Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline
Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline
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DOI：
10.1093/ajcn/nqaa159
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发表时间：
2020-09-01
影响因子：
7.1
通讯作者：
Bhutta, Zulfiqar A.
中科院分区：
文献类型：
--
作者：
Vaivada, Tyler;Akseer, Nadia;Bhutta, Zulfiqar A.
背景资料：全世界在减少5岁以下儿童长期营养不良和线性生长发育迟缓率方面取得了进展，尽管在许多区域，这一比率仍然很高。支持孕产妇和儿童健康和营养的政策、项目和干预措施有可能改善儿童的生长和发育。目的：本文综合了关于各国发育迟缓患病率下降驱动因素的现有全球证据，并比较了各国发育迟缓下降主要驱动因素的相对影响。方法：我们对已发表的同行评议和灰色文献进行了系统回顾，分析了儿童线性生长关键决定因素的变化与线性生长结果随时间变化之间的关系。在发育迟缓的基本决定因素评估枯萎回归分解分析，改善资产指数得分是一个一致的和强大的驱动力，改善线性增长的结果。父母教育程度的提高也是儿童生长发育不良的一个强有力的预测因素。在发育迟缓的基本决定因素中，露天排便率降低，卫生基础设施改善，获得关键孕产妇保健服务的机会增加，包括最佳产前护理和在保健设施内或由熟练助产士接生，所有这些都是儿童生长大幅改善的原因，尽管每个因素所解释的差异程度在各国之间有很大差异。在直接的水平，在几个产妇特征的变化预测适度的发育迟缓减少，包括奇偶校验，interpregnancy间隔，和产妇height.Conclusions：独特的一套发育迟缓的决定因素预测发育迟缓减少的国家内，已经减少了发育迟缓。在基本、根本和直接层面出现了几个共同的驱动因素，包括改善母亲和父亲的教育、家庭社会经济地位、卫生条件、孕产妇保健服务的获得和计划生育。需要进一步收集数据和进行深入的混合方法研究，以加强对发育迟缓负担仍然高得令人无法接受的国家的建议。
Background: Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.Objective: This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.Methods: We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time.Results: Among the basic determinants of stunting assessed wither regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. increased parental education was also a strong predictor of Unproved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height.Conclusions: Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.