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Thc trang dinh dng va mot so yeu to

lien quan cua tre em di 5 tuoi ngi dan toc
Raglai tai hai huyen mien nui Khanh Sn va
Khanh Vnh, tnh Khanh Hoa nam 2013
Bui Xuan Minh1, Le Tan Phung1, Tran Ngoc Thanh1

at van e: Suy dinh dng (SDD) tre em la van e sc khoe quan trong tai cac nc ang phat trien
va ac biet quan trong nhom tre em ngi dan toc thieu so. Dan toc Raglai Khanh Hoa chu yeu
song tap trung tai 2 huyen Khanh Sn va Khanh Vnh. Nghien cu thc trang dinh dng tre em di
5 tuoi ngi Raglai 2 huyen nay se giup xac nh t le SDD cua tre va khao sat moi lien quan gia
SDD vi cac yeu to xa hoi khac. Phng phap nghien cu: S dung thiet ke cat ngang cho tre em di
5 tuoi ngi Raglai tai 2 huyen Khanh Sn va Khanh Vnh. Tien hanh o va tnh toan cac ch so nhan
trac can nang theo tuoi, chieu cao theo tuoi va can nang theo chieu cao. S dung phan mem WHO
Anthro va Stata 12.0 e phan tch cac ch so nhan trac va cac yeu to lien quan. Ket qua: T le SDD cua
tre em di 5 tuoi ngi Raglai tai 2 huyen Khanh Sn va Khanh Vnh rat cao: 56,5% the nhe can va
68,7% the thap coi. Xu hng t le SDD tang theo nhom tuoi, at nh nhom tuoi 2 - <3 tuoi. T le
SDD cao nhng tre co ba me co trnh o hoc van thap. Ket luan: Thc trang SDD cua tre em di
5 tuoi ngi Raglai song tai 2 huyen Khanh Sn va Khanh Vnh la ang bao ong, can co nhng bien
phap can thiep kp thi va hu hieu.

Nutritional status and related factors among

Raglai ethnic minority children under 5 years
old in two mountanous districts of Khanh Hoa
province in 2013
Bui Xuan Minh1, Le Tan Phung1, Tran Ngoc Thanh1

Background: Malnutrition has been a critical health problem in developing countries. It is also
becoming a serious health problem among ethnic minority groups. Raglai ethnic minority people are
mainly living in 2 mountainous districts of Khanh Son and Khanh Vinh, Khanh Hoa province. A survey
on nutritional status of Raglai Children, under five years old, aimed to determine malnutrition rate
among them and its related factors.

Tap ch Y te Cong cong, 10.2015, So 37

19

Ngay nhan bai: 15.04.2015 Ngay phan bien: 20.06.2015 Ngay chnh sa: 01.09.2015 Ngay c chap nhan ang: 30.09.2015

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Methodology: The study was designed as the cross-sectional study to measure and calculate
anthropometric indices: weight-for-age, height-for-age, and weight-for-height. WHO Anthro software
and Stata 12.0 were used to analyze anthropometric indices and possible associations.
Results: Underweight and Stunting malnutrition of Raglai children under 5 years old living in Khanh
Son and Khanh Vinh districts were very high, at 56.5% and 68.7%, respectively. There was an
increasing tendency of malnutrition proportional to children age groups, which reached the peak at
the age group of 2 - < 3 years old. The malnutrition rate was significantly higher in children whose
mothers have low educational level.
Conclusion: Malnutrition status in Raglai children under five years of age living in Khanh Son and
Khanh Vinh district was an alarming condition. Urgent and effective intervention strategies should be
undertaken to resolve this problem.
Key words: Raglai children, Ethnic minority group, Underweight, Stunting, Wasting.

Tac gia:
1.

