GCRF Action against Stunting Hub

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，但我们知道这是目前无法实现的。部分原因在于，在过去30年里，人们一直在寻找“灵丹妙药”或具体的驱动因素，而如果找到了这种方法，就能解决这个棘手的问题。这并不是说没有取得进展，而是说我们的努力没有完全产生影响。虽然在学科上取得了重大进展，但它们往往没有被结合起来。虽然有大量的系统评论，但没有跨学科的理解。因此，儿童发育迟缓是一个亟待统一解决的棘手问题。如果我们把儿童营养不良看作是一个马赛克，那么我们已经了解了许多单独的因素。例如，生物学进展表明，发育迟缓存在可识别的“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性病原体（直接或间接）造成的。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，从饮食选择到喂养习惯，再到水、环境卫生和个人卫生（WASH）。然而，总的来说，我们可能会认为我们错过了马赛克的形状和结构以及组成部分之间的协同作用。在许多方面，关于儿童营养不良的文献被视为“孤立的”和非相关的（Perkins et al., 2017）。但同样重要的是，“综合”营养计划往往没有产生预期的影响。这就是问题所在和相关解决方案：我们迫切需要了解导致儿童发育迟缓的“级联”因素，以及这些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“临界点”或这个级联中的临界点，在那里健康的线性增长偏离到缓慢增长或没有增长。为了做到这一点，我们建议将我们对儿童营养不良的探索从组成部分转变为“整个儿童”。在全面了解发生发育迟缓的生物、社会、环境和行为背景以及这些驱动因素的强度和方向性的情况下，为相关干预提供信息。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的能力，以破坏抑制儿童成长能力的一连串因素。然后，这些行动和结果将构成决策平台的基础，使用户能够确定潜在干预措施的事前和事后影响。然而，在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与所涉及的儿童、家庭和社区的生活联系起来，并改善他们的生活。我们将在三个国家开展工作：印度、印度尼西亚和塞内加尔的50多个社区。我们的目标是将我们社区的儿童发育迟缓率降低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“整个孩子”方法。我们将支持儿童基金会提出的将粮农组织/世界银行/世卫组织在国家一级的工作联系起来的新的妇幼营养区域平台。我们还将让由100多个民间社会组织组成的网络参与我们的调查结果。在整个项目过程中，我们预计将对多达100万儿童的生活产生积极影响。

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.