Drivers of stunting reduction in Nepal: a country case study
Drivers of stunting reduction in Nepal: a country case study
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DOI：
10.1093/ajcn/nqaa218
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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：
Conway, Kaitlin;Akseer, Nadia;Bhutta, Zulfiqar A.
背景：慢性儿童营养不良是一个严重的全球健康问题。在过去的几十年里，尼泊尔的线性增长显着下降，尽管经济增长缓慢且政治不稳定，但长期营养不良的身体表现却受到阻碍。 目的：本研究旨在深入评估 1996 年至 2016 年尼泊尔发育迟缓的决定因素，特别关注国家、社区、家庭和个人层面的因素，以及国内推出的相关营养特定和敏感举措。采用混合方法，采用了 4 种类型的调查：1）对已发表的同行评审文献和灰色文献进行系统回顾； 2）利用1996年至2016年人口和健康调查进行回顾性定量数据分析； 3) 审查针对特定营养和营养敏感的关键政策和计划； 4) 回顾性定性数据收集和分析。结果：从 1996 年到 2016 年，平均年龄别身高 z 得分 (HAZ) 提高了 0.94 个标准差。发育迟缓结果的地方差异和社会经济不平等仍然存在，而且后者随着时间的推移而扩大。 5岁以下儿童分解分析解释了90.9%的HAZ预测变化，关键因素包括父母教育（24.7%）、孕产妇营养（19.3%）、随地排便减少（12.3%）、孕产妇和新生儿保健（11.5%）和经济改善（9.0%）。主要举措侧重于卫生系统权力下放和动员社区卫生工作者提高可及性；长期在全国范围内提供基本卫生干预措施；有针对性地努力改善妇幼健康；政府和捐助者优先考虑营养敏感的举措。国家和社区利益攸关方以及村庄一级的母亲强调，减少贫困、获得医疗服务、改善教育以及增加获得水、环境卫生和个人卫生的机会是减少发育迟缓的驱动因素。 结论：改善营养特定部门和营养敏感部门对于尼泊尔发育迟缓的减少至关重要，特别是在减贫、健康、教育和环境卫生领域。
Background: Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting a physical manifestation of chronic malnutrition despite only modest economic growth and significant political instability.Objective: This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country.Methods: Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses.Results: Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction.Conclusions: Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.