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Birth weight and growth during the first two years of life: a study in urban and rural Vietnam
Nordic Council of Ministers, Nordic School of Public Health NHV. Research Institute for Child Health, National Hospital of Pediatrics, 18/879 La Thanh road, Hanoi, Dong Da district, Vietnam..
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Differences in health and living conditions between urban and rural settings can be seen as an important example of gaps between population groups. Birth weight and child growth are important predictors for the future health of a person and at aggregate level, for the public health of a population.The general aim of this thesis is to describe and discuss birth weight, physical growth and breastfeeding of children, as well as associated factors, from birth to 24 months of age in urban and rural areas of Vietnam, thus contributing to the evidence base for health strategy and policy.

Methods: Two Health and Demographic Surveillance Sites in Hanoi were used; urban Dodalab and FilaBavi in the rural part. To study rural birth weight 1999 to 2010 information was obtained for 10,114 newborn in FilaBavi. To study urban rural growth disparities 2008-2010, 1,466 children were followed for two years after birth with measurements of weight and length. A study of breastfeeding included 2,572 mothers followed for one year after delivery. Background information about households and mothers was taken from routine surveys in the two sites.

Results: The mean birth weight in FilaBavi remained stable at about 3,100 grams, over the 12 years studied despite rapid economic and technological development. At the individual level we found birth weight to be associated with household economy and the education of mothers. In the urban rural comparison, the mean birth weight for urban boys and girls were 3,298 and 3,203 g as compared with 3,105 and 3,057 g for the rural infants. Children in the urban area grew faster than those in the rural area. There were markedly higher frequencies of stunting in the rural area compared with the urban. The initiation of breastfeeding during the first hour of life was more frequent in the urban area. Exclusive breastfeeding during the first three months of age was more commonly reported in the rural than in the urban area. Both birth weight and child growth were statistically significantly and positively associated with economic conditions and mother’s education.

Conclusion: The results of the studies presented in this thesis show that there are large and important differences in child birth weight, child growth and infant breastfeeding between urban and rural areas. There are also major differences between the areas with respect to education and economic resources. All predictors of child birth weight and growth discussed are directly or indirectly associated with the social and economic conditions. Globalization and urbanization means obvious risks for increasing gaps between as well as within the rural and urban areas. Large discrepancies in a society will lead to serious public health problems in all segments of the population, not only the underprivileged.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2014. , 64 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2014:1
Keyword [en]
Key words: Birth weight, child growth, breast feeding, urban rural discrepancy, Vietnam
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3607ISBN: 978-91-86739-65-2 (print)OAI: oai:DiVA.org:norden-3607DiVA: diva2:782231
Public defence
2014-03-28, Nordic School of Public Health NHV, Box 12133, 40242 Göteborg, Sweden, 13:45 (English)
Opponent
Supervisors
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2015-01-22Bibliographically approved
List of papers
1. Physical growth during the first year of life.: A longitudinal study in rural and urban areas of Hanoi, Vietnam.
Open this publication in new window or tab >>Physical growth during the first year of life.: A longitudinal study in rural and urban areas of Hanoi, Vietnam.
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2012 (English)In: BMC pediatrics, ISSN 1471-2431, Vol. 12, 26- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Good infant growth is important for future health. Assessing growth is common in pediatric care all over the world, both at the population and individual level. There are few studies of birth weight and growth studies comparing urban and rural communities in Vietnam. The first aim is to describe and compare the birth weight distributions and physical growth (weight and length) of children during their first year in one rural and one urban area of Hanoi Vietnam. The second aim is to study associations between the anthropometric outcomes and indicators of the economic and educational situations.

METHODS: Totally 1,466 children, born from 1st March, 2009 to June 2010, were followed monthly from birth to 12 months of age in two Health and Demographic Surveillance Sites; one rural and one urban. In all, 14,199 measurements each of weight and length were made. Birth weight was recorded separately. Information about demographic conditions, education, occupation and economic conditions of persons and households was obtained from household surveys. Fractional Polynomial models and standard statistical methods were used for description and analysis.

RESULTS: Urban infants have higher birth weight and gain weight faster than rural infants. The mean birth weight for urban boys and girls were 3,298 grams and 3,203 grams as compared to 3,105 grams and 3,057 grams for rural children. At 90 days, the urban boys were estimated to be 4.1% heavier than rural boys. This difference increased to 7.2% at 360 days. The corresponding difference for girls was 3.4% and 10.5%. The differences for length were comparatively smaller. Both birth weight and growth were statistically significantly and positively associated with economic conditions and mother education.

CONCLUSION: Birth weight was lower and the growth, weight and length, considerably slower in the rural area, for boys as well as for girls. The results support the hypothesis that the rather drastic differences in maternal education and economic conditions lead to poor nutrition for mothers and children in turn causing inferior birth weight and growth.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3595 (URN)10.1186/1471-2431-12-26 (DOI)22409903 (PubMedID)
Available from: 2015-01-16 Created: 2015-01-16 Last updated: 2015-01-20Bibliographically approved
2. Factors associated with physical growth of children during the first two years of life in rural and urban areas of Vietnam.
Open this publication in new window or tab >>Factors associated with physical growth of children during the first two years of life in rural and urban areas of Vietnam.
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2013 (English)In: BMC pediatrics, ISSN 1471-2431, Vol. 13, 149- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Differences between urban and rural settings can be seen as a very important example of gaps between groups in a population. The aim of this paper is to compare an urban and a rural area regarding child growth during the first two years of life as related to mother's use of antenatal care (ANC), breastfeeding and reported symptoms of illness.

