臺灣博碩士論文加值系統

Background: In the year 2000, all member countries of the United Nations and non-governmental organizations adopted the United Nations Millennium Declaration and agreed to work together to achieve eight millennium development goals (MDGs) including eradicating hunger by year 2015. The MDGs are inter-dependent and hunger affects all the MDGs especially education and health which form the basis of an individual’s economic productivity. Although there are many trends that show improvements in reducing hunger in some countries and for selected groups, these assessments indicate that global attainment of MDG 1 target 2 is not on track in Sub-Saharan Africa and children are the hardest hit segments of the population. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.
Methods: The study used data collected in 2009 in the Malawi Global School-based Health Survey. Frequency distribution and chi-squared test were used to estimate and compare the prevalence of self-reported hunger within the last 30 days among primary and secondary school children. Logistic regression analysis was also conducted to identify factors associated with hunger.
Results: A total of 2359 pupils participated in the survey of whom, 53.4% were female. Overall 12.5% of the respondents (11.9% of males and 12.5 % of females) reported to have experienced hunger in the past 30 days. Likewise, 18.9% of rural respondents and 8.3% of urban respondents also reported to have experienced hunger. Finally, geographical location, education grade, eating fruits, bullying, washing hand with soap and worrying preventing from sleeping were significantly associated with hunger.
Conclusion: Hunger is a major social and health problem in both primary and secondary school children in Malawi. The design of hunger alleviation measures (such as food for work and school feeding programmes) should incorporate the factors identified as associated with hunger.

Background: In the year 2000, all member countries of the United Nations and non-governmental organizations adopted the United Nations Millennium Declaration and agreed to work together to achieve eight millennium development goals (MDGs) including eradicating hunger by year 2015. The MDGs are inter-dependent and hunger affects all the MDGs especially education and health which form the basis of an individual’s economic productivity. Although there are many trends that show improvements in reducing hunger in some countries and for selected groups, these assessments indicate that global attainment of MDG 1 target 2 is not on track in Sub-Saharan Africa and children are the hardest hit segments of the population. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi.
Methods: The study used data collected in 2009 in the Malawi Global School-based Health Survey. Frequency distribution and chi-squared test were used to estimate and compare the prevalence of self-reported hunger within the last 30 days among primary and secondary school children. Logistic regression analysis was also conducted to identify factors associated with hunger.
Results: A total of 2359 pupils participated in the survey of whom, 53.4% were female. Overall 12.5% of the respondents (11.9% of males and 12.5 % of females) reported to have experienced hunger in the past 30 days. Likewise, 18.9% of rural respondents and 8.3% of urban respondents also reported to have experienced hunger. Finally, geographical location, education grade, eating fruits, bullying, washing hand with soap and worrying preventing from sleeping were significantly associated with hunger.
Conclusion: Hunger is a major social and health problem in both primary and secondary school children in Malawi. The design of hunger alleviation measures (such as food for work and school feeding programmes) should incorporate the factors identified as associated with hunger.

Abstract
Table of Contents i
List of figures iv
List of the tables v
Abbreviations and acronyms vi
Chapter One 1
1.1 Background 1
1.2 Objectives of the study 3
Chapter Two 4
2.1 Definition of hunger 4
2.2 Measurements of hunger 5
2.2.1 Household Food Insecurity Access Scale 6
2.2.2 WHO Global School-based Health Survey 9
2.3 Global prevalence of hunger in children and adolescents 10
2.4 Window of opportunity 16
2.4.1 Kindergarten and junior primary school period 16
2.4.2 Senior primary and secondary school period 17
2.5 Hunger alleviation measures 21
2.5.2 School feeding programme 22
2.5.3 School and household gardens 24
2.5.4 Clean water and sanitary practices 26
2.5.5 Life skills and sex education 27
2.6 Models used to explain determinants of health 28
2.6.1 Dahlgren and Whitehead Policy Rainbow Model 28
2.6.2 Health Field Concept model 30
2.7 Study setting 31
2.8 Data collection method 33
Chapter three 34