S Y te tnh Khanh Hoa

1. at van e
Suy dinh dng (SDD) tre em la van e sc
khoe toan cau, ac biet la cac nc ang phat
trien.Trong so 10 tre em di 5 tuoi t vong tai
cac nc ang phat trien th co 7 trng hp la do
cac benh nhiem trung ho hap cap, tieu chay, si va
sot ret, trong o SDD co mat mot na cac trng
hp t vong nay [11]. SDD cua ba me va tre em la
nguyen nhan tiem tang cua 3,5 trieu trng hp t
vong tren the gii, ong gop 35% ganh nang benh
tat cua tre em di 5 tuoi [8]. Theo thong ke cua To
chc Y te the gii (WHO), co gan 30% nhan loai
bao gom tre em, tre nho, tre v thanh nien, ngi
trng thanh va ngi gia ang b anh hng bi
nhieu dang SDD khac nhau [12]. Cac hau qua cua
SDD bao gom tang nguy c nhiem trung, nguy c t
vong, cham phat trien the chat, tr tre tinh than, anh
hng ti ket qua hoc tap va kha nang lao ong khi
trng thanh.Tre SDD de co nguy c b nhiem trung.
Khi tre b nhiem trung, nguy c suy dinh dng cao
hn.C nh the tao thanh mot vong luan quan gia
suy dinh dng va nhiem trung lam cho tnh trang
suy dinh dng va nhiem trung tang len, anh hng
20

Tap ch Y te Cong cong, 10.2015, So 37

ti phat trien the chat va tinh than cua tre.Moi mc

o SDD eu lam tang nguy c t vong cua tre: Tre
SDD nang va cap tnh co nguy c t vong cao gap 9
lan so vi tre bnh thng [12].
Thc trang dinh dng tre em, ac biet la tre
em di 5 tuoi a c nghien cu nhieu, ca trong
nc [2, 3, 6] lan the gii [7, 10].Mot so nghien cu
tap trung vao nhom tre em dan toc thieu so [1, 4,
5].Thc te cho thay t le SDD tre em tai cac vung
nui ni co nhieu dan toc thieu so sinh song van con
cao, s chenh lech vung mien ve thc trang dinh
dng van con ln. V vay can co theo doi, giam sat
nhng vung co nguy c cao nh cac tnh, huyen
mien nui.
Tuy nhien, t co nghien cu ve thc trang dinh
dng cua tre em di 5 tuoi thuoc cong ong ngi
dan toc thieu so Raglai ang sinh song tai hai huyen
mien nui Khanh Sn va Khanh Vnh. Nghien cu
nay c thc hien nham anh gia thc trang dinh
dng cua tre em ngi Raglai, tm hieu moi lien
quan gia cac ch so nhan trac vi cac yeu to lien
quan en ba me, ieu kien ve sinh moi trng va
gia nh.

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2. Phng phap nghien cu

2.1. oi tng nghien cu
oi tng nghien cu la tre em di 5 tuoi
ngi dan toc Raglai ang sinh song tai hai huyen
mien nui: Khanh Sn va Khanh Vnh. T le ngi
Raglai sinh song tren a ban huyen Khanh Sn la
75% va tai huyen Khanh Vnh la 48% so vi dan so
toan huyen.

2.2. Thi gian nghien cu

Nghien cu c thc hien t thang 7 en thang
8/2013.
2.3. Thiet ke nghien cu
S dung thiet ke nghien cu cat ngang.
2.4. C mau va phng phap chon mau
C mau c tnh rieng le cho tng huyen, da
theo cong thc tnh c mau cho mot quan the hu
han [9]:

N z p (1 p )
d 2 ( N 1) + z 2 p (1 p )
2

n =
Trong o:
n: C mau

N: Tong so tre em di 5 tuoi ngi dan toc Raglai cua

huyen. Thong ke cho thay co 1.933 tre em ngi Raglai
di 5 tuoi huyen Khanh Sn. Con so nay cua huyen
Khanh Vnh la 1.976.
z: Gia tr tng ng vi phan phoi Z. Trong trng hp
xac nh o tin cay la 95% th gia tr z = 1,96.
p: T le suy dinh dng theo cac nghien cu trc. Tuy
nhien, e toi a hoa c mau, chon p = 0,5.
d: o chnh xac tuyet oi. Chon d = 0,05

C mau s bo da vao cong thc nay la 321 cho

huyen Khanh Sn va 322 cho huyen Khanh Vnh.
Do phng phap chon mau la mau cum 2 giai
oan cho nen c mau c nhan vi he so thiet ke
DE = 2. D kien co 10% so tre t choi tham gia hoac
khong u so lieu, d phong 10%.
Sau khi ieu chnh theo he so DE va d phong
10%, c mau huyen Khanh Sn la 706 va huyen
Khanh Vnh la 708 tre, lam tron cho 2 huyen la
710 tre.
Mau c chon theo phng phap mau cum 2
giai oan:

