Geography Department, McGill University, Burnside Hall Building, Room 705, 805 Sherbrooke Street West, Montreal, Quebec, H3A0B9, Canada.
Priestly International Centre for Climate, University of Leeds, Leeds, LS2 9JT, United Kingdom.
Soc Sci Med. 2018 Nov;217:55-64. doi: 10.1016/j.socscimed.2018.09.027. Epub 2018 Sep 20.
Malnutrition is a persistent health concern throughout the world. Globally, Indigenous peoples experience poorer health outcomes compared to their non-Indigenous neighbours. Despite this, malnutrition among Indigenous populations is poorly understood. This analysis estimated the prevalence, and modeled possible determinants of, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) for Indigenous Batwa and non-Indigenous Bakiga of Kanungu District in Southwestern Uganda. We then characterize possible mechanisms driving differences in malnutrition.
Retrospective cross-sectional surveys were administered to 10 Batwa communities and 10 matched Bakiga Local Councils during April of 2014 (n = 1167). Individuals were classified as MAM and SAM based on middle upper-arm circumference (MUAC) for their age-sex strata. Mixed-effects regression models quantified the variation in malnutrition occurrence, considering individual, household, and community-ethnicity level effects. Models controlled for age, sex, number of dependents, education, and relative wealth.
Malnutrition is high among Batwa children and adults, with nearly half of Batwa adults (45.34%, 95% CI 34.82 to 55.86 for males; 45.86%, 95% CI 37.39 to 54.33 for females) and nearly a quarter of Batwa children (20.31%, 95% CI 13.07 to 26.93 for males; 25.81%, 95% CI 17.56 to 32.84 for females) meeting MAM criteria. SAM prevalence is lower than MAM prevalence, with SAM highest among adult Batwa males (11.60%, 95% CI 4.83 to 18.37) and adult Batwa females (3.00%, 95% CI 0.10 to 5.90). SAM prevalence among children was higher for Batwa males (7.03%, 95% CI 1.36 to 12.70) compared to Bakiga males (0.57%, 95% CI 0 to 1.69). Models that incorporated community ethnicity explained the greatest variance (>60%) in MUAC values.
This research demonstrates a malnutrition inequality between the Indigenous Batwa and non-Indigenous Bakiga of Kanungu District, Uganda, with model results suggesting further investigation into the role of ethnicity as an upstream social determinant of health.
营养不良是全世界普遍存在的健康问题。在全球范围内，与非原住民相比，原住民的健康状况更差。尽管如此，原住民人群中的营养不良问题仍未得到充分理解。本分析旨在估计乌干达西南部卡农古地区的原住民巴塔瓦人和非原住民巴基加的中度急性营养不良（MAM）和严重急性营养不良（SAM）的患病率，并对其可能的决定因素进行建模。然后，我们描述了可能导致营养不良差异的机制。
2014 年 4 月，对 10 个巴塔瓦社区和 10 个匹配的巴基加地方议会进行了回顾性横断面调查（n=1167）。根据年龄-性别分层的上臂中部周长（MUAC）将个体分类为 MAM 和 SAM。混合效应回归模型量化了营养不良发生的变化，同时考虑了个体、家庭和社区种族水平的影响。模型控制了年龄、性别、受抚养人数、教育程度和相对财富。
巴塔瓦儿童和成年人的营养不良情况较为严重，近一半的巴塔瓦成年男性（45.34%，95%CI 34.82 至 55.86）和近四分之一的巴塔瓦成年女性（45.86%，95%CI 37.39 至 54.33）以及近四分之一的巴塔瓦成年女性（45.86%，95%CI 37.39 至 54.33）符合 MAM 标准。与 MAM 患病率相比，SAM 患病率较低，SAM 在成年巴塔瓦男性（11.60%，95%CI 4.83 至 18.37）和成年巴塔瓦女性（3.00%，95%CI 0.10 至 5.90）中最高。与巴基加男性（0.57%，95%CI 0 至 1.69）相比，巴塔瓦男性儿童（7.03%，95%CI 1.36 至 12.70）的 SAM 患病率更高。纳入社区种族的模型解释了 MUAC 值中最大的差异（>60%）。
本研究表明，乌干达卡农古地区的原住民巴塔瓦人与非原住民巴基加之间存在营养不良不平等现象，模型结果表明，需要进一步研究种族作为健康上游社会决定因素的作用。
