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首页> 外文期刊>Journal of South Asian Development >Individual and Ecological Variation in Child Undernutrition in India: A Multilevel Analysis
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Individual and Ecological Variation in Child Undernutrition in India: A Multilevel Analysis

机译：印度儿童营养不良的个体和生态差异：多层次分析

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Despite the substantial burden of child undernutrition in South Asia, little is known on the relative importance and contribution of individual and micro/macro environments in shaping variation in child undernutrition. Using measures of anthropometry, we decompose the variation in child undernutrition in India to the levels of child, communities and states, quantifying the extent to which variation at each of these levels can be explained by known proximal and distal risk factors, measured at the individual (child/household) level. Data are from under-five singleton children participating in the 2005-2006 National Family Health Survey (NFHS-3). The outcome variables were: height-for-age z-score (HAZ), weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ), as well as their associated measures of anthropometric failure: stunting, underweight and wasting, defined as more than two standard deviations below the median of the referred z-scores, respectively. We also considered the composite index of anthropometric failure (CIAF), defined by combinations of child anthropometric failure. After accounting for risk factors, of the total variation in HAZ, 93.2 per cent, 4.9 per cent and 1.9 per cent were attributable to the individual, community and state levels, respectively. The observed risk factors explained 6.3 per cent and 46.9 per cent of the variation at the individual and community level, respectively; however, between-state variation was not explained by these risk factors. Variability in other measures of anthropometry and anthropometric failure largely followed this pattern. Additionally, there were also considerable differences in the amount of variation at the individual and community levels among different states. Hence, there is a substantial variability at the community level compared to the state level, suggesting the presence of micro-geographies of undernutrition. Additionally, while a substantial majority of the variation in child undernutrition is at the individual level, our ability to explain variability in undernutrition at the individual-level risk factors is extremely limited. Further research is needed to explore community level or environmental factors affecting child undernutrition, generating evidence for policies to target these determinants.
机译：尽管南亚儿童营养不良负担沉重，但对于个人和微观/宏观环境在塑造儿童营养不良变化方面的相对重要性和贡献知之甚少。使用人体测量学的方法，我们将印度儿童营养不良的变化分解为儿童，社区和州的水平，量化了每个水平的变化可以通过已知的个体近端和远端风险因素来解释的程度（儿童/家庭）级别。数据来自参加2005-2006年全国家庭健康调查（NFHS-3）的5岁以下单身儿童。结果变量为：年龄高z分数（HAZ），年龄重z分数（WAZ）和体重高z分数（WHZ）以及它们与人体测量学失败相关的度量：发育迟缓，体重不足和浪费，分别定义为比所引用z得分的中位数低两个以上的标准差。我们还考虑了人体测量失败综合指数（CIAF），该指数由儿童人体测量失败的组合定义。在考虑到危险因素之后，在热影响区的总变化中，分别有93.2％，4.9％和1.9％可归因于个人，社区和州。观察到的风险因素分别解释了个人和社区一级变异的6.3％和46.9％；但是，状态间的差异不能由这些风险因素来解释。人体测量学和人体测量学失败的其他度量的变化很大程度上遵循了这种模式。此外，不同州之间在个人和社区级别的变异量也存在相当大的差异。因此，与州一级相比，社区一级存在很大的可变性，表明存在营养不足的微观地区。此外，尽管儿童营养不良的绝大部分变化是在个体层面上，但我们在个体层面上解释营养不足变异性的风险却极为有限。需要进行进一步的研究以探索影响儿童营养不良的社区层面或环境因素，从而为针对这些决定因素的政策提供证据。

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