Factors associated with wasting among children under five years old in South Asia: Implications for action
Factors associated with wasting among children under five years old in South Asia: Implications for action
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DOI：
10.1371/journal.pone.0198749
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发表时间：
2018-07-03
期刊：
影响因子：
3.7
通讯作者：
Webb, Patrick
中科院分区：
文献类型：
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作者：
Harding, Kassandra L.;Aguayo, Victor M.;Webb, Patrick
南亚仍然是全世界被浪费儿童所占比例和数量最多的地区。在决策者重新努力解决这一长期存在的公共卫生和发展问题之际，了解浪费的决定因素非常重要。利用孟加拉国、印度、马尔代夫、尼泊尔、巴基斯坦和阿富汗的国家调查数据，本分析探讨了与0至59个月儿童（n = 252,797）消瘦有关的因素。我们采用多元混合逻辑回归和反向逐步回归方法分别确定每个国家的简约模型（p值均< 0.05）。在所有国家，年龄较小的儿童（0至5个月）和母亲体重指数较低（< 18.5 kg/m(2)）的儿童被浪费的几率更大。出生顺序较晚、男性、母亲文盲、母亲身材矮小、缺乏改善的水源和家庭贫困也与许多国家的浪费有关，但并不是所有国家都有系统的浪费。在最终的模型中，季节性也不总是与浪费有关。这些发现表明，孕前（青春期）、怀孕和产后早期是解决儿童消瘦问题的机会之窗，而不仅仅是发育迟缓问题。我们的分析表明，南亚地区的消瘦和发育迟缓的潜在决定因素是相似的，但在各个地区并不普遍。迫切需要扩大具有成本效益的干预措施，以防止发育迟缓和消瘦，并治疗严重消瘦。将儿童营养不良的这两种表现形式从概念上和规划上分开，可能会不必要地妨碍实现可持续发展目标中旨在解决儿童发育迟缓和消瘦问题的具体目标的进展。
South Asia continues to carry the greatest share and number of wasted children worldwide. Understanding the determinants of wasting is important as policymakers renew efforts to tackle this persistent public health and development problem. Using data from national surveys in Bangladesh, India, the Maldives, Nepal, Pakistan and Afghanistan, this analysis explores factors associated with wasting among children aged 0 to 59 months (n = 252,797). We conducted multivariate mixed logistic regression and backwards stepwise methods to identify parsimonious models for each country separately (all p values < 0.05). Younger children (0 to 5 months), and those whose mothers had a low body mass index (< 18.5 kg/m(2)) had greater odds of being wasted in all countries. Later birth order, being male, maternal illiteracy, short maternal stature, lack of improved water source, and household poverty were also associated with wasting in various countries, but not systematically in all. Seasonality was also not consistently associated with wasting in the final models. These findings suggest that pre-conception (adolescence), pregnancy and early postpartum, represent windows of opportunity for tackling child wasting, not only stunting. Our analysis suggests that the underlying determinants of wasting and stunting in South Asia are similar, but not universal across geographies. Cost-effective interventions to prevent both stunting and wasting, and to treat severe wasting, need to be scaled up urgently. Separating these two manifestations of child undernutrition in conceptual and programmatic terms may unnecessarily impair progress to reach the Sustainable Development Goals targets aimed at addressing both child stunting and wasting.