Anuranga C, Wickramasinghe R, Rannan-Eliya R P, Hossain S M M, Abeykoon A T P L
Institute for Health Policy, Colombo, Sri Lanka.
Ceylon Med J. 2012 Jun;57(2):61-9. doi: 10.4038/cmj.v57i2.4429.
This study analyses the DHS 1993, 2000 and 2006-07 and NFSS 2009 survey data to investigate trends, inequalities and determinants of low birth weight (LBW) in Sri Lanka.
We re-evaluated recent trends in LBW incidence, adjusting for changes in the coverage of DHS surveys to ensure comparability, and used multivariate logistic regression to investigate determinants. We quantified the degree of economic inequality using wealth and concentration indices, and assessed the contribution of determinants to inequality by decomposition.
There was a continuing, but slowing decline in LBW incidence, reaching 17% during 2001/02-2006/07, whilst very low birth weight incidence declined from 0.9% to 0.6%. Concentration indices reveal persistent, large economic inequalities in LBW incidence. Maternal body mass index (BMI), height and education, altitude and Indian Tamil ethnicity were the major determinants of LBW, with supply of 'Thriposha' having no significant impact. Accounting for maternal BMI and height largely eliminates the impact of economic status, and reduces the impact of ethnicity. Decomposition analysis reveals the major contributors to the inequalities are maternal BMI (21%), height (12%) and education (14%), ethnicity (9%) and altitude (7%).
The results imply that food insecurity mediates the association of LBW with poverty, and is the major amenable risk factor. The impact of maternal height and Indian Tamil ethnicity suggests that epigenetic mechanisms play a role, and that reductions in LBW incidence will take considerable time. There is a need to substantially improve the effectiveness of interventions to reduce LBW in coming generations.
本研究分析了1993年、2000年以及2006 - 2007年的人口与健康调查（DHS）数据和2009年全国家庭健康调查（NFSS）数据，以调查斯里兰卡低出生体重（LBW）的趋势、不平等状况及其决定因素。
我们重新评估了低出生体重发生率的近期趋势，对人口与健康调查覆盖范围的变化进行了调整以确保可比性，并使用多变量逻辑回归来研究决定因素。我们使用财富和集中度指数量化经济不平等程度，并通过分解评估决定因素对不平等的贡献。
低出生体重发生率持续下降，但下降速度放缓，在2001/02 - 2006/07年期间降至17%，而极低出生体重发生率从0.9%降至0.6%。集中度指数显示低出生体重发生率存在持续且巨大的经济不平等。孕产妇体重指数（BMI）、身高和教育程度、海拔高度以及印度泰米尔族裔是低出生体重的主要决定因素，而“Thriposha”的供应没有显著影响。考虑孕产妇BMI和身高在很大程度上消除了经济状况的影响，并降低了族裔的影响。分解分析表明，不平等的主要促成因素是孕产妇BMI（21%）、身高（12%）和教育程度（14%）、族裔（9%）以及海拔高度（7%）。
结果表明，粮食不安全介导了低出生体重与贫困之间的关联，并且是主要的可改善风险因素。孕产妇身高和印度泰米尔族裔的影响表明表观遗传机制发挥了作用，而且降低低出生体重发生率将需要相当长的时间。有必要大幅提高干预措施的有效性，以降低后代的低出生体重发生率。
