Is Economic Growth Associated with Reduction in Child Undernutrition in India?
Is Economic Growth Associated with Reduction in Child Undernutrition in India?
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DOI：
10.1371/journal.pmed.1000424
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发表时间：
2011-03-01
期刊：
影响因子：
15.8
通讯作者：
Subramanian, S. V.
中科院分区：
文献类型：
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作者：
Subramanyam, Malavika A.;Kawachi, Ichiro;Subramanian, S. V.
背景：经济增长被广泛认为是减少印度儿童营养不良的主要政策手段。我们评估了国家人均收入的变化和儿童营养不良的风险之间的关联在India.Methods和调查结果：本分析的数据来自全国家庭健康调查（NFHS）在1992-93年，1998-99年和2005-06年在印度进行的三个横截面波。三波的样本量分别为33，816、30，383和28，876名儿童。在排除了儿童人体测量指标和研究中包含的自变量缺失的观察结果后，分析样本量分别为28，066、26，121和23，139，合并样本量为77，326名儿童。缺失数据的比例为12%-20%。结果是体重不足，发育迟缓和消瘦，定义为按年龄和性别比世界卫生组织确定的中位数得分低两个标准差以上。我们还检查了严重的体重不足，严重的发育迟缓和严重的消瘦。主要的关注点是每个调查期间州一级的人均收入，以2008年价格计算的人均净国内生产总值衡量。我们估计了固定和随机效应的logistic模型，这些模型解释了数据的聚类。在没有考虑调查期间影响的模型中，国家经济增长与儿童营养不良风险之间似乎存在负相关关系。然而，在通过调查期效应解释与重复横断面设计相关的数据结构的模型中，州经济增长与体重不足（OR 1.01，95%CI 0.98，1.04）、发育迟缓（OR 1.02，95%CI 0.99，1.05）和消瘦（OR 0.99，95%CI 0.96，1.02）的风险无关。人口统计学和社会经济协变量的调整并没有改变这些估计。观察到类似的模式严重营养不良outcome.Conclusions：我们没有找到一致的证据表明，经济增长导致减少儿童营养不良在印度。为减少印度儿童营养不良，可能需要对适当的保健干预措施进行直接投资。
Background: Economic growth is widely perceived as a major policy instrument in reducing childhood undernutrition in India. We assessed the association between changes in state per capita income and the risk of undernutrition among children in India.Methods and Findings: Data for this analysis came from three cross-sectional waves of the National Family Health Survey (NFHS) conducted in 1992-93, 1998-99, and 2005-06 in India. The sample sizes in the three waves were 33,816, 30,383, and 28,876 children, respectively. After excluding observations missing on the child anthropometric measures and the independent variables included in the study, the analytic sample size was 28,066, 26,121, and 23,139, respectively, with a pooled sample size of 77,326 children. The proportion of missing data was 12%-20%. The outcomes were underweight, stunting, and wasting, defined as more than two standard deviations below the World Health Organization-determined median scores by age and gender. We also examined severe underweight, severe stunting, and severe wasting. The main exposure of interest was per capita income at the state level at each survey period measured as per capita net state domestic product measured in 2008 prices. We estimated fixed and random effects logistic models that accounted for the clustering of the data. In models that did not account for survey-period effects, there appeared to be an inverse association between state economic growth and risk of undernutrition among children. However, in models accounting for data structure related to repeated cross-sectional design through survey period effects, state economic growth was not associated with the risk of underweight (OR 1.01, 95% CI 0.98, 1.04), stunting (OR 1.02, 95% CI 0.99, 1.05), and wasting (OR 0.99, 95% CI 0.96, 1.02). Adjustment for demographic and socioeconomic covariates did not alter these estimates. Similar patterns were observed for severe undernutrition outcomes.Conclusions: We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India. Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India.