Trends in inequalities in child stunting in South Asia.
Trends in inequalities in child stunting in South Asia.
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DOI：
10.1111/mcn.12517
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发表时间：
2018-11
影响因子：
3.4
通讯作者：
Subramanian SV
中科院分区：
文献类型：
--
作者：
Krishna A;Mejía-Guevara I;McGovern M;Aguayo VM;Subramanian SV
我们分析了南亚发育迟缓的社会经济不平等，并调查了与个人、照顾者和家庭层面因素相关的差异（膳食多样性差、母亲受教育程度低和家庭贫困）。我们对孟加拉国、印度、尼泊尔和巴基斯坦（1991-2014 年）人口和健康调查中 55,459 名 6-23 个月儿童的数据进行了时间序列分析。根据年龄、性别、出生顺序和居住地进行调整的逻辑回归模型研究了发育迟缓与多种社会经济劣势之间的关联。所有国家的发育迟缓率都很高。孟加拉国和尼泊尔的降幅最大，分别为每年 2.9 和 4.1 个百分点，而印度和巴基斯坦分别为 1.3 和 0.6 个百分点。无论劣势类型如何，社会经济逆境都与发育迟缓风险增加相关。饮食不足和母亲受教育程度较低的贫困儿童发育迟缓的风险更大。尽管最贫困群体的发育迟缓率有所下降，但随着时间的推移，社会经济差异在很大程度上得以保留，并且在某些情况下，即财富五分位之间的差异进一步恶化。最弱势儿童所承受的发育迟缓负担过大，以及社会经济群体之间日益恶化的不平等，是发育迟缓负担沉重的国家所关注的问题。缩小表现最好和最差国家之间以及国家内最弱势群体和最弱势群体之间的差距将大幅改善南亚的发育迟缓率。为此，需要更加关注解决发育迟缓的社会、经济和政治驱动因素，并有针对性地针对处境最不利和儿童生长迟缓的人群。
We analysed socio‐economic inequalities in stunting in South Asia and investigated disparities associated with factors at the individual, caregiver, and household levels (poor dietary diversity, low maternal education, and household poverty). We used time‐series analysis of data from 55,459 children ages 6–23 months from Demographic and Health Surveys in Bangladesh, India, Nepal, and Pakistan (1991–2014). Logistic regression models, adjusted for age, sex, birth order, and place of residency, examined associations between stunting and multiple types of socio‐economic disadvantage. All countries had high stunting rates. Bangladesh and Nepal recorded the largest reductions—2.9 and 4.1 percentage points per year, respectively—compared to 1.3 and 0.6 percentage points in India and Pakistan, respectively. Socio‐economic adversity was associated with increased risk of stunting, regardless of disadvantage type. Poor children with inadequate diets and with poorly educated mothers experienced greater risk of stunting. Although stunting rates declined in the most deprived groups, socio‐economic differences were largely preserved over time and in some cases worsened, namely, between wealth quintiles. The disproportionate burden of stunting experienced by the most disadvantaged children and the worsening inequalities between socio‐economic groups are of concern in countries with substantial stunting burdens. Closing the gap between best and worst performing countries, and between most and least disadvantaged groups within countries, would yield substantial improvements in stunting rates in South Asia. To do so, greater attention needs to be paid to addressing the social, economic, and political drivers of stunting with targeted efforts towards the populations experiencing the greatest disadvantage and child growth faltering.
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DOI：
10.1016/s0140-6736(16)31389-7
发表时间：
2017-01-07
期刊：
Lancet (London, England)
影响因子：
--
作者：
Black MM;Walker SP;Fernald LCH;Andersen CT;DiGirolamo AM;Lu C;McCoy DC;Fink G;Shawar YR;Shiffman J;Devercelli AE;Wodon QT;Vargas-Barón E;Grantham-McGregor S;Lancet Early Childhood Development Series Steering Committee
通讯作者：
Lancet Early Childhood Development Series Steering Committee
影响因子：
3.4
作者：
Headey D;Hoddinott J;Park S
通讯作者：
Park S
影响因子：
168.9
作者：
Black, Robert E.;Victora, Cesar G.;Uauy, Ricardo
通讯作者：
Uauy, Ricardo
影响因子：
168.9
作者：
Bhutta, Zulfiqar A.;Das, Jai K.;Black, Robert E.
通讯作者：
Black, Robert E.
影响因子：
3.4
作者：
Devkota MD;Adhikari RK;Upreti SR
通讯作者：
Upreti SR