3.1 Study conceptual framework and research questions 34
3.1.1 Component 1 34
3.1.2 Component 2 35
3.1.3 Component 3 35
3.2 Variables in the framework 36
3.2.1 Hunger 36
3.2.2 Biological and genetic variables 36
3.2.3 Physical and social environment variables 37
3.2.4 Lifestyle variables 38
3.2.5 Health care system variables 40
3.3 Statistical analysis 40
3.3.1Frequency 41
3.3.2 Cross-tabulation and Chi-squared test 41
2.5.1 Food for work and cash for work 21
3.3.3 Multivariate logistic regression 41
Chapter Four 44
4.1 Results 44
4.2 Discussion 49
Chapter Five 55
5.1 Recommendations 55
5.2 Conclusion 56
References 57

Fig 1: The Dahlgren and Whitehead Model 28
Fig 2: Health Field Concept Model 30
Fig3: Study Conceptual Framework 34

Table 1: Characteristics of the participants 44
Table 2: Prevalence of hunger among school children 45
Table 3: Hunger inequalities among school children 46
Table 4: Overall Model fit and strength of the model 47
Table 5: Factors associated with hunger among school children 49

American Public Health Association. (2012). Get the facts.What Is Public Health?, Retrieved from http://www.apha.org/NR/rdonlyres/C57478B8-8682-4347-8DDF A1E24E82B919/0/what is PH? Awasthi et al. (2008). Effects of Deworming on Malnourished Preschool Children in India: An Open-Labelled, Cluster-Randomized Trial. Public Library of Science. Banerjee, S. (2002). From famines to food surplus. The Malawi Experience, Retrieved from www.networkideas.org Banerjee, S., Dias, A., Shinkle, R. & Patel, V. (2011). Under-nutrition among adolescents: A survey in five secondary schools in rural goa. The national Medical Journal of India Vol. 24, NO. 1, 2011,
Barker et al. (2002). Fetal Origins of Adult Disease: Strength of Effects and Biological Basis. International Journal of Epidemiology, 2002. 31(6): p. 1235-39. Barker et al. (2008). Concluding remarks. the window of opportunity. Pre-Pregnancy to 24 Months of Age. Nestle Nutr Workshop Ser Pediatr Program, 2008. 61: p. 255-60, Barrett, C., Carter, M. & Little, P. (2003). Understanding and Reducing Persistent Poverty in Africa: Introduction to a Special Issue, Journal of Development Studies (Vol. 42, No. 2, 2006)
Batsell, W.R., Brown, A.S., Ansfield, A.E. & Paschall, G.Y. (2002). You Will Eat All of That: A retrospective analysis of forced consumption episodes. Appetite 38(3): 211-219.
Becker et al. (2010). Youth health-risk behavior assessment in Fiji: The reliability of Global School-based Student Health Survey content adapted for ethnic Fijian girls. Ethnicity & Health 15(2): 181-197, 2010.
Behrman, J.R., Rosenzweig, M.R. (2001). The Returns to Increasing Body Weight, W.P.-. Penn Institute for Economic Research, Editor. 2001: Philadelphia.
Brener et al. (2002). Reliability of the 1999 Youth Risk Behavior Survey Questionnaire. Journal of Adolescent Health 2002;31:336–342.
Brener, N.D., McManus, D., Galuska, R., Lowry, R. & Wechsler, H. (2003). Reliability and validity of self-reported height and weight among high school students. Journal of Adolescent Health 2003;32:281–287.
Brown, K.A., Ogden, J., Vögele, C., & Gibson, E.L. (2008). The role of parental control practices in explaining children's diet and BMI. Appetite. 50(2-3):252-9. Bryson, J. C., Chudy, J. P. & Pines, J.M. (1991). Food for work. A review of the 1980s with recommendations for the 1990s Bundy, D.A.P., Burbano, C., Grosh M., Gelli, A., Jukes, M. & Drake, L. (2009). Rethinking School Feeding: Social Safety Nets, Child Development and the Education Sector. Directions in Development, World Bank, Washington DC.
Burbano, C. (2007). Appraisal mission report: WFP Malawi support to primary education under Country Programme 10106. WFP, Lilongwe. Burchi, F. & De Muro, P. (2007). Education for rural people: a neglected key to food security. Rep. Universita Degla Studi Roma Tre. Burchi, F. (2006). Education, Human Development, and Food Security in Rural Areas: Assessing Casualties. Burns, R.P. & Burns, R. (2008). Business research methods and statistics using spss. Retrieved from http://www.uk.sagepub.com/burns/chapters.htm
Busick, D.B., Brooks, J., Pernecky, S., Dawson, R., & Petzoldt, J. (2008). Parent food purchases as a measure of exposure and preschool-aged children's willingness to identify and taste fruit and vegetables. Appetite; 51 (3):468-73. Cannon, R. (2008). The social determinants of health. Sacoss information paper December 2008. Doi: ISBN 978-0-908293-53-7 CDC. (2006). Nutrition for everyone: Fruits and vegetables. Atlanta, Georgia. Retrieved from http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition
Centers for Disease Control and Prevention. (2010). Hunger and homelessness awareness week. Retrieved from http://www.cdc.gov/Features/Homelessness/ Centre for social research .(2002). Impact of food shortage schooling in Malawi.
