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MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
NATIONAL INSTITUTE OF NUTRITION
DINH PHUONG HOA
NUTRITIONAL STATUS, ANEMIA AND EFFECTIVENESS
OF WEEKLY IRON SUPPLEMENTATION OF WOMEN AT
THE AGE OF 20-35 IN LUC NAM DISTRICT, BAC GIANG
PROVINCE
SUMMARY OF PhD. THESIS
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Specification: Nutrition
Code: 62.72.03.03
HA NOI, 2013
THIS WORK IS COMPLETED AT
THE NATIONAL INSTITUTE OF NUTRITION
Scientific Advisors:
1. Prof. Le Thi Hop, MD, PhD
2. PhD. Pham Thi Thuý Hoa, MD, PhD
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Reviewer 1:
Reviewer 2
Reviewer 3:
This thesis shall be defended in front of the Doctoral Thesis Committee at The Institute Level in the
National Institute of Nutrition
At ,
The thesis can be found at:
- National Library
- National Institute of Nutrition Library
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LIST OF ABBREVIATIONS
BMI Body Mass Index

iron deficiency anemia. Vietnam currently applied treatment regimens for anemia by supplementing iron
daily for children and pregnant women. However, the effectiveness of using iron tablets according to daily
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regimen method is limited by side effects on the gastrointestinal tract, the difficulties of propaganda and
maintaining compliances with medication as directed.
Weekly iron supplementation is one of the effective solutions similar to daily iron supplementation.
Moreover, weekly iron supplementation reduces significantly the rate of side effects and also helps save the
iron tablet, so that we can expand for more objects, especially for women who are not pregnant.
Based on the above reasons, we conduct testing consecutive weekly iron supplementation and
intermittent weekly iron supplementation for women aged 20-35 in Luc Nam, which is a mountainous
district located in the North-East of Bac Giang province.
Objectives
1. To evaluate the nutritional status, anemia, worm infection rate and dietary intakes among women
aged 20-35 in six communes in Luc Nam district, Bac Giang province.
2. To compare the effectiveness of consecutive weekly iron supplementation and intermittent
weekly iron supplementation to anemia status of women aged 20-35.
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NEW CONTRIBUTIONS OF THE THESIS
Provide more data for the Chronic Energy Deficiency (CED), the prevalence of anemia, worm infection
and dietary intakes of women aged 20-35 in six communes of Luc Nam district, Bac Giang province.
Suggest new weekly iron supplementation regimen. This regimen is highly valuable in selecting the
solutions for anemia prevention for reproductive aged women and can be applied in a larger scale.
Suggest for further researches on intermittent weekly iron supplementation trial at 16th, 18th and 20
th
week for reproductive aged women, especially those at the areas that have high CED, anemia and worm
infection rate.
STRUCTURE OF THE THESIS
The thesis consists of 114 pages in which the main content is presented within 105 pages, including:
Introduction (3 pages) Overview (30 pages); Subjects and Methods (21 pages); Results (34 pages)
Discussion (22 pages); Conclusions and Recommendations (4pages). There are 36 tables, 12 figures and 148

The study was conducted in 6 poor communes: Bac Lung, Cam Ly, Bao Dai, Dong Hung, Kham Lang
and Truong Giang, Luc Nam district, Bac Giang province.
2.1.2. Time:
Screening Survey: June 2008
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Intervention study: 6/2008 to 1/2009
2.2. Studying object:
Women aged 20-35 (the age group with the highest childbirth rate)
Excluding criteria: Women aged 20-35 who are breastfeeding, pregnant, suffering from blood diseases,
chronic diseases, birth defects and refuse to take part in.
2.3. Studying methodology
2.3.1. Research design: The research has 2 stages
Stage 1: Cross-sessional study to evaluate nutritional status, worm infection and dieatary intakes.
Stage 2: Community intervention experiment with control group to evaluate the effectiveness of weekly
iron supplementation with each.
2.3.2. Sample size and sampling method
2.3.2.1. Phase 1: Cross-sessional descriptive study
Apply the formula to the research of the nutritional status survey, anemia rate and worm infection rate:
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Nutritional status investigation: p: prevalence of chronic energy deprivation is (36.8%). Estimated object
size is 373.
Anemia rate investigation: p: estimated anemia rate is 28.2%. Estimated object size to take blood is 329.
Worm infection rate investigation: p: estimated worm infection rate is 29%. Estimated object size to test
stool is 341.
Dietary intakes investigation: Use the formula:
δ: standard deviation of the average calories ingested (taken as 400 kcal)., e: acceptable deviation
(appointed to be 100 Kcal). Sample size of dieatary intakes investigation would be 210.
Sampling Method: Sampling process comprises several stages:
Stage 1 (select district): intentionally selected Luc Nam district.
Stage 2 (select commune): intentionally selected Bac Lung, Bao Dai, Dong Hung, Truong Giang and

