Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
PLoS One. 2024 Jul 10;19(7):e0306646. doi: 10.1371/journal.pone.0306646. eCollection 2024.
INTRODUCTION: More than two-third of global child death is occurred due to inappropriate feeding practice that happened during early childhood period. Evidence on meal frequency status among infant and young children at national level can be used to design appropriate interventions to improve the recommended feeding frequency. Therefore, this study was aimed to explore the spatial distribution and identify associated factors of inadequate meal frequency among children aged 6-23 months in Ethiopia. METHODS: Secondary data analysis was conducted using the 2019 mini Ethiopian Demographic and Health Survey data. A total weighted sample of 1,532 children aged 6-23 months were included. To identify significant factors associated with of inadequate meal frequency, multilevel binary logistic regression model was fitted. Variables with p-value < 0.25 from the bi-variable model were exported to multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significantly associated factors and adjusted odds ratio (AOR) with its 95% confidence interval were reported. Multilevel models were compared using deviance and log-likelihood. Spatial analysis tools were utilized to visualize the distribution of inadequate meal frequency. Bernoulli model was fitted using SaTScan V.9.6 to identify most likely clusters and ArcGIS V.10.8 was used to map the hotspot areas. Ordinary least square and geographic weighted regression models were used and compared using information criteria and adjusted-R2. Local coefficients of factors associated with hotspots of inadequate meal frequency were mapped. RESULTS: The prevalence of inadequate meal frequency was 47.03% (95% CI: 44.54%, 49.53%) in Ethiopia. Age of the child, sex of the household head, timely initiation of breastfeeding, current breastfeeding status, number of antenatal care visit, maternal education, and region were significantly associated with inadequate meal frequency. The spatial distribution of inadequate meal frequency was showed significant variation across Ethiopia (Global Moran's I = 0.164, p-value <0.001). A total of 38 significant clusters were detected through SaTScan analysis, from these the 22 primary clusters were located in Somali and Harari. CONCLUSION AND RECOMMENDATION: The prevalence of inadequate meal frequency was high in Ethiopia and had significant clustering patter. Significant hotspot clusters were located in Somali, northern Afar, Harari, Amhara, Gambela, and eastern South nation nationalities and peoples' region. Therefore, public health interventions which enhance breastfeeding practice, optimal number of antenatal care visits, educational empowerments should target hotspot areas to decrease inadequate meal frequency practice.
介绍:全球超过三分之二的儿童死亡是由于儿童早期的不当喂养行为导致的。在国家层面上,关于婴儿和幼儿的用餐频率现状的证据可以用于设计适当的干预措施,以改善推荐的喂养频率。因此,本研究旨在探讨埃塞俄比亚 6-23 个月儿童饮食不规律的空间分布,并确定其相关因素。
方法:本研究采用 2019 年迷你埃塞俄比亚人口与健康调查的二次数据分析。共纳入 1532 名 6-23 个月大的儿童进行加权分析。为了确定与饮食不规律显著相关的因素,采用多水平二元逻辑回归模型进行拟合。对双变量模型中 p 值<0.25 的变量进行导出,并纳入多变量分析。在多变量模型中,p 值<0.05 的变量被宣布为与饮食不规律显著相关的因素,并报告了其调整后的优势比(AOR)及其 95%置信区间。比较了不同模型的偏差和对数似然值。利用空间分析工具可视化饮食不规律的分布。使用 SaTScan V.9.6 拟合 Bernoulli 模型,以确定最有可能的聚类,并使用 ArcGIS V.10.8 绘制热点区域图。使用普通最小二乘法和地理加权回归模型,并比较信息准则和调整后的 R2。对与饮食不规律热点相关的因素进行局部系数映射。
结果:埃塞俄比亚饮食不规律的流行率为 47.03%(95%置信区间:44.54%,49.53%)。儿童年龄、家庭户主性别、及时开始母乳喂养、当前母乳喂养状况、产前护理次数、母亲教育程度和地区与饮食不规律显著相关。饮食不规律的空间分布在埃塞俄比亚表现出显著的差异(全局 Moran's I = 0.164,p 值<0.001)。通过 SaTScan 分析共检测到 38 个显著聚类,其中 22 个主要聚类位于索马里和哈拉里。
结论和建议:埃塞俄比亚饮食不规律的流行率较高,且呈显著聚类模式。显著的热点聚类位于索马里、北阿法尔、哈拉里、阿姆哈拉、甘贝拉和东南国家民族人民地区。因此,应该针对热点地区开展增强母乳喂养实践、优化产前护理次数、加强教育等公共卫生干预措施,以减少饮食不规律的情况。
J Health Popul Nutr. 2021-7-23