Ear-nose-throat morbidity patterns and determinants among Vietnamese Highland schoolchildren

To describe the clinical profile of ear-nose-throat (ENT) diseases among primary school children in mountainous northern Vietnam and to analyze associated demographic, nutritional, and classroom environmental factors.

A school-based cross-sectional study was conducted in four primary schools in Sa Pa, Lao Cai. A total of 422 pupils in Grades 1-5 with complete data were included. Standardized interviews and clinical ENT examinations were conducted, and anthropometric indices were converted to WHO Z-scores (WAZ, HAZ, BAZ). Classroom environments were evaluated following TCVN 13521:2022, including measurements of temperature, humidity, air velocity, CO₂, particulate matter (PM₂.₅, PM₁₀), and bioaerosols (bacteria, fungi, CFU/m³). Statistical analyses used χ² and t-tests.

Half of the children (50.9%) were diagnosed with at least one ENT condition, most commonly nose/sinus disease (32.2%) and tonsillitis (30.1%). ENT morbidity was significantly higher among stunted children (p = 0.040) and varied by ethnicity (p < 0.001), while age, sex, and BMI-for-age were not significant. Affected classrooms had higher bacterial (817.0 vs. 577.4 CFU/m³) and fungal loads (480.0 vs. 371.8 CFU/m³) and elevated CO₂ (550.3 vs. 523.5 ppm), indicating poorer air quality (all p < 0.001).

ENT diseases are common among highland Vietnamese schoolchildren and are linked to chronic undernutrition and suboptimal indoor air quality. Practical interventions such as improved classroom ventilation, humidity control, and regular school-based ENT screening and nutrition programs are urgently needed to reduce disease burden and enhance child health and learning outcomes.