Time-constrained mother and expanding market: emerging model of under-nutrition in India.
Time-constrained mother and expanding market: emerging model of under-nutrition in India.
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DOI：
10.1186/s12889-016-3189-4
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发表时间：
2016-07-25
影响因子：
4.5
通讯作者：
for INCLEN Study Group
中科院分区：
文献类型：
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作者：
Chaturvedi S;Ramji S;Arora NK;Rewal S;Dasgupta R;Deshmukh V;for INCLEN Study Group
尽管经济增长，但印度的营养不良状况仍然居高不下，继续对最高层的政治领导和决策者构成挑战。本次归纳调查旨在了解母亲和其他主要利益相关者的看法，以确定儿童营养不良的新驱动因素。我们在印度六个授权行动小组邦进行了多中心定性调查。研究样本包括 509 名营养不良儿童和营养正常儿童的母亲、政策制定者、区级管理人员、实施者和促进者的深度访谈。分两轮与营养不良儿童的主要看护者、Anganwadi 工作人员和辅助护士助产士进行了 66 次焦点小组讨论和 72 次非正式互动。根据母亲和其他主要利益相关者的看法，一个模型归纳出一个模型，将核心主题显示为营养不良的驱动因素。最有力的新兴主题是：多任务处理、时间有限、家庭支持不断减少的母亲；粮食安全脆弱或季节性粮食短缺；以儿童为目标的市场，即食市场食品的供应和消费广泛；在食品价格上涨的背景下，非食品支出不断增加；喂养不足和不当；延迟认识营养不良和延迟寻求护理；医疗保健系统和综合儿童发展服务（ICDS）的响应能力不足。该研究强调，印度儿童营养不良的持续存在也与母亲的高工作量和随之而来的时间限制密切相关，她们越来越多地从事创收活动并加入有酬劳动力，而没有强有力的儿童保育机构支持。新的框架需要通过混合和多种方法的研究方法进行进一步测试，以量化母亲的时间限制对当前儿童营养不良负担的影响。本文的在线版本 (doi:10.1186/s12889-016-3189-4) 包含补充材料，可供授权用户使用。
Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition. We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives. Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare. The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition. The online version of this article (doi:10.1186/s12889-016-3189-4) contains supplementary material, which is available to authorized users.