摘要：本研究の目的は、ネパールの同一地区内で異なる生活圏に居住する児童を対象に、居住地、カースト、保護者の健康の社会的決定要因（Social Determinants of Health: SDH）、さらに児童の1日のジャンクフード摂取状況と児童の栄養状態との関連を検討することであった. 方法 2017年12月から2019年3月に、ネパール国カスキ郡マチャプチャレ行政区における、JICA支援活動拠点であった村とその近隣地域で、6-12歳の児童331名とその保護者を対象に調査を実施した. 本研究では、WHOで栄養不良の評価の一つとして用いられている年齢別体格指数（Body Mass Index for age z-score: BMIZ）をUnderweightの判定基準として使用し、BMIZ<−2SDをUnderweightと定義づけた. 児童の栄養状態を評価し、児童の保護者を対象に保護者のSDHに加え、児童の1日のジャンクフード摂取状況調査を実施し、ロジスティック回帰分析で検討した. 結果 調査に参加した児童のうち、Underweightであった児童は31名（9.4%）であった. 保護者のSDH、さらに児童の1日のジャンクフード摂取状況と児童のUnderweightとの関連を検討したところ、カースト（OR＝0.241、p＝0.001）、母親の教育歴（OR＝3.879、p＝0.011）、父親のリテラシー（OR＝2.790、p＝0.023）に、統計学的有意差が示された. 結論 本研究では、児童のUnderweightには高位カースト、母親の低い教育歴、リテラシーを持たない父親に関連を示し、児童の1日のジャンクフード摂取状況は関連を示さなかった. 子どもの栄養状態には、保護者のSDHが関連していた.子どもの健康への影響要因を把握するためには、文化、教育、就労、食生活を含む生活状況など、養育提供者である保護者の社会背景の変化を捉え直し、保護者のSDHを多角的に把握した調査が求められる.
其他摘要：This study explored the association of residence, caste, social determinants of health (SDH) of parents, and daily junk food intake with the nutritional status of school children living in different residential areas of a district in Nepal. Methods A survey was conducted from December 2017 to March 2019, including 331 school children aged 6 to 12 years as well as their parents, in the primary village for Japan International Cooperation Agency (JICA) support and the surrounding area in the Machapuchare Administrative Region of Kaski District, Gandagi Province, Nepal. In this study, the body mass index for age z-score (BMIZ), a criterion used by the WHO for assessing malnutrition, was used for determining underweight; BMIZ <−2 SD was defined as underweight. The children’s anthropometric data were measured to assess their nutritional status, and a survey on children’s daily junk food intake and parents' SDH was conducted among parents. The responses were analyzed by logistic regression analysis. Results Of the children who participated in the survey, 31 (9.4%) were underweight. An association between parents’ SDH and children’s underweight was found after adjusting for mothers’ age at marriage, number of siblings, and daily junk food intake, and the results showed that lower caste (OR＝0.241, p＝0.001), lower education of mothers (OR＝3.879, p＝0.011) and non-literacy of fathers (OR＝2.790, p＝0.023) had statistically significant effects on BMIZ. Conclusions In this study, BMIZ, indicating underweight in Nepalese school children, was associated with higher caste and a mother’s level of educational attainment and father’s of non-literacy. To understand the factors influencing children’s health, it is necessary to evaluate sociodemographic parameters of parents as childcare providers, including culture, education, employment, living conditions, and diet, and to conduct surveys that capture data on the SDH of parents from various perspectives.
关键词：児童;栄養状態;保護者;健康の社会的決定要因;ネパール
其他关键词：School children;nutritional status;parents;Social Determinants of Health;Nepal
