Stunting in Nepal: looking back, looking ahead.
Stunting in Nepal: looking back, looking ahead.
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DOI：
10.1111/mcn.12286
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发表时间：
2016-05
影响因子：
3.4
通讯作者：
Upreti SR
中科院分区：
文献类型：
--
作者：
Devkota MD;Adhikari RK;Upreti SR
尽管处于政治、经济和人口转型状态，尼泊尔在健康和营养方面取得了令人瞩目的成就。根据尼泊尔人口健康调查，尼泊尔发育迟缓率已从2001年的57%下降到2011年的41%，年下降1.7个百分点。然而，要实现到2025年发育迟缓儿童减少40%的全球目标，需要每年减少3.9%。中央统计局和联合国儿童基金会于2014年进行的多指标类集调查显示，发育迟缓儿童的比例进一步下降至37.4%。最近起草的尼泊尔2016-2030年可持续发展目标概述了一项艰巨的挑战，即到2030年将5岁以下儿童发育迟缓率减少到1%，以实现长期健康、福祉、人力资本发展和国民经济增长。发育迟缓是由儿童早期长期营养缺乏引起的，通常在出生前就开始出现，并且与儿童时期因腹泻、肺炎和麻疹等传染病而死亡的风险增加有关（Pelletieret al. 2012；UNICEF 2013）。它还会导致不可逆转的身体和认知损伤，以及儿童期和青春期后期的教育成果较差，给个人、家庭和社区带来经济后果（Walkeret al. 2007）。 2 岁后体重快速增加的发育迟缓儿童在以后的生活中超重或肥胖的风险会增加，患冠心病、中风、高血压和 II 型糖尿病等非传染性疾病的风险也会增加（Black 等，2013）。尼泊尔线性增长失败的决定因素由不同程度的因果因素组成，包括贫困、孕产妇教育水平低和粮食不安全。根本原因包括不良的护理行为，包括婴儿和幼儿喂养、家庭无法充分获得多样化和优质的饮食、获得医疗保健的机会较少以及由于不健康的环境而导致的反复感染。不到一半 (46%) 的新生儿在出生后 1 小时内接受母乳喂养，而 70% 的 6 个月以下婴儿接受纯母乳喂养。只有66%的儿童在6-8个月时开始添加辅食，更重要的是，添加辅食频率不高，质量、数量和安全性也不够。只有四分之一的儿童 (24%) 采用了推荐的婴幼儿喂养方式（母乳喂养或接受奶制品、四种或更多食物组，以及根据年龄和母乳喂养状况确定的最低膳食频率）（MoHP、NEW ERA 等，2012）。几乎所有发育迟缓都发生在受孕后的前 1000 天内（Dewey & Vitta 2013）。有证据强调了女性在受孕时和怀孕期间的营养状况对于胎儿健康生长和发育的重要性（Gluckman & Pinal 2003；Black et al. 2013）。据了解，20% 的儿童发育迟缓是由母亲营养不良导致的宫内生长迟缓造成的。导致儿童发育迟缓的其他孕产妇因素包括身材矮小、生育间隔短和青春期怀孕（Prakash 等，2011）。尼泊尔近四分之一 (23%) 的母亲1这份观点论文是受母婴营养特刊客座编辑委托撰写的，目的是从不同国家的角度来看待南亚发育迟缓问题。它尚未经过同行评审。本文中的观点是作者的观点，并不一定反映其组织的观点或政策。
Nepal has made impressive gains in health and nutrition despite being in a state of political, economic and demographic transition. According to the Nepal Demographic Health Surveys, stunting in Nepal has fallen from 57% in 2001 to 41% in 2011, an annual decline of 1.7 percentage points. A 3.9% annual reduction is, however, required to achieve the global target of 40% fewer stunted children by 2025. The Multiple Indicator Cluster Survey conducted in 2014 by the Central Bureau of Statistics and UNICEF indicated a further reduction in the proportion of stunted children to 37.4%. The recently drafted Sustainable Development Goal for Nepal, 2016–2030 has outlined a daunting challenge of reducing stunting in children under 5 years of age to 1% by 2030 for the long-term health, wellbeing, human capital development and national economic growth. Stunting, which is caused by long-term nutrition deprivation early in a child’s life, often begins before birth and is associated with increased risk of mortality from infectious diseases such as diarrhoea, pneumonia and measles in childhood (Pelletieret al. 2012; UNICEF 2013). It also leads to irreversible physical and cognitive damage, and poorer educational outcomes later in childhood and adolescence, with economic consequences for the individual, household and community levels (Walkeret al. 2007). Stunted children who experience rapid weight gain after 2years of age have increased risk of becoming overweight or obese later in life, with associated higher risk of non-communicable diseases like coronary heart disease, stroke, hypertension and type II diabetes (Black et al. 2013). The determinants of linear growth failure in Nepal consist of factors operating at different levels of causation and include poverty, low maternal education and food insecurity. Underlying causes include poor caring behaviours, including infant and young child feeding, inadequate access of households to a diverse and quality diet, low access to health care and repeated infections due to unhealthy environment. Less than half (46%) of newborns are breastfed within 1 h after birth, while 70% of infants younger than 6 months are exclusively breastfed. Only 66% are introduced to complementary foods at 6–8months, and more importantly, complementary feeding is infrequent and inadequate in terms of quality, quantity and safety. Only a quarter of children (24%) are fed with the recommended infant and young child feeding practices (breastfeeding or receiving milk products, four or more food groups, and a minimum meal frequency according to their age and breastfeeding status)(MoHP, NEW ERA, et al. 2012). Almost all stunting takes place in the first 1000 days after conception (Dewey & Vitta 2013). Evidence reinforces the importance of the nutritional status of women at the time of conception and during pregnancy for healthy fetal growth and development (Gluckman & Pinal 2003; Black et al. 2013). Intrauterine growth retardation due to maternal undernutrition is known to account for 20% of childhood stunting. Other maternal contributors to child stunting include short stature, short birth spacing and adolescent pregnancy (Prakash et al. 2011). Nearly a quarter (23%) of mothers in Nepal1This perspective paper was commissioned by the guest editors of this special supplement of Maternal and Child Nutrition to bring countryspecific perspectives to the issue of stunting in South Asia. It has not been peer reviewed. The views in this paper are the authors’ views and do not necessarily reflect the views or policies of their organisations.
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影响因子：
168.9
作者：
Black, Robert E.;Victora, Cesar G.;Uauy, Ricardo
通讯作者：
Uauy, Ricardo
影响因子：
3.2
作者：
Pelletier, David L.;Frongillo, Edward A.;Ahmed, Tahmeed
通讯作者：
Ahmed, Tahmeed
影响因子：
7.7
作者：
Bredenkamp, Caryn;Buisman, Leander R.;Van de Poel, Ellen
通讯作者：
Van de Poel, Ellen
DOI：
10.1136/jfprhc-2011-0080
发表时间：
2011-07-01
影响因子：
--
作者：
Prakash, Ravi;Singh, Abhishek;Parasuraman, Sulabha
通讯作者：
Parasuraman, Sulabha
影响因子：
4.2
作者：
Gluckman, PD;Pinal, CS
通讯作者：
Pinal, CS