- Tai moi huyen chon tat catre em ngi Raglai

di 5 tuoi tuoi song tren a ban huyen (chon tat
ca cac xa).
- Tai moi xa chon ngau nhien 02 thon bang
bang so ngau nhien (Trng hp xa co 02 thon th
chon tat ca). Rieng th tran Khanh Vnh va th tran
To Hap huyen Khanh Sn chon 03 thon.
- Tai moi thon lap khung mau he thong la danh
sach tre em di 5 tuoi ngi Raglai xep theo
thon, gii, ten cua tre. Xac nh khoang cach lay
mau (sampling interval) bang cong thc k = N/n
= 1933/710 3. Chon mot so ngau nhien r t 1
3.oi tng c chon tham gia nghien cu la oi
tng th r, r+k, r+2k, r+3k

2.5. Phng phap thu thap so lieu

S dung bo cau hoi e thu thap cac yeu to lien
quan. Cac ch so chieu cao va can nang cua tre c
o nh sau:
oi vi tre di 2 tuoi: Can nang c o bang
can nang treo do Vien Dinh dng cung cap a c
chuan hoa, chnh xac en 0,1kg. Chieu cao nam c
o bang thc o chieu cao nam do Vien Dinh dng
cung cap a c chuan hoa, chnh xac en 0,1cm.
oi vi tre t 2 tuoi tr len: Can nang c o
bang can ien t hieu Microlife, mi 100%, chnh
xac en 0,1kg. Chieu cao o bang thc o chieu cao
ng c chuan hoa bi Chi cuc tieu chuan o lng
chat lng tnh Khanh Hoa, chnh xac en 0,1cm.

2.6. Phng phap phan tch

So lieu c nhap bang phan mem EpiData
3.1.Cac ch so nhan trac c phan tch bang phan
mem WHO Anthro 3.2.2 cua To chc Y te the gii
(WHO).Phan mem nay s dung quan the tham chieu
cua WHO nam 2006. Mot macro cua phan mem nay
c s dung cho chng trnh Stata 12.0 e trc tiep
tao ra va phan tch cac ch so nhan trac. S dung test
Chi bnh phng (2) e so sanh cac ty le lien quan.
Cac ch so nhan trac s dung trong nghien cu
nay bao gom: Can nang theo tuoi(WA), chieu cao
theo tuoi (HA) va can nang theo chieu cao (WH).
Gia tr Z scores c tnh toan cho 3 ch so nay e
phan tch tnh trang dinh dng cua tre. Theo mac
nh cua chng trnh, cac gia tr Z scores co anh
dau (flagged) se b loai trong qua trnh phan tch.
ay la cac gia tr qua cao hay qua thap mot cach bat
Tap ch Y te Cong cong, 10.2015, So 37

21

| TONG QUAN & NGHIEN CU |

thng, vt qua 4 hoac 5 lan o lech chuan (SD).

Tieu chuan anh gia SDD nhe can khi WAZ < -2SD,
SDD thap coi khi HAZ < -2SD va SDD the gay com
khi WHZ < -2SD. SDD mc o nang khi cac gia tr
tren nho hn -3SD.Tieu chuan anh gia tha can va
beo ph da vao Z scores cua ch so WH: Tha can
khi WHZ > 2SD va beo ph khi WHZ > 3SD.
Bien so phu thuoc trong nghien cu nay la cac
tnh trang dinh dng cua tre thong qua Z scores cua
3 ch so WA, HA va WH. Cac bien so oc lap bao
gom cac yeu to lien quan nh tuoi, gii cua tre, tnh
trang sot va tieu chay cua tre, thi gian bu me, trnh
o hoc van cua me, ieu kien ve sinh ho gia nh.

