埃塞俄比亚南贡德尔区法尔塔县农村1至5岁学龄前儿童临床维生素A缺乏症的患病率及相关因素：一项混合方法研究

Prevalence and Associated Factors of Clinical Vitamin A Deficiency Among Pre-School Children 1-5 Years of Age in Rural Kebeles in Farta District, South Gondar Zone, Ethiopia: A Mixed Methods Study.

作者信息

Yisak Hiwot, Elmneh Rishah, Taklual Wubet, Ewunetei Amien, Kefale Belayneh

机构信息

Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia.

Department of Supply Chain, Distribution and Sales, Julphar Pharmaceuticals Plc, Addis Ababa, Ethiopia.

出版信息

J Multidiscip Healthc. 2020 Oct 20;13:1191-1201. doi: 10.2147/JMDH.S279571. eCollection 2020.

DOI:10.2147/JMDH.S279571

PMID:33116564

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7586053/

Abstract

BACKGROUND

Globally, pre-school children are the most at-risk population groups for vitamin A deficiency (VAD). The 2009 World Health Organization (WHO) report stated that one-third (190 million) of pre-school children worldwide are deficient in vitamin A. Both clinical and subclinical VAD have been a long-standing problem in developing countries. In Ethiopia, VAD was recognized as a public health problem 4-5 decades before. Since then, researches conducted in other parts of the country still showed varied and high prevalence, which is 2-8 times higher than WHO cut-off points. This community-based study was therefore conducted on pre-school children of rural kebeles in Farta district to determine the prevalence of clinical VAD (Bitot's spot and night blindness) and associated factors.

METHODS

A community-based cross-sectional mixed quantitative and qualitative study was conducted. Randomly selected 588 pre-school children participated in the study. The clinical aspect of the study investigated the presence of Bitot's spots on the children's eye with the aid of a magnifying loop and torch. Data on the history of night blindness were obtained from mothers/caregivers by using WHO standard questions. The qualitative study data were obtained via a key informant interview with the mothers/caregivers whose child has clinical VAD. Quantitative data were entered using Epi Data statistical software and analysed by using SPSS version 20 statistical software package. A bivariable logistic regression was employed, and variables that showed significant association with clinical VAD (P < 0.2) were entered a multivariable logistic regression model to identify independent predictors of clinical VAD.

RESULTS

The prevalence of Bitot's spot and night blindness was 0.8% and 1.2%, respectively. Pre-school children who were from highland (AOR: 3.71; 95% CI: 1.01-13.68), a mother having antenatal care (ANC) visit during pregnancy of a child (AOR: 8.63; 95% CI: 2.58-28.79), family monthly income (AOR: 8.63; 95% CI: 2.58-28.79) and handwashing frequency were found to be determinants of VAD (p < 0.05).

CONCLUSION

Clinical vitamin A deficiency in the study area is of public health concern because the prevalence of Bitot's and night blindness was above the WHO threshold level. Accordingly, effective preventive measures should be designed to reduce VAD prevalence.

摘要

背景

在全球范围内，学龄前儿童是维生素A缺乏症（VAD）风险最高的人群。2009年世界卫生组织（WHO）的报告指出，全球三分之一（1.9亿）的学龄前儿童缺乏维生素A。临床和亚临床维生素A缺乏症在发展中国家一直是个长期存在的问题。在埃塞俄比亚，维生素A缺乏症在40 - 50年前就被认定为一个公共卫生问题。从那时起，在该国其他地区进行的研究仍然显示出不同且较高的患病率，比世界卫生组织的临界值高出2 - 8倍。因此，这项基于社区的研究针对法尔塔区农村社区的学龄前儿童展开，以确定临床维生素A缺乏症（毕脱氏斑和夜盲症）的患病率及相关因素。

方法

开展了一项基于社区的横断面混合定量和定性研究。随机选取588名学龄前儿童参与研究。研究的临床部分借助放大环和手电筒检查儿童眼睛上是否有毕脱氏斑。通过使用世界卫生组织的标准问题，从母亲/照料者处获取夜盲症病史数据。定性研究数据通过对其孩子患有临床维生素A缺乏症的母亲/照料者进行关键信息访谈获得。定量数据使用Epi Data统计软件录入，并使用SPSS 20版统计软件包进行分析。采用双变量逻辑回归分析，将与临床维生素A缺乏症显示出显著关联（P < 0.2）的变量纳入多变量逻辑回归模型，以确定临床维生素A缺乏症的独立预测因素。

结果

毕脱氏斑和夜盲症的患病率分别为0.8%和1.2%。来自高地的学龄前儿童（调整后比值比：3.71；95%置信区间：1.01 - 13.68）、孩子母亲在孕期进行过产前检查（ANC）（调整后比值比：8.63；95%置信区间：2.58 - 28.79）、家庭月收入（调整后比值比：8.63；95%置信区间：2.58 - 28.79）以及洗手频率被发现是维生素A缺乏症的决定因素（p < 0.05）。