Pongou Roland, Salomon Joshua A, Ezzati Majid
Harvard School of Public Health, Boston, MA, USA.
Int J Epidemiol. 2006 Jun;35(3):648-56. doi: 10.1093/ije/dyl016. Epub 2006 Mar 27.
It is generally hypothesized that macro economic shocks worsen child health by lowering household economic status and limiting access to health care, but this proposition seldom has been tested empirically. We examined the effects of economic crises and adjustment programmes during the 1990s in Cameroon on childhood malnutrition in population subgroups and evaluated the household and health system mediators of these effects.
We used pooled cross-sectional data from two Demographic and Health Surveys conducted in 1991 and 1998. In multivariate analysis, we stratified data on child sex and age, maternal education, and place and region of residence. We used a linear regression model to estimate the net effects of changes in average household economic status and maternal health seeking behaviour (MHSB) on changes in the prevalence of malnutrition for each stratum, adjusting for all other variables.
The prevalence of malnutrition in children younger than 3 years increased from 16 to 23% (P < 0.001) between 1991 and 1998. The increase in urban areas, from 13 to 15% (P = 0.391), mostly occurred in children of low-educated mothers. The increase in rural areas, from 19 to 25% (P < 0.001), mostly occurred in boys, children older than 6 months of age, those born to low-educated mothers, and those of low economic status. In urban areas, the advantage associated with higher maternal education was robust to all controls, and declines in economic status and MHSB were the mediators of increasing malnutrition. In rural areas, increase in malnutrition was higher in children with lower baseline economic status; decline in MHSB was a significant mediator of worsening nutritional status.
The negative nutritional effects during economic crises and adjustment programmes of the 1990s in Cameroon were largest among children of low socioeconomic status. Declines in household economic status and access to health care were the mediators of increasing malnutrition.
人们普遍认为，宏观经济冲击会通过降低家庭经济状况和限制获得医疗保健的机会来恶化儿童健康状况，但这一观点很少得到实证检验。我们研究了20世纪90年代喀麦隆的经济危机和调整计划对不同人群亚组儿童营养不良的影响，并评估了这些影响的家庭和卫生系统中介因素。
我们使用了1991年和1998年进行的两次人口与健康调查的汇总横断面数据。在多变量分析中，我们按儿童性别和年龄、母亲教育程度以及居住地点和地区对数据进行了分层。我们使用线性回归模型来估计平均家庭经济状况和母亲寻求医疗行为（MHSB）的变化对各层营养不良患病率变化的净影响，并对所有其他变量进行了调整。
1991年至1998年间，3岁以下儿童的营养不良患病率从16%上升至23%（P<0.001）。城市地区的患病率从13%上升至15%（P=0.391），主要发生在母亲受教育程度低的儿童中。农村地区的患病率从19%上升至25%（P<0.001），主要发生在男孩、6个月以上的儿童、母亲受教育程度低的儿童以及经济状况差的儿童中。在城市地区，与母亲较高教育程度相关的优势在所有对照中都很显著，经济状况和MHSB的下降是营养不良增加的中介因素。在农村地区，基线经济状况较低的儿童营养不良增加幅度更大；MHSB的下降是营养状况恶化的一个重要中介因素。
20世纪90年代喀麦隆经济危机和调整计划期间的负面营养影响在社会经济地位较低的儿童中最为明显。家庭经济状况和获得医疗保健机会的下降是营养不良增加的中介因素。
