中国5岁以下儿童营养不良的社会决定因素研究

目的： 了解中国5岁以下儿童营养不良与社会决定因素的关联程度,为制定进一步改善儿童营养不良的社会政策提供依据。方法： 从中国居民健康和营养调查（China Health and Nutrition Survey, CHNS）1991-2011年的纵向数据中提取2 434名5岁以下儿童,使用世界卫生组织igrowup软件计算儿童营养不良率,使用多因素非条件Logistic回归分析营养不良与社会决定因素的关联。结果： 20年间儿童整体低体重率和生长迟缓率分别下降了64.8%和67.8%,儿童低体重和生长迟缓得到显著改善。消瘦率一直维持在较低水平,女童营养不良率的降低幅度大于男童。非社会经济因素中,母亲身高低、儿童蛋白质摄入不足是营养不良的危险因素。社会决定因素中,居住在西部和中部、居住地城市化水平低、家庭收入低、母亲教育水平低是儿童营养不良的危险因素。结论： 为进一步改善儿童营养不良和缓解儿童健康不公平,需要重视儿童营养不良背后的社会决定因素,完善并实施改善儿童营养相关的社会政策,包括关注孕产妇和儿童的膳食营养、提高家庭生活水平和母亲教育水平、平衡地区间发展差距和资源分配等。     

5岁以下儿童营养不良影响因素分析

目的分析5岁以下儿童营养不良的相关影响因素。方法选取2010年1月至2015年1月在廊坊市妇幼保健中心就诊的1432例5岁以下的儿童作为调查研究对象,通过问卷调查的形式了解儿童一般情况,采用多元回归分析法分析影响5岁以下儿童营养不良的相关因素。结果Logistic回归分析结果显示,良好的访视(OR=0.629,95%CI 0.451~0.887)、出生时体质量(OR=0.618,95%CI 0.431~0.879)、添加辅食及时(OR=0.591,95%CI 0.409~0.841)、母亲文化程度(OR=0.579,95%CI 0.371~0.918)、母乳持续时间4~6个月且为纯母乳喂养(OR=0.368,95%CI0.159~0.881)在儿童营养不良中发挥着保护性作用。结论纯母乳喂养在儿童营养不良中起到保护性作用,应重视纯母乳喂养的重要性。     

儿童健康公平性的社会决定因素研究

目的：研究健康社会决定因素对儿童健康及保健服务利用公平性的影响。方法：从中国家庭动态跟踪调查（Chinese Family Panel Studies, CFPS）2008年截面调查资料中提取0~16岁儿童1 118人,绘制低出生体重、自评健康状况、母乳喂养、儿童医疗保险和大额医疗负担的年龄标化集中曲线,并用标化集中指数度量不公平程度。通过集中指数的成分分解度量社区、家庭、母亲和个人各层次健康社会决定因素对儿童健康及保健服务利用公平性的影响。结果：调查人群在儿童健康水平和保健服务利用上存在不公平,母亲和家庭社会因素对不公平程度的贡献最大。结论：为响应WHO号召,用一代人的时间来消除由健康社会决定因素产生的健康不公平问题,有必要从政策层面来关注儿童健康公平问题,特别是要从家庭和母亲等多维度来进行社会政策的干预。     

朔州市5岁以下儿童营养不良状况分析

目的了解本地区5岁以下儿童的营养状况。方法采取随机抽样的方法对我市朔城区、应县、右玉县800名5岁以下儿童进行营养不良调查,并分析发生营养不良的相关因素。结果 3个区县的5岁以下儿童营养不良患病率为8.25%。结论营养不良的发生与家庭经济状况、母亲的文化程度、家庭子女的数量、家庭环境因素、喂养情况、辅食添加时间、饮食习惯、反复感染等因素有关。     

海南省农村5岁以下儿童营养不良现状分析

目的 对海南农村5岁以下儿童营养不良状况进行现状分析,为制定5岁以下儿童营养不良干预政策和干预重点提拱依据.方法 利用实施国家基本公共卫生服务项目和海南省儿童“六·一”体检项目,通过建立全省儿童营养评价网络平台,收集15个市县农村34097名0-60个月儿童体检信息,对儿童营养不良分类、地区分布特点、年龄、性别特点等进行分析.结果 海南15个市县农村5岁以下儿童中重度体重低下患病率为12.4％,发育迟缓患病率为18.7％,消瘦患病率为10.0％,其中海南西部地区和经济较贫困县发病率更高;5岁以下儿童营养不良的高发年龄为1～2岁和4～5岁;男童患病率高于女童.结论 海南农村5岁以下儿童营养不良问题仍是近期公共卫生领域干预的重点,需引起重视.     

