Bangladesh's story of change in nutrition: Strong improvements in basic and underlying determinants with an unfinished agenda for direct community level support
Bangladesh's story of change in nutrition: Strong improvements in basic and underlying determinants with an unfinished agenda for direct community level support
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DOI：
10.1016/j.gfs.2017.01.005
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发表时间：
2017-06-01
影响因子：
8.9
通讯作者：
Akhtar, Nazneen
中科院分区：
文献类型：
--
作者：
Nisbett, Nicholas;Davis, Peter;Akhtar, Nazneen
孟加拉国在减少儿童发育迟缓方面取得了相当大的进展，被誉为全球营养论坛上的成功范例。这项混合方法的研究考虑了现有的统计和定性证据，以帮助揭示孟加拉国营养“变化故事”背后的关键因素。孟加拉国近年来营养状况的改善在很大程度上是由于在有利于穷人的经济增长的更广泛的有利环境中对营养问题有敏感认识的驱动因素。这些因素中的关键是收入增加;家庭规模缩小和生育差距扩大;父母-特别是妇女-教育和更广泛的保健机会。对主要利益攸关方的研究和访谈以及社区一级的工作有助于阐明这些更广泛的决定因素背后的政策和方案选择。基于社区的营养方案尚未像其他国家那样大规模运作，目前提供营养的治理安排也很薄弱。但是，由于孟加拉国面临着日益严重的新营养问题，而且儿童发育迟缓的负担仍然相对较高，这种“营养专项”方案必须发挥比过去更大的作用，因为这些更广泛的驱动因素中的一些因素的进一步收益可能有限，而且可能已经趋于稳定。
Bangladesh has made considerable progress in reducing child stunting and is lauded as a success story in global nutrition fora. This mixed-methods study considers available statistical and qualitative evidence to help reveal the critical factors behind Bangladesh's 'story of change' in nutrition. Much of the improvement in nutrition in Bangladesh in recent years is explained by what can be seen as nutrition-sensitive drivers within a wider enabling environment of pro-poor economic growth. Key amongst these factors have been improving incomes; smaller family sizes and greater gaps between births; parental - and particularly women's - education and wider health access. Research and interviews with key stakeholders and work at a community level has helped shed light on the policy and programmatic choices which lie behind these wider determinants. Community based nutrition programmes have not yet been operating at scale as in other countries and the current governance arrangements for nutrition delivery are weak. But as Bangladesh faces growing new nutritional problems and still suffers from a relatively high burden of child stunting, such 'nutrition-specific' programmes will have to play a greater role than in the past, as the further gains from some of these wider drivers may be limited and are likely to have plateaued.