Rahman M Shafiqur, Howlader Tamanna, Masud Mohammad Shahed, Rahman Mohammad Lutfor
Institute of Statistical Research and Training, University of Dhaka, Dhaka-1000, Bangladesh.
PLoS One. 2016 Jun 29;11(6):e0157814. doi: 10.1371/journal.pone.0157814. eCollection 2016.
Malnutrition in children under five years remains a significant problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although several studies have been conducted to identify the important risk factors of malnutrition, none of them assess the role of low birth weight (LBW) despite its high prevalence (36%). This study examines the association between LBW and malnutrition using data from the Bangladesh Demographic and Health Survey (BDHS) 2011 and provides practical guidelines for improving nutritional status of children.
Malnutrition in children is measured in terms of their height-for-age, weight-for-height, and weight-for-age. Children whose Z-scores for either of these indices are below two standard deviations (-2SD) from median of WHO's reference population are considered as stunted, wasted or underweight, respectively. The association between malnutrition and LBW was investigated by calculating adjusted risk-ratio (RR), which controls for potential confounders such as child's age and sex, mother's education and height, length of preceding-birth-interval, access to food, area of residence, household socio-economic status. Adjusted RR was calculated using both Cochran-Mantel-Haenszel approach and multivariable logistic regression models controlling for confounder.
The prevalence of malnutrition was markedly higher in children with LBW than those with normal birth-weights (stunting: 51% vs 39%; wasting: 25% vs 14% and underweight: 52% vs 33%). While controlling for the known risk factors, children with LBW had significantly increased risk of becoming malnourished compared to their counter part with RR 1.23 (95% CI:1.16-1.30), 1.71 (95% CI:1.53-1.92) and 1.47 (95% CI: 1.38-1.56) for stunting, wasting and underweight, respectively. The observed associations were not modified by factors known to reduce the prevalence of malnutrition, such as higher education of mother, better household socio-economic conditions and longer birth-interval.
Higher education of mother, better household socio-economic conditions and prolonged birth intervals alone are not sufficient in bringing about substantial reductions in prevalence of child malnutrition in Bangladesh. Targeted interventions should be designed to reduce prevalence of LBW in addition to improving mother's education and other socio-demographic conditions.
尽管孟加拉国在社会经济方面取得了显著进步，并且开展了长达十年旨在改善五岁以下儿童营养不良状况的干预措施，但这一问题仍然十分严重。虽然已有多项研究致力于确定营养不良的重要风险因素，但尽管低体重出生（LBW）的患病率很高（36%），却没有一项研究评估其作用。本研究利用2011年孟加拉国人口与健康调查（BDHS）的数据，考察低体重出生与营养不良之间的关联，并为改善儿童营养状况提供实用指南。
儿童营养不良状况通过年龄别身高、身高别体重和年龄别体重来衡量。这些指标中任何一项的Z评分低于世界卫生组织参考人群中位数两个标准差（-2SD）的儿童，分别被视为发育迟缓、消瘦或体重不足。通过计算调整风险比（RR）来研究营养不良与低体重出生之间的关联，该比值控制了诸如儿童年龄和性别、母亲教育程度和身高、上次生育间隔时长、食物获取情况、居住地区、家庭社会经济状况等潜在混杂因素。调整风险比采用 Cochr an - Mantel - Haenszel方法以及控制混杂因素的多变量逻辑回归模型进行计算。
低体重出生儿童的营养不良患病率显著高于正常出生体重儿童（发育迟缓：51% 对39%；消瘦：25% 对14%；体重不足：52% 对33%）。在控制已知风险因素后，与正常出生体重儿童相比，低体重出生儿童营养不良的风险显著增加，发育迟缓、消瘦和体重不足的调整风险比分别为1.23（95%置信区间：1.16 - 1.30）、1.71（95%置信区间：1.53 - 1.92）和1.47（95%置信区间：1.38 - 1.56）。观察到的关联并未因已知可降低营养不良患病率的因素而改变，如母亲受教育程度较高、家庭社会经济条件较好以及生育间隔较长。
仅靠母亲受教育程度较高、家庭社会经济条件较好以及生育间隔延长，不足以大幅降低孟加拉国儿童营养不良的患病率。除了改善母亲教育程度和其他社会人口状况外，还应设计针对性干预措施以降低低体重出生的患病率。
