MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY  NGUYEN THI XUAN HUONG PHYSICAL AND HEALTH GROWTH AMONG UNDER 2-YEAR CHILDREN BORN TO MOTHERS RECEIVING MICRONUTRIENT SUPPLEMENTATION BEFORE AND DURING PREGNANCY IN THAI NGUYEN Speciality: Pediatrics Code number: 62720135 MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY Mã số: 62720135 THAI NGUYEN, 2019 The dissertation was completed at UNIVERSITY OF MEDICINE AND PHARMACY THAI NGUYEN UNIVERSITY Supervisor: Ass.Prof.Ph.D Nguyen Thanh Trung Ph.D Nguyen Hong Phuong Critic 1: ………………………………………… Critic 2: ………………………………………… Critic 3: ………………………………………… The dissertation will be defended nationally to the Evaluation Committee at University of Medicine and Pharmacy, Thai Nguyen University at … on …., 201 The dissertation is available for reference at - The library of Thai Nguyen University of Medicine and Pharmacy - Learing resource centre of Thai Nguyen University - The National Medical Library INTRODUCTION Growth is a fundamental biological feature of children Research on growth is considered the basic science of Pediatrics Pediatricians, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) emphasize that the first 1,000 days of life, from conception to the age of two, is a very important period and considered as “golden days” in children’s life This is a special stage that provides the foundation for lifelong health and has long term impact on the physical, mental and motor development later in life The 1000 golden days are a window of opportunity that provides up to 60% of children’s potential to increase their height in the future In Vietnam, the rate of malnourished children is still high According to the 2015 statistics of the National Institute of Nutrition, underweight prevalence accounted for 14.1%, stunting accounted for 24.6% Undernutrition was especially high in the mountainous and Central Highlands regions The proportion of children under years old with nutritional anemia is 29.2% The nutritional status of mothers before and during pregnancy is also poor Studies worldwide have shown that maternal nutritional status, especially micronutrient status during pregnancy, is a major determinant of birthweight and height development potential This means that maternal nutritional status must be prepared before pregnancy and should be maintained well throughout pregnancy There are plenty studies that examined the role of nutrition and micronutrient on child physical development in the first 1000 golden days However, evidents on the effects micronutrient supplement before and during pregnancy on later period of child physical and health development are limited Therefore, we carried out the thesis: "Physical and health growth among under 2-year children born to mothers receiving micronutrient supplementation before and during pregnancy in Thai Nguyen" The objectives are: To evaluate the physical and health growth of under -2 year children born to mothers receiving micronutrient supplements before and during pregnancy in Thai Nguyen To identify factors affecting the physical and health growth of children under years of age whose mothers receiving micronutrient supplements before and during pregnancy in Thai Nguyen Necessity of the research Stunting is a public health problem in developing countries The World Health Organization has set a goal to reduce stunting by 40% in children under years old by 2025 compared to the year 2010, and also proposed many solutions to achieve this goal, including supplement micronutrients for mothers before and during pregnacy Thus the title of this thesis is topical, consistent with the trend of the world and the national nutrition program NEW CONTRIBUTIONS OF THE THESIS The project is the first project in Vietnam to study the growth and health of children aged 0-24 months whose mothers received micronutrient supplements before and during pregnancy in Thai Nguyen The study has provided data on physical and health growth of children aged 0-24 months in Thai Nguyen and has found a number of factors affecting physical growth and health of children in Thai Nguyen Research has shown the important role of multiple micronutrient supplementation before pregnancy on pregnancy outcomes Children born to mothers who received pre-pregnancy multiple micronutrient supplementation, following by prenatal iron-folic acid supplementation, had higher birth weight and height and lower neonatal anemia rate compared to those born to mothers who received folic acid or iron - folic acid supplementation before pregnancy THESIS STRUCTURE The thesis consists of 143 pages In addition to the introduction (3 pages), the conclusion (3 pages) and the recommendation (1 page), there are chapters: Chapter 1: Literature review (40 pages); Chapter 2: Methodology (18 pages); Chapter 3: Results (48 pages); Chapter 4: Discussion (32 pages) The thesis has 36 tables, 11 figures, 171 references (Vietnamese: 59; English: 112) Chapter1 LITERATURE REVIEW Physical growth of children 1.1 Growth in weight Weight is a measure usually carried out in all basic and routine surveys It is very important measure to assess physical fitness, nutrition and growth It is also universal, simple and easy to measure 1.2 Growth in height Height (length) is one of the most basic dimensions in anthropometric surveys The height represent the length of the whole body so it is used to assess the growth of children, the form of adult stature Height is a faithful measure of growth, height reflects good past life and is evidence that reflects nutrition Long-term malnourished children will slow height development 1.3 Head circumference (or occipital-forehead circumference) The head circumference is a measurement used in anthropology, correlates with brain mass and cognitive function The measurement of the head circumference allows indirect assessment of the secondary abnormalities of the brain due to pathological processes Therefore, the American Society of Pediatrics recommends measuring the head circumference when visiting children, especially among children under years of age 1.4 Mid upper arm circumference Mid upper arm circumference (MUAC) is one of the anthropometric indicators commonly used in field surveys It allows to assess the muscle mass and it also reflects the nutritional status of children MUAC can be used to quickly classify nutritional status in the community WHO has set a threshold for assessing the nutritional status of children: MUAC ≥ 13.5cm: Normal, MUAC 11.5 to less than 12.5cm: moderate acute malnutrition, MUAC