Ghimire Umesh, Vatsa Richa
New ERA, Rudramati Marga, Kalopul, Kathmandu, 44600, Nepal.
Central University of South Bihar, SH-7, Gaya Panchanpur Road, Village - Karhara, Post. Fatehpur, Gaya, 824236, Bihar, India.
SSM Popul Health. 2021 Mar 28;14:100781. doi: 10.1016/j.ssmph.2021.100781. eCollection 2021 Jun.
Addressing both the under-and over-nutritional status of women is an eminent challenge for developing countries like Nepal. This paper examined a critical analysis of factors associated with various forms of malnutrition using Bayesian geoadditive quantile regression approach and assessed spatial variations of malnutrition among Nepalese women using Asian cut-off values. Data drawn from the 2016 Nepal Demographic and Health Survey was utilized to assess the spatial distributions of underweight, overweight and obesity at the provincial level. Spatial and nonlinear components were estimated using Markov random fields and Bayesian P-splines, respectively. The analysis of 4,338 women confirmed that women living in extremely urbanized areas and in Province 1, Province 3, and Province 4 were more likely to be overweight/obese. Similarly, the likelihood of being underweight was prominently high among women residing in rural municipality and women residing in Province 2 and Province 7. Women from the richest and richer quintiles, and with primary education were more likely to be obese. Furthermore, currently-working women and women having access to protected water source were less likely to be obese while improved toilet and access to electricity facility were associated with obesity. Women with access to newspaper and radio were less prone to obesity. Inconsistent distribution of under- and over-nutrition existed in Nepal, given that the high prevalence of overweight/obesity among women living in metropolitan and undernutrition among rural women. Specific intervention measures, addressing location-specific nutrition issues are urgent. Rigorous implementation of strategies incorporated in the national nutrition plan is called for to curb the burden of overweight/obesity. Involving mass media to promote healthier lifestyle and nutritious food could be advantageous at the population level, especially in rural municipalities.
解决尼泊尔等发展中国家妇女营养不足和营养过剩的问题是一项重大挑战。本文采用贝叶斯地理加法分位数回归方法，对与各种形式营养不良相关的因素进行了批判性分析，并使用亚洲临界值评估了尼泊尔妇女营养不良的空间差异。利用2016年尼泊尔人口与健康调查的数据，评估省级层面体重不足、超重和肥胖的空间分布。分别使用马尔可夫随机场和贝叶斯P样条估计空间和非线性成分。对4338名妇女的分析证实，生活在高度城市化地区以及第一省、第三省和第四省的妇女超重/肥胖的可能性更高。同样，居住在农村市镇以及第二省和第七省的妇女体重不足的可能性也非常高。来自最富有和较富有的五分之一阶层且接受过小学教育的妇女更有可能肥胖。此外，目前在职的妇女和能够使用受保护水源的妇女肥胖的可能性较小，而改善厕所和使用电力设施与肥胖有关。能够接触报纸和收音机的妇女肥胖倾向较低。尼泊尔存在营养不足和营养过剩分布不一致的情况，因为大城市地区妇女超重/肥胖的患病率较高，而农村妇女存在营养不良问题。迫切需要采取针对特定地点营养问题的具体干预措施。需要严格实施国家营养计划中纳入的战略，以减轻超重/肥胖的负担。在人口层面，尤其是在农村市镇，让大众媒体参与推广更健康的生活方式和营养食品可能会有好处。
