Can mothers identify malnutrition in their children?

To assess mothers' perceptions about malnutrition and theirability to identify malnutrition in their own children, 339children aged 3–35 months and their mothers were studiedin two urban hospitals in Dhaka, Bangladesh, and in a communityclinic. The weight, height, and mid-upper arm circumferenceof the children were measured, and their mothers were interviewed.Child nutritional status according to their mother's statementand anthropometrically assessed nutritional status were compared.Sixty per cent of the mothers correctly identified better nutritionalstatus (weight/age >75% of NCHS median) and 67% mothers correctlyidentified malnutrition (weight/age < 75% of NCHS median)in their children. Sixty-one per cent of mothers with less than5 years of formal education correctly identified better nutrition(weight/age >75%) whereas 38% mothers with more than 5 yearsof education correctly identified better nutrition. Correctidentification of malnutrition was made by 70% of mothers withless than 5 years of formal education, and 74% of educated mothersdid the same. As regards causes of malnutrition, 33% of mothers stated thatlack of food at home resulted in undernutri-tion in their children(mean weight-for-age of these children was 65% of the NCHS median).Mothers' suggestions for improving child health were: betterfood in 31% cases; treatment of illnesses in 22% cases; andboth in 42% cases. The results suggest that most of the mothersare able to identify malnutrition in their children, and 95%of them are aware of ways to improve it, and that the provisionof adequate food and health care may improve child nutritionalstatus.     

7岁以下农村儿童体格发育调查

目的:了解江西省农村儿童体格发育水平及营养不良的患病率。方法:通过整群抽样调查江西省农村9238例儿童,所有儿童均由统一培训人员测量身高、体重,以WHO/NCHS标准为参数评价儿童体格发育水平,计算年龄别身高Z值(HAZ)、年龄别体重Z值(WAZ)和身高别体重Z值(WHZ)。分别计算儿童生长迟缓、低体重、消瘦的患病率。结果:我省农村儿童体格发育水平6月以内可达甚至超过WHO标准,6月龄后开始滞后。6月龄内儿童Z值主要分布在0～1和-1～0两个区间;6月龄后逐渐向左移,Z值主要分布于-1～0和-1～-2两个区间。儿童HAZ和WAZ主要分布在-1～0和-1～-2两个区间;而WHZ则以0～1和-1～0两个区间为主。生长迟缓、低体重和消瘦的患病率分别是13.2%、13.0%和2.9%,出生后6月内营养不良检出率最低,以后随年龄增长检出率逐渐增加,生长迟缓率在18～24月龄时达高峰。结论:我省农村儿童体格发育水平与WHO标准仍有一定差距,提示应进一步提高农村卫生水平和加强健康教育,有效改善农村儿童营养状况。     

甘肃省农村地区6~24月龄婴幼儿营养状况及其影响因素分析

目的 了解甘肃省农村地区不同民族婴幼儿的营养状况,分析影响因素。方法 采用多阶段分层随机整群抽样方法,在甘肃省抽取12个项目县,于2014年12月-2015年1月进行现场调查,收集样本量为3 663名。调查内容包括婴幼儿看护人问卷调查和婴幼儿的体格测量。结果 甘肃省6~24月龄婴幼儿营养不良发生率为21.3%,其中超重、消瘦、低体重和发育迟缓率分别为7.0%、4.0%、3.2%和7.1%。单因素分析结果显示,影响6~24月龄婴幼儿营养不良的因素有民族、性别、贫血状况、是否早产、出生身长和体重、看护人学历和职业、6个月内喂养方式、辅食添加时间、辅食添加种类以及营养素补充等。多因素Logistic回归分析显示性别、月龄、是否早产、看护人职业、科学喂养知识水平、辅食添加时间和种类的对营养水平的影响有统计学意义。结论 甘肃省6~24月龄婴幼儿营养状况总体有所改善,发育迟缓仍然是主要营养问题,超重率上升是需要特别关注的重要问题。建议采取综合措施改善儿童营养水平。     

