Gender, nutritional disparities, and child survival in Nepal.
Gender, nutritional disparities, and child survival in Nepal.
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DOI：
10.1186/s40795-022-00543-6
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发表时间：
2022-05-23
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影响因子：
2
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中科院分区：
文献类型：
--
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本文审查了现有研究中看似矛盾的证据，即尼泊尔的儿子偏好很高，但男性在死亡率方面的劣势正在增加。为此，我们记录了五岁以下儿童死亡率和喂养方式的时间、地理模式和性别模式的程度。我们对尼泊尔全国代表性人口与健康调查（1996-2016）的五轮数据应用了汇总的多水平回归模型和生存分析。我们控制了潜在的社会人口学混杂因素，包括儿童、孕产妇、家庭和地区相关因素，并按出生顺序和兄弟姐妹性别对调查结果进行了分类。我们发现死亡率存在地区差异的证据，富裕城市地区的女孩死亡率最高。在新生儿期，女孩相对于男孩的死亡率优势掩盖了她们在后期的死亡率劣势。在大多数情况下，男孩死亡率下降的速度比女孩快，导致性别不平等扩大。我们还发现了女性在母乳喂养时间方面处于不利地位的证据，这与更高的死亡风险有关，但在其他食品的消费方面没有性别差异。兄弟姐妹的性别和出生顺序对母乳喂养时间也很重要：有姐妹篇但没有兄弟的年轻女孩处于最不利的地位。虽然我们没有发现产后在获得固体和半固体食物方面存在歧视的证据，但尼泊尔女孩在母乳喂养时间方面处于不利地位。有姐妹篇但没有哥哥的女孩面临最大的不利条件，风险尤其集中在1-4岁的女孩身上。这一不利因素与死亡风险增加有关。为了解决这个问题，可以扩大以社区为基础的保健方案，继续为12个月以上的儿童提供有针对性的保健，特别注重营养监测和为女孩提供保健服务。在线版本包含补充材料，可通过10.1186/s40795-022-00543-6获得。
This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five. We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal’s nationally representative Demographic and Health Surveys (1996–2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender. We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls’ comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged. While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1–4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls. The online version contains supplementary material available at 10.1186/s40795-022-00543-6.
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影响因子：
4.5
作者：
Karkee R;Lee AH;Khanal V;Binns CW
通讯作者：
Binns CW
DOI：
10.1057/dev.2014.62
发表时间：
2014-01-01
期刊：
Development (London)
影响因子：
--
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Upadhyaya, Dipak Prasad
DOI：
10.1073/pnas.0800221105
发表时间：
2008-04-01
影响因子：
11.1
作者：
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通讯作者：
Finch, Caleb E.
影响因子：
2.8
作者：
Gupta, Adyya;Fledderjohann, Jasmine;Vellakkal, Sukumar
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