GCRF-Measuring and Mapping the Prevalence and Patterning of Multiple Malnutrition in Young Children in West and Central Africa

1990至2014年间，撒哈拉以南非洲地区发育迟缓儿童的数量增加了23%，约有5800万5岁以下儿童受到影响。这些儿童中的许多人也经历了消瘦，这些人体测量缺陷(“多重营养不良”，MM)的共同出现导致了更高的发病率风险。在家庭和社区层面，MM可以指营养不足和营养过剩并存，这是许多低收入和中等收入国家(LMIC)观察到的一种模式，2015年和2016年全球营养报告指出这是“新常态”。该项目的重点是世界上最贫穷地区之一--西非和中非国家的幼儿多发性硬化症。利用世界卫生组织24个国家现有家庭调查的数据，该项目将对人体测量和人口统计数据和变量进行量化分析，以探索MM的患病率和模式。它将汇集调查(国土安全部、中等收入国家统计调查)的个人和家庭层面的数据，并将这些信息与宏观指标、国家治理、公共卫生和营养支出以及食品价格结合起来，以审查儿童基金会(MALL)营养概念框架中提出的MM的根本、中间和基本原因。营养不良与死亡风险增加有关，特别是在儿童中；对纵向调查数据的分析表明，患有多种人体测量缺陷的儿童死亡的可能性是后者的12.3倍。这类儿童很可能从营养和其他儿童生存干预措施中受益最多(McDonald等人，2013年)，只要他们能够被识别--这目前还没有发生。尽管如此，儿童基金会/世卫组织/世界银行对儿童营养不良的审查显示，严重缺乏关于MM在幼儿中的患病率和模式的数据，也没有区域或全球估计同时发育迟缓和消瘦的儿童数量。对于各国政府以及联合国儿童基金会和粮农组织等国际机构来说，这一知识差距是一个真实且持续存在的问题。利用先进的量化方法对现有的住户调查进行分析，将为决策者提供关于MM决定因素的政策相关证据。我们还将展示MM的模式如何随着时间的推移而变化，并确定与MM相关的关键地理和社会人口因素。该项目侧重于5岁以下儿童，因为这是身体发育的关键时期，也因为关于这个年龄段的人体测量数据(身高、体重)是最可靠的，并且经常在全国调查中收集。WCA地区有一些世界上最贫穷的国家，其中许多国家的儿童营养不良率很高。这些国家还面临持续不断的粮食安全挑战，尤其是在荒漠化加剧、政治和经济不稳定以及暴力冲突(例如在尼日利亚北部、尼日尔和马里)的背景下，粮食生产不稳定。就拥有现有调查数据的国家数量而言，世界粮食计划署的覆盖面很广，所有这些数据都包含详细的、可比较的数据，用来调查造成贫穷和饥饿的差异的驱动因素。重要的是，该项目产生的证据将有助于评估在实现前三个可持续发展目标--消除贫穷、饥饿和降低儿童死亡率--方面取得的进展。

Between 1990 and 2014, sub-Saharan Africa saw a 23% increase in the number of children experiencing stunting, with around 58 million children under 5 affected. Many of these children also experienced wasting, and the co-occurrence of these anthropometric deficits ("multiple malnutrition", MM) entail heightened morbidity risks. At household and community level, MM can refer to the co-existence of under- and over-nutrition, a pattern observed across many low and middle income countries (LMICs), and which the 2015 and 2016 Global Nutrition Reports have noted to be "the new normal". This project focuses on MM in young children in one of the world's poorest regions, the countries of West and Central Africa (WCA). Utilising data from existing household surveys from the 24 countries of WCA, the project will conduct quantitative analyses on anthropometric and demographic data and variables to explore the prevalence and patterning of MM. It will bring together individual and household level data from the surveys (DHS, MICS), and combine this information with macro-level indicators, of national governance, of public expenditure on health and nutrition, and of food prices, to examine the underlying, intermediate and basic causes of MM, as set out in UNICEF's conceptual framework on (mal)nutrition. Malnutrition is associated with raised mortality risks, particularly in children; analysis of longitudinal survey data has shown that children experiencing multiple anthropometric deficits are 12.3 times more likely to die. Such children are likely to benefit most from nutrition and other child survival interventions (McDonald et al., 2013), as long as they can be indentified - which is not currently happening. Despite this, and the efforts and resources (national and international) which go to early child development programs in LMICs, a UNICEF/WHO/World Bank review of child malnutrition revealed that data on the prevalence and patterning of MM in young children are severely lacking, with no regional or global estimates of the number of children concurrently stunted and wasted. This knowledge gap is a real and ongoing problem for national governments and international agencies like UNICEF and the FAO. The analysis of existing household surveys, using advanced quantitative methods, will provide policy-relevant evidence on the determinants of MM for policy makers. We will also show how patterns of MM have changed over time, and identify key geographic and socio-demographic factors associated with MM. The project focuses on children under 5 years of age, since this is a crucial period of physical development, and also because anthropometric data (heights, weights) on this age group are most reliable and routinely collected in national surveys. The WCA region has some of the world's poorest countries, many with high rates of child malnutrition. These countries also face on-going challenges of food security not least with respect to unstable food production in the context of increasing desertification, political and economic instability, and violent conflict (e.g. in northern Nigeria, Niger and Mali). WCA has excellent coverage in terms of the number of countries with existing survey data, all of which contain detailed, comparable data with which to investigate drivers of disparities in MM. Importatnly, the evidence generated by this project will aid assessment of progress towards the first three Sustainable Development Goals (SDG) - of ending poverty, hunger and reducing child mortality.