TM HIU LIN QUAN S DNG MUI I-T TI T L

BU C V NNG I-T NIU HC SINH 8-12 TUI

TI 3 TRNG PH THNG HUYN VN CHN - YN BI
T Vn Bnh, L Phong v CS
Bnh vin Ni tit Trung ng
Summary
Iodized salt was introduced to
IDD prevention and control in
mountain areas of Viet nam in 1980
and in the whole country in
1994.Many studies have looked at
the effect of iodized salt in the
prevention of goiters. However,
iodine is evaporated by heat so
appropriate use and preservation of
iodized salt will impact the results,
particularly in people living in
iodine depleted areas.As yet, no
reseach has looked at this situation.
In this article, the authors
show that the peoples literacy
status, occupation, knowledge of
iodized salt use-age and storage all
impact the incidence of goiter and
median
urinary
iodine
concentration, OR 2.89 (P<0.05);
3.83 (P<0.001) and 2.15 (P<0.05)
respectively.

Tm tt:
Mui i-t (MI) c a vo s
dng phng chng CRLTI ti Vit Nam t
nhng nm 1980 min ni pha bc v
c s dng trong phm vi ton quc
nm 1994. c rt nhiu cng trnh
nghin cu v tc dng ca MI ti t l
bu c (TLBC), tuy nhin do c tnh
ca i-t d b phn hu bi nhit nn bo
qun v s dng MI lm nh hng n
hiu qu phng bnh ca MI i vi
ngi dn sng vng thiu i-t m cha
c tc gi no cp n.
Trong ti liu ny, cc tc gi
chng minh rng: Trnh hc vn, ngh
nghip v s hiu bit ca ngi dn v
vic bo qun v s dng MI nh hng
rt ln n TLBC v mc trung v i-t
niu, tng ng vi OR=2.89 v p<0.05,
OR =3.83 v p<0.001 v OR =2.15 v
p<0.05.Ngoi ra tc gi cn nhn thy c
mi lin quan cht ch gia nng i-t
niu v t l BC tr m 8-12 tui

1. t vn
Trong nhng nm cui th k ny, vn phng chng thiu cc vi cht dinh
dng thu ht nhiu nh nghin cu khoa hc, nhiu quc gia trn th gii. Thut ng
thiu "Vi cht dinh dng" thng c dng ch thiu 3 vi cht l: thiu i-t,
thiu st v thiu vitaminA. Trong 3 vi cht ni trn th thiu i-t, hin c coi l
thiu vi cht ph bin nht. N khng ch tn ti cc nc ang pht trin m cn
c cc nc pht trin. Theo c tnh ca U hi phng chng cc ri lon thiu i-t
quc t (ICCIDD) th ngy nay c khong 1,5 t ngi trn th gii b e do thiu it trong 200 triu ngi b bu c, 20 triu ngi tn thng no do thiu i-t.
phng chng Cc ri lon thiu i-t (CRLTI), nc ta, mui i-t c s
dng phng chng CRLTI cc tnh min ni pha Bc v Ty Nguyn, sau ny c
ph cp trn ton quc vo nm 1994. Tuy th, hiu qu ca vic s dng mui i-t li
ph thuc rt nhiu vo thi quen tp qun, trnh hiu bit v cch bo qun mui i-

