GCRF Action against Stunting Hub

GCRF 针对发育迟缓中心的行动

• 批准号: MR/S01313X/1
• 负责人: Claire Heffernan
• 金额: $ 2328.11万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS01313X%2F1
• 关键词: GCRF; Action; against; Stunting; Hub

The global community aims to decrease the number of stunted children under five by 40% by 2025. While targeted and specific, we know that this is presently unachievable. Part of the problem is that over the last three decades, the search for the 'silver bullet' or the specific driver, which if addressed could solve this intractable problem, has narrowed praxis. This is not to say that gains have not been made, but rather our efforts have not been entirely impactful. While substantial disciplinary advances have occurred, often they have not been joined-up. And while systematic reviews abound, pan-disciplinary understandings, do not. Hence, child stunting is an intractable problem, waiting for a unified solution. If we perceive child under-nutrition as a mosaic, we have knowledge of many of the individual elements. For example, biological advances demonstrate there is an identifiable 'epigenetic signature' of stunting. Children who are stunted also have immature gut micro-biomes and we also know a large proportion of the global malnutrition burden is caused (either directly or indirectly), by infectious agents ranging from viruses and bacteria to protozoa and helminths. Food-borne toxins also impact stunting. Equally, we know a range of elements can help to prevent stunting from animal source Foods (ASF) to behavioural elements from dietary choices to feeding practices to water, sanitation and hygiene (WASH). Yet overall, it may be argued that we are missing the shape and structure of the mosaic and the synergies between the component parts. In many quarters, the literature on child under-nutrition is viewed as 'siloed' and non-relational (Perkins et al., 2017). But equally importantly, 'integrated' nutritional programmes have often not had the expected impacts.Herein lies the problem and the related solution: we urgently need to understand the 'cascade' of factors driving child stunting and the synergies and inter-relationship between drivers. And equally importantly, we need to better understand the 'tipping points' or the critical points along this cascade where healthy linear growth diverges to slow or no growth. To do this, we propose to transform our exploration of child under-nutrition from the component parts to the 'whole child'. Where the biological, social, environmental and behavioural context in which stunting occurs is understood in its entirety and where the strength and directionality of these drivers, inform related interventions. Based on this joined-up approach, we will explore the ability of a range of child-centred interventions to disrupt the cascade of factors that inhibit the ability of a child to grow. These actions and outcomes will then form the basis of a decision-making platform to enable users to identify the ex-ante and ex-post impacts of potential interventions. Embedded in this process, however, is a values-based approach that ensures that from the outset, our research directly connects to and betters the lives of the children, families and communities involved. We will work across three countries: India, Indonesia and Senegal in over 50 communities. We aim to decrease child stunting by up to 10% our communities. Finally, to enhance our impact and legacy our Hub, we will engage a range of end-users in both our outputs and in the wider 'whole child' approach. We will support new regional platforms on maternal and child nutrition proposed by UNICEF linking the work of FAO/The World Bank/WHO at the country-level. We will also engage our network of over 100 civil society organizations in our findings. Over the course of the project, we expect to positively impact the lives of up to 1 million children.

