Child health inequities in developing countries: differences across urban and rural areas.
Child health inequities in developing countries: differences across urban and rural areas.
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DOI：
10.1186/1475-9276-5-9
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发表时间：
2006-07-11
影响因子：
4.8
通讯作者：
Fotso, Jean-Christophe
中科院分区：
文献类型：
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作者：
Fotso, Jean-Christophe
目标：记录和比较城市和农村地区儿童营养不良的不平等程度，并调查社区、家庭和个人的特征在多大程度上解释了城市内儿童营养不良的差异。方法：使用撒哈拉以南非洲 (SSA) 15 个国家的人口和健康调查 (DHS) 提供的最新数据集。制定选择标准的目的是确保国家的数量、它们在西非/中非和东非/南部非洲的地理分布以及它们的社会经济多样性构成该地区的良好衡量标准，并使我们能够得出一些概括。在每个国家和地区（城市、农村）构建家庭财富指数，并使用从多级逻辑模型得出的最高类别和最低类别之间的优势比来衡量社会经济不平等。控制变量包括母亲和父亲的教育程度、旨在代表家庭居住社区广泛社会经济生态的社区社会经济地位 (SES) 以及相关母亲和儿童层面的协变量。 结果：在撒哈拉以南非洲国家中，尽管城市和农村地区确实存在发育迟缓方面的社会经济不平等，但城市地区的情况要严重得多。儿童营养不良的城市内差异大于儿童营养不良的城乡总体差异，并且一方面，城市内部儿童健康方面的不平等与城市人口增长、城市营养不良或城乡营养不良的总体差异之间似乎没有明显的关系。最后，母亲和父亲的教育程度、社区社会经济地位以及母亲和儿童层面的其他可测量协变量只能解释城市内儿童营养不良差异的一小部分。结论：城市在健康方面的优势掩盖了撒哈拉以南非洲城市地区贫困人口和非贫困人口之间的巨大差异。落实优先改善城市贫民健康和营养的具体政策，在争取最佳平均健康水平的同时，缩小人口群体之间的差距。为了成功监测城市贫困人口和非贫困人口之间的差距，应重新设计现有的数据收集计划，例如国土安全部和其他具有全国代表性的调查，以捕捉人口空间分布的变化模式。
OBJECTIVES: To document and compare the magnitude of inequities in child malnutrition across urban and rural areas, and to investigate the extent to which within-urban disparities in child malnutrition are accounted for by the characteristics of communities, households and individuals.METHODS: The most recent data sets available from the Demographic and Health Surveys (DHS) of 15 countries in sub-Saharan Africa (SSA) are used. The selection criteria were set to ensure that the number of countries, their geographical spread across Western/Central and Eastern/Southern Africa, and their socioeconomic diversities, constitute a good yardstick for the region and allow us to draw some generalizations. A household wealth index is constructed in each country and area (urban, rural), and the odds ratio between its uppermost and lowermost category, derived from multilevel logistic models, is used as a measure of socioeconomic inequalities. Control variables include mother's and father's education, community socioeconomic status (SES) designed to represent the broad socio-economic ecology of the neighborhoods in which families live, and relevant mother- and child-level covariates.RESULTS: Across countries in SSA, though socioeconomic inequalities in stunting do exist in both urban and rural areas, they are significantly larger in urban areas. Intra-urban differences in child malnutrition are larger than overall urban-rural differentials in child malnutrition, and there seem to be no visible relationships between within-urban inequities in child health on the one hand, and urban population growth, urban malnutrition, or overall rural-urban differentials in malnutrition, on the other. Finally, maternal and father's education, community SES and other measurable covariates at the mother and child levels only explain a slight part of the within-urban differences in child malnutrition.CONCLUSION: The urban advantage in health masks enormous disparities between the poor and the non-poor in urban areas of SSA. Specific policies geared at preferentially improving the health and nutrition of the urban poor should be implemented, so that while targeting the best attainable average level of health, reducing gaps between population groups is also on target. To successfully monitor the gaps between urban poor and non-poor, existing data collection programs such as the DHS and other nationally representative surveys should be re-designed to capture the changing patterns of the spatial distribution of population.