Saito K, Korzenik J R, Jekel J F, Bhattacharji S
School of Epidemiology and Public Health, Yale University, New Haven, Connecticut, USA.
Yale J Biol Med. 1997 Mar-Apr;70(2):149-60.
In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children's nutritional status in rural south India.
A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital's list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition.
Poor nutritional status was associated with socioeconomic variables such as sex of the child and father's occupation. Female gender (OR = 3.44, p = .02) and father's occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles.
The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father's occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.
在印度，约20%的4岁以下儿童患有严重营养不良，而所有儿童中有一半存在营养不良问题。母亲对营养相关行为的认知和态度对儿童营养不良的影响尚不清楚。本研究旨在探讨印度南部农村地区母亲对营养不良原因的认知、寻求医疗保健的态度以及与儿童营养状况相关的社会经济风险因素。
在印度泰米尔纳德邦的一个农村地区进行了一项病例对照研究。通过当地医院的幼儿名单，从约97000人的人群中选取了34例病例和34例对照。病例定义为4岁以下严重营养不良儿童的母亲。严重营养不良定义为年龄别体重低于预期中位数的60%。对照为有营养良好儿童的母亲，并按儿童的居住地和年龄进行匹配。通过访谈获取：（1）家庭的社会经济信息，（2）对营养不良原因的认知，以及（3）对包括营养不良在内的常见儿童疾病寻求医疗保健的态度。
营养状况不佳与儿童性别和父亲职业等社会经济变量有关。女性（比值比=3.44，p=0.02）和父亲为体力劳动者（比值比=2.98，p=0.05）是严重营养不良的重要风险因素。两组在轻度混合性营养不良的营养相关知识方面存在显著差异（比值比=2.62，p=0.05）。在寻求医疗保健的态度方面没有明显差异。基于传统观念，母亲们不认为医疗护理是治疗营养不良或麻疹等儿童疾病的合适干预措施。
结果表明，儿童性别和社会经济因素比医疗保健可及性和寻求医疗保健的态度更能成为营养不良的风险因素。父亲的职业比家庭收入更能准确反映营养不良情况。这些结果表明需要针对贫困女童及其母亲开展强化营养项目。