农村126名5岁以下儿童营养不良产生原因分析

为了及时了解小儿生长发育及营养状况，及早发现和治疗慢性疾病，消除对小儿生长发育中的不利因素，从而促进小儿生长发育和健康水平的提高，安塞县妇幼保健院在20天内对沿河湾镇1042名5岁以下儿童进行了营养不良调查，现报告如下。     

南通市区7岁以下儿童营养不良调查分析

目的调查南通市区7岁以下儿童营养不良患病情况及其影响因素,提出相应的措施及解决方案。方法对南通市区3678名7岁以下儿童进行体格检查,以身高和体重作为衡量儿童营养状况的指标,根据WHO推荐的NCHS标准对营养不良进行分型。结果南通市区7岁以下儿童营养不良患病率为：营养不良占总受检人数的1.11%,其中低体重占0.57%,生长迟缓占0.41%,消瘦占0.14%。结论营养不良是多种因素相互作用的结果,是通过营养相关知识的宣传教育、饮食指导可以预防的疾病。     

2012年韶关市5岁以下儿童营养不良的影响因素分析

目的研究分析5岁以下儿童营养不良的各项影响因素。方法选取该地区2012年5岁以下儿童2 800人,对所有儿童的营养状况、饮食情况、出生情况以及家庭各成员知识程度等方面进行调查,探讨5岁以下儿童营养不良的各项不良因素。结果该次调查的2 800名5岁以下儿童中,有348名儿童存在不同程度的营养不良,占12.4%,其中：体重偏低92人,占3.3%。体重偏重104人,占3.7%。生长发育延缓152人,占5.4%。在348名营养不良儿童中,家庭成员文化程度在初中及以下的共有264人,占75.9%。儿童日常饮食中较为常见的辅助食品为：谷物、薯类、肉类、奶制品、蔬菜以及水果等。结论影响5岁以下儿童营养不良的主要因素为家庭成员的文化程度、日常饮食以及出生情况,对此应该尽量改善儿童膳食结构、建议母乳喂养,对于儿童后期的健康成长具有十分重要的意义。     

灵武市5岁以下儿童营养状况监测分析

目的了解5岁以下儿童营养状况，及早地发现儿童中存在的营养问题。方法对灵武市5岁以下儿童营养状况监测调查。结果实查儿童13280人，监测率为89．63％。检出中、重度营养不良304人（2．29％），农村高于城市（P〈0．05），4岁组营养不良检出率最高（4．46％）。结论灵武市5岁以下儿童中、重度营养不良患病率较高，农村儿童高于城市儿童，导致的原因主要是喂养不当、疾病影响和不良饮食习惯。     

梅州市5岁以下儿童健康状况分析

目的：掌握梅州市5岁以下儿童健康现状,为进一步改善学龄前儿童健康水平提供科学依据。方法：采用流行病学横断面调查方法,整群随机抽取本市区30所托幼机构的12 928名5岁以下儿童,采用世界卫生组织（WTO）推荐使用的参考标准,对儿童健康状况进行分析和评价。结果：5岁以下儿童中、重度营养不良患病率为3.77%,男女差异无统计学意义（P〉0.05）;1岁以下婴儿营养不良患病率较低,1岁以后开始增高,组间差异有统计学意义（P〈0.05）;营养不良的类型以生长迟缓居多（44.56%）,其次是体重低下（40.04%）、消瘦（15.40%）;5岁以下儿童单纯性肥胖患病率为5.01%,男童检出率（5.53%）高于女童（4.45%）,差异有统计学意义（P〈0.05）;5岁以下儿童贫血患病率为22.42%,男童贫血患病率（23.76%）高于女童（20.93%）,差异有统计学意义（P〈0.05）。结论：儿童健康状况值得关注,仍要加强儿童健康管理,加大科学宣传力度,培养儿童良好的生活习惯。     

Social determinants of stunting in rural area of Wardha,Central India

Background

Stunting is a consequence of long term, cumulative inadequacies of health and nutrition. Health system uses underweight for growth monitoring for its simplicity. Lately there is renewed interest in stunting and especially severe acute malnutrition. Stunting is a relatively neglected indicator. It is therefore imperative to understand the causes of stunting early in infancy and childhood, so that preventive measures can be taken. Hence, the present study was undertaken to study the social determinants of stunting in rural Wardha.

Methods

The present cross-sectional study was undertaken in three Primary Health Centres (PHCs) of Wardha district with total population of 88,187. The sample was drawn from three PHC areas by 30-cluster sampling technique. Stunting was defined using WHO Child Growth Standards for ‘height-for-age’. ‘Height-for-age’ values below 2 standard deviations were considered as stunted while below 3 standard deviations were considered ‘severe stunting’.

Result

Prevalence of stunting was observed to be 52.3% and severe stunting was 25.1%. The significant determinants of stunting were found to be age, father''s education, fathers'' occupation, low income, not receiving Vitamin-A supplement during last 6 months and having anaemia. Sex, caste, mother''s education and mothers'' occupation did not contribute significantly to the stunting.

Conclusion

Low income and related factors such as father''s education and his occupation are important determinant of the stunting. Father being the decision maker, his education is of importance. Vitamin-A supplementation and anaemia as surrogate indicators for access to health care also found out to be significant determinants of stunting.     

Social determinants of stunting in rural area of Wardha,Central India

Background

Stunting is a consequence of long term, cumulative inadequacies of health and nutrition. Health system uses underweight for growth monitoring for its simplicity. Lately there is renewed interest in stunting and especially severe acute malnutrition. Stunting is a relatively neglected indicator. It is therefore imperative to understand the causes of stunting early in infancy and childhood, so that preventive measures can be taken. Hence, the present study was undertaken to study the social determinants of stunting in rural Wardha.

