Nutrition and Health in Vietnam

By Baukje Vrieswijk

The title of the proposal is Nutritional Status and health of Women in relation to Household Food Security in Urban and Rural Vietnam. Two Dutch researchers and two Vietnamese PhD students will be working together in the proposed project. In the second half of the project phase a post-doc will be recruited. The focus of the project will be the food security of households in the urban slum areas of Ho Chi Min City in South Vietnam in comparison with the food security situation of households in one of the provinces of the Northern Red River delta (e.g. Vinh Phu province). Women play a central role in the household food security and the overall health situation of preschool children in the household. Their abilities, knowledge, health and nutritional status directly affect the well-being of their children. malnutrition, high morbidity and mortality among pre-school children is still a world-wide problem,. Therefore special attention will be given to the health and nutritional status of women (mothers of pre-school children, pregnant and lactating women) and the underlying causes of malnutrition among women. More specifically: the research will aim at assessing the direct causes and underlying factors, as well as the processes which lead to the quantitative inadequacy of habitual diets in urban slums and rural areas, with a special focus on the relationship: food security - health - nutritional status.
The multi-disciplinary integration of nutritional and sociological aspects of the nutritional problems in urban and rural Vietnam will be a major goal as well. The final aim will be to identify opportunities to improve the nutritional status and well-being of women and, through them, pre-school children in the specific areas.

Why Vietnam?
Nutrition science in Vietnam is relatively new. Moreover, nutrition research that has been done up to now has been mainly carried out by researchers of one discipline only. Research with a multi-discipline character, assessing direct causes and underlying factors as well as processes which lead to nutritional problems, will be a learning opportunity for Vietnamese researchers.
Another important reason for focusing on Vietnam is the recent changes in Vietnam. Vietnam is a country in transition since the renovation process which started in 1986. Vietnam is opening up and, being in a transitional phase, it is a challenging place to do research and help with solving problems that arise at this time of many changes.
Recent studies showed that 20 percent of Vietnamese households lived below the poverty line, eating fewer than 2,100 calories per day per person. A quarter of that group was found to be poor enough to be classed as 'hunger stricken'. A recent World Bank examination put Vietnam below China, Indonesia and the Philippines. It classed 27 percent of Vietnam's urban residents as poor, compared to 57 percent in the countryside, where nearly 80 percent of Vietnam's 72 million people live.

Health and nutrition related problems
The emancipation of women is actively promoted in Vietnam and they are encouraged and helped to work outside the home. However, women's health status is at risk, as attested by the apparently high rates of maternal mortality and nutritional deficiency, particularly anaemia.
Chronic malnutrition affects more than half Vietnamese children between one and five years of age. Acute malnutrition is highest in the 12-23 month age group. There is also a high frequency of anaemia in the infant group. Several factors can explain this situation: low birth weight, anaemia in the mother, duration of breast feeding, early weaning, inappropriate complementary feeding. In addition, vitamin A deficiency is a problem of public health significance in all areas of Vietnam and many children are affected. Four variables play an important role in the development of vitamin A deficiency among children in Vietnam: insufficient breast milk, premature weaning, interruption of breast feeding during illness and lack of green leafy vegetables in children's meals.
In Vietnam about 85 percent of the energy intake is supplied by rice and there is a limited variety of food intake. Supplementary feeding for pregnant women and young children is also inadequate., Children's precarious nutritional status reduces their immunity and makes them vulnerable to disease and infection.
Understanding of basic issues such as behaviour and coping strategies of poor households and their members must be improved, especially with regard to household food security and health, both having an important impact on the nutritional status of women and pre-school children. This is true for rural areas,, but equally for urban areas. Both have their specific problems and any food security and health improvement policy must be tailored to the specific areas.

Recent urbanization processes
Urbanization is starting to play an important role in Vietnam, with all its specific problems. Ho Chi Minh City is the largest metropolitan area in Vietnam, with a population of 4 million people. However, there is a considerable additional number of illegal residents and about 1 million square metre of slum housing along the banks of canals.
The urban population declined considerably in the southern provinces after 1976 (reunification of Vietnam), following the return to the countryside of the people who had moved to the city during the War. However, between 1984 and 1989 there was considerable movement of the population back into Ho Chi Minh City from the surrounding provinces, from the mid-eastern seaboard provinces and from the province of Hanoi.
Concentration of the population in a particular area has serious implications for employment, food and nutrition, health, education, housing and social welfare. Recently, a start has been made with studies to determine urban poverty and how it affects food security. It is too early to determine relationships, but a better understanding of how women and hence their children cope would be useful in identifying the best points of entry for public policy intervention.

The research project
The research projects will consist of two parts:

1. Determinants of health and nutritional status of women in urban slum areas in Ho Chi Mich City and a province in rural Northern Red River delta in Vietnam.
- Immediate objective: Improve health and nutritional status of women and pre-school children
- research topic: Understanding the factors that influence poor health and malnutrition among pregnant and lactating women, and mothers of pre-school children in slum areas of urban Ho Chi Mich City and rural areas in Northern Vietnam.

2. Determinants of household food security and women's role in food security, in urban slum areas in Ho Chi Mich City and a province in rural Northern Red River delta in Vietnam.
- Immediate objective: Improve effectiveness of strategies and projects to battle specific urban and rural food insecurity.
- Research topic: Understanding coping strategies of women in urban and rural settings with regards to household food security and understanding of determinants of food security in slum areas of urban Ho Chi Mich City and rural areas in Northern Vietnam.
Funds have been requested from WOTRO and we hope that approval will be given to the research project. When approval is given, researchers can be recruited for the formulation of proposals for separate research topics. The project division of the IIAS will then take care of the administration of the project and, in co-operation with Prof, A. Niehof and the advisory committee, be responsible for the supervision of the researchers. In the final stage of the project, the projects division of the IIAS will organize a workshop in which the results of this project will be presented.