Drivers of stunting reduction in Peru: a country case study
Drivers of stunting reduction in Peru: a country case study
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DOI：
10.1093/ajcn/nqaa164
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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：
Huicho, Luis;Vidal-Cardenas, Elisa;Bhutta, Zulfiqar A.
背景：秘鲁5岁以下儿童发育迟缓率显著下降，从2000年的31.3%降至2016年的13.1%。目的：我们旨在研究2000-2016年秘鲁儿童发育迟缓减少的因素和关键推动因素。方法：采用人口统计学和健康调查进行描述性分析[身高年龄比z分数（HAZ）均值和分布，公平性分析，通过多项式回归预测儿童生长曲线]和高级回归分析。采用生态（部门层面）多层次回归分析，确定2000 - 2016年发育迟缓下降的主要预测因子；采用瓦哈卡-布林德分解，确定各因子对儿童HAZ变化的相对贡献。通过系统的文献综述、政策和项目分析以及与相关利益相关者的访谈，我们了解了秘鲁发育迟缓下降的主要驱动因素。结果：从2000年到2007/2008年，HAZ得分的分布呈现轻微的右移，2007/2008年到2016年，HAZ得分的分布呈现较大的右移。在收入最低的五分之一家庭、农村地区以及母亲受教育程度最低的儿童中，发育迟缓的发生率更高。对预测变化的分解表明，最重要的因素是母亲体重指数和身高的增加、孕产妇和新生儿保健的改善、父母教育程度的提高、向城市地区迁移和生育率的降低。关键驱动因素包括自21世纪初以来民间社会和政治领导在减少贫困和发育迟缓方面的倡导作用。关键的推动因素包括自21世纪初以来的经济增长和民主的巩固，以及人们认识到减少发育迟缓需要的不仅仅是补充食物。结论：秘鲁减少儿童发育迟缓的原因是社会经济决定因素的改善、卫生部门外和卫生部门内变革的持续实施以及卫生干预措施的实施。这些努力是通过多部门方法、民间社会的大力倡导和敏锐的政治领导推动的。秘鲁的经验为如何在多部门参与的情况下解决不同情况下的发育迟缓问题提供了有益的教训。
Background: Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016.Objectives: We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016.Methods: Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru.Results: The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation.Conclusions: Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.