Hong Rathavuth, Mishra Vinod
Demographic and Health Research Division, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705, USA.
J Health Popul Nutr. 2006 Mar;24(1):89-99.
The problems of food insecurity and under-nutrition remain particularly severe in countries recovering from recent wars or civil unrest, where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. Using information on 3235 children aged 0-59 month(s) included in the 2000 Cambodia Demographic and Health Survey, this study examined how economic inequality was associated with inequalities in chronic childhood under-nutrition. An under-nourished (stunted) child was defined as having his/her height-for-age more than two standard deviations below the reference median. Household wealth status was measured by an index based on household ownership of durable assets. Binary and multinomial logistic regressions were used for estimating the effects of household wealth status on moderate and severe stunting. The results indicated that children in the poorest 20% households were more than twice as likely to suffer from stunting as children in the richest 20% households (odds ratio [OR]=2.54; 95% confidence interval [CI] 1.91-3.39). Adjusting for child's age, sex, birth order, and duration of breastfeeding; age of mother at childbirth, body mass index, and education; and household access to safe drinking-water, hygienic toilet facility, residence, and geographic region made little difference to this effect (OR=2.05; 95% CI 1.28-3.28). The adjusted effect of wealth status was somewhat stronger on severe stunting (relative risk ratio [RRR]=2.26; 95% CI 1.22-4.18) than on moderate stunting (RRR=1.89; 95% CI 1.12-3.20). The study concludes that wealth inequality is strongly associated with chronic childhood under-nutrition and emphasizes that reducing poverty and making services more accessible to the poor will be key to improving the health and nutritional status of children in Cambodia.
在刚从近期战争或内乱中恢复的国家，粮食不安全和营养不良问题仍然尤为严峻，在这些国家，经济状况的改善往往使优势群体受益，并导致了广泛的健康不平等。本研究利用2000年柬埔寨人口与健康调查中纳入的3235名0至59个月儿童的信息，考察了经济不平等与儿童慢性营养不良不平等之间的关联。营养不良（发育迟缓）儿童的定义为其年龄别身高比参考中位数低两个以上标准差。家庭财富状况通过基于家庭耐用资产所有权的指数来衡量。二元和多项逻辑回归用于估计家庭财富状况对中度和重度发育迟缓的影响。结果表明，最贫困的20%家庭中的儿童发育迟缓的可能性是最富裕的20%家庭中儿童的两倍多（优势比[OR]=2.54；95%置信区间[CI]1.91 - 3.39）。对儿童的年龄、性别、出生顺序和母乳喂养时长；母亲分娩时的年龄、体重指数和教育程度；以及家庭获得安全饮用水、卫生厕所设施、居住情况和地理区域进行调整后，这种影响变化不大（OR=2.05；95% CI 1.28 - 3.28）。财富状况对重度发育迟缓的调整效应（相对风险比[RRR]=2.26；95% CI 1.22 - 4.18）比对中度发育迟缓的调整效应（RRR=1.89；95% CI 1.12 - 3.20）略强。该研究得出结论，财富不平等与儿童慢性营养不良密切相关，并强调减少贫困以及让穷人更容易获得服务将是改善柬埔寨儿童健康和营养状况的关键。