1998～2007年南昌县小兰村儿童体格发育变化趋势

[目的]了解1998～2007年南昌县小兰村7岁以下儿童体格发育动态变化趋势。[方法]1998～2007年每年5月下旬对小兰村7岁以下儿童进行一次体格测量,用WHO标准评价儿童年龄别身高、年龄别体重和身高别体重,并统计每年的营养不良发生率。[结果]1998～2007年该村儿童年龄别身高和年龄别体重高于WHO标准以上的由20%以下提高到30%以上;儿童生长迟缓率下降75%,低体重率下降50%,消瘦率无明显变化。[结论]10年间该村儿童体格发育水平有较大改善,营养不良发生率明显降低,但体格发育水平在WHO标准平均值以下的仍占较大比例,和WHO标准仍有一定距离。     

2008年广西部分贫困农村2岁以下婴幼儿营养不良现状及其影响因素分析

目的分析广西部分贫困农村2岁以下婴幼儿营养不良现状及其影响因素。方法选择广西4个贫困县作为调查点,采用整群分层抽样法,对每个调查县随机抽取2个乡、每个乡抽取2个村共653名2岁以下婴幼儿作为调查对象。采用WHO/NCHS推荐的性别年龄别身高体重参考值Z评分法,评价儿童营养健康状况,采用多因素非条件Logistic回归模式进行营养不良影响因素分析。结果 653名2岁以下婴幼儿低出生体重率为8.7%,生长迟缓率为39.7%,低体重率为42.1%,消瘦率为14.4%,贫血患病率为25.4%。营养不良多因素非条件Logistic回归分析显示,儿童的年龄、看护人和母亲外出务工时间是婴幼儿生长迟缓、低体重发生的相关影响因素。结论广西部分贫困地区儿童低出生体重发生率明显高于中国2010年控制目标(即小于5%),2岁以下婴幼儿生长迟缓率、低体重率、消瘦发生率和贫血患病率较高。     

中国儿童营养状况15年变化分析——应用2006世界卫生组织儿童生长标准评价中国儿童营养状况

目的探讨2006年WHO新标准与NCHS参考标准评价中国儿童营养状况的差别。方法利用2005年中国儿童营养监测调查资料,比较不同生长标准的儿童Z评分和营养不良率的差别。结果2种标准评价农村儿童的Z评分有显著差别,不同月龄儿童表现不一致。农村儿童WHO标准计算的低体重率是6.1%,低于NCHS参考标准得到的8.6%(P<0.0001),除了<6月龄的婴儿,其余年龄组WHO标准儿童低体重率都要低于NCHS参考标准。农村儿童WHO标准生长迟缓率是16.3%,高于NCHS参考标准的13.0%(P<0.0001),<6月龄以下儿童WHO标准生长迟缓率是NCHS参考标准的2.1倍;儿童消瘦率没有显著性差别(P>0.05),但是<6月龄儿童WHO标准消瘦率是NCHS参考标准的1.9倍。利用WHO标准计算的城市儿童超重率是6.7%,要高于NCHS参考标准得到的5.4%(P<0.0001)。结论与NCHS参考标准相比,WHO标准评价儿童的营养情况随月龄、评价指标的不同而改变,WHO标准可以更好地监测婴儿早期的生长变化,有必要应用该标准进一步分析现有数据。     

Nutritional status of primary school children from low income households in kuala lumpur