t, cch s dng... khc phc tnh trng trn v xy dng chin lc truyn thng
phng chng CRLTI thch hp cho tng khu vc nhm tin ti thanh ton CRLTI vo
nm 2005 vduy tr bn vng bao ph MI tiu chun phng bnh chng ti tin
hnh nghin cu ti ny v gp phn tm hiu vic s dng mui i-t tin ti loi
tr CRLTI trong chu k 2 t nm 2001 - 2005.
Mc tiu nghin cu:
- Mc tiu chung: Xc nh mt s yu t lin quan s dng mui i-t ti t
l bu c v nng i-t niu hc sinh 8-12 tui ti 3 trng ph thng
huyn Vn Chn, tnh Yn Bi nm 2001.
- Mc tiu c th:
+ nh gi t l bu c v nng i-t niu hc sinh 8-12 tui.
+ Tm hiu tnh hnh s dng mui i-t ti h gia nh, xc nh nng mui
i-t.
+ Tm hiu mt s yu t lin quan n vic s dng mui i-t ti t l bu c
v nng i-t niu tr em 8-12 tui.
2. i tng v phng php nghin cu
2.1. i tng v vt liu nghin cu:
2. 1. 1. a im nghin cu:
Ti 3 x ng Kh, Trn Ph v Trung Tm huyn Vn Chn tnh Yn Bi.
2.1.2. i tng nghin cu:
Chng ti la chn i tng nghin cu l b m ang sinh sng ti x v
hc sinh t 8-12 tui ang hc ti trung ph thng trung hc c s, thuc 3 x: Trn
Ph, ng Kh v Trung Tm ca huyn Vn Chn tnh Yn Bi.
* i tng nh gi v CRLTI: l hc sinh 8-12 tui ca 3 trng ph
thng thuc huyn Vn Chn.
2.1.3. Thi gian nghin cu: Thng 4-5 nm 2001.
2.2. Phng php nghin cu:
2.2.1. Thit k nghin cu:
Phng php dch t hc m t, nghin cu ct ngang.
Giai on 1: Chn huyn, trng.
Giai on 2: Khm bu c, ly nc tiu.
Giai on 3: Phng vn b m c con bu c v khng bu c. Ly mu mui.
2.2.2. C mu v cch chn mu:
2.2.2.1. C mu:
C mu xc nh t l bu c c tnh theo cng thc:
n =Z21- /2. p(1-p).HSTK/e2
Trong :
p = T l bu c tr em 8-12 tui theo iu tra dch t hc nm 1998
= 0,10, q = 1-p

Z 1 - / 2 : tin cy 95% ( ngng tin cy 95% th Z=1. 96)

e : chnh xc = 5%, HSTK (H s thit k) = 3
Nh vy c mu tnh c: n = 1, 962 x 0,1(1-0,1) x3/0, 052 = 414
c c mu trn, mi x cn khm 140 tr t 8-12 tui.
2. 2. 2.2. Phng php chn mu
* Chn hc sinh t 8-12 tui
Theo phng php ngu nhin c h thng (Systematic Random sample), c
tnh ton sao cho tng ng vi nhm tui, gii.
* Chn h phng vn:
Tt c cc h gia nh c b m c phng vn hai nhm trn, mi h gia
nh s ly 5-10g mui n hng ngy nh lng i-t mui.

3. kt qu nghin cu
3.1.Mt s c im ca i tng nghin cu:
3.1.2. Nhm hc sinh 8-12 tui:
Bng 3.1: c im ca hc sinh 8-12 tui tham gia nghin
cu:
c im
a im:
ng Kh
Trn Ph
Trung Tm
Dn tc:
Ty
Thi
Dao
Kinh
Tng s

S lng

T l (%)

137
140
139

32,9
33,7
33,4

115
70
61
170
416

27,7
16,8
14,7
40,8
100,0

Nhn xt: T l hc sinh l ngi kinh 40,8%, cao hn cc

nhm dn tc khc nh Ty 27,7%, Thi 16,8%, Dao 14,7%.
Bng 3.2: T l % hc sinh theo tui v gii:
Tui

8
9
10
11
12
Chung

85
84
85
81
81
416

Nam
n
42
43
43
40
39
207

%
49,4
51,2
50,6
49,4
48,1
49,8

N
n
43
41
42
41
42
209

%
50,6
48,8
49,4
50,6
51,9
50,2

Nhn xt: T l phn b gia gia hai gii tr em nam v tr

em n cng tng t nh nhau. Trong nam 49,8% (n=207) v n
50,2% (n=209), s khc nhau gia nam v n khng c ngha
thng k (p>0,05)
3.1.3. Nhm cc b m:
Bng 3.3: c im ca cc b m tham gia nghin cu:
c im chung

S lng (n)

T l %

Tui ca b m:
5
3,8
- 30 Tui
153
87,0
- 31-40 Tui
16
9,2
- 40-50 Tui
Dn tc:
81
46,4
- Kinh
95
53,6
- Dn tc thiu s
Ngh nghip:
148
84,2
- Lm rung
12
7,0
- Cn b
9
5,2
- Bun bn
7
3,6
- Ngh khc
Trnh vn ho:
128
72,9
- Cp I
30
17,2
- Cp II
10
5,6
- Cp III
8
4,3
- THCN&H
Nhn xt: Cc b m tham gia phng vn tui ch yu nm
t 31- 40 tui chim 87,0%,phn ln l ngi dn tc thiu s (ch
yu l Ty, Thi v Dao): 53,6%,a s b m lm rung 84,2%,
trnh vn ho ca cc b m hc cp I: 72,9%, s hc THCN&H
chim phn nh 4,3%.
3. 2. Thc trng cc ri lon thiu i-t hc sinh 8-12 tui:
3.2.1. Bnh bu c hc sinh 8-12 tui:
16

