印度南部肺结核患者家庭食物不安全及其相关因素的横断面分析。
Household food insecurity among patients with pulmonary tuberculosis and its associated factors in South India: a cross-sectional analysis.
机构信息
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
出版信息
BMJ Open. 2020 Feb 28;10(2):e033798. doi: 10.1136/bmjopen-2019-033798.
OBJECTIVES
Food insecurity is 'the limited or uncertain availability of nutritionally adequate, safe foods or inability to acquire foods in socially acceptable ways'. Majority of tuberculosis (TB) cases of resource-poor settings experience food insecurity, which impacts treatment adherence and outcomes. We aimed to determine level of household food insecurity (HFI) and its associated factors in patients with pulmonary TB.
DESIGN
This is a cross-sectional analysis of data from an ongoing cohort study.
SETTING
National Tuberculosis Programme (NTP) in three districts of South India.
PARTICIPANTS
All newly diagnosed pulmonary TB cases of the cohort enrolled in the NTP at the Designated Microscopy Centres (DMCs) and Primary Health Centres (PHCs) from October 2015 to October 2018.
PRIMARY OUTCOME MEASURES
The proportion of baseline HFI assessed using a validated HFI Access Scale was summarised as percentage with 95% CI. Possible association of sociodemographic, morbidity and behavioural characteristics with HFI was assessed using χ test, and unadjusted prevalence ratios with 95% CI were calculated. The characteristics with values of p<0.2 in the univariate model were included in the multivariable generalised linear model (binomial function, log link) to derive adjusted prevalence ratios (aPRs) with 95% CI.
RESULT
Of a total of 765 patients, 261 had HFI and the proportion was 34.1% (95% CI 30.8% to 37.6%). Mild, moderate and severe food insecurity was found in 17 (2.2%), 67 (8.8%) and 177 (23.1%) TB cases, respectively. Patients with TB who had monthly family income less than rupees 3000 (aPR 2.0; 95% CI 1.3 to 3.0), Karnofsky Score of 60 or less (aPR 1.5; 95% CI 1.1 to 1.9) and those who were employed (aPR 1.4; 95% CI 1.0 to 2.0) were independently associated with HFI.
CONCLUSIONS
A high level of food insecurity was seen in households with TB cases. Additional food or cash assistance for this subgroup might improve food insecurity and thereby nutritional status.
目的
食物不安全是指“营养充足、安全的食物供应有限或不稳定，或无法以社会可接受的方式获得食物”。大多数资源匮乏环境中的肺结核（TB）病例都经历着食物不安全，这会影响治疗的依从性和结果。我们旨在确定肺结核患者家庭食物不安全（HFI）的程度及其相关因素。
设计
这是对正在进行的队列研究数据的横断面分析。
地点
印度南部三个地区的国家结核病规划（NTP）。
参与者
2015 年 10 月至 2018 年 10 月期间，在指定显微镜中心（DMC）和初级卫生中心（PHC）登记的新诊断为肺结核的队列中的所有病例。
主要结局测量
使用经过验证的 HFI 准入量表评估的基线 HFI 的比例以百分比和 95%置信区间（CI）表示。使用 χ2检验评估社会人口统计学、发病率和行为特征与 HFI 的可能关联，并计算未经调整的患病率比和 95%CI。在单变量模型中 p 值<0.2 的特征被纳入多变量广义线性模型（二项式函数，对数链接），以得出调整后的患病率比（aPR）和 95%CI。
结果
在总共 765 名患者中，有 261 名患者存在 HFI，比例为 34.1%（95%CI 30.8%至 37.6%）。轻度、中度和重度食物不安全分别见于 17 例（2.2%）、67 例（8.8%）和 177 例（23.1%）肺结核患者。月家庭收入低于 3000 卢比（aPR 2.0；95%CI 1.3 至 3.0）、卡诺夫斯基评分 60 分或以下（aPR 1.5；95%CI 1.1 至 1.9）和就业（aPR 1.4；95%CI 1.0 至 2.0）的肺结核患者与 HFI 独立相关。
结论
肺结核患者家庭中存在较高水平的食物不安全。为这一亚组提供额外的食物或现金援助可能会改善食物不安全状况，从而改善营养状况。
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