Chugh, S. (2004). Why Children Dropout: Case Study of a Metropolitan City. New Delhi: Bookwell. Claydon, N.C. (2000). Current concepts in toothbrushing and interdental cleaning. Periodontol 2000 2008, 48:10-22, Coates, J. (2004). “Experience and Expression of Food Insecurity Across Cultures: Practical Implications for Valid Measurement.” Washington, D.C.: Food and Nutrition TechnicalAssistance Project, Academy for Educational Development, 2004. Coates, J., Swindale, A & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access:Indicator Guide Version 3. USAID Food and Nutrition Technical Assistance Project (FANTA). Dahlgren, G. & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm: Institute for Future Studies. Davie, M. & McDowall, W. (2006). Health promotion theory.Open University Press
Delisle, H., Chandra-Mouli, V. & de Benoist, B. (2000). Should Adolescents be Specifically Targeted for Nutrition in Developing Countries? To Address Which Problems, and How? Disease Control Priorities Project. (2008). Deworming Children Brings Huge Health and Development Gains in Low Income Countries, Retrieved from http://www.dcp2.org/file/162/dcpp-helminths-web
Fanzo, J. (2012). The Nutrition Challenge in SubSharan Africa. United Nations Development Programme, Regional Bureau for Africa. January 2012.
FAO. (2005a). Setting up and running a School Garden - a manual for teachers, parents and communities. FAO. (2005b). Measuring Food Insecurity. Food and Agriculture Organization of the United Nations, Retrieved from: http://www.fao.org/docrep/008/y5898e/y5898e06.htm FAO. (2010). Promoting life healthy eating habits. A new deal for school gardens, Retrieved from http://www.fao.org/docrep/013/i1689e/i1689e00
HU, B., Palta, M. & Shao, J. (2006). Properties of R statistic for logistic regression. Statistic in Medicine, 25, 1383-1395. International Labour Standards on Child labour. (1973). Ratifications of C138 - Minimum Age Convention, 1973 (No. 138). Isanaka, S., Mora-Plazas, M., Lopez-Arana, S., Baylin, A. & Villamor, E. (2007). Food insecurity is highly prevalent and predicts underweight but not overweight in adults and school children from Bogotá, Colombia. J Nut. 2007 Dec; 137(12):2747-55 Johannessen, B. (2008). Building Rural Roads. International Labor Organization. Kakakios. (2008). The Provision of Health Care in a Culturally Diverse Community. Primary Health and Community Partnerships Branch NSW Department of Health Kalengamaliro, H. (2008). Improving water, sanitation and hygiene behaviours in schools.Success and lessons learned from Mangochi District, Malawi, September 2008.
Kelly, C., Molcho, M., Gavin, A., Clarke, N., Callagha, M. and Gabhainn,S.N. (2007). Food poverty and health among schoolchildren: Findings from the Health Behaviour in School-aged Children (HBSC) study. Public Health Nutrition, 10(4), 364-370.
Kendall, A., Olson, C.M., Frongillo, E.A. (1996). Relationship of hunger and food insecurity to food availability and consumption.J Am Diet Assoc, 96, pp. 1019–1024 quiz 1025-1026
Kleinman, R. et al. (1998). Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics 101(1):e3. Lalonde, M. (1974). A New Perspective on the Health of Canadians: A Working Document. Ottawa:Government of Canada Lancaster, P.A., Broooks, J,E. (1983). Cassava leaves as human food – 1983 Lasserre, A.M., Viswanathan, B. & Bovet, P. (2008). Seychelles Global School-based student Health Survey Full Report.
Leanne, Findlay, L.C., Kellie, A., Langlois & Kohen, D.E. (2013). Hunger among Inuit children in Canada. Int J Circumpolar Health 2013, 72: 20324 - http://dx.doi.org/10.3402/ijch.v72i0.20324 Ligomeka, B.(2002). Food crisis worsens in Malawi. News and views on Africa 2002 Magen, B., Donovan, C. and Kelly, V. (2009). Can cash transfers promote food security in the context of volatile commodity prices?. Food, agriculture and natural resource policy analysis network. Malawi Institute Education, SIDA & UNFPA. (2005). Life Skills and Sexual Reproductive Health Education for Primary and Secondary Schools. Findings from a Baseline Survey Malawi Institute of Education. (2005). Life Skills and Sexual Reproductive Health Education. Paper presented to Heads of Secondary Schools. Malawi Institute of Education, Domasi Markham, D. (2010). Harnessing the wind with junk: Malawian wind inventor William Kamkwamba. Green Living Ideas.
