Adamu W/Amilak, Jara Dube, Alemayehu Mulunesh, Burrowes Sahai
SCI-MNCH, North Gondar, Ethiopia.
2Department of Public Health, College of Medicine and Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
BMC Nutr. 2017 Dec 22;3:88. doi: 10.1186/s40795-017-0208-5. eCollection 2017.
Left untreated, moderate acute malnutrition (MAM) in children can lead to severe acute malnutrition, stunting, developmental delays, and death. Despite recent progress the prevalence of malnutrition remains high throughout Ethiopia. The ability to make accurate prognoses and develop effective treatment strategies for children with MAM is currently limited and, as result, a significant proportion of children with MAM fail to recover even with treatment. We seek to address this limitation by assessing the risk factors for poor outcomes among children under the age of 5 with MAM in a rural area of Ethiopia's Amhara Region. This region is considered relatively food secure and does not have food supplementation treatment programs.
We conducted a prospective cohort study of 404 randomly sampled children, 0-59 months old stratified by household food security status. We followed the study children for approximately 2 months, assessing their health status; and used bivariate and multivariate Cox-proportional hazard regression models to identify risk factors for poor health outcomes.
Household food security was significantly associated with low recovery from MAM: 191 (60%) of children in food-insecure and 129 (40%) of children in food-secure households had poor health outcomes. The risk factors found to be significantly associated with poor health outcomes included the duration of exclusive breastfeeding (AHR 1.50, 95%CI: 1.05, 2.15), dietary diversity (AHR 1.74, 95%CI: 1.18, 2.54), and maternal mid-upper arm circumference (AHR=1.36, 95% CI: 1.04, 1.86). Children from pregnancies that were wanted but unplanned had 80% higher incidence of poor health outcomes than others, and children from pregnancies that were both unwanted and unplanned had more than double the incidence of poor health outcomes compared to their counterparts.
We found that without treatment, the majority of children from food insecure households and over a third of children from food secure households did not recover from MAM. Maternal factors particularly the mother's ability to plan her pregnancy were the main determinants of recovery in this study. Together these findings support arguments for targeting of nutrition support programs to vulnerable households regardless of regional food security status, and for closely integrating robust family planning, and antenatal care services with nutrition interventions.
儿童中度急性营养不良（MAM）若不治疗，可能导致重度急性营养不良、发育迟缓以及死亡。尽管近期有所进展，但埃塞俄比亚全国营养不良的患病率仍然很高。目前，准确预测患有MAM的儿童病情并制定有效治疗策略的能力有限，因此，相当一部分患有MAM的儿童即使接受治疗也未能康复。我们试图通过评估埃塞俄比亚阿姆哈拉地区农村5岁以下患有MAM的儿童预后不良的风险因素来解决这一局限性。该地区被认为粮食相对安全，且没有食品补充治疗项目。
我们对404名随机抽样的0至59个月大的儿童进行了前瞻性队列研究，并按家庭粮食安全状况进行分层。我们对研究儿童进行了约2个月的随访，评估他们的健康状况；并使用双变量和多变量Cox比例风险回归模型来确定健康不良结局的风险因素。
家庭粮食安全状况与MAM康复率低显著相关：粮食不安全家庭中有191名（60%）儿童和粮食安全家庭中有129名（40%）儿童健康结局不良。发现与健康不良结局显著相关的风险因素包括纯母乳喂养持续时间（风险比1.50，95%置信区间：1.05，2.15）、饮食多样性（风险比1.74，95%置信区间：1.18，2.54）以及母亲的上臂中部周长（风险比=1.36，95%置信区间：1.04，1.86）。意外怀孕但想要孩子的孕妇所生的孩子健康不良结局的发生率比其他孩子高80%，而意外怀孕且不想要孩子的孕妇所生的孩子健康不良结局的发生率是其他孩子的两倍多。
我们发现，未经治疗的情况下，大多数粮食不安全家庭的儿童以及超过三分之一粮食安全家庭的儿童未能从MAM中康复。母亲因素，尤其是母亲计划怀孕的能力，是本研究中康复情况的主要决定因素。这些研究结果共同支持了以下观点：无论地区粮食安全状况如何，营养支持项目都应针对弱势群体家庭，并且应将强有力的计划生育和产前护理服务与营养干预紧密结合。
