Cheah Whye Lian, Muda Wan Abdul Manan Wan, Zamh Zabidi-Hussin
Universiti Malaysia Sarawak, Sarawak, Malaysia.
Rural Remote Health. 2010 Jan-Mar;10(1):1248. Epub 2010 Feb 25.
Many studies had shown that poor growth in children is associated with malnutrition. The underlying factors are diverse, multisectoral and interrelated, ranging from biological to social, cultural and economically related. Because the highest levels of under-nutrition worldwide are found in South Asia, it is essential that policymakers in the region understand the underlying determinants, in order to design effective public health intervention programs. This is especially so if public resources are limited. The purpose of this cross-sectional study was to examine causal relationships among the biological, behavioural and environmental factors related to malnutrition in children aged 5 years and under.
The instrument used in this study was based on a previously described conceptual framework for malnutrition in children, and tested for its psycometric component, using both qualitative and quantitative methods. As well as the use of a questionnaire, anthropometric and dietary data were collected from 295 children aged 5 years and below, randomly selected from clinics in Tumpat, Kelantan. The proposed model was tested and modified using structural equation modelling (AMOS software: ADC, Chicago, IL, USA).
The modified model fitted the data adequately. The results demonstrated that an environmental construct (with factors that included total household income beta = 0.68, p <0.01; total expenditure beta = 0.67, p <0.01; number of rooms in the house beta = 0.46, p <0.01; and socioeconomic status beta = 0.71, p <0.01) had a significant effect on malnutrition. Neither the biological nor behavioural constructs had significant effects.
These findings provide useful insights into the importance of focusing on environmental factors as the main target when designing intervention programs. This information will be useful for the prioritization of preventive programs when resources are limited, especially in a rural setting. Future studies should focus on the issues of the ability of the households to meet their basic needs, inequality in the population, and the effectiveness of intervention at both micro and macro levels. This study focused on a rural community, therefore the results can only be generalized to areas with similar characteristics.
许多研究表明，儿童生长发育不良与营养不良有关。其潜在因素多种多样、涉及多个部门且相互关联，涵盖从生物因素到社会、文化和经济相关因素。由于全球营养不良程度最高的地区在南亚，该地区的政策制定者必须了解潜在的决定因素，以便设计有效的公共卫生干预项目。在公共资源有限的情况下尤其如此。这项横断面研究的目的是检验与5岁及以下儿童营养不良相关的生物、行为和环境因素之间的因果关系。
本研究使用的工具基于先前描述的儿童营养不良概念框架，并使用定性和定量方法对其心理测量成分进行了测试。除了使用问卷外，还从吉兰丹州通帕诊所随机选取的295名5岁及以下儿童中收集了人体测量和饮食数据。使用结构方程模型（AMOS软件：美国伊利诺伊州芝加哥的ADC）对提出的模型进行了测试和修改。
修改后的模型与数据拟合良好。结果表明，一个环境结构（其因素包括家庭总收入β = 0.68，p <0.01；总支出β = 0.67，p <0.01；房屋房间数β = 0.46，p <0.01；社会经济地位β = 0.71，p <0.01）对营养不良有显著影响。生物结构和行为结构均无显著影响。
这些发现为在设计干预项目时将环境因素作为主要目标的重要性提供了有益的见解。这些信息在资源有限时，特别是在农村地区，对预防项目的优先排序将很有用。未来的研究应关注家庭满足基本需求的能力、人群不平等以及微观和宏观层面干预的有效性等问题。本研究聚焦于一个农村社区，因此结果仅能推广到具有相似特征的地区。
