European Commission Joint Research Centre, Ispra, Italy.
Instituto de Salud Carlos III, Centro Nacional de Medicina Tropical, Madrid, Spain.
PLoS One. 2019 Oct 9;14(10):e0223237. doi: 10.1371/journal.pone.0223237. eCollection 2019.
One of the reported causes of high malnutrition rates in Burundi and Rwanda is children's inadequate dietary habits. The diet of children may be affected by individual characteristics and by the characteristics of the households and the communities in which they live. We used the minimum dietary diversity of children (MDD-C) indicator as a proxy of diet quality aiming at: 1) assess how much of the observed variation in MDD-C was attributed to community clustering, and 2) to identify the MDD-C associated factors.
Data was obtained from the 2010 Demographic and Health Surveys of Burundi and Rwanda, from which only children 6 to 23 months from rural areas were analysed. The MDD-C was calculated according to the 2007 WHO/UNICEF guidelines. We computed the intra-class coefficient to assess the percentage of variation attributed to the clustering effect of living in the same community. And then we applied two-level logit regressions to investigate the association between MDD-C and potential risk factors following the hierarchical survey structure of DHS.
The MDD-C was 23% in rural Rwanda and 16% in rural Burundi, and a 29% of its variation in Rwanda and 17% in Burundi was attributable to community clustering. Increasing age and living standards were associated with higher MDD-C in both countries, and only in Burundi also increasing level of education of the mother's partner. In Rwanda alone, the increasing ages of the head of the household and of the mother at first birth were also positively associated with it. Despite the identification of an important proportion of the MDD-C variation due to clustering, we couldn't identify any community variable significantly associated with it.
We recommend further research using hierarchical models, and to integrate dietary diversity in holistic interventions which take into account both the household's and the community's characteristics the children live in.
布隆迪和卢旺达儿童营养不良率高的一个原因是儿童饮食不当。儿童的饮食可能受到个人特征、家庭特征以及他们所居住社区的特征的影响。我们使用儿童最低饮食多样性（MDD-C）指标作为饮食质量的替代指标，目的是：1）评估观察到的 MDD-C 变异中有多少归因于社区聚类，2）确定与 MDD-C 相关的因素。
数据来自布隆迪和卢旺达 2010 年的人口与健康调查，其中仅分析了农村地区 6 至 23 个月的儿童。MDD-C 是根据 2007 年世卫组织/儿基会的指南计算的。我们计算了组内系数，以评估归因于生活在同一社区的聚类效应的变异百分比。然后，我们应用两水平逻辑回归调查 MDD-C 与潜在风险因素之间的关系，调查结构遵循 DHS 的分层结构。
卢旺达农村地区的 MDD-C 为 23%，布隆迪农村地区为 16%，其中 29%的变异归因于社区聚类。在这两个国家，年龄和生活水平的提高与更高的 MDD-C 相关，而在布隆迪，母亲伴侣的教育水平提高也与更高的 MDD-C 相关。仅在卢旺达，户主和母亲初育年龄的增加也与之呈正相关。尽管确定了 MDD-C 变异的很大一部分归因于聚类，但我们无法确定任何与 MDD-C 显著相关的社区变量。
我们建议使用分层模型进行进一步研究，并将饮食多样性纳入整体干预措施中，这些措施既要考虑儿童所在家庭的特征，也要考虑他们所在社区的特征。