consecutive weekly iron/acid folic supplementation (group CT1); 1 commune: intermittent weekly iron/acid
folic supplementation (group CT2)
Sampling the dietary intakes: choose randomly system from 165 objects, select 90 samples to ask for
dietary intakes.
Supplement dose: iron/acid folic Fumafer B9 Corbière, coated tablet which contains Fe (II) fumarat:
200mg equals to 66mg elemental iron and 1mg acid folic in each tablet.
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Supplement 16 iron/acid folic in 16 consecutive weeks with group CT1. Supplemet 16 iron/acid folic in
28 intermitternt weeks with group CT2.
2.4. CONDUCTING STUDY
Before conducting study, PhD student had a meeting with local health centre, presented purpose,
methodology, research plan and list out criteria for selecting communes and objects.
2.4.1. Collecting data methodology
2.4.1.1. Interview: collect necessary information related to health and nutrional status of objects.
2.4.1.2. Investigate nutritional status:
Weight: Use SECA electronic scale with an accuracy of 0.01 kg.
Height: Use UNICEF wooden ruler.
2.4.1.3. Dietary intakes asking: 24 hours recall
2.4.1.4. Laboratory tests:
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Hemoglobin laboratory test: By Cyanmethemoglobin method, using Hemoglobinometer.
Ferritin laboratory test: By enzyme-linked immune asay method (ELISA method)
Stool laboratory test: By Kato method (WHO)
2.4.1.5. Clinic examination: detect acute, chronic cases, pregnant cases and physical defecting,…
2.4.2. Variables, research index and assessment criteria:
Nutritional status: categorizing based on BMI
BMI < 18.5: CED
BMI: 18.5 – 24.9: Normal
BMI ≥ 25: overweight – obesity
Anemia status: According to WHO’s classification

Keep the investigators who weigh, measure height, ask dietary intakes from the beginning to the end to avoid
error by the implementers. Accurate weighing, measuring and asking technique.
Comply with processes of sample taking, storage, preventing contamination of chemicals from the outside.
Measurements were analyzed using updatedly standard method.
Entry double data and cross-examine when combine data.
2.8. Study ethics
The research was conducted since Science Council and Ethics Council of Nutrition Institute approved.
Blood collection devices were ensured safe and used only 1 time.
Objects suffering from severe anemia (Hb<70 g/L) in screening survey were given iron tablets according to
treatment regimens before excluding from the study. The anemic objects, right after the end of the study
were informed and treated with iron tablets.
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CHAPTER 3. RESEARCH RESULTS
3.1. NUTRITIONAL STATUS AND WORM INFECTION
3.1. Results of the screening survey of nutritional status, anemia, worm infection and dietary intakes of women
aged 20-35.
The survey’s result on 650 women aged 20-35 showed that 94.9% of women working in the fields.
Most of them were literate (99.7%), the majority (64.0%) of women had education level at secondary school.
About half of the surveyed households were in poverty (50.9%).
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3.1.1. The nutritional status of the PN 20-35 age 6 communes
Figure 3.1. CED prevalence (BMI<18,5) of women aged 20-35
Among 650 objects surveyed, there were 254 women suffering from CED, accounting for 39.1% of
total studying objects.
3.1.2. Anemia status among women aged 20-35 at 6 communes
Table 3. 1. Mean Hb concentration of women by age groups
Age groups N Mean Hb (g/dl) p
20-24 125 13,1 ± 1,3
>0,05
25-29 236 13,0 ± 1,2

3.1.3. Worm infection status of women aged 20-35 at 6 communes
Table 3.4. Worm infection status of women aged 20-35
Worm infection rate n Prevalence (%)
Mono-infection
- Ascaris infection 105 19,4
- Trichuris infection
28 5,2
- Hookworm infection 77 14,2
Multi-infection
- One type of worm infection 9 1,7
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- Two types of worm infection
87 16,1
- Three types of worm infection
9 1,7
Total 541 100,0
3.1.4. Dietary intakes of women aged 20-35 at 6 research communes
Table 3. 5. Dietary nutrition value of women compared to recommended dietary allowances
(person/day)
Nutrients
Mean ± SD Demand % response to
demand*
Energy (Kcal) 1954,2 ± 360,7 2300 85,0
Total protein (g) 64,5 ± 17,8 12-14% 94,3
Animal protein (g) 19,4 ± 13,9 30-35% 85,9
Total lipid (g) 29,9 ± 16,2 20% 68,9
Plant lipid (g) 9,9 ± 8,1 30% 110,4
Glucid (g) 356,9 ± 72,1 66% 73,0
Iron (mg) 13,0 ± 4,3 39,2 33,2
Vitamin C (mg) 46,5 ± 30,5 70 66,4