Espo M, Kulmala T, Maleta K, Cullinan T, Salin M L, Ashorn P
Medical School, University of Tampere, Finland.
Acta Paediatr. 2002;91(12):1364-70. doi: 10.1111/j.1651-2227.2002.tb02835.x.
Stunting is common among children under 5 y of age in sub-Saharan Africa. Several risk factors have been associated with poor growth but few studies have prospectively addressed the development of linear growth faltering and stunting during the first year of life. The present study was designed to analyse typical growth among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. A community-based cohort of 613 singleton newborns was prospectively followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal size and weight gain during pregnancy, birth events, morbidity, breastfeeding and complementary feeding, growth and mortality. Univariate and multivariate analyses were used to determine associations between predictor variables and poor linear growth. The proportions of stunted infants (Height-for-age Z-score < -2) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, respectively. At I y of age, over two-thirds (71%) of the infants were at least moderately (HAZ < -2) and 31% severely stunted (HAZ < -3).
The strongest predictor of severe stunting at 12 mo of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy. Interventions increasing birth size could have a significant role in the prevention of early childhood stunting. The ideal strategy should also emphasize the importance of appropriate infant feeding and decreasing the number of illness episodes amongst the infants.
发育迟缓在撒哈拉以南非洲5岁以下儿童中很常见。有几种风险因素与生长发育不良有关，但很少有研究前瞻性地探讨生命第一年线性生长发育迟缓和发育迟缓的发展情况。本研究旨在分析马拉维农村婴儿的典型生长情况，特别关注出生时的大小、遵循喂养指南情况和发病率对婴儿期严重发育迟缓发展的影响。对一个基于社区的613名单胎新生儿队列进行前瞻性跟踪，每月进行家访。收集了有关儿童社会经济背景、母亲孕期的身材和体重增加、出生情况、发病率、母乳喂养和辅食添加、生长发育及死亡率的数据。采用单变量和多变量分析来确定预测变量与线性生长不良之间的关联。3个月、6个月和9个月龄时发育迟缓婴儿（年龄别身高Z评分＜-2）的比例分别为27%、51%和63%。1岁时，超过三分之二（71%）的婴儿至少有中度发育迟缓（身高别年龄Z评分＜-2），31%有严重发育迟缓（身高别年龄Z评分＜-3）。
12月龄时严重发育迟缓的最强预测因素是出生时身材小。与这一结果独立相关的其他变量包括辅食添加不当、发病率高、母亲身材矮小、男性性别和在家分娩。线性生长发育迟缓在出生后不久就开始，并在整个婴儿期持续。增加出生时身材大小的干预措施在预防幼儿发育迟缓方面可能发挥重要作用。理想的策略还应强调适当婴儿喂养的重要性，并减少婴儿患病次数。
