The University of Sydney, School of Public Health, Sydney, Australia.
National Institute of Nutrition, Hanoi, Vietnam.
Public Health Nutr. 2023 Aug;26(8):1644-1657. doi: 10.1017/S1368980023001076. Epub 2023 May 31.
The study's objective was to investigate multiple underlying social, economic and agricultural determinants of stunting among under-five children in three distinct ecological areas in rural Myanmar.
Repeated cross-sectional surveys in three states of Myanmar.
Rural households in Chin (mountainous), Magway (plains) and Ayeyarwady (delta).
From two purposively selected adjacent townships in each state, we randomly selected twenty villages and, in each village, thirty households with under-five children. Households in the first survey in 2016 were revisited in late 2017 to capture seasonal variations.
Stunting increased from 40·4 % to 42·0 %, with the highest stunting prevalence in Chin state (62·4%). Univariate Poisson regression showed factors contributing to child stunting varied across the regions. Adjusted Poisson regression models showed that child's age and short maternal stature (aRR = 1·14 for Chin, aRR = 1·89 for Magway and aRR = 1·86 for Ayeyarwady) were consistently associated with child stunting across three areas. For Chin, village-level indicators such as crop consumption (aRR = 1·18), crop diversity (aRR = 0·82) and land ownership (aRR = 0·89) were significantly associated with stunting. In Magway, the number of household members (aRR = 1·92), wealth status (aRR = 0·46), food security status (aRR = 1·14), land ownership (aRR = 0·85) and in Ayeyarwady, women's decision-making (aRR = 0·67) and indicators related to hygiene (aRR = 1·13) and sanitation (aRR = 1·45) were associated with stunting.
Area-specific factors were associated with stunting. Maternal short stature and child age were consistent determinants of stunting. A multi-sectoral local approach, including improvements in transport, is needed to address the intergenerational malnutrition problem.
本研究旨在调查缅甸三个不同生态区五岁以下儿童发育迟缓的多个潜在社会、经济和农业决定因素。
在缅甸三个邦进行重复的横断面调查。
钦邦（山区）、马圭邦（平原）和仰光邦（三角洲）的农村家庭。
我们从每个邦两个有针对性选择的相邻乡镇中，随机选择了二十个村庄，在每个村庄中，随机选择了三十户有五岁以下儿童的家庭。2016 年第一次调查中的家庭于 2017 年末再次进行了调查，以捕捉季节性变化。
发育迟缓率从 40.4%增加到 42.0%，钦邦的发育迟缓率最高（62.4%）。单变量泊松回归显示，不同地区导致儿童发育迟缓的因素各不相同。调整后的泊松回归模型显示，儿童年龄和母亲身材矮小（钦邦 aRR=1.14，马圭邦 aRR=1.89，仰光邦 aRR=1.86）与三个地区的儿童发育迟缓均相关。对于钦邦，村庄层面的指标，如作物消费（aRR=1.18）、作物多样性（aRR=0.82）和土地所有权（aRR=0.89）与发育迟缓显著相关。在马圭，家庭人口数量（aRR=1.92）、财富状况（aRR=0.46）、粮食安全状况（aRR=1.14）、土地所有权（aRR=0.85）和在仰光，妇女决策（aRR=0.67）和与卫生（aRR=1.13）和卫生设施（aRR=1.45）相关的指标与发育迟缓相关。
特定地区的因素与发育迟缓有关。母亲身材矮小和儿童年龄是发育迟缓的一致决定因素。需要采取多部门的地方方法，包括改善交通，以解决代际营养不良问题。
