Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter?
Identifieur interne : 001284 ( Ncbi/Checkpoint ); précédent : 001283; suivant : 001285Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter?
Auteurs : Ngianga-Bakwin Kandala [Royaume-Uni, Botswana] ; Tumwaka P. Madungu [République démocratique du Congo] ; Jacques Bo Emina ; Kikhela Pd Nzita [République démocratique du Congo] ; Francesco P. Cappuccio [Royaume-Uni]Source :
- BMC Public Health [ 1471-2458 ] ; 2011.
Abstract
Although there are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors.
We examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures.
Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors.
Although childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location.
Childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in provinces such as Bas-Congo that produce foods, childhood malnutrition is higher probably because of the economic decision to sell more than the population consumes. Improving maternal and child nutritional status is a prerequisite for achieving MDG 4, to reduce child mortality rate in the DRC.
Url:
DOI: 10.1186/1471-2458-11-261
PubMed: 21518428
PubMed Central: 3111378
Affiliations:
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Madungu</name><affiliation wicri:level="1"><nlm:aff id="I3">Institut National de Statistique, Kinshasa, Republique Democratique du Congo</nlm:aff><country xml:lang="fr" wicri:curation="lc">République démocratique du Congo</country><wicri:regionArea>Institut National de Statistique, Kinshasa</wicri:regionArea><wicri:noRegion>Kinshasa</wicri:noRegion></affiliation></author><author><name sortKey="Emina, Jacques Bo" sort="Emina, Jacques Bo" uniqKey="Emina J" first="Jacques Bo" last="Emina">Jacques Bo Emina</name><affiliation><nlm:aff id="I4">African Populations and Health Research Center, Shelter Afrique Centre, Longonot Road, P.O.Box 10787, 00100 GP.O. Nairobi - Kenya</nlm:aff><wicri:noCountry code="subfield">00100 GP.O. Nairobi - Kenya</wicri:noCountry></affiliation></author><author><name sortKey="Nzita, Kikhela Pd" sort="Nzita, Kikhela Pd" uniqKey="Nzita K" first="Kikhela Pd" last="Nzita">Kikhela Pd Nzita</name><affiliation wicri:level="1"><nlm:aff id="I5">Département des Sciences de la Population et du Développement, Faculté des Sciences Economiques, Université de Kinshasa, B.P. 176 Kinshasa XI, Republique Democratique du Congo</nlm:aff><country xml:lang="fr" wicri:curation="lc">République démocratique du Congo</country><wicri:regionArea>Département des Sciences de la Population et du Développement, Faculté des Sciences Economiques, Université de Kinshasa, B.P. 176 Kinshasa XI</wicri:regionArea><wicri:noRegion>B.P. 176 Kinshasa XI</wicri:noRegion></affiliation></author><author><name sortKey="Cappuccio, Francesco P" sort="Cappuccio, Francesco P" uniqKey="Cappuccio F" first="Francesco P" last="Cappuccio">Francesco P. Cappuccio</name><affiliation wicri:level="1"><nlm:aff id="I6">University of Warwick, Warwick Medical School, Clinical Sciences Research Institute, Clifford Road Bridge, CV2 2DX, Coventry, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Warwick, Warwick Medical School, Clinical Sciences Research Institute, Clifford Road Bridge, CV2 2DX, Coventry</wicri:regionArea><wicri:noRegion>Coventry</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Although there are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors.</p></sec><sec><title>Methods</title><p>We examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures.</p><p>Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors.</p></sec><sec><title>Results</title><p>Although childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location.</p></sec><sec><title>Conclusion</title><p>Childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in provinces such as Bas-Congo that produce foods, childhood malnutrition is higher probably because of the economic decision to sell more than the population consumes. Improving maternal and child nutritional status is a prerequisite for achieving MDG 4, to reduce child mortality rate in the DRC.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Black, R" uniqKey="Black R">R Black</name></author><author><name sortKey="Morris, S" uniqKey="Morris S">S Morris</name></author><author><name sortKey="Jennifer, B" uniqKey="Jennifer B">B Jennifer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Reed, Ba" uniqKey="Reed B">BA Reed</name></author><author><name sortKey="Habicht, Jp" uniqKey="Habicht J">JP Habicht</name></author><author><name sortKey="Niameogo, C" uniqKey="Niameogo C">C Niameogo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Madise, Nj" uniqKey="Madise N">NJ Madise</name></author><author><name sortKey="Matthews, Z" uniqKey="Matthews Z">Z Matthews</name></author><author><name sortKey="Margetts, B" uniqKey="Margetts B">B Margetts</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gwatkin, Dr" uniqKey="Gwatkin D">DR