HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia.
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Int Health. 2023 Jan 3;15(1):10-18. doi: 10.1093/inthealth/ihac002.
Today, an estimated 7.3% (50 million) of all children <5 y of age suffer from wasting, with more burden in African countries including Guinea. Investigating inequalities in childhood wasting is essential for designing efficient programs and interventions, but no related evidence exists in Guinea. This study aimed to examine the trends in the prevalence of childhood wasting and the extent of sex, socio-economic and geographic-based disparities in Guinea.
Data from the 1999, 2005 and 2012 Guinea Demographic and Health Surveys and the 2016 Guinea Multiple Indicator Cluster Survey, with a total of 16 137 children <5 y of age were included for analysis. For inequality analysis, we used the 2019 updated World Health Organization Health Equity Assessment Toolkit (HEAT) software. Inequality was measured using four summary measures (difference [D], population attributable risk [PAR], ratio [R] and population attributable fraction [PAF]) for five equity stratifiers (economic status, education, place of residence, sex and subnational region). We computed 95% confidence intervals (CIs) around the points estimates to measure statistical significance.
The findings revealed a pro-rich (R=1.68 [95% CI 1.11 to 2.24]), pro-urban (PAR=-1.04 [95% CI -1.90 to -0.18]) and subnational region (D=8.11 [95% CI 4.85 to 11.36]) inequalities in childhood wasting across all surveys. Except in 2005, education-based disparities (PAF=-18.2 [95% CI -36.10 to -0.26]) were observed across all survey years, but not sex-based disparities. An approximately constant inequality pattern was seen across all dimensions.
This study showed inequalities in childhood wasting in Guinea with a disproportionately higher risk of wasting among children from disadvantaged subpopulations/mothers, including uneducated, poorest/poor, rural residents and regions. Policies that target disadvantaged populations need to be considered in order to ensure social protection, access to a wholesome diet and universal and quality health services.
目前，估计有 7.3%（5000 万）5 岁以下儿童患有消瘦症，其中包括几内亚在内的非洲国家负担更重。调查儿童消瘦症的不平等现象对于设计有效的项目和干预措施至关重要，但几内亚没有相关证据。本研究旨在检查几内亚儿童消瘦症的流行趋势，以及性别、社会经济和地理差异的程度。
本研究纳入了 1999 年、2005 年和 2012 年几内亚人口与健康调查以及 2016 年几内亚多指标类集调查中的 16137 名 5 岁以下儿童的数据。对于不平等分析，我们使用了 2019 年更新的世卫组织卫生公平评估工具包（HEAT）软件。不平等程度使用四个综合指标（差异[D]、人群归因风险[PAR]、比值[R]和人群归因分数[PAF]）和五个公平分层指标（经济地位、教育、居住地、性别和国家以下地区）进行衡量。我们计算了点估计值周围的 95%置信区间（CI）以衡量统计显著性。
研究结果显示，在所有调查中，消瘦症存在贫富差距（R=1.68[95%CI 1.11-2.24]）、城乡差距（PAR=-1.04[95%CI-1.90至-0.18]）和国家以下地区差距（D=8.11[95%CI 4.85-11.36]）。除了 2005 年，在所有调查年份中都观察到了教育差异（PAF=-18.2[95%CI-36.10 至-0.26]），但没有性别差异。所有维度的不平等模式基本保持不变。
本研究显示，几内亚儿童消瘦症存在不平等现象，来自弱势人群/母亲的儿童，包括未受教育者、最贫穷/贫穷、农村居民和地区，面临更高的消瘦症风险。需要考虑针对弱势人群的政策，以确保社会保护、获得全面饮食以及普及和高质量的卫生服务。
