Jeyaseelan Visalakshi, Jeyaseelan Lakshmanan, Yadav Bijesh
Department of Biostatistics,Christian Medical College,Vellore,India.
J Biosoc Sci. 2016 May;48(3):289-305. doi: 10.1017/S0021932015000309. Epub 2015 Oct 6.
Protein-energy malnutrition is a major health problem contributing to the burden of disease in developing countries. The aim of this study was to assess the incidence of, and risk factors for, malnutrition among school-going children in south India. A total of 2496 children aged 5-7 years from rural and urban areas of south India were recruited in 1982 and followed up for malnutrition over a period of 9 years. Their body heights and weights were measured every six months and socio-demographic factors such as mother's education and father's education and relevant household characteristics and hygiene practices collected. Body mass index and height-for-age z-scores were used to determine children's levels of underweight and stunting, respectively, classified as normal, mild/moderate or severe. Risk factor analysis was done for pre-pubertal ages only using Generalized Estimating Equations with cumulative odds assumption. There was a significant difference between male and female children in the incidence of severe underweight and stunting (6.4% and 4.2% respectively). Children in households with no separate kitchen had 1.3 (1.0-1.6) times higher odds of being severely underweight (p=0.044) compared with those with a kitchen. Children without a toilet facility had significantly higher odds of severe underweight compared with those who did. Children with illiterate parents had higher odds of severe stunting than those with literate parents. In conclusion, the prevalence of malnutrition among these south Indian children has not changed over the years, and the incidence of severe malnutrition was highest in children when they were at pubertal age. The risk factors for stunting were mostly poverty-related, and those for underweight were mostly hygiene-related. Adolescent children in south India should be screened periodically at school for malnutrition and provided with nutritional intervention if necessary.
蛋白质 - 能量营养不良是一个主要的健康问题，加重了发展中国家的疾病负担。本研究的目的是评估印度南部学龄儿童营养不良的发生率及其危险因素。1982年，从印度南部农村和城市地区招募了总共2496名5至7岁的儿童，并对其进行了为期9年的营养不良随访。每六个月测量他们的身高和体重，并收集社会人口统计学因素，如母亲的教育程度、父亲的教育程度以及相关的家庭特征和卫生习惯。体重指数和年龄别身高Z评分分别用于确定儿童的体重不足和发育迟缓水平，分为正常、轻度/中度或重度。仅对青春期前年龄组进行危险因素分析，采用具有累积优势假设的广义估计方程。重度体重不足和发育迟缓的发生率在男童和女童之间存在显著差异（分别为6.4%和4.2%）。与有单独厨房的家庭相比，没有单独厨房的家庭中的儿童重度体重不足的几率高1.3（1.0 - 1.6）倍（p = 0.044）。没有厕所设施的儿童重度体重不足的几率显著高于有厕所设施的儿童。父母为文盲的儿童重度发育迟缓的几率高于父母有文化的儿童。总之，这些印度南部儿童的营养不良患病率多年来没有变化，重度营养不良的发生率在儿童青春期时最高。发育迟缓的危险因素大多与贫困相关，体重不足的危险因素大多与卫生相关。印度南部的青少年儿童应在学校定期进行营养不良筛查，必要时给予营养干预。