14.1
12.3

14
12
10

8.3

9.3

9.4

8
6
4
2
0
8Tu
i

9Tu
i

10Tu
i

11Tu
i

12Tu
i

Biu 3.1: T l % hc sinh mc bu c theo tui:

Nhn xt: S lng hc sinh gia cc nhm tui tng t nh
nhau nhng t l bu c khc nhau, t l bu c tng theo la tui.
S khc bit v t l bu c theo cc la tui khc nhau c ngha
thng k (p <0,05).
Bng 3.4: T l % hc sinh mc bu c theo gii
S hc sinh c S hc sinh
Gii
T l %
khm
b bu c
Nam
207
12
5,8
N

209

32

15,3

Tng
chung

416

44

10,6

p
p<0,
01

Bng 3.5: T l % hc sinh mc bu c theo v th bu

Nam

207

bu
O
n
%
195 94,2

209

177

84,7

29

13,9

1,4

32

14,
8

Chun
g

416

372

89,5

41

9,8

0,7

44

10,
6

Gii

Tng
s
khm

I
N
12

%
5,8

II
n
%
0
0

Th bu
Lan to
n
%
12
5,8

Nhn xt: Tr em hc sinh nam mc bnh bu c I: 5,8%,

tr em hc sinh n khng ch mc bu c I l: 13,9%, m cn
mc c bu c II: 1,4%.
3.2.2. I-t niu hc sinh 8-12 tui:
20
12.5

10.4
8.3

10

0
ngKh

TrnPh

Trung T
m

Biu 3.2: T l % nng i-t niu < 10 g /dL 3 im

Nhn xt: T l % s mu thiu i-t mc nh ca trng ph thng ng
Kh: 12,5%, Trn Ph 10,4%, trng ph thng Trung Tm l 8,3%. So snh cc mc
i-t niu khng c s khc bit (p>0,05).
Bng 3.6: Nng i-t niu hc sinh gia hai nhm c BC v khng BC
T l % i-t niu ( g/dL)
Trung
v
Nhm
Tng s
Thiu<10
( g 10 ( g/dL)
mu (n) ( g/dL)
nghin cu
dL)
n
%
n
%
Bu c
44
24
8
18,2
36
81,1
Khng BC
88
18
12
13,6
76
86,4
Tng cng
132
22
18
13,6
112
86,4
So snh mc i-t niu ca 2 nhm p > 0,05
Nhn xt: T l % nng i-t niu < 10 g/dL l 13,6%. Nhm bu c c t
l nng i-t niu < 10 g/dL cao hn nhm khng bu c. Khng c s khc bit
gia hai nhm (p > 0,05).
Bng 3.7: Mi lin quan i-t niu dng mui i-t vi nhm dng mui khng
i-t
Hm lng i-t
Hm lng i-t
mui < 20 ppm
I-t niu
mui 20 ppm
Thiu
i-t
<10 g/dL)

(I-t

N
niu 32

i-t (I-t niu 10 g/dL)

Tng chung

%
65,3

n
17

%
34,7

8,4

76

91,6

39

29,5

93

70,5

Nhn xt: Nhm dng mui i-t (hm lng i-t 20ppm) c t l hm
lng i-t niu >10 g/dL cao gp 1,4 ln so vi nhm dng mui khng i-t (p <
0,001).
3.3. Tnh hnh s dng mui i-t:
Bng 3.8: S dng mui i-t theo a im nghin cu:
S dng cha ng
a
im Tng s h S dng ng
p
nghin cu
gia nh
n
%
n
%
ng Kh
Trn Ph
Trung Tm
Tng chung

