1 INTRODUCTION According to the The United Nations International Children's Emergency Fund (UNICEF), in 2013, among developing countries, about 195 million children under years of age suffered from the stunted malnutrition the low age-based height (accounting about 30%), 129 million children suffered from the underweight malnutrition - low age-based weight (making up 25%) and 67 million children suffered from the wasted malnutrition - low weight/height (13%) and about 20 million infants with the low weight less than 2500g (15%) Most recently, according to the UNICEF/WHO/WB reports (2018), there are still 151 million children with the stunting in the world (22.2%) and 51 million children with the acute malnutrition (wasted; 7.5%) and 38 million children with the overweight/obesity (5.6%); Asia alone accounts for more than half of these figures (83.6 million; 35 million and 17.5 million; respectively) According to the statistics of the National Institute of Nutrition, in Vietnam, the malnutrition rate of children under years old has decreased significantly: in 1985 the rate of underweight malnutrition was 51.5%, stunting 59.7%, wasting 7.0% By 2013, the rate of underweight malnutrition decreased down to 15.3%, wasting 6.6%, but the rate of stunting malnutrition was still 25.9%; this figure was still approximately at a high level according to WHO classification and in 2014, the rate of stunting malnutrition in children under years old nationwide was reduced down to 24.9%; however, this rate in many provinces and cities in Vietnam is still higher than 30%, especially in the Central Highlands and Northern mountainous areas Therefore, the national strategy for 2010-2020 and vision up to 2030 has set the target of reducing the rate of stunting malnutrition down to 23% by 2020 and identified the most effective intervention with the stunting malnutrition, which had to the prophylactic and comprehensive features, improving the infant feeding practices (including breastfeeding and complementary feeding) and this intervention is considered to be the priority interventions In particular, the nutrition education and communication, promoting the use of on-site food sources are the key activities and the focal point, but they should be carried out according to the characteristics of the geographical area, ethnicity and based on evidence or researches on nutrition and nutritional practices of each locality 2 In Vietnam, there have also been a number of nutritional intervention studies during the pregnancy and the first years of life of children through communication and education, which have been recorded to improve the stunting of children in some areas However, there have not been many intervention studies in the midland and poor mountainous areas to guide the community to know and use micronutrient-rich foods available to improve the stunting in young children Tam Nong is one of the poor districts of Phu Tho province, with the economy depending mainly on agriculture in the region of the Northern midland and mountainous provinces, the project titled “The effectiveness of nutrition communication and education by using available local micronutrient-rich food on nutritional status of the infants aged 6-23 months in a Northern midland district” has been implemented; contributing to solutions to preventing the stunting malnutrition, improving the micronutrient status of children in this locality as well as areas with similar conditions Objectives of the study: Describing the actual status of infant feeding practices of mothers and the nutritional status of the infants aged 6-23 months in Tam Nong district, Phu Tho province in 2012 Evaluating the effectiveness of nutrition education and communication on the nutrition practices of mothers who have infants aged 6-23 months suffered from stunting or at risk of stunting in intervention communes Evaluating the effectiveness of nutrition education and communication on the nutritional status, Vitamin A status, zinc status and anemia of the infants aged 6-23 months suffered from stunting or at risk of stunting in intervention communes The outline of the thesis: The thesis includes 121 pages and has the layout as follows: Introduction: pages; Objectives and hypothesis of the research: page; Overview: 38 pages; Subjects and methods of the research: 23 pages; Research results: 24 pages; Discussion: 29 pages; Conclusions and recommendations: pages; 181 pages of references 3 Chapter OVERVIEW 1.1 Stunting malnutrition in the infants under years old 1.1.1 Causes of stunting malnutrition In 1997, UNICEF built and developed a model of malnutrition causes A number of other organizations have also had cause-and-effect models of malnutrition alone or developed a new model based on UNICEF's model But UNICEF's model is still the most widely used Direct causes: Poor quality or low quantity diets are an important factor that directly affects malnutrition: Infants are not fully breastfed, supplemented too early or fed the solid food too late, fed insufficient amount of food, and low energy and protein in the diet The frequency of using foods such as meat, fish, eggs, and milk in the infant meal is low due to limited family economic conditions or limited knowledge of mothers about the nutritional care Malnutrition and infections in children affect the overall development of children in the long term Along with diarrhea, the acute respiratory infections and malnutrition are one of the leading causes of infant death The intestinal parasite infection is also an important, which causes the infant malnutrition and anemia Potential causes: The underlying cause is the weakness in maternal and child care services; knowledge of infant caregivers, factors of caring the family, issues of clean water, environmental