Khulna University, Khulna, Bangladesh.
Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, Bangladesh.
BMJ Open. 2023 Dec 20;13(12):e072775. doi: 10.1136/bmjopen-2023-072775.
This study aimed to determine the factors associated with minimum dietary diversity (MDD) and estimate the socioeconomic inequalities in MDD among children from five South Asian countries.
Cross-sectional.
The study used the most recent round of secondary databases of Demographic Health Survey data of Bangladesh (2017-2018), India (2019-2021), Maldives (2016-2017), Nepal (2018) and Pakistan (2017-2018).
This study used information on MDD and other explanatory variables from a total of 136 980 (weighted) children aged 6-23 months.
Multivariable logistic regression was employed to identify the factors associated with MDD and concentration index (CIX) and Lorenz curve were used to measure the socioeconomic inequalities in MDD.
The overall weighted prevalence of MDD in South Asia was 23.37%. The highest prevalence of MDD was found among children from Maldives (70.7%), while the lowest was in Pakistan (14.2%). Living in affluent versus poor households, having a mother who is employed versus a mother who is unemployed, exposure to various forms of media (newspapers and magazines), seeking antenatal care (ANC) more than four times compared with those who sought ANC less than four times and having children older than 4 years old are the most common significant factors associated with MDD deficiency. This study found the value of the CIX for MDD (MDD: CI=0.0352; p<0.001) among children with a higher socioeconomic status, suggesting inequality in MDD in favour of the more among well-off households.
Inequality in the prevalence of MDD favours the affluent. Health policy and intervention design should prioritise minimising socioeconomic inequalities concerning the MDD. In addition, policy-makers should prioritise the associated factors of MDD such as education, wealth status, employment, media exposure while designing intervention or policies.
本研究旨在确定与最低膳食多样性（MDD）相关的因素，并估计来自五个南亚国家的儿童中 MDD 的社会经济不平等情况。
横断面研究。
本研究使用了孟加拉国（2017-2018 年）、印度（2019-2021 年）、马尔代夫（2016-2017 年）、尼泊尔（2018 年）和巴基斯坦（2017-2018 年）的最新一轮人口健康调查数据的二级数据库。
本研究共使用了来自年龄在 6-23 个月之间的 136980 名（加权）儿童的 MDD 和其他解释变量的信息。
采用多变量逻辑回归确定与 MDD 相关的因素，并使用集中指数（CIX）和洛伦兹曲线来衡量 MDD 的社会经济不平等情况。
南亚地区总的 MDD 加权患病率为 23.37%。MDD 患病率最高的是马尔代夫的儿童（70.7%），而巴基斯坦的儿童患病率最低（14.2%）。与生活在贫困家庭的儿童相比，生活在富裕家庭、母亲有工作而非失业、接触多种媒体（报纸和杂志）、接受 ANC 次数超过四次而不是少于四次以及儿童年龄大于 4 岁是与 MDD 缺乏最常见的显著相关因素。本研究发现，社会经济地位较高的儿童的 MDD 的 CIX 值（MDD：CI=0.0352；p<0.001）较高，表明富裕家庭中 MDD 存在不平等现象。
MDD 患病率的不平等现象有利于富裕家庭。卫生政策和干预措施的制定应优先考虑减少 MDD 方面的社会经济不平等。此外，政策制定者在设计干预或政策时，应优先考虑 MDD 的相关因素，如教育、财富状况、就业、媒体接触。