Methods

The present cross-sectional study was undertaken in three Primary Health Centres (PHCs) of Wardha district with total population of 88,187. The sample was drawn from three PHC areas by 30-cluster sampling technique. Stunting was defined using WHO Child Growth Standards for ‘height-for-age’. ‘Height-for-age’ values below 2 standard deviations were considered as stunted while below 3 standard deviations were considered ‘severe stunting’.

Result

Prevalence of stunting was observed to be 52.3% and severe stunting was 25.1%. The significant determinants of stunting were found to be age, father's education, fathers' occupation, low income, not receiving Vitamin-A supplement during last 6 months and having anaemia. Sex, caste, mother's education and mothers' occupation did not contribute significantly to the stunting.

Conclusion

Low income and related factors such as father's education and his occupation are important determinant of the stunting. Father being the decision maker, his education is of importance. Vitamin-A supplementation and anaemia as surrogate indicators for access to health care also found out to be significant determinants of stunting.     

健康社会决定因素对恶性肿瘤死亡人群总生存时间的影响

目的  从健康社会决定因素角度分析云南省恶性肿瘤死亡人群的存活差异,为有针对性地制定防治策略提供依据。 方法  利用Stata15.1整理分析2015年至2019年云南省恶性肿瘤死亡数据,采用多元线性回归控制相关协变量获得调整后的总生存时间（OS）,分析比较各健康社会决定因素（年龄、性别、居住地区、民族、文化程度、职业和婚姻状况）对恶性肿瘤死亡人群OS的影响,同时对因17种恶性肿瘤死亡的人群OS进行亚组分析。 结果  云南省2015年至2019年因恶性肿瘤死亡人群中登记了OS信息的有128 356人,平均OS为（17.28±23.33）月。因恶性肿瘤死亡的人群中,年龄65岁以下、男性、居住在农村、少数民族、初中及以下学历、农民、非在婚人群的平均OS较短（P < 0.001）;但是在深度贫困县和“直过民族”因恶性肿瘤死亡人群的平均OS分别比在一般贫困县和其他少数民族长（P < 0.001）。控制了混杂因素后,年龄、性别、居住地、民族、学历、职业、婚姻状态仍然对恶性肿瘤OS有影响（P < 0.001）,但在不同恶性肿瘤中各健康社会决定因素对OS的影响不同。 结论  云南省最脆弱地区和群体的恶性肿瘤患病生存得到改善,但不同人群恶性肿瘤的OS仍存在较大差异,需有针对性地制定恶性肿瘤防治策略,促进健康公平。     

北京市外来农村流动人口自我医疗情况及其影响因素分析

目的：了解北京市外来农村流动人口自我医疗情况,分析影响自我医疗的主要因素。方法：采用第四次国家卫生服务调查--城市中农村流动人口健康与卫生服务利用调查数据,根据Andersen卫生服务利用模型建立Logistic回归模型进行影响因素分析。结果：在北京曾经感觉身体不适或患病时,51.7%的研究对象会首选自我医疗。预置因素、能力因素和需要因素对自我医疗均有不同程度的影响。结论：北京市外来农村流动人口存在一定比例的自我医疗行为,可以采取一定措施促进自我医疗的有效性和保证自我医疗安全性。     

营养不良患儿胃运动及排空检测

为了解营养不良患儿的胃动力及排空情况，应用Ｂ型实时超声对３０例营养不良患儿液体试验餐后的胃运动与排空功能进行检测。结果：与正常组比较，营养不良患儿餐后胃体蠕动和胃窦收缩频率明显减少，液体胃排空速度明显减慢（Ｐ均＜０．０１），提示对营养不良症的治疗可应用促进胃动力药物（如吗丁林，普瑞博恩）或采取其他相应措施，以增加胃排空速度，增加能量的摄入，提高治疗效果。     

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework

Background

Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to ‘close the gaps within a generation’. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre).

Method

For ‘assessment’ part of the project, 65 indicators in six policy domains namely ‘physical and infrastructure’,‘human and social’, ‘economic’, ‘governance’, ‘health and nutrition’, and also ‘cultural’ domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For ‘response’ part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013.

Conclusion

Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin ‘assessment’ and ‘response’ parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.     

影响流动人口妇幼保健服务利用的障碍及对策研究

系统调研发现,影响流动人口妇幼保健服务利用的主要障碍体现在国家政策缺位、区域政策失调、卫生服务管理和提供方乏力、需求方需求层次的制约、对非法接生的打击力度不够等5个方面。对此提出了加强流动人口宏观管理、积极营造关心尊重流动人口的社会环境、明确社区在流动人口管理中的基础性地位、加强健康教育转变流动人口的生育观和健康观、降低流动人口接受妇幼保健服务的经济门槛、提高流动人口妇女住院分娩率、加强对流动人口计划外生育管理、加大对非法行医与非法接生的执法力度等建议。