3. Ket qua va ban luan

Co tong cong 1.423 tre di 5 tuoi c khao

sat (Bang 1). Phan tch s bo cho thay co 3 tre
tren 60 thang tuoi tai thi iem ieu tra, do o b
loai trong qua trnh phan tch. Co 707 tre song tai
huyen Khanh Sn, chiem t le 49,8%, va 713 tre
thuoc huyen Khanh Vnh (50,2%). C mau cho tng
huyen la at yeu cau so vi c mau thiet ke. Co 719
tre trai (50,6%) va 701 tre gai (49,4%). Co 20,8%
tre di 24 thang tuoi.
Bang 1: ac iem cua mau nghien cu (n = 1.420)
So lng

T le %

707
713

49,8
50,2

719
701

50,6
49,4

Gii tnh

3.2. Phan tch thc trang dinh dng cua tre

theo cac ch so Z scores
3.2.1. Thc trang SDD
- T le SDD noi chung
T le SDD cac the nhe can (WA) va thap coi
(HA) rat cao tre em di 5 tuoi ngi Raglai tai 2
huyen Khanh Sn va Khanh Vnh. Cac t le nay lan
Tap ch Y te Cong cong, 10.2015, So 37

SDD the thap coi

(n=1.369)

SDD the gay com

(n=1.345)

So lng

T le %

So lng

T le %

So lng

T le %

408
383

58,6
54,3

514
426

74,4
62,8

123
122

17,9
18,5

a phng
Khanh Sn
Khanh Vnh
So sanh

p = 0,105

p < 0,001

p = 0,762

Gii tnh
424
367

60,1
52,7

493
447

p = 0,005

70,6
66,6

152
93

p = 0,11

22,3
14,1
p < 0,001

Nhom tuoi
< 1 tuoi

11

20.0

22

43,1

14,6

1 - < 2 tuoi

109

46,8

131

60,4

46

21,6

2 - < 3 tuoi

243

60,7

277

70,7

84

21,8

3 - < 4 tuoi

252

60,0

298

71,3

64

15,7

4 - < 5 tuoi

176

60,1

212

72,8

43

15,1

So sanh

3.1. ac iem mau nghien cu

22

SDD the nhe can

(n=1.401)

So sanh

e tai a c thong qua hoi ong ao c

nghien cu S Y te Khanh Hoa.

Trai
Gai

Bang 2: T le SDD cac the cua tre em < 5 tuoi

2 huyen Khanh Sn va Khanh Vnh

Trai
Gai

2.7. Van e ao c nghien cu

a phng
Khanh Sn
Khanh Vnh

lt la 56,5% va 68,7%. T le SDD the gay com co

thap hn (18,2%) nhng van la t le cao so vi t le
chung cua toan tnh (Bang 2).

p < 0,001
p trend < 0,001

p < 0,001
p trend < 0,001

p = 0,06
p trend = 0,87

Chung

791

56,5

940

68,7

245

18,2

95% CI

53,8

59,1

66,1

71,1

16,2

20,4

S dung test thong ke Chi bnh phng (2) cho

thay t le SDD the thap coi tre em di 5 tuoi huyen
Khanh Sn cao hn huyen Khanh Vnh mot cach
co y ngha (74,4% so vi 62,8%, p< 0,001). cac
the khac, t le SDD khong co s khac biet gia 2 a
phng. So sanh gia tre trai va tre gai, tr SDD the
thap coi, SDD the nhe can va gay com cao hn mot
cach co y ngha tre trai so vi tre gai. S khac biet
ve t le SDD cua tre gia 5 nhom tuoi la co y ngha
thong ke oi vi the nhe can va thap coi, ong thi co
xu hng gia tang t le SDD 2 the nay theo thang tuoi
cua tre (p trend < 0,001), at nh cao nhat nhom
tuoi 2 3 tuoi. oi vi SDD the gay com, ket qua
phan tch cho thay khong co s khac biet co y ngha
gia cac nhom tuoi va cung khong the hien xu hng
gia tang SDD the nay theo thang tuoi cua tre (p trend
oi vi ch so WH = 0,87). Bieu o 1 cho thay xu
hng gia tang t le SDD cac the theo nhom tuoi, at
nh vao nhom tuoi 2 3 tuoi.
- Phan o SDD
Ve phan loai mc o SDD, ket qua phan tch
cho thay t le SDD nang chiem kha cao, > 20%.
Theo cach phan loai cua Vien Dinh dng Quoc
gia, cac t le nay cua 2 the nhe can va thap coi the
hien tai Bang 3.

| TONG QUAN & NGHIEN CU |

o tre. Tre c cho la sot khi than nhiet > 37,5oC,

tieu chay khi tre i cau phan long tren 3 lan/ngay.
Khao sat moi lien quan gia tnh trang SDD cua tre
va sc khoe tai thi iem khao sat (co sot va/hoac
tieu chay), ket qua phan tch cho thay cha co moi
lien quan co y ngha gia tnh trang SDD cua tre vi
sc khoe tre tai thi iem ieu tra (p > 0,05), mac
du cac t le SDD tai Bang 4 cho thay nhng tre co
sot hoac tieu chay th t le SDD cao hn.

