背景:卫生条件差和/或露天排便是埃塞俄比亚的一个重大公共卫生问题,改善的卫生设施仍然有限。关于开放式排便对儿童线性生长障碍的影响的文献越来越多。然而,关于开放式排便对儿童贫血的影响的研究很少。在这项研究中,我们检查童年是否营养不良(即发育迟缓,浪费,和体重不足)介导了埃塞俄比亚6-59个月儿童的开放式排便与儿童贫血之间的关系。
方法:我们使用了埃塞俄比亚人口与健康调查汇总数据(2005-2016年),其中包括21,918名(加权数据)6-59个月的儿童。贫血定义为5岁以下儿童的海拔调整血红蛋白(Hb)水平低于11g/分升(g/dl)。使用身高年龄Z评分(HAZ)评估儿童营养不足,年龄体重Z分数(WAZ),身高体重Z分数(WHZ)用于发育迟缓,浪费,和体重不足。使用自举计算中介效应,当95%自举置信区间(95%CI)不包含零时,间接效应被认为是显着的。此外,使用单独的多水平回归分析来探索开放排便与儿童贫血之间的统计关联,在调整了潜在的混杂因素后。
结果:我们的分析显示,在6至59个月的儿童中,将近一半(49.6%)患有贫血,46.8%发育迟缓,9.9%被浪费,29.5%体重不足。此外,45.1%的儿童属于开放式排便(OD)的家庭。排便与贫血相关(AOR:1.28;95%CI:1.18-1.39),它正预测贫血,直接作用β=0.233,p<0.001。儿童营养不良在OD与贫血之间的关系中显示出部分中介作用。分析间接影响,结果表明,儿童营养不良显著介导了开放式排便与贫血之间的关系(发育迟缓(β间接=0.014,p<0.001),浪费(β间接=0.009,p=0.002),和体重不足(β间接=0.012,p<0.001))。当考虑到儿童营养不良的中介作用时,开放排便对贫血有积极影响,总效应βtotal=0.285,p<0.001.
结论:开放式排便对贫血有显著的直接作用。儿童营养不良显着介导了OD和贫血之间的关系,进一步放大了影响。这一发现具有重要的纲领性意义,需要加强,加速和大规模实施战略,以结束埃塞俄比亚的露天排便和实现普遍获得卫生设施。
BACKGROUND: Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children\'s linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this
study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia.
METHODS: We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.
RESULTS: Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.
CONCLUSIONS: Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.