Gwatkin</name></author><author><name sortKey="Rustein, S" uniqKey="Rustein S">S Rustein</name></author><author><name sortKey="Johnson, S" uniqKey="Johnson S">S Johnson</name></author><author><name sortKey="Pande, K" uniqKey="Pande K">K Pande</name></author><author><name sortKey="Wagstaff, A" uniqKey="Wagstaff A">A Wagstaff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pongou, R" uniqKey="Pongou R">R Pongou</name></author><author><name sortKey="Ezzati, M" uniqKey="Ezzati M">M Ezzati</name></author><author><name sortKey="Salomon, Ja" uniqKey="Salomon J">JA Salomon</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Coghlan, B" uniqKey="Coghlan B">B Coghlan</name></author><author><name sortKey="Brennan, Rj" uniqKey="Brennan R">RJ Brennan</name></author><author><name sortKey="Ngoy, P" uniqKey="Ngoy P">P Ngoy</name></author><author><name sortKey="Dofara, D" uniqKey="Dofara D">D Dofara</name></author><author><name sortKey="Otto, B" uniqKey="Otto B">B Otto</name></author><author><name sortKey="Clements, M" uniqKey="Clements M">M Clements</name></author><author><name sortKey="Stewart, T" uniqKey="Stewart T">T Stewart</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kandala, Nb" uniqKey="Kandala N">NB Kandala</name></author><author><name sortKey="Emina, Jbo" uniqKey="Emina J">JBO Emina</name></author><author><name sortKey="Nzita, Dk" uniqKey="Nzita D">DK Nzita</name></author><author><name sortKey="Cappuccio, Fp" uniqKey="Cappuccio F">FP Cappuccio</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mosley, W" uniqKey="Mosley W">W Mosley </name></author><author><name sortKey="Chen, L" uniqKey="Chen L">L Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, L" uniqKey="Smith L">L Smith</name></author><author><name sortKey="Haddad, L" uniqKey="Haddad L">L Haddad</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kandala, Nb" uniqKey="Kandala N">NB Kandala</name></author><author><name sortKey="Fahrmeir, L" uniqKey="Fahrmeir L">L Fahrmeir</name></author><author><name sortKey="Klasen, S" uniqKey="Klasen S">S Klasen</name></author><author><name sortKey="Priebe, J" uniqKey="Priebe J">J Priebe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moradi, A" uniqKey="Moradi A">A Moradi</name></author><author><name sortKey="Klasen, S" uniqKey="Klasen S">S Klasen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Caputo, A" uniqKey="Caputo A">A Caputo</name></author><author><name sortKey="Roraita, R" uniqKey="Roraita R">R Roraita</name></author><author><name sortKey="Klasen, S" uniqKey="Klasen S">S Klasen</name></author><author><name sortKey="Pigeot, I" uniqKey="Pigeot I">I Pigeot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kammann, Ee" uniqKey="Kammann E">EE Kammann</name></author><author><name sortKey="Wand, Mp" uniqKey="Wand M">MP Wand</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fahrmeir, L" uniqKey="Fahrmeir L">L Fahrmeir</name></author><author><name sortKey="Lang, S" uniqKey="Lang S">S Lang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Spiegelhalter, D" uniqKey="Spiegelhalter D">D Spiegelhalter</name></author><author><name sortKey="Best, N" uniqKey="Best N">N Best</name></author><author><name sortKey="Carlin, B" uniqKey="Carlin B">B Carlin</name></author><author><name sortKey="Van Der Line, A" uniqKey="Van Der Line A">A Van der Line</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brezger, A" uniqKey="Brezger A">A Brezger</name></author><author><name sortKey="Kneib, T" uniqKey="Kneib T">T Kneib</name></author><author><name sortKey="Lang, S" uniqKey="Lang S">S Lang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Klasen, S" uniqKey="Klasen S">S Klasen</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Botswana</li><li>Royaume-Uni</li><li>République démocratique du Congo</li></country></list><tree><noCountry><name sortKey="Emina, Jacques Bo" sort="Emina, Jacques Bo" uniqKey="Emina J" first="Jacques Bo" last="Emina">Jacques Bo Emina</name></noCountry><country name="Royaume-Uni"><noRegion><name sortKey="Kandala, Ngianga Bakwin" sort="Kandala, Ngianga Bakwin" uniqKey="Kandala N" first="Ngianga-Bakwin" last="Kandala">Ngianga-Bakwin Kandala</name></noRegion><name sortKey="Cappuccio, Francesco P" sort="Cappuccio, Francesco P" uniqKey="Cappuccio F" first="Francesco P" last="Cappuccio">Francesco P. Cappuccio</name></country><country name="Botswana"><noRegion><name sortKey="Kandala, Ngianga Bakwin" sort="Kandala, Ngianga Bakwin" uniqKey="Kandala N" first="Ngianga-Bakwin" last="Kandala">Ngianga-Bakwin Kandala</name></noRegion></country><country name="République démocratique du Congo"><noRegion><name sortKey="Madungu, Tumwaka P" sort="Madungu, Tumwaka P" uniqKey="Madungu T" first="Tumwaka P" last="Madungu">Tumwaka P. Madungu</name></noRegion><name sortKey="Nzita, Kikhela Pd" sort="Nzita, Kikhela Pd" uniqKey="Nzita K" first="Kikhela Pd" last="Nzita">Kikhela Pd Nzita</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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