Kikafunda J K, Walker A F, Collett D, Tumwine J K
Department of Food Science and Technology, Makerere University, Kampala, Uganda.
Pediatrics. 1998 Oct;102(4):E45. doi: 10.1542/peds.102.4.e45.
To assess the dietary and environmental factors influencing stunting and other signs of poor nutritional status of children <30 months of age in a central Ugandan community, whose main dietary staples are banana (matoki) and maize.
The study was a cross-sectional survey using stratified multistage random sampling to select households with a child <30 months of age in rural and semi-urban environments. A questionnaire was administered to mothers of 261 infants and toddlers in their home setting. Their health status was assessed by clinical examination and anthropometric measurements (mid-upper arm circumference [MUAC], weight, and supine length).
A large minority (21.5%) of the children surveyed were found in poor health after clinical examination: 3.8% being classified as suffering from kwashiorkor and 5.7% with marasmus. A high proportion of children were stunted (23. 8%), underweight (24.1%), or had low MUAC (21.6%). Although rural living, poor health, the use of unprotected water supplies, lack of charcoal as fuel, lack of milk consumption, and lack of personal hygiene were shown as risk factors for marasmus and underweight, different factors were found to be associated with risk of stunting and low MUAC, despite these three parameters being significantly correlated. For stunting the risk factors were: age of the child, poor health, prolonged breastfeeding (from >18 months to <24 months), low socioeconomic status of the family, poor education of the mother of infants <12 months, lack of paraffin as fuel, consumption of food of low energy density (<350 kcal/100 g dry matter), presence of eye pathology, and consumption of small meals. Risk factors for low MUAC were poor health, lack of meat and cow's milk consumption, low intake of energy from fat, and less well educated and older mothers. Food taboos had no influence on any of the anthropometric measurements. Although 93.1% of the children had been immunized against tuberculosis, polio, diphtheria, and measles and showed better general health than children who were not immunized, there was a high prevalence of infection in the week preceding the survey interview, including diarrhea (23.0%), malaria (32.3%), or cough/influenza (72.8%).
This first account of dietary and environmental risk factors involved in the etiology of early childhood malnutrition in Uganda indicates differences in risk factors for marasmus and underweight compared with stunting and low MUAC. The high prevalence of malnutrition and current infection of children in this survey suggests poor immune function as a result of inadequate nutrition.
评估影响乌干达中部一个社区30个月以下儿童发育迟缓及其他营养不良状况体征的饮食和环境因素，该社区的主要主食是香蕉（马托基）和玉米。
本研究为横断面调查，采用分层多阶段随机抽样法，在农村和半城市环境中选取有30个月以下儿童的家庭。对261名婴幼儿的母亲在其家中进行问卷调查。通过临床检查和人体测量（上臂中部周长[MUAC]、体重和仰卧身长）评估他们的健康状况。
临床检查后发现，接受调查的儿童中有很大一部分（21.5%）健康状况不佳：3.8%被归类为患有夸希奥科病，5.7%患有消瘦症。很大比例的儿童发育迟缓（23.8%）、体重不足（24.1%）或上臂中部周长较低（21.6%）。虽然农村生活、健康状况不佳、使用无保护的水源、缺乏木炭作为燃料、不喝牛奶以及缺乏个人卫生被证明是消瘦症和体重不足的风险因素，但尽管这三个参数显著相关，却发现不同的因素与发育迟缓和上臂中部周长较低的风险相关。发育迟缓的风险因素包括：儿童年龄、健康状况不佳、母乳喂养时间过长（从>18个月至<24个月）、家庭社会经济地位低、12个月以下婴儿的母亲教育程度低、缺乏石蜡作为燃料、食用能量密度低的食物（<350千卡/100克干物质）、存在眼部病变以及少食多餐。上臂中部周长较低的风险因素包括健康状况不佳、不吃肉和牛奶、脂肪能量摄入低以及母亲教育程度较低且年龄较大。食物禁忌对任何人体测量指标均无影响。虽然93.1%的儿童已接种结核病、脊髓灰质炎、白喉和麻疹疫苗，且总体健康状况比未接种疫苗的儿童更好，但在调查访谈前一周感染率很高，包括腹泻（23.0%）、疟疾（32.3%）或咳嗽/流感（72.8%）。
乌干达关于幼儿营养不良病因中饮食和环境风险因素的首次描述表明，消瘦症和体重不足的风险因素与发育迟缓和上臂中部周长较低的风险因素存在差异。本次调查中儿童营养不良和当前感染的高发生率表明，营养不足导致免疫功能不佳。
