女童婚姻、社会经济地位与营养不良：来自撒哈拉以南非洲 35 个国家的证据。

Girl child marriage, socioeconomic status, and undernutrition: evidence from 35 countries in Sub-Saharan Africa.

机构信息

Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Bldg. 1, 11th floor, Boston, MA, 02115, USA.

FXB Center for Health and Human Rights, Harvard T. H. Chan School of Public Health, 651 Huntington Ave, 7th Floor, Boston, MA, 02115, USA.

出版信息

BMC Med. 2019 Mar 8;17(1):55. doi: 10.1186/s12916-019-1279-8.

DOI:10.1186/s12916-019-1279-8

PMID:30845984

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6407221/

Abstract

BACKGROUND

Girl child marriage, a formal union of a female before age 18, and undernutrition remain common in Sub-Saharan Africa. The aim of this study is to establish the extent to which girl child marriage contributes to socioeconomic status and underweight, a measure of undernutrition, among adult women.

METHODS

We used data from 103 Demographic and Health Surveys (DHS), representing 35 African countries from 1991 to 2014. Girl child marriage was coded both as a binary variable (before 18 years) and categorical variable (before 14, 14 to 15 years, 16 to 17 years). The primary outcome was underweight (body mass index less than 18·5). Secondary outcomes were early and multiple childbearing, secondary education completion, and wealth index. Logistic regression models were used to estimate associations.

RESULTS

Fifty-five percent of women married before age 18. Girl child marriage was associated with reduced risk of being underweight both in models adjusted for basic confounders (risk difference = - 0.020, 95% CI [- 0.026, - 0.014], p < 0.01) and in models adjusted for childbearing, women's relative status, and socioeconomic outcomes (risk difference = - 0.018, 95% CI [- 0.024, - 0.011], p < 0.01). Conditional on completing primary education and community fixed-effects, women married before 18 years had an increased risk of early motherhood (risk difference = 0.38, 95% CI [0.38, 0.38], p < 0.01) and of being in the poorest quintile (risk difference = 0.024, 95% CI [0.012, 0.036], p < 0.01), and were 27 percentage points less likely to complete secondary education (risk difference = - 0.27, 95% CI [- 0.28, - 0.26)], p < 001), compared to women married as adults.

CONCLUSIONS

Though associated with substantially reduced socioeconomic status, girl child marriage appears to be associated with slightly reduced risk of being underweight in the population studied. Further research is needed to understand the determinants of undernutrition in this context as well as the broader relationship between socioeconomic status and nutritional outcomes.

摘要

背景

在撒哈拉以南非洲地区，童婚（女性在 18 岁之前结婚）和营养不良仍然很常见。本研究旨在确定童婚对成年女性的社会经济地位和体重不足（营养不良的一种衡量标准）的影响程度。

方法

我们使用了来自 1991 年至 2014 年的 103 次人口与健康调查（DHS）的数据，这些数据代表了来自 35 个非洲国家的情况。童婚被编码为二分类变量（18 岁之前）和分类变量（14 岁之前、14 至 15 岁、16 至 17 岁）。主要结局是体重不足（体重指数低于 18.5）。次要结局是早育和多育、完成中等教育和财富指数。使用逻辑回归模型来估计关联。

结果

55%的女性在 18 岁之前结婚。在调整了基本混杂因素的模型中（风险差异= -0.020，95%CI[-0.026，-0.014]，p<0.01）和在调整了生育情况、女性相对地位和社会经济结局的模型中（风险差异= -0.018，95%CI[-0.024，-0.011]，p<0.01），童婚与体重不足的风险降低有关。在完成小学教育和社区固定效应的条件下，18 岁之前结婚的女性生育早的风险增加（风险差异=0.38，95%CI[0.38，0.38]，p<0.01），处于最贫困五分位数的风险增加（风险差异=0.024，95%CI[0.012，0.036]，p<0.01），完成中等教育的可能性降低 27 个百分点（风险差异= -0.27，95%CI[-0.28，-0.26]，p<0.01）。