64
64
48
176

10
27
27
64

15,6
42,2
56,2
36,4

54
37
21
112

84,4
57,8
43,8
63,6

<0,05

Nhn xt: 100% cc h gia nh dng mui i-t. Cch s dng mui i-t khng
ng ca cc b m thuc ng Kh cao nht 84,4%, thp nht Trung Tm 43,8%. C
s khc bit cch bo qun v s dng MI ca cc b m theo a im (p < 0,05).
Bng 3.9: S dng mui i-t gia hai nhm bu c v khng c BC
S b m S dng ng
S dng cha ng
Nhm
phng
p
n
%
n
%
Nghin cu vn
Bu c
44
7
15,9
37
84,1
Khng BC
132
57
43,2
75
56,8
<0,05
Tng chung 176
64
36,4
112
63,6
Nhn xt: Tnh trng dng mui i-t khng ng ca cc b m thuc nhm
bu c 84,1%, nhm khng bu c l 56,8%. C s khc bit cch bo qun mui it ca cc b m gia hai nhm 0 (p < 0,05).
Bng 3.10. Nng i-t trong mui 2 nhm c v khng bu c
Nng i-t < 20ppm
Nhm
Tng s h
T
l
(Khng tiu chun phng
p
nghin cu gia nh
(%)
bnh)
Bu c
44
5
11,4
Khng BC 132
9
6,8
>0,05
Tng
176
14
7,9
Nhn xt: T l % nng i-t mui <20ppm cao nhm c bu c l:11,4%,
thp hn nhm khng bu c: 6,8%. Khng c s khc bit v nng i-t mui
3 x p>0,05.
Bng 3.11: Hiu bit ca b m v s dng mui i-t v tc hi thiu i-t
T l b m T l % b m hiu bit
a
im S b m bit s dng
Hiu cch
Hiu v tc
nghin cu
phng vn
mui i-t
s dng MI
hi thiu i-t
ng Kh
Trn Ph
Trung Tm
Tng chung

64
64
48
176

90,3
96,7
99,5
95,5

13,2
22,9
34,5
23,5

60,3
71,2
74,5
68,6

Nhn xt: Hn 95,5% cc b m bit mua v s dng mui i-t phng bnh
bu c, nhng t l b m hiu cch s dng mui i-t y ch chim 23,5% v
68,6% cc b m hiu tc hi thiu i-t.

3.4. Mt s yu t lin quan s dng mui i-t n t l bu c v nng i-t niu

hc sinh 8-12 tui.
Bng 3.12: Mt s yu t lin quan s dng mui i-t ti t l bu c tr em.
T l% bnh
Cc gi tr thng k
Cc yu t lin quan
C
Khng
OR
p
2
bu c
bu c
Tui
8-10 tui
9,7
90,3
1,4
2,19
> 0,05
11-12 tui
13,3
86,7
Gii
N
15,3
84,7
<
2,46
9,9
0,01*
Nam
5,8
94,2
Dn tc
Thiu s
11,4
88,6
1,12
0,85
> 0,05
Kinh
10,2
89,8
a im Gn trung 8,5
91,5
tm
7,9
92,1
1,08
0,38
> 0,05
Xa
trung
tm
I-t niu: < 10 g/dL 15,4
84,6
<
91,5
1,83
4,34

10 8,5
0,05*
g/dL
I-t mui < 20ppm
16,5
83,5
<
2,01
3,95
hgianh 20ppm
8,8
91,2
0,05*
*
So snh c ngha thng k p < 0,05
Bng 3.13: Mt s yu t lin quan s dng mui i-t ti nng i-t niu tr
em.
T l nng i-t
Cc gi tr thng k
niu
Cc yu t lin quan
<10 g/d 10 g/
OR
p
2
L
dL
24,7
75,3
Dn tc Thiu s
0,48
2,10
>0,05
m
Kinh
20,1
79,9
25,8
74,2
Trnh cp I
2,89
4,84
<0,05*
hc vn:
8,9
91,1
> cp II
Lm rung
62,3
37,7
Ngh
3,83
21,39
<0,001*
nghip
Ngh khc
35,0
65,0
Gn trung
tm
44,0
56,0
a im
1,28
1,93
>0,05
Xa
trung 42,2
57,8
tm
16,5
83,5
Nng i- <20ppm
2,01
3,95
<0,05*
t mui
8,2
91,8
20ppm

