Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
Public Health Nutr. 2011 Jun;14(6):951-9. doi: 10.1017/S1368980010003356. Epub 2011 Feb 11.
The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0-59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status.
Cross-sectional survey.
The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey.
Respondents were ever-married women (aged 15-49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community.
Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0.18 (SE 0.07)) and weight-for-age (highest v. lowest tertile, β = 0.21 (SE 0.06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0.13 (SE = 0.06)).
The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.
本研究旨在探讨社区环境对孟加拉国 0-59 月龄儿童营养状况（年龄别体重和年龄别身高）的影响。此外，我们还检验了社区环境特定特征与儿童营养状况之间的关联。
横断面调查。
数据来自具有全国代表性的 2004 年孟加拉国人口与健康调查。
调查对象为已婚妇女（年龄 15-49 岁）及其儿童（n=5731），居住在 361 个社区。儿童营养结局为年龄别体重和年龄别身高的 sd 单位测量值。我们考虑了以下可能与儿童营养相关的社区环境属性：（i）社区水和卫生基础设施；（ii）社区卫生和教育服务的提供情况；（iii）社区就业和社会参与情况；以及（iv）社区教育水平。
多水平回归分析表明，母亲和儿童协变量的空间分布并未完全解释儿童营养状况的社区间差异。社区教育水平是儿童身高别年龄（最高三分位与最低三分位相比，β=0.18（SE 0.07））和年龄别体重（最高三分位与最低三分位相比，β=0.21（SE 0.06））的最强社区水平预测因素。在身高别年龄模型中，社区就业和社会参与也具有统计学意义（最高三分位与最低三分位相比，β=0.13（SE=0.06））。
社区环境会影响孟加拉国儿童的营养状况，而母亲和儿童层面的协变量可能无法捕捉到社区的全部影响。在发展中国家减少儿童营养不良的干预措施应考虑更广泛的社区背景。
