Modjadji Perpetua, Mashishi Josephine
Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa.
Int J Environ Res Public Health. 2020 Oct 19;17(20):7580. doi: 10.3390/ijerph17207580.
Despite years of interventions intended to reduce child malnutrition in South Africa, its negative effects, stunting in particular, persist mainly among children under five years old living in under-resourced regions. A cross-sectional study was conducted to determine the prevalence of malnutrition and associated factors among 404 children under age five attending childcare services with their mothers in selected healthcare facilities of Limpopo Province, South Africa. Anthropometry, socio-demographics and obstetric history were collected. Height-for-age, weight-for-age and body mass index-for-age Z-scores were used to determine stunting, underweight and thinness among children, respectively. Logistic regression analyses were performed to generate the factors associated with malnutrition. Stunting (45.3%) was the prevalent form of malnutrition among children under age five, affecting boys (51.7%) more than girls (38.8%) and children aged 12-23 months (62.4%) more than those <11 months old (40.1%), in addition to the overall prevalence of underweight (29.0%) and thinness (12.6%). Boys had increased odds of stunting (adjusted odds ratio, AOR = 2.07, 95% CI: 1.26-3.41, = 0.004) and underweight (AOR = 2.17, 95% CI: 1.32-3.57, = 0.002) than girls. Children aged 12-23 months were more likely to be stunted (AOR = 4.79, 95% CI: 2.36-9.75, ≤ 0.0001) than children aged ≤11 months. Delayed introduction of solid foods increased the odds of stunting (AOR = 5.77, 95% CI: 2.63-12.64, ≤ 0.0001) and underweight (AOR = 2.05, 95% CI: 1.08-3.89, = 0.028). Children with normal birth weight were less likely to be thin (AOR = 0.42, 95% CI: 0.19-0.92, = 0.029) and underweight (AOR = 0.34, 95% CI: 0.17-0.68, = 0.003) than children who had low birth weight. Children whose mothers had obtained secondary school education (AOR = 0.39, 95% CI: 0.16-0.97, = 0.044), and Grade 12 or post-Grade 12 education (AOR = 0.32, 95% CI: 0.12-0.83, = 0.020) were less likely to be stunted than were children of mothers who had only primary school education. Suboptimal complementary feeding predisposed children to stunting and underweight. National nutrition programs should be context-specific to improve the introduction of complementary foods among children, especially in the remote and poor areas.
尽管南非多年来一直采取干预措施以减少儿童营养不良现象，但其负面影响，尤其是发育迟缓，仍主要存在于生活在资源匮乏地区的五岁以下儿童中。在南非林波波省的选定医疗机构中，开展了一项横断面研究，以确定404名与母亲一同接受儿童保育服务的五岁以下儿童的营养不良患病率及相关因素。收集了人体测量数据、社会人口统计学数据和产科病史。年龄别身高、年龄别体重和年龄别体重指数Z评分分别用于确定儿童的发育迟缓、体重不足和消瘦情况。进行逻辑回归分析以找出与营养不良相关的因素。发育迟缓（45.3%）是五岁以下儿童中普遍存在的营养不良形式，男孩（51.7%）受影响的程度高于女孩（38.8%），12至23个月大的儿童（62.4%）受影响的程度高于11个月以下的儿童（40.1%），此外还有总体体重不足（29.0%）和消瘦（12.6%）的情况。男孩发育迟缓（调整后的优势比，AOR = 2.07，95%置信区间：1.26 - 3.41，P = 0.004）和体重不足（AOR = 2.17，95%置信区间：1.32 - 3.57，P = 0.002）的几率高于女孩。12至23个月大的儿童比11个月及以下的儿童更易发育迟缓（AOR = 4.79，95%置信区间：2.36 - 9.75，P≤0.0001）。固体食物引入延迟会增加发育迟缓（AOR = 5.77，95%置信区间：2.63 - 12.64，P≤0.0001）和体重不足（AOR = 2.05，95%置信区间：1.08 - 3.89，P = 0.028）的几率。出生体重正常的儿童比出生体重低的儿童消瘦（AOR = 0.42，95%置信区间：0.19 - 0.92，P = 0.029）和体重不足（AOR = 0.34，95%置信区间：0.17 - 0.68，P = 0.003）的可能性更小。母亲接受过中学教育（AOR = 0.39，95%置信区间：0.16 - 0.97，P = 0.044）以及接受过12年级或12年级以上教育（AOR = 0.32，95%置信区间：0.12 - 0.83，P = 0.020）的儿童，发育迟缓的可能性低于母亲仅接受过小学教育的儿童。辅食添加不当使儿童易出现发育迟缓和体重不足的情况。国家营养计划应因地制宜，以改善儿童尤其是偏远贫困地区儿童的辅食添加情况。
