Parental violence and the occurrence of severe and acute malnutrition in childhood
Parental violence and the occurrence of severe and acute malnutrition in childhood
复制标题
DOI：
10.1111/j.1365-3016.2006.00735.x
复制
发表时间：
2006-07-01
影响因子：
2.8
通讯作者：
Reichenheim, Michael E.
中科院分区：
文献类型：
--
作者：
Hasselmann, Maria H.;Reichenheim, Michael E.
来自发达国家的证据表明，家庭暴力与严重急性营养不良有关，但在严重急性营养不良风险较高的发展中国家尚未进行类似的研究。为了弥补这一差距，本研究的目的是探讨亲密伴侣暴力（IPV）之间的照顾者作为一个独立的风险因素SAM的作用。一项以医院为基础的病例对照研究（n = 172：345）在里约热内卢的六家儿科医院进行（1995-99）。病例包括患有SAM的儿童（1-24个月）（身高体重z评分< -2 SD）。对照组为接受非创伤性手术的同龄儿童。通过冲突策略量表从两个角度来衡量夫妻暴力：（a）两个顺序变量，描述基于分数的言语和身体攻击的强度，和（B）一个四水平变量，代表暴力严重性增加的模式。非条件Logistic回归分析控制混杂因素，SAM病例组父母的冲突策略得分高于对照组，表明更严重的伴侣暴力。最高评分与最低评分（10 vs. 0）比较的调整比值比为4.15（95%置信区间1.55，11.15）。使用四个级别的变量暴力的严重性，三倍SAM风险被发现与父母报告严重的身体虐待的儿童，但不是那些与父母报告口头侵略或更轻微的身体攻击。除了传统上研究的风险因素外，研究结果表明，家庭暴力也可能在儿童SAM中发挥重要作用。此外，这些发现表明SAM的风险与所有类型的IPV无关，但暴露于严重和复发性事件的儿童更有可能因SAM而入院。为了预防或早期发现严重性家庭暴力，这一结果指出，需要严格的公共卫生目标，特别是在准确发现严重性家庭暴力和严重性家庭暴力以及适当处理和跟踪暴力家庭方面。
Evidence from developed countries has linked family violence with severe acute malnutrition (SAM), yet no similar studies have been conducted in developing countries where the risk of SAM is higher. To redress this gap, the objective of this study was to explore the role of intimate partner violence (IPV) among caregivers as an independent risk factor for SAM. A hospital-based case-control (n = 172: 345) study was carried out in six paediatric hospitals of Rio de Janeiro (1995-99). Cases comprised children (1-24 months) admitted with SAM (weight-for-height z-score < -2 SD). Controls were children of the same age admitted for non-traumatic surgery. Couple violence was gauged through the Conflict Tactics Scales from two perspectives: (a) two ordinal variables characterising the intensity of verbal and physical aggression based on scores, and (b) a four-level variable representing a pattern of increasing violence seriousness. Unconditional logistic regression analysis was performed to control for confounding factors.Parents of SAM cases had higher Conflict Tactics scores than parents of controls, indicating more severe partner violence. The adjusted odds ratio for the comparison of the highest to the lowest scores (10 vs. 0) was 4.15 (95% confidence interval 1.55, 11.15). Using the four-level variable for violence seriousness, a threefold SAM risk was found for children with parents reporting severe physical abuse, but not for those with parents reporting verbal aggression or more minor physical assaults. In addition to traditionally studied risk factors, the findings suggest that family violence may also play an important role in SAM among children. Moreover, these findings indicate that the risk for SAM is not associated with all types of IPV, but that children exposed to severe and recurrent events are more likely to be admitted for SAM. For the prevention or early detection of SAM, this result points to a specific population group requiring rigorous public health targeting, especially in terms of accurate detection of both SAM and IPV, as well as appropriate handling and follow-up of violent families.