Growth status was examined in relation to gender and age factors in urban primary school children (6-10 years old) from low income households in Kuala Lumpur, Wilayah Persekutuan. The sample consisted of 4212 boys (53%) and 3793 girls (47%). Data on weight and height data were obtained from two sources - investigator's and teachers' measurements of the school children. This study defined mildly and significantly underweight, stunted or wasted as z-score below minus one and below minus two of the NCHS/CDC reference median, respectively. Approximately 52% (n = 4149), 50% (n = 3893) and 30% (n = 2568) of the school children were underweight, stunted and wasted, respectively. However, the majority of these undernourished children were in the mild category. Prevalence of overweight (> 2 SD of NCHS/WHO reference median) was found in 5.8% of the sample. For both, prevalence of undernutrition and overnutrition, more boys than girls were found to be underweight stunted wasted and overweight. Compared to girls, boys had lower mean z-scores for the variables height-for-age (p<0.05) and weight-for-height (p<0.01). Older children had significantly lower mean z-scores for height-for-age (p<0.001) but higher mean z-scores for weight-for-height (P<0.001) than younger children. This finding indicates that with increasing age, stunting is associated with improved weight-for-height or that the children's weights have been adapted to their short statures. In conclusion, results demonstrate a high prevalence of underweight, stunting and wasting and an increasing prevalence of overweight among these low-income school children. Efforts recommended to address health and nutrition problems among school children should include health and nutrition monitoring (e.g. growth monitoring using the existing growth data collected by schools) and interventions.     

0～5岁住院儿童营养状况及影响因素分析

目的分析西藏自治区昌都市人民医院5岁以下住院儿童营养不良和贫血状况及其影响因素,为制定儿童营养相关策略和政策提供科学依据。方法采用整群随机抽取法抽取1 208名住院儿童,用Z评分法和血红蛋白值评价儿童营养和贫血状况,用Logistic回归分析可能的影响因素,运用SPSS 13.0软件进行统计学分析。结果住院儿童的生长迟缓率为12.2%、低体重率为8.2%、消瘦率为6.8%、贫血率为20.2%,儿童生长迟缓率、低体重率、消瘦率和贫血率在各月龄组间差异均有统计学意义(P0.01),其中24~36月龄组生长迟缓率最高,低体重率、消瘦率和贫血率的患病高峰在6~12月龄,各月龄组性别间差异均无统计学意义(P0.05)。多因素分析结果表明,儿童生长迟缓的影响因素是出生体重(OR=1.001),低体重的影响因素有月龄(OR=1.018)、出生体重(OR=1.001),消瘦的影响因素有月龄(OR=1.052)和出生体重(OR=1.001),贫血的影响因素为月龄(OR=1.028)。结论西藏自治区昌都市人民医院5岁以下住院儿童营养不良和贫血状况仍然较为严重,应针对各年龄段儿童营养不良状况特点制定相应干预措施,从而改善当地儿童营养健康状况。     

Birth weight and subsequent growth among Navajo children

An examination of length, weight, and birth weight data routinely collected from the clinics supported by the Navajo Nation Special Supplemental Program for Women, Infants, and Children (WIC) showed an association between birth weight and subsequent growth status. Navajo children less than 2 years of age entering the WIC Program were divided into low, normal, and high birth weight groups, and their growth patterns were plotted when they returned periodically for reassessment. Overall, the children tended to have low length-for-age and high weight-for-length measures, relative to the reference population, that suggest suboptimal nutritional status. Children with birth weights less than 2,500 grams (g) were consistently shorter, lighter, and thinner than children with birth weights greater than 2,500 g. Although the overall growth status of the children improved between 1975 and 1980, the growth among the children with low birth weights never fully caught up with that of the other Navajo children. Moreover, during that period, the normal birth weight group had a modest improvement in length-for-age relative to the reference population, but the low birth weight group did not. These findings suggest that prenatal interventions to improve the birth weight status of Navajo infants may result in improving the growth status of Navajo children.     