Martorell, R., Kettel Khan, L. & Schroeder, D.G. (1994). Reversibility of stunting: epidemiological findings in children from developing countries. Eur. J. Clin. Nutr.,1994. 48: p. S45-S57. Mar'ys Meals. (2007). A simple solution to world hunger.Mary’s meals FAQ, Malawi.
Maslow, A. (1943). A theory of human motivation. Psychological Review, 50, 370-396. Retrieved from http://psychclassics.yorku.ca/Maslow/motivation.htm. Masset, Edoardo & Aulo Gelli. (2013). Improving community development by linking agriculture, nutrition and education: design of a randomised trial of home-grown school feeding in Mali. Trials. McGinnis, J.M., Williams-Ruso, P., Knickman, J.R. (2002). The case for more active policy attention to health promotion. Health Affairs 21(2)
Mekonnen et al. (2013). Malnutrition and its Correlates among Rural Primary School Children of Fogera District, Northwest Ethiopia. J Nutr Disorders Ther 2013, S12http://dx.doi.org/10.4172/2161-0509.S12-002
Ministry of Education and Vocational Training, Ministry of Health & National Statistical Office .(2006). National school health and nutrition baseline survey. Zomba: Malawi Government.
Muehlhoff, E. (2007). Garden-based learning for Improved Livelihoods and Nutrition Security of School Children in High HIV-Prevalence Areas in Southern Africa. Workshop Report. Harare, Zimbabwe. Retrieved from // ftp.fao.org/docrep/fao/010/a1432e/a1432e00.pdf.
Mushtaq et al. (2011). Prevalence and socio-demographic correlates of stunting and thinness among Pakistani primary school children. BMC Public Health 2011, 11:790 http://www.biomedcentral.com/1471-2458/11/790 Najman, J., Aird, R., Bor, W., O’Callaghan, M., Williams, G. & Shuttlewood, J. (2004). The generational transmission of socioeconomic inequalities in child cognitive development and emotional health, in, Social Science and Medicine, Vol. 58, No. 6, pp. 1147 – 1158. Narayan, D. (2002). Employment and poverty reduction: a sourcebook. World Bank.
National Centers for Chronic Disease Prevention and Health Promotion. (2008). Youth Risk Behavior Surveillance System (YRBSS), Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/
National Research Council. (2006). Food Insecurity and Hunger in the United States: An Assessment of the Measure. Committee on National Statistics, Panel to Review the U.S. Department of Agriculture’s Measurement National Statistical Office (Malawi), Minnesota Population Center. Malawi Population and Housing Census 2008 from the Integrated Public Use Microdata Series, International. Minneapolis: University of Minnesota, 2011.
National Statistics Office. (2009). Welfare Monitoring Survey. Lilongwe: NSO. Niclasen, B., Petzold, M., Schnohr, C.W. (2013). Adverse health effects of experiencing food insecurity among Greenlandic school children. Int J Circumpolar Health. 2013; 72: 10.3402/ijch.v72i0.20849. Nnakwe, N. & Yegammia, C. (2002). Prevalence of food insecurity among households with children in Coimbatore, India. Nutrition Research 22 (2002) 1009–1016
Nord et al.(2009). What Should the Government Mean by Hunger? Journal of Hunger and Environmental Nutrition 4:1-28.
Nord, M.(2009) Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. EIB-56. U.S. Dept. Of Agriculture, Econ. Res. Serv.
