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。

Research on the social determinants of malnutrition among children under the age of 5 in China

Objective:To understand the relationship between child malnutrition and social determi-nants among children under the age of 5 in China,and to provide evidence and useful information to help policy makers develop social policies to improve child nutritional status.Methods:Information of 2 434 children aged 0 -5 was extracted from year 1 991 to 201 1 longitudinal survey data in the China Health and Nutrition Survey (CHNS)was extracted for analysis.Child underweight,child stunting,and child wasting were defined using World Health Organization Child Growth Standards for weight-for-age,height-for-age,and weight-for-height.Weight-for-age values,height-for-age values or weight-for-height values below 2 standard deviations were considered as underweight,stunting and wasting.World Health Organi-zation igrowup software was used to calculate the prevalence of child underweight,child stunting,and child wasting.Multivariate Logistic regression model was used to analyze the relationship between child malnutrition and social determinants (household income,parents’educational level,living regions,and communities’urbanization level).Results:The prevalence of child underweight and child stunting were decreased by 64.8% and 67.8%,respectively from 1 991 to 201 1 ,while the prevalence of child wasting had remained at a relatively low level (below 5%).The problem of child underweight and stunting had been significantly resolved in China.Female children had better outcomes than male children on impro-ving nutritional status.Among all the non-socio-economic determinants of child malnutrition,children with low height mother and children had inadequate protein intake were both risk factors of malnutrition. The social determinants significantly associated to child malnutrition included:living in the western re-gions and central regions,living in low level urbanization communities,with low household incomes,and low maternal educational levels.Conclusion:In order to further decrease the prevalence of child malnu-trition and alleviate the inequity of child health,we should pay more attention to the social determinants behind child malnutrition.Besides,social policies beneficial to child nutrition promotion need to be taken urgently,the important social policies suggested by the researchers included focusing on maternal and child dietary intake,improving household economic situation,improving maternal educational level, and balancing economic development and resource distribution between different regions in China.