国际社会的目标是到 2025 年将五岁以下发育迟缓儿童的数量减少 40%。虽然目标明确且具体，但我们知道这一目标目前无法实现。部分问题在于，在过去的三十年里，对“银弹”或特定驱动因素的寻找（如果得到解决可以解决这个棘手的问题）已经缩小了实践范围。这并不是说没有取得成果，而是说我们的努力还没有完全产生影响。虽然纪律方面取得了重大进展，但它们往往并没有结合起来。虽然系统评价比比皆是，但跨学科的理解却很少。因此，儿童发育迟缓是一个棘手的问题，有待统一解决。如果我们将儿童营养不良视为一个马赛克，那么我们就了解许多单独的元素。例如，生物学进展表明存在可识别的发育迟缓“表观遗传特征”。发育迟缓的儿童的肠道微生物群也不成熟，我们还知道，全球营养不良负担的很大一部分是由病毒、细菌、原生动物和蠕虫等传染原造成的（直接或间接）。食源性毒素也会影响发育迟缓。同样，我们知道一系列因素可以帮助预防发育迟缓，从动物源食品 (ASF) 到行为因素，从饮食选择到喂养方式，再到水、环境卫生和个人卫生 (WASH)。但总的来说，有人可能会说我们忽略了马赛克的形状和结构以及各组成部分之间的协同作用。在许多方面，有关儿童营养不良的文献被视为“孤立的”和非相关的（Perkins 等，2017）。但同样重要的是，“综合”营养计划往往没有达到预期的效果。问题和相关解决方案就在这里：我们迫切需要了解导致儿童发育迟缓的一系列因素以及驱动因素之间的协同作用和相互关系。同样重要的是，我们需要更好地理解这一级联中的“临界点”或关键点，在这些点上，健康的线性增长会转向缓慢增长或无增长。为此，我们建议将对儿童营养不良的探索从组成部分转向“整体儿童”。发育迟缓发生的生物、社会、环境和行为背景得到了全面的了解，这些驱动因素的强度和方向性为相关干预措施提供了信息。基于这种联合方法，我们将探索一系列以儿童为中心的干预措施破坏抑制儿童成长能力的一系列因素的能力。这些行动和结果将构成决策平台的基础，使用户能够识别潜在干预措施的事前和事后影响。然而，这一过程中嵌入了一种基于价值观的方法，确保我们的研究从一开始就直接联系并改善所涉及的儿童、家庭和社区的生活。我们将在三个国家的 50 多个社区开展工作：印度、印度尼西亚和塞内加尔。我们的目标是将社区儿童发育迟缓率减少多达 10%。最后，为了增强我们中心的影响力和遗产，我们将让一系列最终用户参与我们的产出和更广泛的“整体儿童”方法。我们将支持联合国儿童基金会提议的新的孕产妇和儿童营养区域平台，将粮农组织/世界银行/世界卫生组织在国家一级的工作联系起来。我们还将让 100 多个民间社会组织网络参与我们的调查结果。在该项目的过程中，我们预计将为多达 100 万儿童的生活带来积极影响。

项目成果

Measuring cognition and profiling early learning environments: Methods and challenges

测量认知和分析早期学习环境：方法和挑战

• 发表时间: 2022
• 期刊: BMJ Open Paediatrics
• 作者: Ang, L.

Food systems for nutrition: Investigating market-based opportunities for the provision of nutritious and safe diets to prevent childhood stunting: a protocol for the Food Systems theme of the UKRI-GCRF Action Against Stunting Hub

营养食品系统：调查提供营养和安全饮食以预防儿童发育迟缓的市场机会：UKRI-GCRF 发育迟缓行动中心食品系统主题协议

• 发表时间: 2022
• 期刊: BMJ Open Paediatrics
• 作者: Cooper, G.S.

Understanding the role of household hygiene practices and foodborne disease risks in child stunting: a UKRI GCRF Action Against Stunting Hub protocol paper

了解家庭卫生习惯和食源性疾病风险在儿童发育迟缓中的作用：UKRI GCRF 针对发育迟缓中心的行动协议文件

• DOI: 10.1136/bmjpo-2022-001695
• 发表时间: 2024
• 期刊: BMJ Paediatrics Open
• 影响因子: 2.6
• 作者: Dominguez-Salas P

Developing an open-access data repository for supporting interdisciplinary research into childhood stunting: a UKRI GCRF Action Against Stunting Hub protocol paper

开发开放获取数据存储库以支持儿童发育迟缓的跨学科研究：UKRI GCRF 反对发育迟缓中心协议文件

• 发表时间: 2023
• 期刊: BMJ Open Paediatrics
• 作者: Conway-Moore, K

Anthropometric, biochemical, dietary, morbidity and well-being assessments in women and children in Indonesia, India and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper.

对印度尼西亚、印度和塞内加尔妇女和儿童的人体测量、生化、饮食、发病率和福祉评估：UKRI GCRF 反对发育迟缓中心协议文件。

• DOI: 10.1136/bmjpo-2022-001683
• 发表时间: 2024
• 期刊: BMJ paediatrics open
• 影响因子: 2.6
• 作者: Davies-Kershaw H