterns and associated factors among Vietnamese women of reproductive age Nutrition journal 2013; 12(1): 126 35 15 Weatherall DJ, Clegg, JB The Thalassaemia Syndromes, 4th ed Oxford: Blackwell Science 2001 16 Ayoya MA, Ngnie-Teta I, Séraphin MN, et al Prevalence and risk factors of anemia among children 6-59 months old in Haiti Anemia 2013; 502968 17 Sachdev HP, Gera T Preventing childhood anemia in India: iron supplementation and beyond Eur J Clin Nutr 2013; 67(5):475-80 18 Stoltzfus RJ Research needed to strengthen science and programs for the control of iron deficiency and its consequences in young children J Nutr 2008; 138 (12):2542-6 19 Mohanty D, Gorakshakar AC, Colah RB, et al Interaction of iron deficiency anemia and hemoglobinopathies among college students and pregnant women: a multicenter evaluation in India Hemoglobin 2014; 38(4):252-7 20 Martínez H, González-Cossío T, Flores M, et al Anemia in women of reproductive age: The results of a national probability survey Salud Publica Mex 1995; 37(2):10819 21 Bekele A, Tilahun M, Mekuria A Prevalence of anemia and its associated factors among pregnant women attending antenatal care in health institutions of Arba Minch town, Gamo Gofa zone, Ethiopia: a cross-sectional study Anemia 2016; 2016:1073192 22 World Health Organization, United Nations University, and Unicef Iron deficiency anemia: assessment, prevention and control WHO 2010 23 Turgeon and Louise M Clinical hematology: theory and procedures 5th edited 2012 Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, c2012 24 Index Mundi Vietnam – Prevalence of Anemia [Online] Available from: https://www.indexmundi.com/facts/vietnam/prevalence-of-anemia 25 Nguyen PH, Nguyen KC, Le MB, et al Risk factors for anemia in Vietnam Southeast Asian J Trop Med Public Health 2006; 37(6):1213-23 32 26 Nhien NV, Khan NC, Yabutani T, et al Relationship of low serum selenium to anemia among primary school children living in rural Vietnam J Nutr Sci Vitaminol (Tokyo) 2008; 54(6):454-9 27 Nhien N, Khan NC, Ninh NX, et al Micronutrient deficiencies and anemia among preschool children in rural Vietnam Asian Pac J Clin Nutr 2008; 17(1):48-55 28 Le HT, Brouwer ID, Verhoef H, et al Anemia and intestinal parasite infection in school children in rural Vietnam Asia Pac J Clin Nutr 2007; 16(4):716-23 29 Van NN, Yabutani T, Khan NC, et al Association of low serum selenium with anemia among adolescent girls living in rural Vietnam Nutrition, 2009; 25(1):610 30 Aikawa R, Ngyen CK, Sasaki S, et al Risk factors for iron-deficiency anemia among pregnant women living in rural Vietnam Public Health Nutr 2006; 9(4):443-8 31 Trinh LT, Dibley M Anemia in pregnant, postpartum and non-pregnant women in Lak district, Daklak province of Vietnam Asia Pac J Clin Nutr 2007; 16(2):310-5 32 Pasricha SR, Caruana SR, Phuc TQ, et al Anemia, iron deficiency, meat consumption, and hookworm infection in women of reproductive age in northwest Vietnam Am J Trop Med Hyg 2008; 78(3):375-81 33 Casey GJ, Phuc TQ, Macgregor L, et al A free weekly iron-folic acid supplementation and regular deworming program is associated with improved hemoglobin and iron status indicators in Vietnamese women BMC Public Health 2009; 24;9:261 34 Le Hung Q, De vries PJ, Giao PT, et al Anemia, malaria and hookworm infections in a Vietnamese ethnic minority Southeast Asian J Trop Med Public Health, 2005; 36(4):816-21 35 Laillou A, Pham TV, Tran NT, et al Micronutrient deficits are still public health issues among women and young children in Vietnam PLoS One 2012; 7(4):e34906 36 Siridamrongvattana S, Nguyen VH, Sanchaisuriya K, et al Burden of anemia in relation to thalassemia and iron deficiency among Vietnamese pregnant women Acta Haematol 2013; 130(4): p 281-7 37 Tran TD, Tran T, Simpson JA, et al Infant motor development in rural Vietnam and intrauterine exposures to anemia, iron deficiency and common mental disorders: a prospective community-based study BMC Pregnancy Childbirth 2014; 14-8 38 Nguyen PH, Young M, Gonzalez-Casanova I, et al Impact of preconception micronutrient supplementation on anemia and iron status during pregnancy and post- 33 partum: a randomized controlled trial in rural Vietnam PLoS One 2016; 11(12): e0167416 39 Le NBK, Tran TN, Nguyen HC, Khouw I, Deurenberg P Anemia and Iron Deficiency in Vietnamese Children, to 11 Years Old Asia Pac J Public Health 2016; 28(5 Suppl): 94S-102S 40 Sae-ung N, Fucharoen G, Sanchaisuriya K, Fucharoen S Alpha (0)-thalassemia and related disorders in Northeast Thailand: a molecular and hematological characterization Acta Haematol 2007; 117(2): 78-82 41 World Health Organization The global prevalence of anemia in 2011 Geneva: World Health