Mohsena Masuda, Goto Rie, Nicholas Mascie-Taylor C G
Department of Community Medicine, Ibrahim Medical College, Dhaka, Bangladesh.
Department of Biological Anthropology, University of Cambridge, Cambridge, UK.
WHO South East Asia J Public Health. 2015 Jul-Dec;4(2):139-149. doi: 10.4103/2224-3151.206683.
BACKGROUND: Undernutrition among mothers and children is currently a major public health and development concern in Bangladesh. In literature relating to nutritional determinants, of particular interest is the geography, as regions with poor nutrition tend to pull down the overall nutritional status of the country. As such, reducing the regional gap can alone reduce overall undernutrition significantly, especially when regional gaps are high. The aim of this study is, therefore, to assess the magnitude of inequalities in undernutrition in children aged under 5 years in Bangladesh and their mothers, and relate this to the administrative divisions of the country. METHODS: The Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004 and 2007) were the sources of data, and a total of 16 278 mother-child pairs whose records were complete for the required individual and household-level variables were included in the analysis. Maternal nutritional status was measured by the body mass index (BMI). Weight-for-age, height-for-age and weight-for-height z-scores were calculated by use of the World Health Organization (WHO) Child Growth Standards to assess the nutritional status of children aged under 5 years. General linear model, sequential linear and multinomial logistic regression analyses were done to assess the inequalities in maternal and child nutritional status among the six administrative divisions of Bangladesh. Socioeconomic variables that were controlled for were residency, education and occupation of the mothers and their husbands, house type and possession score in the household. RESULTS: Maternal BMI and prevalence of underweight, stunting and wasting in children aged under 5 years were found to vary significantly according to administrative division. Of the six divisions, Sylhet was found to have highest prevalence of undernourished mothers and children. The trends from 1996 to 2007 also established Sylhet as the poorest-performing region overall. CONCLUSION: The Sylhet administrative division needs specially focused attention from policy-makers if the overall performance of the health, nutrition and population sector is to reach the targets set by the country.
背景:母婴营养不良目前是孟加拉国主要的公共卫生和发展问题。在有关营养决定因素的文献中,地理位置特别值得关注,因为营养状况较差的地区往往会拉低该国的整体营养状况。因此,缩小地区差距本身就能显著降低整体营养不良水平,尤其是当地区差距较大时。因此,本研究的目的是评估孟加拉国5岁以下儿童及其母亲营养不良的不平等程度,并将其与该国的行政区划分联系起来。 方法:数据来源于孟加拉国人口与健康调查(1996 - 1997年、1999 - 2000年、2004年和2007年),分析纳入了总共16278对母婴,其记录包含所需的个人和家庭层面变量且完整。通过体重指数(BMI)衡量母亲的营养状况。使用世界卫生组织(WHO)儿童生长标准计算年龄别体重、年龄别身高和身高别体重Z评分,以评估5岁以下儿童的营养状况。进行了一般线性模型、序贯线性和多项逻辑回归分析,以评估孟加拉国六个行政区中母婴营养状况的不平等情况。所控制的社会经济变量包括母亲及其丈夫的居住情况、教育程度和职业、房屋类型以及家庭财产得分。 结果:发现母亲的BMI以及5岁以下儿童体重不足、发育迟缓及消瘦的患病率因行政区划分而异。在六个行政区中,锡尔赫特被发现是营养不良母亲和儿童患病率最高的地区。1996年至2007年的趋势也表明,锡尔赫特是总体表现最差的地区。 结论:如果卫生、营养和人口部门的整体表现要达到该国设定的目标,政策制定者需要特别关注锡尔赫特行政区。
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