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

1990年至2014年期间，撒哈拉以南非洲遭受发育迟缓的儿童人数增加了23%，约有5800万5岁以下儿童受到影响。其中许多儿童还经历过消瘦，这些人体测量缺陷的共同发生（“多重营养不良”，MM）增加了发病风险。在家庭和社区层面，营养均衡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普遍存在的一种模式，《2015年和2016年全球营养报告》已将其视为“新常态”。该项目重点关注世界上最贫穷地区之一西非和中非国家（WCA）幼儿的MM。该项目将利用来自世界卫生组织24个国家的现有家庭调查数据，对人体测量学和人口统计数据及变量进行定量分析，以探索MM的流行程度和模式。它将汇集调查（人口调查、多指标类集调查）中的个人和家庭数据，并将这些信息与国家治理、卫生和营养公共支出以及粮食价格等宏观指标相结合，以审查潜在的、小儿麻痹症的中间和基本原因，如儿童基金会关于（不良）营养的概念框架所述。营养不良与死亡风险增加有关，尤其是儿童；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要高出12.3倍。这些儿童很可能从营养和其他儿童生存干预措施中获益最多（McDonald等人，2013），只要他们能够被识别出来——目前还没有这样做。尽管如此，尽管为中低收入国家的早期儿童发展项目投入了国家和国际的努力和资源，但联合国儿童基金会/世界卫生组织/世界银行对儿童营养不良的审查显示，关于幼儿MM患病率和模式的数据严重缺乏，没有对同时发育迟缓和消瘦的儿童数量的区域或全球估计。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，这种知识差距是一个现实和持续存在的问题。利用先进的定量方法对现有住户调查进行分析，将为决策者提供有关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。该项目重点关注5岁以下儿童，因为这是身体发育的关键时期，也因为这个年龄组的人体测量数据（身高、体重）是最可靠的，并且在全国调查中定期收集。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。这些国家还面临着粮食安全方面的持续挑战，尤其是在荒漠化加剧、政治和经济不稳定以及暴力冲突（如尼日利亚北部、尼日尔和马里）的背景下，粮食生产不稳定。就现有调查数据的国家数量而言，WCA覆盖范围很好，所有这些数据都包含详细的、可比较的数据，可用于调查MM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前三个可持续发展目标（SDG）的进展情况，即消除贫困、饥饿和降低儿童死亡率。

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.