Association of food security and other socioeconomic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh
Association of food security and other socioeconomic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh
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DOI：
10.1371/journal.pone.0221929
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发表时间：
2019-08-29
期刊：
影响因子：
3.7
通讯作者：
El Arifeen, Shams
中科院分区：
文献类型：
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作者：
Ali, Nazia Binte;Tahsina, Tazeen;El Arifeen, Shams
膳食多样性评分（DDS）是衡量营养充足性的代理指标。在这项研究中，我们旨在确定孟加拉国农村6-59个月大儿童的营养状况和DDS的当前模式，以及它们与不同个人和家庭水平因素的关系。方法2014 - 2017年，孟加拉国世界宣明会的Nobokoli项目在孟加拉国的Mymensingh、Sherpur、Rangpur、Dinajpur、Thakurgaon、Panchagar和Nilphamari地区实施。2014年7月至10月期间进行了一项横断面社区住户调查，收集基线数据，以评估Nobokoli规划。最终的分析包括6,468名6-59个月大的儿童。人体测量数据是根据世卫组织关于使用木制高度和数字体重秤的指导方针收集的。我们收集了过去24小时的食物摄入信息。采用世界卫生组织的儿童生长标准中位数来确定发育迟缓、消瘦和体重不足的营养指标。消费的食物被分为九个食物组，DDS是通过计算这些食物组在过去24小时内的食物消费来构建的。使用多变量模型检验了DDS和营养状况（发育迟缓、消瘦和体重不足）与社会人口因素和家庭粮食安全状况的关系；分别为线性回归和logistic回归。结果6 ~ 59月龄儿童发育迟缓、消瘦和体重不足的发生率分别为36.8%、18.2%和37.7%。我们的研究结果显示，几乎所有的儿童都吃任何形式的淀粉，然后分别食用牛奶或奶制品（76%）和肉肉/鱼（61%）。儿童平均DDS为3.93（sd 1.47）。40%的儿童的DDS得分低于4分。多变量分析表明，母亲受教育程度较高且是熟练工人的儿童的DDS（分别为15%和48%）高于其同行。DDS与家庭财富状况呈显著正相关。来自粮食安全家庭的儿童的DDS比来自粮食不安全家庭的儿童高26%。同样，增加母亲教育和家庭财富被发现可以防止儿童发育迟缓和营养不良。我们的研究结果重申了改善家庭社会经济因素和家庭粮食安全状况的必要性，以改善饮食多样性实践和儿童营养状况。需要大规模实施和扩大基于证据的解决方案，以确保适当的饮食习惯，并改善当地儿童的营养状况。
IntroductionDietary diversity score (DDS) is a proxy indicator for measuring nutrient adequacy. In this study, we aimed to identify the nutritional statuses and current patterns of DDS among children between 6-59 months old and their associations with different individual and household level factors in rural Bangladesh.MethodsThe Nobokoli programme of World Vision Bangladesh was implemented in Mymensingh, Sherpur, Rangpur, Dinajpur, Thakurgaon, Panchagar, and Nilphamari districts of Bangladesh between 2014 and 2017. A cross-sectional community household survey was administered between July and October 2014 to collect baseline data to evaluate the Nobokoli programme. A total of 6,468 children between 6-59 months old were included in the final analysis. Anthropometric data was collected following WHO guidelines on using wooden height and digital weight scales. We collected food intake information for the past 24 hours of the survey. The WHO's child growth standard medians were used to identify the nutritional indices of stunting, wasting, and underweight. Food items consumed were categorized into nine food groups and the DDS was constructed by counting the consumption of food items across these groups during the preceding 24 hour period. The association of DDS and nutritional status (stunting, wasting and underweight) with sociodemographic factors and household food security status were examined using multivariable models; linear regression and logistics regression respectively.ResultsThe prevalence of stunting, wasting and underweight among children aged 6-59months were 36.8%, 18.2% and 37.7% respectively. Our findings revealed that almost all children ate any form of starch followed by consumption of milk or milk products (76%) and fleshy meat/fish (61%) respectively. The mean DDS among children was 3.93(sd 1.47). Forty percent of the children obtained a DDS score less than 4. Multivariable analysis suggested that children whose mothers had higher educational attainment and are skilled workers had higher DDS (15% and 48% respectively) compared to their counterparts. The DDS showed strong positive association with household wealth status. Children from food secure households had 26% higher DDS compared to children from food insecure households. Similarly, increasing maternal education and household wealth were found to be protective against childhood stunting and undernutrition.DiscussionOur findings reiterate the need for improving household socioeconomic factors and household food security status for improving dietary diversity practices and nutritional status of children. Evidence-based solutions are needed to be implemented and expanded at scale to ensure appropriate dietary practices and improve nutritional status of the children in local context.