Flood David, Petersen Ashley, Martinez Boris, Chary Anita, Austad Kirsten, Rohloff Peter
Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.
Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, United States.
BMJ Paediatr Open. 2019 Aug 22;3(1):e000510. doi: 10.1136/bmjpo-2019-000510. eCollection 2019.
There has been limited research on the relationship between contraception and child growth in low-income and middle-income countries (LMICs). This study examines the association between contraception and child linear growth in Guatemala, an LMIC with a very high prevalence of child stunting. We hypothesise that contraceptive use is associated with better child linear growth and less stunting in Guatemala.
Using representative national data on 12 440 children 0-59 months of age from the 2014-2015 Demographic and Health Survey in Guatemala, we constructed multivariable linear and Poisson regression models to assess whether child linear growth and stunting were associated with contraception variables. All models were adjusted for a comprehensive set of prespecified confounding variables.
Contraceptive use was generally associated with modest, statistically significant greater height-for-age z-score. Current use of a modern method for at least 15 months was associated with a prevalence ratio of stunting of 0.87 (95% CI 0.81 to 0.94; p<0.001), and prior use of a modern method was associated with a prevalence ratio of stunting of 0.93 (95% CI 0.87 to 0.98; p<0.05). The severe stunting models found generally similar associations with modern contraceptive use as the stunting models. There was no significant association between use of a modern method for less than 15 months and the prevalence ratio of stunting or severe stunting.
Contraceptive use was associated with better child linear growth and less child stunting in Guatemala. In addition to the human rights imperative to expand contraceptive access and choice, family planning merits further study as a strategy to improve child growth in Guatemala and other countries with high prevalence of stunting.
在低收入和中等收入国家（LMICs），关于避孕与儿童生长之间关系的研究有限。本研究考察了危地马拉（一个儿童发育迟缓患病率极高的低收入和中等收入国家）避孕与儿童线性生长之间的关联。我们假设在危地马拉，使用避孕措施与儿童更好的线性生长及更少的发育迟缓相关。
利用来自危地马拉2014 - 2015年人口与健康调查的12440名0 - 59个月儿童的具有代表性的全国数据，我们构建了多变量线性和泊松回归模型，以评估儿童线性生长和发育迟缓是否与避孕变量相关。所有模型都针对一组预先设定的全面混杂变量进行了调整。
使用避孕措施通常与适度的、具有统计学显著意义的更高的年龄别身高Z评分相关。当前使用现代方法至少15个月与发育迟缓患病率比为0.87（95%可信区间0.81至0.94；p<0.001）相关，之前使用现代方法与发育迟缓患病率比为0.93（95%可信区间0.87至0.98；p<0.05）相关。严重发育迟缓模型发现与现代避孕措施使用的关联通常与发育迟缓模型相似。使用现代方法少于15个月与发育迟缓或严重发育迟缓患病率比之间无显著关联。
在危地马拉，使用避孕措施与儿童更好的线性生长及更少的儿童发育迟缓相关。除了扩大避孕措施的可及性和选择的人权必要性外，计划生育作为改善危地马拉和其他发育迟缓患病率高的国家儿童生长的一项策略值得进一步研究。
