The influence of maternal psychosocial circumstances and physical environment on the risk of severe wasting in rural Gambian infants: a mixed methods approach.
The influence of maternal psychosocial circumstances and physical environment on the risk of severe wasting in rural Gambian infants: a mixed methods approach.
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DOI：
10.1186/s12889-017-4984-2
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发表时间：
2018-01-06
影响因子：
4.5
通讯作者：
Prentice AM
中科院分区：
文献类型：
--
作者：
Nabwera HM;Moore SE;Mwangome MK;Molyneux SC;Darboe MK;Camara-Trawally N;Sonko B;Darboe A;Singhateh S;Fulford AJ;Prentice AM
严重的消瘦影响着1600万5岁以下的儿童，并有立即死亡的危险。撒哈拉以南非洲的流行率仍然高得令人无法接受，婴儿早期是一个高风险时期。我们的目的是探讨冈比亚农村婴儿严重消瘦的危险因素。我们于2014年11月至2015年6月在冈比亚农村进行了一项病例对照研究。婴儿期至少有一次WHO标准身高别体重z评分（WLZ）<-3。选择在相同时间间隔内WLZ >-3的对照组，年龄，性别，村庄大小和距离诊所的距离匹配。标准问卷被用来评估产妇的社会经济地位，水卫生和个人卫生和产妇的心理健康。使用多变量模型的条件logistic回归用于确定严重消瘦的危险因素。定性深入访谈进行了有目的的抽样母亲和父亲。采用专题框架分析深入访谈。招募了280名（77例病例和203例对照）儿童。对16名母亲、3名父亲和4名研究人员进行了深入访谈。病例组和对照组引入补充饲料的平均年龄相似（5.2 [SD 1.2] vs 5.1 [SD 1.3]个月）。严重消瘦的几率增加与补充饲料频率增加相关（范围1-8）[校正OR 2.06（95%：1.17-3.62），p = 0.01]。母亲坚持建议的婴儿护理做法受到她的社会支持网络，最重要的是她的丈夫，婴儿喂养困难和母亲的心理社会压力，包括子女或配偶死亡，经常性的健康状况不佳的儿童和缺乏自主权的生育间隔。在冈比亚农村，不适当的婴儿喂养做法与婴儿严重消瘦有关。此外，不利的心理社会环境和婴儿喂养困难限制了母亲采取建议的儿童保育做法。通过赋予妇女权力、优先考虑产妇心理社会支持和鼓励父亲参与婴幼儿护理促进战略来促进产妇复原力的干预措施，将有助于防止这些婴儿严重消瘦。本文的在线版本（10.1186/s12889-017-4984-2）包含补充材料，可供授权用户使用。
Severe wasting affects 16 million under 5’s and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants. We undertook a case-control study from November 2014 to June 2015, in rural Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < −3 on at least 1 occasion in infancy. Controls with a WLZ > −3 in the same interval, matched on age, gender, village size and distance from the clinic were selected. Standard questionnaires were used to assess maternal socioeconomic status, water sanitation and hygiene and maternal mental health. Conditional logistic regression using a multivariable model was used to determine the risk factors for severe wasting. Qualitative in depth interviews were conducted with mothers and fathers who were purposively sampled. A thematic framework was used to analyse the in-depth interviews. Two hundred and eighty (77 cases and 203 controls) children were recruited. In-depth interviews were conducted with 16 mothers, 3 fathers and 4 research staff members. The mean age of introduction of complementary feeds was similar between cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe wasting were associated with increased frequency of complementary feeds (range 1–8) [adjusted OR 2.06 (95%: 1.17–3.62), p = 0.01]. Maternal adherence to the recommended infant care practices was influenced by her social support networks, most importantly her husband, by infant feeding difficulties and maternal psychosocial stressors that include death of a child or spouse, recurrent ill health of child and lack of autonomy in child spacing. In rural Gambia, inappropriate infant feeding practices were associated with severe wasting in infants. Additionally, adverse psychosocial circumstances and infant feeding difficulties constrain mothers from practising the recommended child care practices. Interventions that promote maternal resilience through gender empowerment, prioritising maternal psychosocial support and encouraging the involvement of fathers in infant and child care promotion strategies, would help prevent severe wasting in these infants. The online version of this article (10.1186/s12889-017-4984-2) contains supplementary material, which is available to authorized users.
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影响因子：
6.6
作者：
Adewuya, Abiodun O.;Ola, Bola O.;Okeniyi, John A. O.
通讯作者：
Okeniyi, John A. O.
影响因子：
4.4
作者：
Coleman, Rosalind;Morison, Linda;Walraven, Gijs
通讯作者：
Walraven, Gijs
影响因子：
168.9
作者：
Black, RE;Morris, SS;Bryce, J
通讯作者：
Bryce, J
影响因子：
6.6
作者：
Cox, JL;Chapman, G;Jones, P
通讯作者：
Jones, P
影响因子：
3.7
作者：
Ali GC;Ryan G;De Silva MJ
通讯作者：
De Silva MJ