Cha
y
54,6
Hiu v

mui i-t
25,3
y
*

45,4
74,7

2,15

4,1

<0,05*

So snh c ngha thng k p < 0,05

- So snh mi lin quan v gii vi t l bu c th hc sinh n c nguy c

mc bu c cao hn hc sinh nam vi OR=2,46. S khc bit c ngha thng k (p
< 0,01).
- Mi lin quan v nng i-t niu vi t l bu c th khi nng i-t niu
<10 g/dL c nguy c mc bu c cao hn nng i-t niu 10 g/dL vi
OR=1,83. S khc bit c ngha thng k (p<0,05).
- V mi lin quan v nng i-t mui vi t l bu c th khi nng i-t
mui <20ppm c nguy c mc bu c cao hn nng i-t mui 20ppm vi
OR=2,01. S khc bit c ngha thng k (p<0,05).
Tm li: Hc sinh n, nng i-t trong mui thp <20ppm, nng i-t niu
<10 g/dl th c nguy c mc bu c cao hn nhm khng c cc yu t lin quan
trn. S khc bit c ngha thng k vi p < 0,05 n 0,01.
- Mi lin quan s dng mui i-t ca cc b m ti t l i-t niu gia nhm
b m c trnh hc vn thp cp I vi nhm b m c vn ho > cp II th nhm
b m trnh hc vn thp cp I c nguy c s dng mui i-t cha ng lin quan
n i-t niu thp < 10 g/dL cao hn nhm vn ho > cp II (OR=2,98), S khc bit
c ngha thng k (p < 0,05).
- So snh mi lin quan s dng mui i-t ti i-t niu gia nhm m lm
rung vi ngnh ngh khc (bun bn, cn b) th nhm m lm rung c nguy c s
dng mui i-t lin quan nhiu n i-t niu thp <10 g/dL cao hn nhm ngnh
ngh khc (bun bn, cn b) (OR=3,83). S khc bit c ngha thng k (p<0,05).
- Mi lin quan nng mui i-t lin quan ti i-t niu th khi nng i-t
trong mui < 20ppm c nguy c lm tng t l nng i-t niu < 10 g/dL
(OR=1,28). S khc bit c ngha thng k (p < 0,05).
- V mi lin quan hiu bit ca cc b m v mui i-t lin quan ti nng it niu th s hiu khng ng v mui i-t c lin quan n nng i-t niu lm
tng t l nng i-t niu <10 g/dL (OR=1,28). S khc bit c ngha thng k (p
< 0,05).
Cc b m trnh hc vn thp, lm rung, mui i-t c nng <20ppm,
hiu khng ng v s dng mui th lm cho t l % nng i-t niu <10 g/dL.
4. kt lun
Qua kt qu iu tra, khm xc nh bu c v nh lng i-t niu, TSH mu
416 hc sinh thuc 3 trng ph thng thuc huyn Vn Chn tnh Yn Bi v
phng vn v s dng, quan st cch bo qun mui i-t ca 176 b m c con 8-12
tui chng ti c nhng kt lun sau:
4.1. T l bu c hc simh 8-12 tui l 10,6%, mc trung v i-t niu l
24 g/dL (trong s mu <10 g/dL l 10,6%). Theo phn loi ca WHO/ICCIDD
th vng nghin cu ca 3 x huyn Vn Chn l vng thiu i-t nh.
4.2. Tnh hnh s dng mui i-t: 100% cc h gia nh u s dng mui i-t.
a s cc b m bit tc hi thiu i-t v s dng mui i-t cho gia nh phng

chng bu c nhng h li cha hiu cch s dng mui i-t nh th no cho thch
hp 63,1% cc b m s dng mui i-t cha ng, ch yu nhng h lm rung,
trnh vn ho thp, l ngi dn tc thiu s.
4.3. Mt s yu t c lin quan s dng mui i-t ca cc b m lm gia tng t
l bu c v nng i-t niu thp hc sinh 8-12 tui l: Gii ca tr, i-t niu,
nng i-t trong mui, trnh vn ho, ngh nghip v hiu bit ca m v mui it.
5. kin ngh
Trn c s cc kt qu thu c trong nghin cu ny, thc hin tt mc tiu
ca chng trnh quc gia phng chng CRLTI, chng ti c mt s khuyn ngh v
cc bin php gim t l bu c v nng cao nng i-t niu:
- Nn tng cng gim st cht lng mui i-t c 3 khu: ni sn xut,
niphn phi v ni tiu th m bo nng i-t trong mui ni tiu th (h gia nh
20 ppm).
- Nn tng cng gio dc cho nhn dn v bo qun mui i-t. Cn c nhng
pan, p-phch ph hp vi trnh v hiu bit ca ngi dn v bo qun mui it.