Deshmukh P R, Dongre A R, Sinha N, Garg B S
Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India.
Indian J Med Sci. 2009 Aug;63(8):345-54.
In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications.
To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children.
The cross-sectional study was carried out in Wardha district of central India.
We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey.
The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model.
Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested that anemia and mother's poor educational status are predictors of childhood morbidity.
Nutritional anemia and mother's poor educational status are the most important risk factors of acute childhood morbidity. There is need to revitalize existing health care delivery and child health programs in rural India with emphasis on immediate correction of nutritional anemia.
在印度，3岁以下儿童的常见疾病有发热、急性呼吸道感染、腹泻。在家中进行有效的早期管理以及出现危险体征时的就医行为是预防严重及危及生命并发症发生的关键策略。
了解急性儿童疾病的患病率、其决定因素以及这些儿童母亲的就医行为。
在印度中部的瓦尔道地区开展了这项横断面研究。
我们采用30群集抽样法对990名3岁以下儿童的母亲进行了访谈。营养状况根据美国国家卫生统计中心（NCHS）的参考标准来定义。构建了人体测量失败综合指数（CIAF）。使用“滤纸氰化高铁血红蛋白法”对每个儿童的血红蛋白浓度进行了估算。根据世界卫生组织的指南，贫血定义为血红蛋白浓度低于110g/L。调查后开展了焦点小组讨论（FGD）以弥补从调查中获得的信息缺口。
使用SPSS 12.0.1软件包对数据进行分析。采用卡方检验来检验关联性，同时计算比值比以衡量关联强度。应用多元逻辑回归分析得出最终模型。
80.3%的儿童检测出贫血，CIAF显示59.6%的儿童营养不良。急性疾病的总体患病率为59.9%。轻度贫血、中度贫血和重度贫血的儿童患病风险分别高出1.52倍、1.61倍和9.21倍。同样，出现1项、2项和3项人体测量失败的儿童患病风险分别高出1.16倍、1.29倍和2.27倍。在594名（60%）至少患有一种急性疾病的儿童中，520名（87.5%）寻求了医疗护理，其中大多数（66.1%）在私人诊所接受了治疗。最终模型表明贫血和母亲教育程度低是儿童患病的预测因素。
营养性贫血和母亲教育程度低是儿童急性疾病最重要的风险因素。有必要振兴印度农村现有的医疗服务和儿童健康项目，重点是立即纠正营养性贫血。
