Health for Life, RTI International, Kathmandu, Nepal.
New ERA, Rudramatimarg, Kalopul, Kathmandu, Nepal.
BMC Public Health. 2020 Nov 25;20(1):1788. doi: 10.1186/s12889-020-09915-8.
Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.
We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001.
The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children's birth order and the prevalence of undernutrition had strong statistical significance. Mother's age at marriage (p = 0.001), underweight mother, mother's education, father's education, wealth quintile, no exposure to mass media, children's age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9).
The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.
儿童期营养不良是包括尼泊尔在内的中低收入国家的一个重大公共卫生问题。然而，目前仅有有限的证据表明生育规划（PoB）与儿童期营养不良（发育迟缓与消瘦）之间存在关联。本研究旨在探究 PoB 与儿童期营养不良之间的关系。
我们使用了具有全国代表性的横断面家庭调查——2016 年尼泊尔人口与健康调查（NDHS）的数据。本研究将儿童期营养不良的两个人体测量指标作为结果。PoB 是主要预测因素。我们使用带有抽样权重的二项逻辑回归来估计调整后的优势比（OR）和 95%置信区间（CI），以检验 PoB 与儿童期营养不良之间的关联。除非另有说明，否则变量之间的显著关联通过 p<0.001 来计算。
尼泊尔 5 岁以下儿童的发育迟缓总患病率为 35.8%，消瘦率为 27.1%。我们发现，在间隔生育和随后生育之间的间隔为 2 年以上和 3 年以下的儿童中，发育迟缓率（52.7%）和消瘦率（41.1%）更高。儿童出生顺序与营养不良发生率之间存在较强的统计学关联。母亲的初婚年龄（p=0.001）、消瘦的母亲、母亲的教育程度、父亲的教育程度、财富五分位数、未接触大众媒体、儿童年龄和居住地点（p=0.001）与儿童期营养不良显著相关。多因素逻辑回归结果显示，间隔生育和首次生育之间的生育间隔为 12-24 个月的儿童，与间隔生育和首次生育之间的生育间隔为 12 个月以下的儿童相比，发育迟缓的几率显著降低（OR 0.6，95%CI 0.4-0.9）。
研究结果表明，PoB 对儿童期营养不良具有保护作用。发现生育间隔延长至结婚后 12-24 个月与儿童期发育迟缓几率降低有关。为了减轻儿童期营养不良，尼泊尔政府需要促进婚后晚育，并重点提高家庭经济地位以及大众媒体的广泛覆盖和利用。
