Rodriguez-Llanes Jose Manuel, Ranjan-Dash Shishir, Mukhopadhyay Alok, Guha-Sapir Debarati
Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain , Brussels , Belgium.
Department of Management, Siksha 'O' Anusandhan University, Bhubaneswar, India; Tata Trusts, Mumbai, India.
PeerJ. 2016 Mar 1;4:e1741. doi: 10.7717/peerj.1741. eCollection 2016.
Background. Child undernutrition and flooding are highly prevalent public health issues in many developing countries, yet we have little understanding of preventive strategies for effective coping in these circumstances. Education has been recently highlighted as key to reduce the societal impacts of extreme weather events under climate change, but there is a lack of studies assessing to what extent parental education may prevent post-flood child undernutrition. Methods and Materials. One year after large floods in 2008, we conducted a two-stage cluster population-based survey of 6-59 months children inhabiting flooded and non-flooded communities of Jagatsinghpur district, Odisha (India), and collected anthropometric measurements on children along with child, parental and household level variables through face-to-face interviews. Using multivariate logistic regression models, we examined separately the effect of maternal and paternal education and other risk factors (mainly income, socio-demographic, and child and mother variables) on stunting and wasting in children from households inhabiting recurrently flooded communities (2006 and 2008; n = 299). As a comparison, separate analyses on children in non-flooded communities were carried out (n = 385). All analyses were adjusted by income as additional robustness check. Results. Overall, fathers with at least completed middle education (up to 14 years of age and compulsory in India) had an advantage in protecting their children from child wasting and stunting. For child stunting, the clearest result was a 100-200% lower prevalence associated with at least paternal secondary schooling (compared to no schooling) in flooded-areas. Again, only in flooded communities, an increase in per capita annual household income of 1,000 rupees was associated to a 4.7-4.9% lower prevalence of child stunting. For child wasting in flooded areas, delayed motherhood was associated to better nutritional outcomes (3.4% lower prevalence per year). In flooded communities, households dedicated to activities other than agriculture, a 50-51% lower prevalence of child wasting was estimated, suggesting farmers and fishermen as the most vulnerable livelihoods under flooding. In flooded areas, lower rank castes were at higher odds of both child wasting and stunting. Conclusions. In the short-term, protracted nutritional response in the aftermath of floods should be urgently implemented and target agricultural livelihoods and low-rank castes. Education promotion and schooling up to 14 years should have positive impacts on improving children nutritional health in the long run, especially under flooding. Policies effectively helping sustainable livelihood economic development and delayed motherhood are also recommended.
背景。儿童营养不良和洪水是许多发展中国家普遍存在的公共卫生问题，但我们对在这些情况下有效应对的预防策略了解甚少。最近，教育被视为减少气候变化下极端天气事件对社会影响的关键，但缺乏研究评估父母教育在多大程度上可以预防洪灾后儿童营养不良。
方法与材料。2008年大洪水发生一年后，我们对居住在印度奥里萨邦贾加廷布尔区受洪水影响和未受洪水影响社区的6至59个月大儿童进行了两阶段整群人口调查，并通过面对面访谈收集了儿童的人体测量数据以及儿童、父母和家庭层面的变量。我们使用多元逻辑回归模型，分别研究了母亲和父亲的教育程度以及其他风险因素（主要是收入、社会人口统计学以及儿童和母亲变量）对居住在经常遭受洪水社区（2006年和2008年；n = 299）家庭中儿童发育迟缓与消瘦的影响。作为对比，我们对未受洪水影响社区的儿童进行了单独分析（n = 385）。所有分析都以收入进行调整，作为额外的稳健性检验。
结果。总体而言，至少完成初中教育（在印度最高到14岁且为义务教育）的父亲在保护孩子免受消瘦和发育迟缓方面具有优势。对于儿童发育迟缓，最明显的结果是在受洪水影响地区，与至少父亲接受过中等教育（与未接受教育相比）相关的患病率降低了100 - 200%。同样，仅在受洪水影响的社区，家庭人均年收入增加1000卢比与儿童发育迟缓患病率降低4.7 - 4.9%相关。对于受洪水影响地区的儿童消瘦，母亲生育年龄推迟与更好的营养结果相关（每年患病率降低3.4%）。在受洪水影响的社区，从事农业以外活动的家庭，儿童消瘦患病率估计降低50 - 51%，这表明农民和渔民是洪水影响下最脆弱的生计群体。在受洪水影响地区，低种姓阶层儿童消瘦和发育迟缓的几率更高。
结论。短期内，应紧急实施洪水后长期的营养应对措施，并将目标对准农业生计群体和低种姓阶层。从长远来看，促进教育和普及到14岁的学校教育应该对改善儿童营养健康产生积极影响，尤其是在洪水影响的情况下。还建议制定有效帮助可持续生计经济发展和推迟母亲生育年龄的政策。