Organization; 2015 42 Nguyen PH, Gonzalez-Casanova I, Nguyen H, et at Multicausal etiology of anemia maong women of reproductive age in Vietnam Eur JClin Nutr 2015; 69 (1): 107-13 43 Wieringa FT, Sophonneary P, Whitney S, et al Low prevalence of iron and vitamin a deficiency among cambodian women of reproductive age Nutrients 2016; 8(4):197 44 Fucharoen S, Winichagoon P Haemoglobinopathies in Southeast Asia Indian J Med Res 2011; 134:498-506 45 Fucharoen G, Sanchaisuriya K, Sae-ung N, et al A simplified screening strategy for thalassaemia and haemoglobin E in rural communities in south-east Asia Bull World Health Organ 2004; 82(5): 364-72 46 Sanchaisuriya K, Fucharoen S, Fucharoen G, et al A reliable screening protocol for thalassemia and hemoglobinopathies in pregnancy: an alternative approach to electronic blood cell counting Am J Clin Pathol 2005; 123(1):113-8 34 APPENDIX – A Information sheet and consent form 35 INFORMATION SHEET Project title: Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen Province, Vietnam Principal researcher: Miss Hoa Thi Hong Hanh Co-researcher: MD, MDH, PHd Hac Van Vinh Introduction: Anemia is a condition in which hemoglobin and/or red blood cell production is reduced The condition may result in many unpleasant outcomes such as weakness & fatigue, dizziness, shortness of breath, and if left untreated, heart failure may occur It is considered as one of the major public health problems requiring a proper prevention program According to the World Health Organization, the prevalence of anemia is particularly high in developing countries The most common cause is thought to be iron deficiency (ID) Besides young children and pregnant women, non-pregnant women of reproductive age are considered as the high risk group because of blood loss via menstruation Being ethnic minorities, the occurrence of anemia is probably higher than expected because anemia also links to inherited disorders of hemoglobin, thalassemia and hemoglobinopathies To test whether our assumption is true, we therefore would like to determine the prevalence of anemia among female students of ethnic minorities as well as identify risk factors for anemia in this population We anticipate that the findings provide basic information for further development of appropriate prevention program within this community Objective: To determine the prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen province, Vietnam Procedure: We will provide information sheet and explain the details of the project to all participants prior to enrolling the project If you agree to participate the project, you need to sign your name in the consent form This participation will take time about 15 to 30 minutes and has two steps Step I: Face-to-face interview using questionnaires (15-20 minutes) We will ask you about demographic information as well as family history and medical history Step II: Blood collection (5-10 minutes) 36 We will take you blood sample (approximately milliliters or half of a teaspoon) from venous blood vessel This will done by laboratory staff of Thai Nguyen Institute of Hematology and Blood Transfusion Your blood samples will be used for laboratory investigations as follows; - Measure hemoglobin level to diagnose anemia and screen for thalassemia - In case of anemia, your blood sample will be investigated further for iron status - All laboratory results will be sent to you via email or other channels as you wish If you agree, your left-over of blood sample will be kept at the Thai Nguyen Institute of Hematology and Blood Transfusion for further research work approved by the Institution Review Board (IRB) of Thailand and Vietnam If you not agree, your left-over blood sample will be discarded Be noted that The participation in this study is anonymous and voluntary You have the right to refuse without any consequences If you not want to participate in the study, you will be able to withdrawn at any time you want Risk: This participation will cause minimal disturbance to you or your feeling such as tighten at upper arm, red or purple spot on the point of the blood puncture area but this will not affect your health Benefits to participants: Feedback will be given to each participant regarding the written report of the result of the laboratory test as part of benefit for the participants We also give you 30000 VND compensation for your time Confidentiality: All data will be kept confidential and anonymous Your blood sample will be re-coded, so nobody can identify the participants Address of principal investigators Ms Hoa Thi Hong Hanh 13, Tan Thinh district, Thai Nguyen city, Vietnam Tel: 0912.468.596 37 Email: hoathihonghanhdpk2@gmail.com