探索埃塞俄比亚儿童饮食多样性的空间差异及其决定因素：利用埃塞俄比亚人口与健康调查（2011 - 2016年）进行的空间和多水平分析
Exploring Spatial Variations and Determinants of Dietary Diversity Among Children in Ethiopia: Spatial and Multilevel Analysis Using EDHS (2011-2016).
作者信息
Seboka Binyam Tariku, Hailegebreal Samuel, Yehualashet Delelegn Emwodew, Gilano Girma, Kabthymer Robel Hussen, Ewune Helen Ali, Demeke Abel Desalegn, Amede Endris Seid, Tesfa Getanew Aschalew
机构信息
School of Public Health, Dilla University, Dilla, Ethiopia.
Department of Health Informatics, Arba Minch University, Arba Minch, Ethiopia.
出版信息
J Multidiscip Healthc. 2021 Sep 21;14:2633-2650. doi: 10.2147/JMDH.S327456. eCollection 2021.
INTRODUCTION
Dietary diversity has a significant impact on children's nutritional health. For developing and implementing interventions, it is critical to understand the regional distribution of dietary diversity and underlying factors. However, the application of spatial techniques in dietary studies has not been well documented. The study's goal was to look into the regional variances and factors that influence children's dietary diversity. Further, we have discussed the spatial correlation of dietary diversity with nutritional status.
METHODS
Data from the National Demographic and Health Survey were used during analyses. This work evaluated the overall dietary diversity of children aged 6-23 months based on the 2017 WHO and UNICEF classification of minimum dietary diversity (MDD). The Local Anselin Moran's I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariate multilevel logistic regression was used for factor analyses.
RESULTS
Overall, only 13.3% (95% CI: 10.2-14.7%) of children in 2011 and 24% (95% CI: 15.5-26.5%) in 2016 achieved MDD. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) in the districts of northern Ethiopia, notably in the Amhara, Tigray, and Afar regions, and clusters of low inadequate dietary diversity (cold spots) in the country's central and western regions. In both studies, the frequency of dietary diversity was significantly higher among older children, those who had media exposure, and mothers and fathers who had received formal education.
CONCLUSION
According to our findings, the MDD of children in Ethiopia, as measured by WHO dietary assessment, slightly increased from 2011 to 2016. The dietary diversity of children was distributed non-randomly in different districts across regions of Ethiopia. Localized intervention and preventative methods to improve dietary patterns and culture can be developed using existing socio-demographic factors and districts with a larger distribution of inadequate dietary diversity.
引言
饮食多样性对儿童营养健康有重大影响。对于制定和实施干预措施而言，了解饮食多样性的区域分布及潜在因素至关重要。然而，空间技术在饮食研究中的应用尚未得到充分记录。本研究的目的是探究影响儿童饮食多样性的区域差异及因素。此外，我们还讨论了饮食多样性与营养状况的空间相关性。
方法
分析过程中使用了来自全国人口与健康调查的数据。本研究根据2017年世界卫生组织和联合国儿童基金会的最低饮食多样性（MDD）分类标准，评估了6至23个月儿童的总体饮食多样性。通过估计局部安塞尔林莫兰指数（Local Anselin Moran's I）来探究饮食多样性的区域差异以及热点和冷点地区。此外，采用多变量多层次逻辑回归进行因素分析。
结果
总体而言，2011年仅有13.3%（95%置信区间：10.2 - 14.7%）的儿童达到MDD，2016年这一比例为24%（95%置信区间：15.5 - 26.5%）。我们发现埃塞俄比亚北部地区，特别是阿姆哈拉、提格雷和阿法尔地区的部分县存在饮食多样性严重不足的统计学显著聚类（热点），而在该国中部和西部地区则存在饮食多样性不足程度较低的聚类（冷点）。在两项研究中，年龄较大的儿童、有媒体接触经历的儿童以及父母接受过正规教育的儿童，其饮食多样性频率显著更高。
结论
根据我们的研究结果，按照世界卫生组织饮食评估标准衡量，埃塞俄比亚儿童的MDD在2011年至2016年间略有增加。埃塞俄比亚各地区不同县的儿童饮食多样性分布并非随机。利用现有的社会人口因素以及饮食多样性不足分布较广的县，可以制定本地化的干预和预防措施，以改善饮食模式和文化。
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