Partnership for Child Development. (1999). A Situation Analysis: A Participatory Approach to Building Programmes that Promote Health, Nutrition and Learning in Schools. Partnership for Child Development Series GEN 20
Phiri & Frank. (2006). Challenges 2005-2006: A Difficult Year Ahead for Famine-Hit Malawi, Retrieved from http://www.ipsterraviva.net/Africa/print.asp?idnews=484 Planting Peace. (2005). Stomp the Worm Project. Retrieved from http://www.plantingpeace.org/deworm.php
Puckree, T., Naidoo, P., Pillay, P. & Naidoo, T. (2011). Underweight and overweight in primary school children in eThekwini district in KwaZulu-Natal, South Africa. Afr J Prm Health Care Fam Med. 2011;3(1), Art. #203, 6 pages. doi:10.4102/phcfm.v3i1.203
Radimer, K. (2002). Measurements of households food security in the USA and other industralized countries, Public Health Nutr 5(6A), 859-864. RIPPLE Africa. (2008). providing a hand Up, not a hand out. Retrieved from http://www.rippleafrica.org/education-in-malawi-africa/general-education-in-malawi-africa Samman, E. & Santos M.E. (2009). Agency and Empowerment: Review of Concepts, Indicators, and Empirical evidence. Oxford Poverty and Human Development Initiative. Sharkey, J.R., Dean, W.R. and Nalty, C.C. (2013). Child hunger and the protective effects of supplemental nutrition assistance program (SNAP) and alternative food sources among Mexican-origin families in Texas border colonias. BMC Pediatrics 2013, doi: 10.1186/1471-2431-13-143 Siziya, Muula & Rudatsikira. (2011). Self-reported poor oral hygiene among in-school adolescents in Zambia, Retrieved from http://www.biomedcentral.com/1756-0500/4/255
Stormer, A. & Harrison, G.G. (2003). Does household food insecurity affect cognitive and social development of kindergarteners? California Center for Population Research, University of California - Los Angeles, November 2003.
Swahn, M.H., Bossarte, R.M., Gaylor, E., Elimam, D.M. & Walingo, M.K. (2010). Associations between hunger and emotional and behavioral problems: A comparison between students in Botswana, Kenya, Uganda, and Zambia. International Public Health Journal 2(2):185- 194, 2010.
The hunger project report. (2007). Gender Dimensions of Hunger. Retrieved from http://hungerproject.org/gender.htm The United Nations. (2013). Millennium Development Goals, Retrieved 18 August 2013.
UN Hunger Task Force. (2004). Halving Hunger: It can be done, in UN Mellenium Project. 2004, New York. United Nations Human Rights. (2010). The Right to Adequate Food. New York, NY: Office of the United Nations High Commission for Human Rights
United Nations. (2000). United Nations Millennium Declaration, General Assembly resolution, A/RES/55/2
Webb, P. & Rodgers, B. 2003. Addressing the “In” in Food Insecurity. Retrieved from http://www.dec.org/pdf_docs/PNACS926
Weinreb, L. et al. (2002). Hunger: Its impact on children’s health and mental health. Pediatrics 110(4):e41. WHO. (1993). Global AIDS News, No. 4, Geneva Wielkiewicz, M. (2000). SPSS Online Guide. Retrieved from http://www.mhhe.com/socscience/psychology/runyon/spss/chisquare.html Wilkinson, R. & Marmot, M. (2003). Social Determinants of Health: The Solid Facts. 2nd edition, World Health Organisation, Denmark
World Bank. (2006). Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action. Washington DC, Retrieved from http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy
World Food Programme & United Nations Children’s Fund. (2005). The Essential Package: Twelve interventions to improve the health and nutrition of school-age children. Rome: WFP. 19 August 2010.
World Food Programme .(2006). Where we work: Malawi, Retrieved from www.wfp.org
World Food Programme. (2002). VAM Standard Analytical Framework Guidelines. Role and Objectives of VAM Activities to Support WFP-Food-Oriented Interventions. Rome, WFP. World Food Programme. (2007). Annual Performance Report for 2006. Rome,WFP.
World Health Organisation. (2001). Macroeconomics and health: Investing in health for economic development. Report on the Commission on Macroeconomics and Health. World Health Organisation: Geneva.
World Health Organization .(1998). Health for All in the 21st Century. Copenhagen:WHO Regional Office for Europe
World Health Organization, United Nations Population Fund & United Nations Children’s Fund. (1995). Action for Joint Adolescent Health: Towards a Common Agenda. Recommendations from a Joint Study Group
World Health Organization. (2003). Strategic Directions for Improving the Health and Development of Children and Adolescents, Retrieved from: http://whqlibdoc.who.int/publications/2003/9241591064
World Health Organization. (2009). Global School-based student health survey (GSHS). Retrieved from: http://www.who.int/chp/gshs/en/
World Health Organization.(1997). Preventing and managing the global epidemic of obesity. Geneva: World Health Organization; 1997. World Hunger Statistics. (2012). World Food Programme 2012, Retrieved from http://www.wfp.org/hunger/glossary.
Zullig, K.J., Pun, S., Patton, J.M., Ubbes, V.A. (2006). Reliability of the 2005 Middle School Youth Risk Behavioral Survey. Journal of Adolescent Health 2006;39:856–60.