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背景人们普遍认为经济增长是改善人们健康状况的必要条件(通常也是充分条件)。此研究针对低收入和中等收入国家的宏观经济增长与早期儿童营养不良的减少的相关性进行评估。方法对1990年1月1日—2011年12月31日的36个国家的121项人口学和健康调查的数据进行分析。样本包含了具有国家代表性的0~35个月儿童的横断面调查数据,结果变量为发育迟滞、低体质量及消瘦。主要自变量为不变价的人均生产总值和校正后的购买力平价。研究采用逻辑回归模式评价人均生产总值的变化与营养不良儿童变化的关联。根据国家固定效应,调查年-固定效应,群组,儿童、母亲和家庭的地区及社会经济复合变量进行模式校正。结果研究样本含发育迟滞儿童462 854例;低体质量儿童485 152例;消瘦儿童459 538例。总体而言,发育迟滞儿童占35.6%〔95%CI(35.4,35.9)〕,从约旦的8.7%〔95%CI(7.6,9.7)〕至尼日尔的51.1%〔95%CI(49.1,53.1)〕;低体质量儿童占22.7%〔95%CI(22.5,22.9)〕,从约旦的1.8%〔95%CI(1.3,2.3)〕至印度的41.7%〔95%CI(41.1,42.3)〕;消瘦儿童占12.8%〔95%CI(12.6,12.9)〕,从秘鲁的1.2%〔95%CI(0.6,1.8)〕至布吉纳法索的28.8%〔95%CI(27.5,30.0)〕。从国家层面上看,儿童营养不良的发生率与人均生产总值不相关。仅从国家及调查年-固定效应的校正模式来看,人均生产总值上升5%与发育迟滞〔让步比(OR)=0.993,95%CI(0.989,0.995)〕、低体质量〔OR=0.986,95%CI(0.982,0.990)〕及消瘦〔OR=0.98395%CI(0.979,0.986)〕相关。校正后的整套协变量OR(95%CI)为:发育迟滞0.996(0.993,1.000)、低体重0.989(0.985,0.992)、消瘦0.983(0.979,0.986)。研究所见与多种亚样本及替代变量描述一致。显然,人均生产总值与最贫穷的家庭经济五分位数的儿童营养不良没有相关性。最贫穷的家庭经济五分位数的OR(95%CI):发育迟滞0.997(0.990,1.004)、低体重0.999(0.991,1.008)、消瘦0.991(0.978,1.004)。阐述人均生产总值上升与儿童早期营养不良减少的相关性极其微小甚至为零相关,因而需加强直接医疗投资的力度以改善低、中等收入国家儿童的营养状况。
Background It is generally accepted that economic growth is a necessary (and often sufficient) condition for improving people’s health. This study assesses the relevance of macroeconomic growth in low- and middle-income countries to the reduction of malnutrition in early childhood. Methods The data of 121 demographic and health surveys in 36 countries from January 1, 1990 to December 31, 2011 were analyzed. The sample contains cross-sectional data from a nationally representative child aged 0-35 months. The resulting variables are retardation, low body weight, and weight loss. The main independent variables are constant prices of GDP per capita and corrected purchasing power parity. The study used logistic regression to evaluate the association between changes in per capita GDP and changes in undernourished children. The pattern of regional and socioeconomic compound variables in the year-fixed effects, cohorts, children, mothers and households is modeled based on the country’s fixed effects. Results The study included 462 854 children with developmental delay, 485 152 children with low birth weight and 459 538 children with weight loss. Overall, children with developmental delay accounted for 35.6% [95% CI (35.4,35.9)], from 8.7% [95% CI (7.6,9.7)] in Jordan to 51.1% [95% CI (49.1,53.1) (95% CI (22.5,22.9)], ranging from 1.8% [95% CI (1.3,2.3)] in Jordan to 41.7% [95% CI (41.1,42.3)] in India for low-quality children ; Emaciated children accounted for 12.8% [95% CI (12.6,12.9)], from 1.2% [95% CI (0.6,1.8)] in Peru to 28.8% [95% CI (27.5,30.0)] in Burkina Faso . At the national level, the incidence of child malnutrition is not related to the per capita GDP. Only from the national and year-by-year fixed-effect correction models, GDP per capita rose 5% and developmental delay (RR = 0.993,95% CI (0.989,0.995)], low body mass [OR = 0.986, 95% CI (0.982, 0.990)] and weight loss [OR = 0.98395% CI (0.979,0.986)]. The adjusted covariate OR (95% CI) was 0.996 (0.993, 1.000) for developmental delay, 0.989 (0.985, 0.992) for low body weight, and 0.983 for weight loss (0.979, 0.986). The findings are consistent with the description of multiple sub-samples and surrogate variables. Clearly, there is no correlation between per capita GDP and child malnutrition in the poorest quintile of the household economy. OR (95% CI) for the poorest household economic quintiles: developmental delay 0.997 (0.990, 1.004), low birth weight 0.999 (0.991, 1.008), weight loss 0.991 (0.978, 1.004). Explaining the small or even zero correlation between rising per capita GDP and childhood malnutrition, it is necessary to increase direct medical investment to improve the nutritional status of children in low- and middle-income countries.