Chatterjee Pritha, Chen Jarvis, Yousafzai Aisha, Kawachi Ichiro, Subramanian S V
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Confl Health. 2023 May 7;17(1):23. doi: 10.1186/s13031-023-00519-8.
Protracted, internal conflicts with geographic variations within countries, are an important understudied community exposure for adverse child health outcomes.
Violent events from the Uppsala Conflict Data Program (UCDP) between January 2016-December 2020 and January 2010-December 2015, were included as exposure events for children sampled in National Family Health Surveys (NFHS) 5 (2019-21) and NFHS 4 (2015-16), respectively. Geocoded data from UCDP were merged with residential clusters from NFHS, to identify children living in villages or urban blocks situated at <= 50 km from conflict sites. Within these clusters, which we defined as conflict exposed, we studied risks of stunting, underweight and wasting in children, prenatally, and in 0-3 years. We assessed sensitivity on a subsample of siblings with discordant conflict exposures.
For NFHS 5, exposure to violence between 0 and 3 years was associated with 1.16 times (95% CI 1.11-1.20) higher risks of stunting, 1.08 (1.04, 1.12) times higher risks of underweight, and no change in wasting. In-utero violence exposure was associated with 1.11 times (95% CI 1.04-1.17) higher risks of stunting, 1.08 (95% CI 1.02-1.14) times higher risks of underweight, and no change in wasting, among children <= 2 years. In 17,760 siblings of 8333 mothers, exposure to violence during 0-3 years, was associated with a 1.19 times higher risk of stunting (95% CI - 0.24 to 0.084). Incremental quartiles of violence exposure had higher risks of stunting and underweight until quartile 3.
In-utero and early childhood indirect exposure to protracted conflicts were associated with increased stunting and underweight in India. Given the continued exposures of such historically and contextually rooted internal conflicts in many LMICs, chronic violence exposures should be targeted in public health policies as important social and political determinant of child health.
国内存在地域差异的长期内部冲突，是一个重要但研究不足的社区暴露因素，会对儿童健康产生不良影响。
分别将2016年1月至2020年12月以及2010年1月至2015年12月期间来自乌普萨拉冲突数据项目（UCDP）的暴力事件，作为在全国家庭健康调查（NFHS）5（2019 - 21）和NFHS 4（2015 - 16）中抽样儿童的暴露事件。将UCDP的地理编码数据与NFHS的居住集群数据合并，以识别居住在距离冲突地点<=50公里的村庄或城市街区的儿童。在这些我们定义为冲突暴露的集群中，我们研究了儿童在出生前以及0至3岁时发育迟缓、体重不足和消瘦的风险。我们对冲突暴露情况不一致的兄弟姐妹子样本进行了敏感性评估。
对于NFHS 5，0至3岁期间暴露于暴力与发育迟缓风险高1.16倍（95%置信区间1.11 - 1.20）、体重不足风险高1.08倍（1.04，1.12）以及消瘦情况无变化相关。对于2岁及以下儿童，宫内暴露于暴力与发育迟缓风险高1.11倍（95%置信区间1.04 - 1.17）、体重不足风险高1.08倍（95%置信区间1.02 - 1.14）以及消瘦情况无变化相关。在8333名母亲的17760名兄弟姐妹中，0至3岁期间暴露于暴力与发育迟缓风险高1.19倍相关（95%置信区间 - =0.24至0.084）。暴力暴露的四分位数增加，直到第3四分位数，发育迟缓和体重不足的风险更高。
在印度，宫内和幼儿期间接暴露于长期冲突与发育迟缓和体重不足增加相关。鉴于许多低收入和中等收入国家持续存在这种具有历史和背景根源的内部冲突暴露情况，在公共卫生政策中应将长期暴力暴露作为儿童健康的重要社会和政治决定因素加以关注。
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