PDF(Pubmed)
Abstract：
Child malnutrition remains a public health challenge in developing countries, but a comprehensive understanding of its burden and its determinants in specific local contexts is generally lacking. This study examined the prevalence of malnutrition and its determinants among children aged <5 years across contrasting agroecosystems in northwest Ethiopia. A community-based cross-sectional study involving 400 respondents was employed. Data were collected through semi-structured questionnaires and anthropometric measurements, complemented with focus group discussions and key informant interviews. The direct and indirect effects of the determinants of malnutrition were examined using structural equation modeling (SEM). The overall prevalence of child malnutrition, measured using the Composite Index of Anthropometric Failure, was 49%, with notable variation across agroecosystems (from 36.1% [midland with red soil] to 59% [lowland and valley fragmented]). Disease experience had significant positive direct effects on malnutrition. Dietary intake had negative and significant total (direct and indirect) effects on malnutrition, partially mediated through disease experience. Serial mediation in SEM analysis revealed significant indirect relationships between malnutrition and food security, feeding and care practices, household environment, health services, maternal diet, maternal empowerment, household wealth, and nutrition-sensitive agricultural practices. In conclusion, child malnutrition was highly prevalent and higher among children in the lowland and valley fragmented agroecosystem, characterized by unfavorable agro-climatic conditions, lower wealth status, poor health services access, and higher disease (particularly malaria) exposure. This study demonstrates the dynamics and multifaceted nature of malnutrition, highlighting the importance of considering geographical differences when planning interventions for childhood malnutrition and its determinants.
摘要：
儿童营养不良仍然是发展中国家的公共卫生挑战，但是，通常缺乏对其负担及其在特定地方情况下的决定因素的全面了解。这项研究调查了埃塞俄比亚西北部农业生态系统中<5岁儿童营养不良的患病率及其决定因素。采用了一项基于社区的横断面研究，涉及400名受访者。通过半结构化问卷和人体测量收集数据，辅以焦点小组讨论和关键线人访谈。使用结构方程模型（SEM）检查了营养不良决定因素的直接和间接影响。儿童营养不良的总体患病率，使用人体测量失败综合指数测量，49%,在农业生态系统中具有显着的变化（从36.1％[红壤中部]到59％[低地和山谷支离破碎]）。疾病经验对营养不良有显著的正向直接影响。饮食摄入对营养不良有负面和显著的总(直接和间接)影响，部分通过疾病经验介导。SEM分析中的系列调解揭示了营养不良与粮食安全之间的显著间接关系，喂养和护理实践，家庭环境,卫生服务,产妇饮食,母亲赋权，家庭财富,和营养敏感的农业实践。总之,儿童营养不良在低地和山谷支离破碎的农业生态系统中非常普遍，以不利的农业气候条件为特征，财富地位较低，医疗服务难以获得，和更高的疾病（特别是疟疾）暴露。这项研究证明了营养不良的动态性和多面性，强调在规划儿童营养不良及其决定因素的干预措施时考虑地域差异的重要性。
