Methodology for estimating regional and global trends of child malnutrition
Methodology for estimating regional and global trends of child malnutrition
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DOI：
10.1093/ije/dyh202
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发表时间：
2004-12-01
影响因子：
7.7
通讯作者：
Frongillo, EA
中科院分区：
文献类型：
--
作者：
de Onis, M;Blössner, M;Frongillo, EA
儿童营养不良是监测千年发展目标进展情况的一个重要指标。本文介绍了世界卫生组织（世卫组织）为得出儿童发育迟缓和体重不足的全球和区域趋势而制定的方法，并报告了1990-2005年流行率和受影响人数的趋势。方法从世界卫生组织儿童生长和营养不良全球数据库中提取139个国家的国家患病率数据。体重不足和发育迟缓的调查数据点分别为419和388。为了估计趋势，我们使用了线性混合效应模型，允许在国家层面上的随机效应和异质协方差结构。使用流行率的logit变换为每个联合国区域拟合一个模型，并将结果反转换为原始比例尺。根据明确的统计和图形标准选择最佳模型。结果1990-2000年期间，全球发育迟缓和体重不足患病率分别从34%下降到27%和从27%下降到22%。东亚和东南亚的营养不良率大幅下降，而中南亚的营养不良率仍然很高。拉丁美洲和加勒比地区也取得了重大进展，而在非洲，发育迟缓和体重不足儿童的人数分别从40万增加到45万和2500万增加到3100万。结论线性混合效应模型最有效地利用了所有可用信息。各区域的趋势并不均衡，有些地区表明需要采取更加协调和有效的干预措施，以实现在1990年至2015年期间将儿童营养不良水平减半的千年发展目标。
Background Child malnutrition is an important indicator for monitoring progress towards the Millennium Development Goals (MDG). This paper describes the methodology developed by the World Health Organization (WHO) to derive global and regional trends of child stunting and underweight, and reports trends in prevalence and numbers affected for 1990-2005.Methods National prevalence data from 139 countries were extracted from the WHO Global Database on Child Growth and Malnutrition. A total of 419 and 388 survey data points were available for underweight and stunting, respectively. To estimate trends we used linear mixed-effect models allowing for random effects at country level and for heterogeneous covariance structures. One model was fitted for each United Nation's region using the logit transform of the prevalence and results back-transformed to the original scale. Best models were selected based on explicit statistical and graphical criteria.Results During 1990-2000 global stunting and underweight prevalences declined from 34% to 27% and 27% to 22%, respectively. Large declines were achieved in Eastern and South-eastern Asia, while South-central Asia continued to suffer very high levels of malnutrition. Substantial improvements were also made in Latin America and the Caribbean, whereas in Africa numbers of stunted and underweight children increased from 40 to 45, and 25 to 31 million, respectively.Conclusion Linear mixed-effect models made best use of all available information. Trends are uneven across regions, with some showing a need for more concerted and efficient interventions to meet the MDG of reducing levels of child malnutrition by half between 1990 and 2015.