Ngirabega J D D, Hakizimana C, Wendy L, Donnen P, Dramaix-Wilmet M
Ministère de la Santé, hôpital de Ruli, BP 1285, Kigali, Rwanda.
Rev Epidemiol Sante Publique. 2010 Apr;58(2):111-9. doi: 10.1016/j.respe.2009.11.003. Epub 2010 Feb 21.
In order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training.
The prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition.
Our findings show that children from 12-35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan.
Community based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.
为了改善卢旺达鲁利区医院集水区内社区营养项目的管理，我们开展了一项营养调查，以确定该地区儿童营养不良的风险因素。识别营养不良风险儿童群体及其风险因素，有助于社区营养工作者针对需要密切监测的儿童，并协助制定营养教育培训的关键信息。
采用年龄别身高、年龄别体重和身高别体重的Z评分，并参照美国国家卫生统计中心/世界卫生组织/2000标准，估算三种营养不良形式的患病率。进行逻辑回归分析以确定营养不良的风险因素。
我们的研究结果表明，12至35个月大的儿童营养不良风险最高。消瘦的风险因素包括：家庭月收入低、儿童同时患有疾病以及家庭不实行养育。体重不足的风险因素包括：儿童年龄大于12个月、儿童母亲怀孕以及家庭中有营养不良史。最后，发育迟缓的风险因素包括：家庭中没有蚊帐、家庭中工作的成年人数量不足、儿童年龄大于12个月以及由男性独自管理或由孤儿管理的家庭。
基于社区的生长监测必须将重点放在9至35个月大的儿童身上。9个月以下的儿童通常由卫生中心通过免疫规划进行跟踪，年龄较大的儿童通常在需要在所有小区推广的托儿所中进行跟踪。社区宣传信息必须聚焦于已确定的营养不良风险因素，并且必须在整个区域引入积极偏差方法。
