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Stigma as a barrier to treatment for child acute malnutrition in Marsabit County, Kenya

机译：肯尼亚马萨比特县，耻辱成为儿童急性营养不良治疗的障碍

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Acute malnutrition affects millions of children each year, yet global coverage of life-saving treatment through the community-based management of acute malnutrition (CMAM) is estimated to be below 15%. We investigated the potential role of stigma as a barrier to accessing CMAM. We surveyed caregivers bringing children to rural health facilities in Marsabit County, Kenya, divided into three strata based on the mid-upper arm circumference of the child: normal status (n = 327), moderate acute malnutrition (MAM, n = 241) and severe acute malnutrition (SAM, n = 143). We used multilevel mixed effects logistic regression to estimate the odds of reporting shame as a barrier to accessing health care. We found that the most common barriers to accessing child health care were those known to be universally problematic: women's time and labour constraints. These constituted the top five most frequently reported barriers regardless of child acute malnutrition status. In contrast, the odds of reporting shame as a barrier were 3.64 (confidence interval: 1.66-8.03, P < 0.05) times higher in caregivers of MAM and SAM children relative to those of normal children. We conclude that stigma is an under-recognized barrier to accessing CMAM and may constrain programme coverage. In light of the large gap in coverage of CMAM, there is an urgent need to understand the sources of acute malnutrition-associated stigma and adopt effective means of de-stigmatization.
机译：急性营养不良每年影响数百万儿童，但是通过基于社区的急性营养不良管理（CMAM），全球挽救生命的治疗覆盖率估计低于15％。我们调查了柱头作为访问CMAM的障碍的潜在作用。我们对将孩子带到肯尼亚马萨比特县农村卫生机构的保姆进行了调查，根据孩子的上臂中上围将其分为三个层次：正常状态（n = 327），中度急性营养不良（MAM，n = 241）和严重急性营养不良（SAM，n = 143）。我们使用多层次混合效应逻辑回归来估计报告羞辱的可能性，因为羞辱是获得卫生保健的障碍。我们发现，获得儿童保健的最常见障碍是众所周知的普遍问题：妇女的时间和劳动限制。无论儿童急性营养不良状况如何，这些都是最常报告的前五名障碍。相比之下，与正常儿童相比，MAM和SAM儿童的看护者将羞辱报告为障碍的几率高3.64倍（置信区间：1.66-8.03，P <0.05）。我们得出的结论是，污名化是访问CMAM的公认障碍，可能会限制程序的覆盖范围。鉴于CMAM的覆盖范围仍然很大，因此迫切需要了解与营养不良相关的严重污名的来源，并采取有效的消除污名的手段。

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