MD, MPH, PHD Hac Văn Vinh Dean of Science Technology and International Cooperation Department, Thai Nguyen University of Medicine and Pharmacy, Vietnam Tel: 091 2235226 Email: vinh.hv@tnmc.edu.vn Address of IRB of Khon Kaen University (for further information) Office of the Khon Kaen University Ethics Committee in Human Research Office of President Building (2nd Floor) Khon Kaen University, Mittraphap road, Muang District, Khon Kaen, 40002 Thailand Tel.: +66-43-203331 38 CONSENT FORM Project title: Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen Province, Vietnam Name …………………… Surname Age years Address: I have received information about the project entitled “Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen Province, Vietnam” from Ms Hoa Thi Hong Hanh The details include objectives, methodology as well as risk and benefit to participants I have read and understood all above information; I hereby agree to participate the project Also, I  allow  not allow (please check by using ) the researcher to keep my left-over blood sample at the Thai Nguyen Institute of Hematology and Blood Transfusion for the future research that has been approved by the Institution Review Board of Thailand and Vietnam Also, I would like you to send me laboratory results via (please check by using )  Email (please specify address): …………………………… ……………  Other channels (please specify) ………………………………………… This consent is given to the researcher on voluntary basis I have the right to withdraw my consent at any time during this study without any consequences Participant’s signature ( ) Witness’s signature ( .) Date 39 APPENDIX – B QUESTIONNAIRE 40 Questionnaire Code:……… PREVALENCE AND RISK FACTORS FOR ANEMIA AMONG FEMALE STUDENTS OF ETHNIC MINORITIES IN THAI NGUYEN PROVINCE, VIETNAM Date of survey: … /… /…… A SOCIO – DEMOGRAPHIC SECTION Q.No Questio A1 ID code A2 Birthday A3 n Resident Response Var …………………………………… Day month A1 year A2 Urban Rural A3 Tay Nung Ethnicity A4 Dao Muong A4 San Diu Other…………… Tay Nung Ethnicity of your mother A5 Dao Muong San Diu Other…………… A5 41 Tay Nung Ethnicity of your father A6 Dao A6 Muong San Diu Other…………… First year Which year are you in? Second year Third year A7 A7 Fourth year Fifth year Six year A8 Where you stay now? A8 Home with parents Outside by yourself A9 Marital status Yes A9 A10 A10 Number of children (If any) No ……………Child A11 Pocket money per month …………………………VND A11 A12 Family income …………………………VND A12 B HEALTH INFORMATION SECTION B1 Weight …………………Kg B1 B2 Height …………………Cm B2 Do you have chronic illness Yes, please specify……………… Do you have peptic ulcer No B3 B4 Yes, please specify duration……months………year No B3 B4 42 Do you have frequent fatigue or Yes B5 tired or dizziness? No B5 Are you currently taking iron Yes, please specify (if you can)…… B6 tablet or vitamin? No B6 During the past months, have Yes B7 you ever had accidents with heavy No B7 blood loss or major operation? History of blood donation Yes No (Move to B12) B8 B8 If yes, How many times you 1 time B9 donated blood last year? 2 times ≥ times B9 After donating blood, did you take Yes B10 iron tablets? No B10 For the one who took iron tablet, Yes, continuing taking iron tablet for B11 B12 did you take it continuously? ……days or……tablets History of menstruation < days Duration of menstruation – days > days B11 B12 43 Number of menstrual pads used / < pads day – pads B13 B13 – 10 pads >10 pads Estimation of quantity of blood 1 glass loss by comparing with a glass of B14 2-3 glasses water B14 (research assistant demonstrate a >3 glasses glass of water  100 ml/glass) C FOOD CONSUMPTION PRATICES Vegetarianism Yes; please specify type (lacto-ovovegetarian/ovovegetarian/vegan) ……………………………… No; in case that non-vegetarian, C1 C1 please specify frequency of meat consumption Approximately ………………… meals/day or …………… meals/week Tea/coffee consumption Yes; please specify type of drink (tea/coffee) and frequency  Tea  Coffee  both tea and C2 coffee Frequency C2 ……… ……… times/week No times/day or 44 APPENDIX C ETHICAL APPROVAL FORM 45 APPENDIX D RESEACH PRESENTATION ... reproductive-age females of ethnic minorities, the risk of anemia is thought to be high This study aims to determine the prevalence and risk factors for anemia among females of ethnic minorities studying... ิ าค ii Hoa Thi Hong Hanh Prevalence and risk factors for anemia among female students of ethnic minorities in Thai Nguyen province, Vietnam Master of Science Thesis in Medical Sciences, Graduate.. .PREVALENCE AND RISK FACTORS FOR ANEMIA AMONG FEMALE STUDENTS OF ETHNIC MINORITIES IN THAI NGUYEN PROVINCE, VIETNAM MISS HOA THI HONG HANH A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE