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Rate of Vitamin D Deficiency and Frequency of Acute Respiratory Infections in Children Under 5 Years Old in An Lao District, Hai Phong City


Chapter 4: DISCUSSION


During the study, we recruited 406 pairs of mothers and children under 5 years of age who met the criteria for the status study and 164 for the intervention study. Here are some key points to consider:

4.1. Rate of vitamin D deficiency and frequency of acute respiratory infections in children under 5 years old in An Lao district, Hai Phong city

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4.1.1. Prevalence of vitamin D deficiency

4.1.1.1. Information about research subjects

Rate of Vitamin D Deficiency and Frequency of Acute Respiratory Infections in Children Under 5 Years Old in An Lao District, Hai Phong City

During the study, we recruited 406 mother-child pairs, which we collectively call the research subjects. Of these, 221 were boys, accounting for 54.5%, and 185 were girls, accounting for 45.6% (Figure 3.1). The difference in the proportion of boys and girls, in our opinion, may be due to the influence of the current gender imbalance that is quite common in many provinces and cities of Vietnam.

Hoang Van Thin and Dam Thi Tuyet in 2013 [102] studied the status of NKHHC in children under 5 years old in 2 communes of Hiep Hoa district, Bac Giang province and found that more boys participated in the study than girls (355/673=52.7% and 318/673=47.3%).

Nguyen Xuan Hung in Kim Dong, Hung Yen [91 ] when conducting a study on intervening in 2-3 year old children with vitamin D to improve the rate of stunting also found that boys accounted for 52.9%, and children in the 2 year old group accounted for 51.1%. The author did not find this difference statistically significant. Similarly, Tran Thi Nguyet Nga

[92] In Gia Loc Hai Duong, a study on vitamin D supplementation and mineral-rich meals also showed that boys had more than girls and the 3-year-old group had more than the 2-year-old group, but the difference was not statistically significant. When studying


Researching vitamin D deficiency in children 6-11 years old at the National Children's Hospital and some related factors, Luu Thi My Thuc and colleagues [103] found that boys (54.2%) were higher than girls (45.8%).

Dang Viet Linh [104 ] studied the current status of NKHHC in children under 5 years old at the Hai Phong Children's Hospital clinic in 2020 and also found that the rate of boys participating in the study was higher than that of girls. The rates were 63% and 37% respectively and the difference was statistically significant.

By age group (Figure 3.2), we found that the group of patients aged 36-<48 months had 111 children, accounting for 27.3%, followed by the group aged 24-<36 months with 107 children, accounting for 26.4%, the group aged 12-<24 months had 92 children, accounting for 22.7%, the group aged 48-<60 months had 83 children, accounting for 20.4%, and the group aged 0-<12 months had the lowest rate of 13/406, accounting for 3.2%.

We found that the group under 1 year old participated in the study the least, possibly due to the mothers' fear of having their children tested for blood, so they did not participate in the study. The group of children from 2-4 years old accounted for a higher proportion, although the proportion was not equal in each group, but they all accounted for 20.4% to 27.3%.

Thanh Minh Hung and CS [105] in Kon Tum, when studying the characteristics of NKHHC in 102 children under 5 years old, the authors also found that the group 2-<24 months had the highest rate of 64%, boys accounted for 68.6%, girls accounted for 31.4%.

According to Dang Viet Linh [ 104], the 1 and 2 year old groups accounted for the highest proportions, 39.1% and 28.3%, respectively. The 3 year old group accounted for 14.1%, the 4 year old group accounted for 8.7%, and the 5 year old group accounted for 9.8%. The reason for the difference in the proportion of research subjects by age is that in the study by author Dang Viet Linh on sick children, the 1 and 2 year old group is the group that often gets pneumonia, so this group comes to the clinic at a higher rate than other age groups.

According to the characteristics of mothers (Table 3.1), we see that mothers with primary education and below account for 93.6% and mothers with secondary education and above account for 6.4%. The education of mothers is relatively low. This result shows that mothers with education


The higher educated people tend to work in other cities and provinces, but the rest are those with low education and no stable jobs.

According to the new classification of the Government on criteria for poor, near-poor and normal households, we found that the research subjects were poor and near-poor accounting for 79.1% and 20.9% had normal economic status. More than half of the mothers participating in the study (51.2%) were farmers, the rest were workers, housewives, traders and freelancers which we called other occupations. The rate of occupations and the rate of mothers with low economic status further confirmed that the research location was poor communes of An Lao district, Hai Phong.

According to Thanh Minh Hung and CS [105], in Kon Tum, 82.4% of mothers participating in the study were farmers, and 74.5% had secondary school education or higher.

According to Dang Viet Linh [104 ], the highest proportion of self-employed mothers is 30.8%, followed by workers 28.8%, civil servants 27.5%, housewives 9.3% and farmers 3.6%. This difference, according to us, is a study in the city. The occupational structure of mothers in the city is much different from that in rural areas. Also according to this author, mothers with university education and above account for 25.7%, primary school 0.5%. The group of mothers with high school education accounts for the highest proportion of 58.4%. Vocational training accounts for 10.8% and secondary school accounts for 4.6%. The education rate of mothers here is more representative than in our study. Therefore, mothers have much higher education than the education of mothers in our study.

Regarding the economic status of the mothers, the author found that 91% of the mothers had average economic conditions or higher, only 9% had low income. This result is understandable because this is an economic model in the city while we studied in the poor commune of An Lao, so the economic status of the mothers is still low.


According to Tran Thi Nguyet Nga [92] , the education of the mothers in our study is similar to ours. 58.6% of the mothers have a junior high school education, 23.2% have a high school education, 14.4% have a college education, and 3.8% have a primary education. This model is often the model of rural areas in Vietnam.

Regarding occupation, the author's research shows that 33.1% of mothers are workers, 18.6% are farmers. This occupational model is similar to the model of author Nguyen Xuan Hung in Hung Yen. The reason is that mothers leave farming to work as workers in the city or neighboring provinces with more attractive incomes.

Nguyen Xuan Hung [91] in Hung Yen showed that the mothers in the author's study had the highest percentage of high school education at 34.9%, followed by junior high school and below at 33.9% and 11.6% of mothers had university education and above. The mothers here had better education than the mothers in our study. Regarding occupation, the author found that 46.8% of mothers were workers, farmers accounted for only 19%. Although the author was researching in an agricultural district, the percentage of mothers who were farmers was low. According to the author, this was because the mothers left for the city or went to neighboring areas to work as workers, and there were many developed industrial parks around the district. According to Economics, the author found that the percentage of mothers with average and above income was high at 78.6% compared to 21.4% with below average income.

Regarding the socio-economic conditions of the mothers participating in the study, we have the following general comments: occupation, education and income depend largely on the region, area, rural area and city. In places with good socio-economic conditions, the education, occupation and economic status of the mothers are also different.

4.1.1.2. Rate of vitamin D deficiency in study subjects

Table 3.2 presents the mean vitamin D concentrations by age group. We found the lowest mean vitamin D concentrations in the 1-year-old group (18.20 ± 6.38 ng/ml) and


highest in the 3-year-old group (24.19 ± 5.86 ng/ml). The mean vitamin D concentration of the study subjects was 23.23 ± 5.50 ng/ml. The difference in mean vitamin D concentration by age group was statistically significant with p=0.028. We did not see any difference in mean vitamin D concentration by gender (boys: 23.32 ± 5.28 ng/ml and girls 23.13 ± 5.76 ng/ml with p=0.272) (Figure 3.3).

Mean vitamin D concentrations according to some maternal characteristics are presented in Table 3.3. We found that the mean vitamin D concentrations of the children of mothers with primary and lower education were significantly lower than those of the children of mothers with secondary and higher education (23.03±5.35 ng/ml compared to 26.13±6.79 ng/ml, p=0.023). We did not find any difference in the mean vitamin D concentrations of the study subjects according to the economic conditions and occupation of the mother (p=0.056 and 0.124, respectively).

Figure 3.4 shows the rate of mild deficiency (deficiency) and severe vitamin D deficiency in the study subjects. According to the results, the deficiency group (vitamin D concentration from 20-<30 ng/ml) accounted for the highest rate of 56.4%, the deficiency group (<20 ng/ml) accounted for the lowest rate of 2.2%. The group of subjects with vitamin D concentration ≥ 30 ng/ml accounted for 41.1%.

We used the threshold of vitamin D concentration <30 ng/ml to determine vitamin D deficiency and no vitamin D deficiency (some authors use no deficiency as the ideal vitamin D concentration). According to this division, we did not find any difference in the rate of vitamin D deficiency by age group (Table 3.4). According to this table, the 1-year-old group had the highest rate of deficiency at 76.9% and the group with the lowest rate was the 3-year-old group at 50.5% (p=0.233).

The prevalence of vitamin D deficiency in this study did not differ between boys and girls (58.8% vs. 58.4% and p=0.92) (Figure 3.5).

Tran Thi Nguyet Nga [92] in Hai Duong did not find any difference in vitamin D concentration according to age. Specifically, in the 2-year-old group, the concentration was 53.5 ± 42.1 nmol/l and 50.1 ± 12.0 nmol/l (p>0.05). The author also did not find any difference in vitamin D concentration.


Vitamin D levels in men and women do not differ by gender. Specifically, boys have concentrations of 53.8% ± 34.6 nmol/l and 48.2 ± 11.3 nmol/l and p>0.05). To calculate vitamin D levels, there are currently two systems of measurement units: ng/ml and nmol/l. For ease of tracking and understanding, we introduce the following unit conversion. If you want to convert from ng/ml to nmol/l, multiply by 2.5 and convert from nmol/l to ng/ml, multiply by 0.4. For example, vitamin D levels of 50 nmol/l to ng/ml are 20.

Nguyen Xuan Hung [91] research in Hung Yen showed that there was no difference in the average vitamin D concentration according to age group (32.26 ± 9.13 ng/ml in the 2-year-old group and 32.79 ± 14.97 ng/ml in the 3-year-old group and p>0.05). However, the author found that the average vitamin D concentration in boys was 33.65 ± 15.23 ng/ml, higher than that in girls at 31.25 ± 7.72 ng/ml with p<0.05). The average vitamin D concentration of Nguyen Xuan Hung's research subjects was also higher than the average vitamin D concentration of our research subjects. The concentrations were 32.52 ± 12.32 ng/ml and 23.23 ± 5.50 ng/ml, respectively. This difference may be related to the different timing of our study and the author's study. The author's study was conducted in October when the amount of sunlight was decreasing, while our study was conducted in December when the amount of sunlight was decreasing. This may have caused our study subjects to have lower mean vitamin D levels than the author's.

Regarding the rate of vitamin D deficiency, Nguyen Xuan Hung's study [91] showed that the overall rate of vitamin D deficiency was 47.7%, much lower than our rate of 58.6%. The rate in boys was 46.8% and in girls was 48.7% (p>0.05) compared to our results by gender, which were 58.8% and 58.4%, respectively (p=0.92). By age group, the author found that the 2-year-old group accounted for 42.5% and the 3-year-old group accounted for 46.9% (p=0.055). Our results by age group 1-5 were 76.9%, 58.7%, 50.5%, 62.2% and 61.4%, respectively. These rates were all higher than those of author Nguyen Xuan Hung [91].


The research results of Tran Thi Nguyet Nga [92] showed that the rate of vitamin D deficiency was also lower than ours, 49.8% compared to 58.6%, similarly by gender (boys: 44.16%, girls: 56.8%), by age 48.9% in the 1-year-old group and 49.1% in the 3-year-old group were both lower than our research results.

Our rate of vitamin D deficiency is much higher than the research results of Luu Thi My Thuc and CS [103] at the National Children's Hospital in 2019 on children aged 6-11 (58.4% compared to 23.9%). Our research results are also much higher than the research results of Nguyen Song Tu and CS.

[106] in Luc Yen and Yen Binh, Yen Bai province in 2017 on 600 preschool and primary school students. The rate of vitamin D deficiency in preschool students was 29.2% and in primary school students was 24.7%. The author also showed that the average vitamin D concentration of preschool students was 57.85 nmol/l and that of primary school students was 60 nmol/l. This concentration is also similar to ours.

Vu Thi Thu Hien [107] studied 288 children aged 12-36 months in some kindergartens in Hoai Duc district, Hanoi in 2014 to determine the rate of NKHHC, the rate of vitamin D deficiency and some related factors, showing that the rate of vitamin D deficiency was 27% and the rate of deficiency was 57%. This rate is much higher than our rate of 58.6% (deficiency and deficiency).

When referring to studies on the rate and factors related to vitamin D deficiency in children, we also obtained very different deficiency rates according to the studies. Patricia Garcia Soler and CS [108] studied the rate of vitamin D deficiency in sick children aged 6 months to 16 years and found that the overall rate of vitamin D deficiency was 43.8%, with an average vitamin D concentration of 22.28 ng/ml.

Chungsong Yang and CS [109] also studied the rate of vitamin D deficiency and insufficiency in 460,537 children in 825 hospitals from 18 provinces of China. The results showed that the rate of vitamin D deficiency was 6.69% and insufficiency was 15.92% (overall 2.61%), which was lower than the rate in our study.


A study in 10-18 year olds by Renuka Jayatissa et al [110] in Sri Lanka in 2017 showed that the prevalence of vitamin D deficiency was 13.2% and the prevalence of insufficiency was 45.6%, the overall prevalence was 58.8%, similar to our prevalence.

Vicka Oktaria and CS [89] studied the rate and factors associated with vitamin D deficiency in infants after birth and at 6 months of age. The results showed that 90% (308/344 infants with vitamin D deficiency) of infants were vitamin D deficient, and at 6 months of age 13% (33/255 infants) were vitamin D deficient. There was a large difference between the rate of vitamin D deficiency at birth and at 6 months of age.

Lenka Sochorová and CS [111] assessed the vitamin D status in 419 healthy children aged 5-9 years in the Czech Republic and found that 27% of children were vitamin D deficient, of which 3% were deficient and 24% were vitamin D deficient.

Maryam Delshad and CS [ 54 ] studied the winter vitamin D status and related factors in children living in Auckland, New Zealand on 507 healthy school-age students aged 8-11 years. The authors found that the average vitamin D concentration was 64 ± 21 nmol/l, 41% were deficient and 28% were vitamin D deficient.

D. This is a fairly high deficiency rate.

Kristen A Herrick and CS [112] studied the current status of D deficiency in the United States, from 2011 to 2014, and found that among 16,180 study subjects, 22.3% of children over 1 year old were deficient in vitamin D. The authors also found that the group of non-Hispanic black subjects had the highest rate of 17%, non-Hispanic Asians 7.6%, non-Hispanic whites 2.7%, and Hispanics 5.9%.

Darling AL's study [113] on the rate of vitamin D deficiency in populations living in Southwest Asia showed that 27-60% of people had vitamin D levels <12.5 nmol/l. The author also emphasized that this deficiency rate depends on the season.

Through domestic and foreign research on the rate of vitamin D deficiency, we found that the rate of vitamin D deficiency is high or low depending on the time.

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