Impact of ICDS on health and nutritional status of children

The Integrated Child Development Services (ICDS) in India comprises health, nutrition, and education human resource development in 1745 rural, 716 tribal, and 235 urban projects in about 45% of community development blocks of the country. Research studies have found that in ICDS areas there were fewer children suffering from Grades S II and IV malnutrition compared with non ICDS areas and the percentage of normal children has increased. 6.8% of children aged 0-3 years and 4.0% of children aged 3-6 years in ICDS areas were in Grades III and IV of malnutrition. The ICDS treatment for malnutrition is administration of 16-20 gm of protein and about 600 calories and monitoring monthly; there are 13.9 million children presently receiving supplementary nutrition in the ICDS program. The nutrition program in general aims to provide health and nutrition inputs to expectant mothers throughout the gestation period in order to prevent low birth weight babies; the nutrition supplement distribution has improved, but chronic malnutrition among pregnant mothers persists. The ICDS program provides regular health checkups, immunization, detection of malnutrition, treatment of diarrhea, and deworming of and for children. These services have contributed to improved health among children in ICDS areas. The infant mortality rate (IMR) of 71.3/1000 live births in 1992 in ICDS areas was found to be lower than national estimates in 1989. In ICDS projects more than 3 years old, IMR was found to be 84.5; further decline in IMR in 1990 were found in projects older than 5 years. Morbidity and mortality have been fund to be higher in non-ICDS areas, and declines have been observed in ICDS areas. The incidence of vaccine preventable diseases was not found to have declined in ICDS areas, in spite of increased immunization. ICDS provides anganwadi community workers (AWWs) and services through a network of Primary Health Centers and subcenters, which are not optimally used. However, when compared with non-ICDS areas, prenatal services are used by 71.9% of the pregnant population compared with 40% in a non-ICDS control group. In 1992, there was 90% coverage of children aged 0-6 years with health check ups; this level of usage may be due to the availability of medicine kits through AWWs. ICDS provides potential for enhancing the survival of children.     

Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.     

1990年、1995年北京市5岁以下儿童营养状况分析比较

本文采用NCHS/WHO标准为参照人群,以年龄别体重、年龄别身高、身高别体重为评价指标,用Z评分法分别对1990年、1995年北京市5岁以下儿童体格发育及营养状况抽样调查资料进行评价,并分析比较两次调查资料。结果显示5岁以下儿童体重低下、生长迟缓、消瘦3项指标患病率1995年均比1990年下降,下降幅度分别为61.38％、54.19％、44.02％。3项指标各年龄组Z评分均值有所增加(除6～11月龄外),提示1995年北京市5岁以下儿童营养状况比1990年有明显改善。     

Strategies for nutritional improvement

India has achieved self-sufficiency in the production of food grains, yet the production of milk, legumes, vegetables, oils and fats, eggs, and meat is far short of the needs of the population. The Indian diet predominantly comprises cereals, and the diets of expectant and nursing mothers as well as children are grossly deficient in protective foods. Serious nutritional inadequacies have resulted in low birth weight, retarded growth, and nutritional deficiencies (protein energy malnutrition in preschool children, vitamin A deficiency, iron deficiency in women of reproductive age, and iodine deficiency disorders among neonates and schoolchildren). General malnutrition is prevalent in 25% of the rural and 20% of the urban population. Deficiency symptoms of vitamin B complex and vitamin C are also not uncommon. 37% of the population of India lives below the poverty limit, the literacy rate is only 52.1% (39.4% for women), safe drinking water is scarce, nutritional ignorance is rampant, there is a lack of personal hygiene, and poor sanitation all account for malnutrition. A number of government and nongovernmental organizations' programs have attempted to raise the level of nutrition and the standard of living of the people. Some of them include the integrated child development services, special nutritional program, national vitamin A deficiency prophylaxis program, national anemia prophylaxis program, national goiter control program, midday meal program, special class feeding programs, universal immunization program, nutritional and health education through the mass media as well as the observance of world food day and world health day. The national health policy gives high priority to the promotion of family planning, the provision of primary health care, and the acceleration of welfare programs for women and children. As a result of policies and programs of health and nutrition, the infant, child, and maternal mortality rates have declined and life expectancy at birth has risen.     

Nutritional status and the characteristics related to malnutrition in children under five years of age in nghean, Vietnam.