METHODS: The studies were conducted in two Health and Demographic Surveillance Sites, one rural and one urban in Hanoi, Vietnam.

RESULTS: We found that children in the urban area grow faster than those in the rural area. There were statistical associations between growth and the education of the mother as well as household resources. There were positive correlations between the number of ANC visits and child growth. We also saw a positive association between growth and early initiation (first hour of life) of breastfeeding but the reported duration of exclusive breastfeeding was not statistically significantly related to growth. Reporting symptoms of illness was negatively correlated to growth, i.e. morbidity is hampering growth.

CONCLUSIONS: All predictors of growth discussed in this article, ANC, breastfeeding and illness, are associated with social and economic conditions. To improve and maintain good conditions for child growth it is important to strengthen education of mothers and household resources particularly in the rural areas. Globalization and urbanization means obvious risks for increasing gaps not least between urban and rural areas. Improvement of the quality of programs for antenatal care, breastfeeding and integrated management of childhood illness are also needed in Vietnam.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3596 (URN)10.1186/1471-2431-13-149 (DOI)24066791 (PubMedID)
Available from: 2015-01-16 Created: 2015-01-16 Last updated: 2015-01-20Bibliographically approved
3. Birth weight and delivery practice in a Vietnamese rural district during 12 year of rapid economic development.
Open this publication in new window or tab >>Birth weight and delivery practice in a Vietnamese rural district during 12 year of rapid economic development.
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2013 (English)In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 13, 41- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Since the Doi Moi reform 1986 economic conditions in Vietnam have changed significantly and positive health and health care developments have been observed. International experience shows that improved economic conditions in a country can reduce the risk of perinatal mortality, decrease the risk of low birth weight and increase the mean birth weight in newborns. The Health and Demographic Surveillance Site (HDSS) FilaBavi in Bavi district outside Hanoi city has been operational since 1999. An open cohort of more than 12,000 households (52,000 persons) has been followed primarily with respect to demography, economy and education. The aim of this research is to study trends in birth weight as well as birth and delivery practices over the time period 1999-2010 in FilaBavi in relation to the social and economic development.

METHODS: Information about birth weight, sex, place and method of delivery, mother's age and education as well as household economy of 10,114 children, born from 1999 to 2010, was obtained from the routine data collection in the HDSS.

RESULTS: Over the study period the mean birth weight remained at the same level, about 3,100 g, in spite of increased economic resources and technology development. At the individual child level we found associations between birth weight and household economy as well as the education of the mother. Hospital delivery increased from about 35% to 65% and the use of Caesarian section increased from 2.6% to 10.1%.

CONCLUSION: During the twelve years studied, household income as well as the use of modern technology increased rapidly. In spite of that, the mean and variation of birth weight did not change systematically. It is suggested that increasing gaps in economic conditions and misallocation of resources, possibly to overuse of technology, are partly responsible.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3593 (URN)10.1186/1471-2393-13-41 (DOI)23418725 (PubMedID)
Available from: 2015-01-16 Created: 2015-01-16 Last updated: 2015-01-20Bibliographically approved
4. Breastfeeding practices in urban and rural Vietnam.
Open this publication in new window or tab >>Breastfeeding practices in urban and rural Vietnam.
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2012 (English)In: BMC public health, ISSN 1471-2458, Vol. 12, 964- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to describe and compare breastfeeding practices in rural and urban areas of Vietnam and to study associations with possibly influencing person and household factors. This type of study has not been conducted in Vietnam before.

METHODS: Totally 2,690 children, born from 1st March 2008 to 30th June 2010 in one rural and one urban Health and Demographic Surveillance Site, were followed from birth to the age of 12 months. Information about demography, economy and education for persons and households was obtained from household surveys. Standard statistical methods including survival and regression analyses were used.

RESULTS: Initiation of breastfeeding during the first hour of life was more frequent in the urban area compared to the rural (boys 40% vs. 35%, girls 49% vs. 40%). High birth weight and living in households with large number of assets significantly increased the probability for early initiation of breastfeeding. Exclusive breastfeeding at three months of age was more commonly reported in the rural than in the urban area (boys 58% vs. 46%, girls 65% vs. 53%). The duration of exclusive breastfeeding as well as of any breastfeeding was longer in the rural area than in the urban area (medians for boys 97 days vs. 81 days, for girls 102 days vs. 91 days). The percentages of children with exclusive breastfeeding lasting at least 6 months, as recommended by WHO, were low in both areas. The duration of exclusive breastfeeding was significantly shorter for mothers with three or more antenatal care visits or Caesarean section in both areas. High education level of mothers was associated with longer duration of exclusive breastfeeding in the rural area. No significant associations were found between duration of exclusive breastfeeding and mother's age, household economy indicators or household size.

CONCLUSION: Intervention programs with the aim to promote breastfeeding are needed. Mothers should particularly be informed about the importance of starting breastfeeding early and to prolong exclusive breastfeeding. In order to reach the WHO recommendation of six months exclusive breastfeeding, we propose an extended maternity leave legislation to at least six months.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3597 (URN)10.1186/1471-2458-12-964 (DOI)23140543 (PubMedID)
Available from: 2015-01-16 Created: 2015-01-16 Last updated: 2015-01-20Bibliographically approved

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