Man S Lm, Guo Y
Department of Health Policy and Administration, Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2016 Jun 18;48(3):418-23.
To understand the relationship between child malnutrition and social determinants among children under the age of 5 in China, and to provide evidence and useful information to help policy makers develop social policies to improve child nutritional status.
Information of 2 434 children aged 0-5 was extracted from year 1991 to 2011 longitudinal survey data in the China Health and Nutrition Survey (CHNS) was extracted for analysis. Child underweight, child stunting, and child wasting were defined using World Health Organization Child Growth Standards for weight-for-age, height-for-age, and weight-for-height. Weight-for-age values, height-for-age values or weight-for-height values below 2 standard deviations were considered as underweight, stunting and wasting. World Health Organization igrowup software was used to calculate the prevalence of child underweight, child stunting, and child wasting. Multivariate Logistic regression model was used to analyze the relationship between child malnutrition and social determinants (household income, parents' educational level, living regions, and communities' urbanization level).
The prevalence of child underweight and child stunting were decreased by 64.8% and 67.8%, respectively from 1991 to 2011, while the prevalence of child wasting had remained at a relatively low level (below 5%). The problem of child underweight and stunting had been significantly resolved in China. Female children had better outcomes than male children on improving nutritional status. Among all the non-socio-economic determinants of child malnutrition, children with low height mother and children had inadequate protein intake were both risk factors of malnutrition. The social determinants significantly associated to child malnutrition included: living in the western regions and central regions, living in low level urbanization communities, with low household incomes, and low maternal educational levels.
In order to further decrease the prevalence of child malnutrition and alleviate the inequity of child health, we should pay more attention to the social determinants behind child malnutrition. Besides, social policies beneficial to child nutrition promotion need to be taken urgently, the important social policies suggested by the researchers included focusing on maternal and child dietary intake, improving household economic situation, improving maternal educational level, and balancing economic development and resource distribution between different regions in China.
了解中国5岁以下儿童营养不良与社会决定因素之间的关系，为政策制定者制定改善儿童营养状况的社会政策提供依据和有用信息。
从中国健康与营养调查（CHNS）1991年至2011年的纵向调查数据中提取2434名0至5岁儿童的信息进行分析。采用世界卫生组织儿童生长标准中年龄别体重、年龄别身高和身高别体重来定义儿童低体重、发育迟缓及消瘦。年龄别体重值、年龄别身高值或身高别体重值低于2个标准差被视为低体重、发育迟缓和消瘦。使用世界卫生组织igrowup软件计算儿童低体重、发育迟缓及消瘦的患病率。采用多因素Logistic回归模型分析儿童营养不良与社会决定因素（家庭收入、父母教育水平、居住地区及社区城市化水平）之间的关系。
1991年至2011年，儿童低体重和发育迟缓患病率分别下降了64.8%和67.8%，而儿童消瘦患病率一直处于较低水平（低于5%）。中国儿童低体重和发育迟缓问题已得到显著解决。女童在改善营养状况方面比男童有更好的结果。在儿童营养不良的所有非社会经济决定因素中，母亲身高较低的儿童和蛋白质摄入不足的儿童均为营养不良的危险因素。与儿童营养不良显著相关的社会决定因素包括：居住在西部地区和中部地区、居住在城市化水平低的社区、家庭收入低以及母亲教育水平低。
为进一步降低儿童营养不良患病率并缓解儿童健康的不平等现象，应更加关注儿童营养不良背后的社会决定因素。此外，急需采取有利于促进儿童营养的社会政策，研究人员建议的重要社会政策包括关注母婴饮食摄入、改善家庭经济状况、提高母亲教育水平以及平衡中国不同地区的经济发展和资源分配。
