Belay Daniel Gashaneh, Taddese Asefa Adimasu, Gelaye Kassahun Alemu
Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Nutr. 2022 Apr 7;8(1):30. doi: 10.1186/s40795-022-00521-y.
Child undernutrition is a major public health problem in many resource-poor communities in the world. More than two-thirds of malnutrition-related child deaths are associated with inappropriate feeding practices during the first 2 years of life. Socioeconomic inequalities are one of the most immediate determinants. Though sub-Saharan Africa (SSA) shares the huge burden of children undernutrition, as to our search of literature there is limited evidence on the pooled magnitude, socioeconomic inequalities of minimum acceptable diet intake and its contributing factors among children aged 6 to 23 months in the region. This study aimed to assess the level of socio-economic inequalities of minimum acceptable diet intake, and its contributor factors among children aged 6-23 months in SSA using recent 2010-2020 DHS data.
A total of 78,542 weighted samples from Demographic and Health Survey datasets of SSA countries were used for this study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. The concentration index and curve and wag staff type decomposition analysis were applied to examine wealth-related inequalities in the outcomes. P-value < 0.05 was taken to declare statistical significance.
The pooled magnitude of MAD intake among children age 6-23 months in SSA was 9.89% [95%CI: 8.57, 11.21%] ranging from 3.10% in Guinea to 20.40% in Kenya. MAD intake in SSA was disproportionately concentrated on the rich households (pro-rich) [C = 0.191; 95% CI: 0.189, 0.193]. Residence (36.17%), media exposure (23.93%), and women's education (11.63%) explained the pro-rich inequalities in MAD intake. The model explained 55.55% of the estimated socioeconomic inequality in MAD intake in SSA.
Minimum acceptable diet intake in SSA is relatively low. There are moderate socioeconomic inequalities in MAD intake in SSA, mainly explained by residence, media exposure and women's education. The government of sub-Saharan African countries should plan and work in short terms through the program that endorses women empowerment such as income generation, cash assistance for mothers who have under 2 years of children and women employment using affirmative actions, and nutrition education such as media campaigns and promoting breast feedings. Long-term plans are also needed for those SSA countries with lower income status through programs to enhance their country's economy to the middle and higher economic level and to improve the wealth index of individual households to narrow the poor-rich gap in the minimum acceptable diet intake.
儿童营养不良是世界上许多资源匮乏社区的一个主要公共卫生问题。超过三分之二与营养不良相关的儿童死亡与生命最初两年的不当喂养习惯有关。社会经济不平等是最直接的决定因素之一。尽管撒哈拉以南非洲地区（SSA）承担着儿童营养不良的巨大负担，但就我们对文献的检索而言，关于该地区6至23个月儿童最低可接受饮食摄入量的总体规模、社会经济不平等及其影响因素的证据有限。本研究旨在利用2010 - 2020年最新的 DHS 数据评估撒哈拉以南非洲地区6 - 23个月儿童最低可接受饮食摄入量的社会经济不平等程度及其影响因素。
本研究共使用了来自撒哈拉以南非洲国家人口与健康调查数据集的78542个加权样本。数据使用MS excel进行清理，并使用STATA V.16软件进行提取和分析。应用浓度指数和曲线以及 wag 工作人员类型分解分析来检验结果中与财富相关的不平等。P值<0.05被视为具有统计学意义。
撒哈拉以南非洲地区6 - 23个月儿童的平均每日膳食摄入量（MAD）总体规模为9.89% [95%置信区间：8.57，11.21%]，范围从几内亚的3.10%到肯尼亚的20.40%。撒哈拉以南非洲地区的MAD摄入量不成比例地集中在富裕家庭（有利于富人）[C = 0.191；95%置信区间：0.189，0.193]。居住地区（36.17%）、媒体接触（23.93%）和女性教育程度（11.63%）解释了MAD摄入量中有利于富人的不平等现象。该模型解释了撒哈拉以南非洲地区MAD摄入量估计社会经济不平等的55.55%。
撒哈拉以南非洲地区的最低可接受饮食摄入量相对较低。该地区在MAD摄入量方面存在中等程度的社会经济不平等，主要由居住地区、媒体接触和女性教育程度来解释。撒哈拉以南非洲国家的政府应通过支持妇女赋权的项目，如创收、为有2岁以下儿童的母亲提供现金援助以及通过平权行动促进妇女就业，以及开展媒体宣传和推广母乳喂养等营养教育，在短期内进行规划和工作。对于收入水平较低的撒哈拉以南非洲国家，还需要制定长期计划，通过提高国家经济水平至中高经济水平以及改善单个家庭的财富指数的项目，来缩小最低可接受饮食摄入量方面的贫富差距。
