Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data.
Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data.
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DOI：
10.1016/s0140-6736(12)60647-3
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发表时间：
2012-09-01
期刊：
影响因子：
168.9
通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
--
作者：
Stevens, Gretchen A.;Finucane, Mariel M.;Paciorek, Christopher J.;Flaxman, Seth R.;White, Richard A.;Donner, Abigail J.;Ezzati, Majid
关于儿童人体测量状况完整分布的国家趋势的资料很少，而评估各种程度的轻度至严重营养不良需要这些资料。我们的目的是估计儿童人体测量状况的分布趋势，并评估实现千年发展目标1（MDG 1）的进展情况，即在1990年至2015年期间将年龄别体重Z评分（WAZ）低于-2的患病率减半或达到2.3%或更低的患病率。我们整理了年龄别身高Z评分（HAZ）和WAZ的人群代表性数据，WAZ是根据2006年WHO儿童生长标准计算的。我们的数据来源是健康和营养调查、世卫组织儿童生长和营养不良全球数据库的汇总统计数据以及其他国家和国际机构报告的汇总统计数据。我们使用贝叶斯分层混合模型来估计Z分数分布。我们量化了估计的不确定性，评估了其有效性，将其性能与替代模型进行了比较，并评估了对关键模型选择的敏感性。在发展中国家，平均HAZ从1985年的−1·86（95%不确定区间−2·01至−1·72）提高到2011年的−1·16（-1 statist 29至−1·04）;平均WAZ从−1·31（-1 statist 41至−1·20）提高到−0·84（-0 statist 93至−0·74）。在此期间，中度和重度发育迟缓的发生率从47.2%（44.0至50.3）下降到29.9%（27.1至32.9），体重不足的发生率从30.1%（26.7至33.3）下降到19.4%（16.5至22.2）。绝对改善幅度最大的是亚洲，流行率相对下降幅度最大的是拉丁美洲南部和热带地区。撒哈拉以南非洲的人体测量状况恶化，直到1990年代末，此后有所改善。2011年，3.14亿（2.96至3.31亿）5岁以下儿童轻度、中度或严重发育迟缓，2.58亿（2.40至2.74亿）轻度、中度或严重体重不足。发展中国家作为一个整体实现千年发展目标1的可能性不到5%，但这141个国家中有61个国家的可能性为50%至100%。1980年代和1990年代的宏观经济冲击、结构调整和贸易政策改革可能是撒哈拉以南非洲儿童营养状况恶化的原因。要在改善儿童生长和营养方面取得进一步进展，就需要公平的经济增长和对扶贫粮食和初级保健方案的投资，在全球经济危机的背景下尤其如此。比尔和梅林达盖茨基金会和英国医学研究理事会。
There is little information on country trends in the complete distributions of children's anthropometric status, which are needed to assess all levels of mild to severe undernutrition. We aimed to estimate trends in the distributions of children's anthropometric status and assess progress towards the Millennium Development Goal 1 (MDG 1) target of halving the prevalence of weight-for-age Z score (WAZ) below −2 between 1990 and 2015 or reaching a prevalence of 2·3% or lower. We collated population-representative data on height-for-age Z score (HAZ) and WAZ calculated with the 2006 WHO child growth standards. Our data sources were health and nutrition surveys, summary statistics from the WHO Global Database on Child Growth and Malnutrition, and summary statistics from reports of other national and international agencies. We used a Bayesian hierarchical mixture model to estimate Z-score distributions. We quantified the uncertainty of our estimates, assessed their validity, compared their performance to alternative models, and assessed sensitivity to key modelling choices. In developing countries, mean HAZ improved from −1·86 (95% uncertainty interval −2·01 to −1·72) in 1985 to −1·16 (–1·29 to −1·04) in 2011; mean WAZ improved from −1·31 (–1·41 to −1·20) to −0·84 (–0·93 to −0·74). Over this period, prevalences of moderate-and-severe stunting declined from 47·2% (44·0 to 50·3) to 29·9% (27·1 to 32·9) and underweight from 30·1% (26·7 to 33·3) to 19·4% (16·5 to 22·2). The largest absolute improvements were in Asia and the largest relative reductions in prevalence in southern and tropical Latin America. Anthropometric status worsened in sub-Saharan Africa until the late 1990s and improved thereafter. In 2011, 314 (296 to 331) million children younger than 5 years were mildly, moderately, or severely stunted and 258 (240 to 274) million were mildly, moderately, or severely underweight. Developing countries as a whole have less than a 5% chance of meeting the MDG 1 target; but 61 of these 141 countries have a 50–100% chance. Macroeconomic shocks, structural adjustment, and trade policy reforms in the 1980s and 1990s might have been responsible for worsening child nutritional status in sub-Saharan Africa. Further progress in the improvement of children's growth and nutrition needs equitable economic growth and investment in pro-poor food and primary care programmes, especially relevant in the context of the global economic crisis. The Bill & Melinda Gates Foundation and the UK Medical Research Council.