Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan
Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan
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DOI：
10.1016/j.socscimed.2017.06.017
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发表时间：
2017-08-01
影响因子：
5.4
通讯作者：
Subramanian, S. V.
中科院分区：
文献类型：
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作者：
Kim, Rockli;Mejia-Guevara, Ivan;Subramanian, S. V.
儿童早期的最佳生长和发育取决于影响营养摄入量的儿童、母亲、家庭、环境和社会经济因素的复杂相互作用，但减少儿童营养不良的干预措施有时单独针对特定的风险因素。在这项分析中，我们基于对现有多因素框架的集体审查，评估了13个与儿童发育迟缓相关的因素的相对重要性：补充喂养、母乳喂养、喂养频率、饮食多样性、母亲身高、体重指数(BMI)、教育程度、结婚年龄、儿童接种疫苗、获得改善的饮水源和卫生设施的机会、家庭室内空气质量和家庭财富。分析样本包括孟加拉国(2014年)、印度(2005年)、尼泊尔(2011年)和巴基斯坦(2013年)的最新人口和健康调查以及阿富汗(2013年)全国营养调查的具有全国代表性的横断面调查。在相互调整的3,159名6-8个月婴儿的Logistic回归模型中，母亲身材矮小(OR：2.93；95%CI：1.93-4.46)和缺乏辅食(OR：1.47；95%CI：1.12-1.93)与明显更高的发育迟缓风险相关。在18,586名6-23个月大的儿童中，与儿童发育迟缓相关最强的因素是：母亲身高(OR：3.37，95%CI：2.82-4.03)、家庭财富(OR：2.25，95%CI：1.72-2.94)、母亲BMI(OR：1.59，95%CI：1.27-2.00)、最低饮食多样性(OR：1.48，95%CI：127-1.72)、母亲教育(OR：1.36，95%CI：1.18-1.56)、结婚年龄(OR：1.17，95%CI：1.05~1.30)。对于这个年龄段的儿童，充分接种疫苗和最低饮食频率也被发现对严重发育迟缓很重要。在国别分析中发现，相关因素的相对顺序和统计意义有所不同。我们的发现表明，需要综合战略，包括在社会经济条件方面取得更广泛的进展，以及投资于营养特定项目，以改善南亚儿童营养不良的状况。(C)爱思唯尔有限公司发布的2017年。
Optimal growth and development in early childhood is determined by a complex interplay of child, maternal, household, environmental, and socioeconomic factors that influence nutritional intake, but interventions to reduce child undernutrition sometimes target specific risk factors in isolation. In this analysis, we assess the relative importance of 13 correlates of child stunting selected based on a collective review of existing multi-factorial frameworks: complementary feeding, breastfeeding, feeding frequency, dietary diversity, maternal height, body mass index (BMI), education, age at marriage, child vaccination, access to improved drinking source and sanitation facilities, household indoor air quality, and household wealth. The analytic sample consisted of nationally representative cross-sectional surveys from the most recent Demographic and Health Surveys for Bangladesh (2014), India (2005), Nepal (2011), and Pakistan (2013), and from the National Nutrition Survey for Afghanistan (2013). In the mutually adjusted logistic regression model for 3,159 infants aged 6-8 months, short maternal stature (OR: 2.93; 95% CI: 1.93-4.46) and lack of complementary foods (OR: 1.47; 95% CI: 1.12-1.93) were associated with significantly higher risk of stunting. For 18,586 children aged 6-23 months, the strongest correlates of child stunting were: maternal height (OR: 3.37, 95% CI: 2.82-4.03), household wealth (OR: 2.25, 95% CI: 1.72-2.94), maternal BMI (OR: 1.59, 95% Cl: 1.27-2.00), minimum dietary diversity (OR: 1.48, 95% CI: 127-1.72), maternal education (OR: 1.36, 95% CI: 1.18-1.56), and age at marriage (OR: 1.17, 95% CI: 1.05-1.30). Full vaccination and minimum dietary frequency were also found to be important for severe stunting for children of this age group. Some differences were found in the relative ordering and statistical significance of the correlates in country-specific analyses. Our findings indicate that comprehensive strategies incorporating a broader progress on socioeconomic conditions as well as investments in nutrition specific programs are needed to improve child undernutrition in South Asia. (C) 2017 Published by Elsevier Ltd.