sanitation and the state of unsafe sanitary housing, poverty and backwardness in terms of general development including economic inequality Household food security situation Household food insecurity: It is the cause of making malnutrition become a health burden in many developing countries; pre-school malnutrition rate accounts for 20-50%; In Southeast Asia, the incidence is quite high (40-50%), this rate increases when there is the hunger or there are emergency situations such as war, flood, earthquake 1.1.2 The situation of stunting malnutrition and micronutrient deficiency in Vietnam The rate of stunting malnutrition among children under years of age has decreased within 10 years from 2000 to 2009 from 36.5% down to 31.9%, especially since 2010, this rate tends to decrease quite rapidly, down to 29.3% and by 2015 only 24.6% The rate of stunting malnutrition has also tended to decrease gradually, from 21.5% in 2002 down to 16.1% in 2011 However, the rate of severe stunting malnutrition has not decreased Micronutrient deficiency especially anemia and zinc deficiency are closely related to the stunting malnutrition Micronutrients participate in most of the body's processes, such as cell reproduction and development, and therefore they have a direct or indirect effects on the growth of the body In addition to the role of increasing immunity and being micronutrients playing an important role in protein synthesis for the body, zinc also plays an important role in the development of the digestive system and enhancing the metabolism especially for malnourished children, helping to improve the height of stunted children The rate of children in the first year of life with anemia due to iron deficiency is still very high, up to 60-80%, especially in underweight children The deficiency rate of Zinc, Selenium, Magnesium, and Copper are 86.9%, 62.3%, 51.9%, and 1.7%, respectively On the other hand, 55.6% of children are anemic and 11.3% of children are deficient in Vitamin A The concomitant deficiency of the two micronutrients accounts for 79.4% of children 1.2 Strategies of popularizing and improving the quality of complementary food to improve nutritional status and micronutrient deficiency WHO/WB/UNICEF/UN (2016) all commented that malnutrition has been involved in 33% of the approximately million children under years old each year and these deaths are related to wrong nurturing practices during the first five years due to not being fully breastfed in the first months, supplementing food too early or too late, malnourished and unsafe food related to the level and understanding of mothers IFPRI estimated the involvement of a number of factors in reducing the rate of underweight malnutrition in developing countries, particularly for women education, contributed 43.01% Therefore, improving knowledge and skills of maternal nutrition practice is one of the solutions that need to be considered Therefore, nutrition communication and education are considered as the most important solution in improving knowledge and changing behavior of the community and mothers, especially for promoting the breastfeeding In order to improve the nutritional status, especially reducing the stunting rate of children under years old, many studies have intervened to practice child feeding in the early years of life For Vietnam, nutrition education and reasonable eating guidance should be further promoted in parallel with other solutions Improving the quality of complementary foods: The period from starting the complementary feeding until weaning is the most threatening time for a child's nutritional status if he/she is fed supplementary diet too early or too late, or complementary meals of children are not sufficient in quantity and not guaranted the quality Complementary foods should provide adequate energy, protein and trace elements to compensate for the child's energy and nutritional deficiencies, and together with the breast milk, it can meet all of the child's needs Food from meat and fish is a good source of food for protein, iron and zinc The liver provides plenty of Vitamin A and folic acid Egg yolks also provide plenty of protein and Vitamin A Legumes are high in protein and some iron Green vegetables, fruits, especially oranges and tangerines, provide plenty of Vitamin C Orange-colored fruits and vegetables such as carrots, pumpkins, mangoes and papaya are rich in Vitamin A and Vitamin C Oil and fat are also essential foods that provide energy and fat for the baby's developmental needs Like many developing countries in the world, many studies in Vietnam also show similar results about complementary feeding practices of children from to 23 months old Many young families have not properly implemented supplementary feeding for children both in terms of supplementary feeding, quantity and quality of supplementary meals 6 Chapter RESEARCH SUBJECTS AND METHODS 2.1 Designing The Research The study is divided into phases: Descriptive study and controlled community intervention study 2.2 Research Location And Time 2.2.1 Research location: at four communes of Thuong Nong, Dau Duong, Thanh Uyen and Tam Cuong, Tam Nong District, Phu Tho Province 2.2.2 Research period: from November 2012 to June 2018 2.3 The Research Subjects All children aged to 23 months are eligible to participate in the study and mothers of these children Criteria for selecting the subjects for the Intervention Research: the pairs of mothers and children aged 6-23 months are selected from the descriptive study and meet the criteria: Children at risk of stunting malnutrition and with stunting malnutrition (-3SD < HAZ < -1SD; no congenital malformations that affect human anthropology and blood biochemistry; No chronic diseases, acute infections, severe and very severe anemia (Hb from