Bieu o 1. Xu hng t le SDD cac the theo nhom tuoi

Bang 3: Phan o SDD cua tre em di 5 tuoi 2 huyen

Khanh Sn va Khanh Vnh
Suy dinh dng
the nhe can
(n = 1.401)

Phan o SDD

Suy dinh dng

the thap coi
(n = 1.369)

So lng

T le %

So lng

T le %

SDD nang

321

22,9

500

36,5

SDD va

470

33,6

440

32,1

3.2.2. Thc trang tha can beo ph

Tha can beo ph khong phai la van e sc khoe
cua tre em Raglai di 5 tuoi tai 2 huyen nay. Ch
co 1,9% (25/1.345) tre em c ghi nhan la tha can
va beo ph, trong o tha can chiem 1,3% va beo
ph ch chiem 0,5%. T le tha can beo ph gia tre
trai va gai khong co s khac biet co y ngha (1,8%
va 2,0%).

3.3. Moi lien quan gia SDD va cac yeu to

gia nh, xa hoi
3.3.1. Moi lien quan gia SDD va cac yeu to
thuoc ve tre
Bang 4. Lien quan gia SDD va tnh trang sot, tieu
chay cua tre
The SDD
The nhe can

Sot

Tieu chay

Co

Khong

So sanh

Co

Khong

So sanh

60,7%

55,8%

p = 0,220

61.0%

56,3%

p = 0,471

71,8%

68,0%

p = 0,314

75,4%

68,3%

p = 0,241

(WAZ2 SD)
(n = 1.398)
The thap coi
(HAZ2SD)
(n = 1.363)

Sot va tieu chay c ghi nhan tai thi iem can

Ve thi gian bu sa me, khao sat cho thay trong

so tre t 24 thang tuoi tr len ch co 39,4% c bu
me cho en 24 thang hoac hn (351/892). Phan ln la
ch cho bu me t 12-24 thang (48,4%). Mot t le nho
ch cho bu me < 6 thang (3,9%) hoac t 6-12 thang
(8,3%). Khao sat moi lien quan gia thi gian bu me
va t le SDD cha cho thay co y ngha thong ke.
Bang 5. Lien quan gia SDD va thi gian cho tre bu me
Thi gian bu me

The SDD

So sanh

<6
thang

6 12
thang

1224
thang

thang

The nhe can

(WA)
(n = 884)

61,8%

56,8%

56,1%

60,3%

p = 0,641

The thap coi

(HA)
(n = 875)

80,0%

69,9%

69,4%

70,2%

p = 0,625

24

3.3.2. Moi lien quan gia SDD va trnh o hoc

van ba me
Bang 6. Lien quan gia SDD va trnh o hoc van
cua Bo Me
The SDD

Trnh o hoc van

Khong

Tieu hoc

THCS

60,9%

58,5%

54,6%

THPT

> THPT

47,1%

50,0%

Bo
The nhe can
(WA) (n = 1.298)
So sanh

p = 0,072, p trend = 0,005

The thap coi

(HA) (n = 1.263)

74,7%

So sanh

70,2%

66,9%

57,6%

50,0%

p = 0,005, p trend = 0,000

Me

The nhe can

(WA) (n = 1.298)