OBJECTIVES: This study was conducted to assess the nutritional status and characteristics related to malnutrition in children less than five years of age in Nghean, Vietnam. METHODS: In this study, which was conducted in November 2007, 650 child-mother pairs were selected using a two-stage cluster sampling methodology. A structured questionnaire was then administered to the mothers in their home settings. Anthropometric measurement was then used to determine if children were underweight (weight-for-age), wasting (weight-for-height) and stunting (height-for-age) based on reference data from the National Center for Health Statistics (NCHS)/World Health Organization (WHO). Logistic regression analysis was then used to describe the hierarchical relationships between potential risk factors and malnutrition. RESULTS: The mean Z-scores for weight-for-age, heightfor-age and weight-for-height were -1.46 (95% CI=-1.57, -1.35), -1.44 (95% CI=-1.56, -1.32) and -0.71 (95% CI=-0.82, -0.60), respectively. Of the children included in this study, 193 (31.8%) were underweight, 269 (44.3%) were stunting and 72 (11.9%) were wasting. Region of residence, the mother's level of education and occupation, household size, number of children in the family, weight at birth and duration of exclusive breastfeeding were found to be significantly related to malnutrition. CONCLUSIONS: The findings of this study indicate that malnutrition is still an important problem among children less than five years of age in Nghean, Vietnam. In addition, maternal, socio-economic and environment factors were found to be significant factors for malnutrition among children under five.     

2018年襄阳市0～5岁儿童营养状况分析

目的 分析2018年襄阳市5岁以下儿童营养现状，为制定儿童营养相关政策措施提供科学依据。方法 采用整群分层随机抽样法抽取襄阳1 669名5岁以下儿童，对其主要健康体检指标进行Z评分，并通过SPSS 20.0对营养不良和营养过剩情况进行描述分析。结果 襄阳市5岁以下儿童低体重率为1.08%、生长迟缓率2.22%、超重率5.09%；其中男童低体重率高于女童（χ2 = 5.508，P = 0.019），女童生长迟缓率高于男童（χ2 = 4.816，P = 0.028）；县区生长迟缓率和超重率均高于市区（χ2 = 26.162，P＜0.001；χ2 = 4.374，P = 0.036）。结论 襄阳市5岁以下儿童营养不良与超重问题并存，应加强重点地区（县区）儿童营养异常状况的早期筛查、识别和评估；大力开展儿童营养健康教育，提高人群营养知识知晓率；联合疾控机构、医疗机构、托幼机构和家庭实施干预措施，帮助5岁以下儿童建立正确合理的饮食和生活习惯。     

Nutritional interventions through primary health care: impact of the ICDS projects in India

In 1975 the Government of India initiated an integrated approach for the delivery of health care as well as nutrition and education services for deprived populations at the village level and in urban slums through centres, each of which was run by a local part-time female worker (anganwadi) who was paid an honorarium and had a helper. This national programme, known as the Integrated Child Development Services (ICDS), began with 33 projects but, by March 1986, had expanded to 1611 projects covering 23% of the country's population and representing about 50% of the population in the socioeconomically backward areas. The ICDS can therefore be considered to function as a primary health care programme for preschool children (under 6 years old), pregnant women, and lactating mothers. The present study investigated the impact on the nutritional status of the target population after 3-5 years and after 8 years of ICDS interventions, compared with the nutritional status of non-ICDS (control) groups. The results showed that the ICDS nutrition intervention programmes achieved better coverage of the target population and led to a significant decline in malnutrition among preschool children in the ICDS population, compared with the non-ICDS groups that received nutrition, health care and education through separate programmes. This example may lead other developing countries to introduce integrated programmes with certain modifications to suit local conditions. International agencies and national governments should strive to bring about the integration of nutritional services with primary health care and development programmes for children because of the good results in terms of child survival and child development.     

某高校近6年来新生儿出生情况及分娩方式调查

目的了解某高校新生儿出生情况及分娩方式变化，为进一步提高孕产期保健水平提供依据。方法对华南农业大学社区2002年9月-2008年9月出生的419例新生儿出生情况及分娩方式进行回顾性分析。结果近6年来巨大儿占4．30％，低出生体重儿占4．06％，巨大儿、低出生体重儿比例呈下降趋势，但早产儿的比例变化趋势不明显；自然分娩率42．96％，剖宫产率54．65％，自然分娩率逐年上升，剖宫产率逐年下降；产妇平均年龄30．08岁，高龄产妇占5．26％；2002年9月-2007年9月各年份的平均出生体重之间比较，差异无统计学意义（P〉0．05），2007年9月-2008年9月较前5年体重增加，差异有统计学意义（P〈0．05）。结论近年来新生儿出生情况及分娩方式呈现良好变化，反映妇幼保健工作已初见成效。应提倡积极利用社区优势，用多种方式进行孕产妇健康教育（营养及自然分娩等方面），以防止巨大儿的出生，提高自然分娩率，降低剖宫产率，减少围产儿死亡率，提高产妇生活质量。     

