Center for Integrative Approaches to Health Disparities, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
PLoS Med. 2011 Mar;8(3):e1000424. doi: 10.1371/journal.pmed.1000424. Epub 2011 Mar 8.
Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India.
Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992-93, 1998-99, and 2005-06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%-20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization-determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes.
We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India. Please see later in the article for the Editors' Summary.
经济增长被广泛认为是减少印度儿童营养不良的主要政策手段。我们评估了州人均收入变化与印度儿童营养不良风险之间的关系。
本分析的数据来自印度于 1992-1993 年、1998-1999 年和 2005-2006 年进行的三次全国家庭健康调查（NFHS）的三个横断面波。这三个波的样本量分别为 33816、30383 和 28876 名儿童。在排除儿童人体测量测量值和研究中包含的自变量的缺失观察值后，分析样本量分别为 28066、26121 和 23139，合并样本量为 77326 名儿童。缺失数据的比例为 12%-20%。结果是体重不足、发育迟缓、消瘦，定义为按年龄和性别由世界卫生组织确定的中位数分数减去两个标准差以上。我们还检查了严重体重不足、严重发育迟缓、严重消瘦。主要暴露变量是每个调查期间州一级的人均收入，以 2008 年价格衡量的人均净州内生产总值表示。我们估计了固定和随机效应逻辑模型，这些模型考虑了数据的聚类。在没有考虑调查期间效果的模型中，州经济增长与儿童营养不良风险之间似乎存在反比关系。然而，在考虑与重复横断面设计相关的数据结构的模型中，州经济增长与体重不足的风险无关（OR 1.01，95%CI 0.98，1.04）、发育迟缓（OR 1.02，95%CI 0.99，1.05）和消瘦（OR 0.99，95%CI 0.96，1.02）。调整人口统计学和社会经济协变量并没有改变这些估计。对于严重营养不良的结果也观察到类似的模式。
我们没有发现一致的证据表明经济增长会导致印度儿童营养不良减少。在印度，可能需要直接投资于适当的卫生干预措施，以减少儿童营养不良。请在文章后面查看编辑摘要。
