Maternal and Child Wellbeing Unit, Research Division, African Population and Health Research Center, Nairobi, Kenya.
Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
PLoS One. 2020 Mar 11;15(3):e0224118. doi: 10.1371/journal.pone.0224118. eCollection 2020.
This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects.
本研究使用来自加纳、肯尼亚、尼日利亚、莫桑比克和刚果民主共和国（DRC）的调查数据，考察了与富裕家庭中学龄前儿童正常线性生长相关的社会人口因素。主要结局变量是儿童身高年龄 z 分数（HAZ），分为 HAZ≥-2SD（正常生长/未发育迟缓）和 HAZ<-2（发育迟缓）。使用逻辑回归，我们估计了与正常生长相关的因素的调整后优势比（aOR）。莫桑比克、DRC、肯尼亚和尼日利亚的母亲体重（通过体重指数衡量）较高与正常生长的几率增加有关。母亲受教育年限每增加一年与 DRC（aOR = 1.06，95%CI = 1.03，1.09）、加纳（aOR = 1.08，95%CI = 1.04，1.12）、莫桑比克（aOR = 1.08，95%CI = 1.05，1.11）和尼日利亚（aOR = 1.07，95%CI = 1.06，1.08）的正常生长几率增加有关。母亲年龄每增加一岁与五个国家的正常生长均呈正相关。母乳喂养与尼日利亚（aOR = 1.30，95%CI = 1.16，1.46）和肯尼亚（aOR = 1.37，95%CI = 1.05，1.79）的正常生长几率增加有关。母亲工作的儿童正常生长的几率降低了 25%（aOR = 0.75，95%CI = 0.60，0.93）在 DRC。母亲生育次数的变化与 DRC 的 10%（aOR = 0.90，95%CI = 0.84，0.97）、23%（aOR = 0.77，95%CI = 0.63，0.93）、25%（aOR = 0.75，95%CI = 0.69，0.82）、6%（aOR = 0.94，95%CI = 0.89，0.99）和 5%（aOR = 0.95，95%CI = 0.92，0.99）的正常生长几率降低有关，分别在 DRC、加纳、肯尼亚、莫桑比克和尼日利亚。男孩的几率降低了 18%（aOR = 0.82，95%CI = 0.68，0.98）、40%（aOR = 0.60，95%CI = 0.40，0.89）、37%（aOR = 0.63，95%CI = 0.51，0.77）和 21%（aOR = 0.79，95%CI = 0.71，0.87）在 DRC、加纳、肯尼亚和尼日利亚的正常儿童生长几率降低。总之，母亲的教育、体重、年龄、母乳喂养和产前保健与正常儿童生长呈正相关。相比之下，母亲的生育次数、就业情况以及儿童的性别和年龄与正常生长呈负相关。改善儿童生长的干预措施应考虑到这些差异效应。