Evidence for a secular change in obesity, height, and weight among Navajo Indian schoolchildren

A survey measuring heights and weights of 1969 schoolchildren residing on the Navajo Indian Reservation was conducted in 1989. The findings were compared with National Center for Health Statistics (NCHS) reference data and with surveys of Navajo children from 1955, 1968, and 1981. Approximately twice as many children exceeded the 95th percentile of weight-for-age (11.2% of girls, 12.5% of boys) than would be expected for the NCHS reference population. The mean weight-for-height z scores exceeded those for the NCHS reference population for all ages in both sexes. Compared with data from 1955, mean heights increased 6.1% among boys and 4.4% among girls whereas mean weights increased 28.8% among boys and 18.7% among girls across all age groups. The data suggest that there has been a secular change in height, weight, and obesity in Navajo Indian children over the past 35 y.     

中国傈僳族儿童青少年营养发展趋势

目的 分析2005-2014年10年间中国傈僳族儿童青少年体格生长发育和营养状况的发展变化趋势,并提出改善傈僳族儿童青少年目前生长发育和营养现状的建议。方法 采用多阶段分层随机整群抽样的方法,在云南省怒江州3个县随机抽取24所中小学7~18岁傈僳族学生作为研究对象。采用WHO-2006标准,对2005-2014年间历次参加全国学生体质健康调研的学生进行学生体格生长发育的变化趋势,以及生长迟缓和消瘦检出率的变化情况的比较。结果 2005-2014年傈僳族男、女生的营养不良率从48.84%和41.13%下降到30.96%和23.41%。其中 2005、2010年和2014年男生生长迟滞率分别为43.22%、35.54%和25.80%;女生分别为38.15%、33.56%和20.30%。2005、2010年和2014年傈僳族18岁身高性差分别为8.94 cm、9.96 cm和11.28 cm。结论 傈僳族儿童青少年营养状况得到明显改善,但学生营养不良问题仍很严重。针对学生营养不良和性差<13 cm等问题,建议开展人群的营养与健康教育干预工作,进一步加大力度推动和促进学生营养改善计划工作的开展,深度挖掘傈僳族成年身高的增长潜力。     

上海市虹梅社区婴幼儿营养性疾病影响因素调查分析

目的探讨上海市虹梅社区发生婴幼儿营养性疾病的影响因素,为优化社区婴幼儿营养性疾病的管理模式提供科学依据。方法采用回顾性调查的方式,收集2013~2017年社区0~3岁婴幼儿保健相关资料,通过描述性统计和Logistic二元回归对婴幼儿营养性疾病的发生、分类、顺位及其影响因素进行分析,筛选和确定社区发生婴幼儿营养性疾病的重点因素。结果0~3岁婴幼儿中,有30.93%(459/1484)的婴幼儿发生了营养性疾病,其中男童的发生率略高于女童(χ^2=4.706,P<0.05);营养性疾病分类的顺位情况依次是超重、缺铁性贫血、肥胖、营养不良、佝偻病及生长迟缓,排列前两位的超重和缺铁性贫血分别为18.60%和11.93%;营养性疾病的发生主要在0~12月龄的低年龄段;影响其发生的因素分别是喂养方式、婴儿出生时体质量、婴幼儿性别及父母体质指数(BMI),其中,喂养方式、婴儿出生时体质量及父母BMI为营养性疾病发生的重点因素。结论关注孕妇BMI的控制和婴儿的科学喂养是早期预防婴幼儿营养性疾病的关键。