67,2%

55,2%

77,4%

67,8%

So sanh

36,9%

35,7%

p = 0,000, p trend = 0,000

The thap coi

(HA) (n = 1.263)
So sanh

50,0%

63,2%

51,8%

56,7%

p = 0,000, p trend = 0,000

Tap ch Y te Cong cong, 10.2015, So 37

23

| TONG QUAN & NGHIEN CU |

Phan tch SDD the nhe can va thap coi cua tre
trong moi tng quan gia trnh o hoc van cua bo
me cho thay s khac biet ve t le SDD la co y ngha
thong ke gia cac mc trnh o hoc van vi nhau.
Phan tch xu hng cho thay trnh o hoc van cua
bo me cang cao th t le SDD con cua ho the thap
coi va the nhe can cang thap. Tuy nhien, moi tng
quan xu hng nay manh hn oi vi hoc van cua
ngi me (p trend < 0,001).
3.3.3. Moi lien quan gia SDD va ieu kien ve
sinh ho gia nh
Khao sat moi lien quan gia t le SDD the nhe
can va thap coi vi 2 ieu kien ve sinh ho gia nh
la nguon nc s dung va ho x, ket qua phan tch
cho thay cha co moi lien quan co y ngha gia t
le SDD the nhe can vi nguon nc s dung va co
hay khong co ho x (Bang 7). Tuy nhien, oi vi
SDD the thap coi th gia nh khong co ho x co t
le tre SDD cao hn co y ngha so vi gia nh co
ho x (p < 0,05).
Bang 7. Lien quan gia SDD va ieu kien ve sinh
ho gia nh
Ho x
The SDD

Nguon nc hp ve sinh

Co

Khong

So sanh

Co

Khong

So sanh

The nhe can

(WAZ 2SD)
(n = 1.401)

53,9

56,8

p = 0,425

55,9

56,9

p = 0,709

The thap coi

(HAZ2SD)
(n = 1.397)

61,6

69,9

p = 0,015

67,3

69,8

p = 0,326

Viec s dung ho x hp ve sinh co lien quan trc

tiep en sc khoe va benh tat cua cac thanh vien
trong gia nh v hau het cac benh ly nhiem trung,
ky sinh trung c lay truyen trc tiep theo ng
tieu hoa. Viec khong s dung ho x hoac s dung ho
x khong hp ve sinh se lam tang nguy c mac cac
benh ly nay va do o anh hng en dinh dng
cua tre.

24

Tap ch Y te Cong cong, 10.2015, So 37

4. Ket luan va khuyen ngh

4.1. Ket luan
4.1.1. Ve thc trang dinh dng cua tre em
di 5 tuoi ngi Raglai ang sinh song tai 2 huyen
Khanh Sn va Khanh Vnh, tnh Khanh Hoa:
- T le SDD the nhe can va thap coi rat cao
(56,5% va 68,7%), trong o Khanh Sn co t le SDD
cao hn so vi Khanh Vnh, nhat la the thap coi
(74,4% so vi 62,8%).
- SDD tre trai cao hn tre gai the nhe can
va gay com.
- SDD co xu hng gia tang dan theo tuoi, at
nh en nhom tuoi 2 - < 3 tuoi
4.1.2. Ve cac yeu to nguy c lien quan en tnh
hnh SDD cua tre em di 5 tuoi ngi Raglai tai 2
huyen Khanh Sn va Khanh Vnh:
- Trnh o hoc van cua Me co lien quan chat che
en tnh trang dinh dng cua tre.
- Xu hng SDD cao nhng tre co ba me co
trnh o hoc van thap.
- ieu kien ve sinh ho gia nh (ho x) co lien
quan en tnh trang dinh dng cua tre.

4.2. Khuyen ngh

- Can co can thiep dinh dng cho tre di 5
tuoi ngi Raglai tai 2 huyen Khanh Sn va Khanh
Vnh, chu trong can thiep nhom tuoi di 24 thang
do xu hng SDD tang cao nhom tuoi nay.oi vi
tre SDD nang, can to chc phuc hoi dinh dng trc
tiep chotre thong qua bo sung thc pham dinh dng
trong cac ba an hang ngay cua tre.
- Nang cao nhan thc va thc hanh nuoi dng
tre cho cac ba me hoac ngi nuoi dng chnh
thong qua cac bien phap giao duc, truyen thong lien
quan en dinh dng va thc hanh dinh dng, nhat
la kien thc va thc hanh ve bu me va an bo sung
ung cach.
- Ve lau dai, can nang cao trnh o hoc van cua
ngi dan toc Raglai, ong thi vi viec cai thien
ieu kien kinh te va thu nhap ho gia nh.

| TONG QUAN & NGHIEN CU |

Tai lieu tham khao
Tieng Viet

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