Cattaneo Adriano, Timmer Arnold, Bomestar Tamara, Bua Jenny, Kumar Sanjiv, Tamburlini Giorgio
Unit for Health Services Research and International Health, Institute for Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Italy.
Public Health Nutr. 2008 Dec;11(12):1209-19. doi: 10.1017/S1368980008003261. Epub 2008 Jul 23.
Countries in the Commonwealth of Independent States made little progress in child nutrition and mortality between 1990 and 2005. The present paper assesses the nutritional status of children <5 years of age and discusses possible strategies for improvement.
Data on low birth weight, infant and young child feeding, underweight, overweight and micronutrient deficiencies were compiled from available reports and databases, complemented through questionnaires to UNICEF Country Offices, and analysed by country, age, gender, urban/rural residence, maternal education and wealth quintiles.
Exclusive breast-feeding in the first 6 months and continuing breast-feeding up to 2 years fall short of WHO and UNICEF recommendations. Complementary foods are introduced too early and may be poor in protein and micronutrients. Stunting and underweight are prevalent, especially in children aged 12 to 35 months; overweight is even more prevalent. Vitamin A and I deficiencies are still present in some countries, despite current control efforts. Anaemia ranges between 20 % and 40 %. Higher rates of malnutrition are found in rural areas, children of less educated mothers and lower-income families.
Current public health strategies should be redirected to address: (i) overall protection, promotion and support of infant and young child feeding, in addition to breast-feeding; (ii) overweight, in addition to underweight and stunting; and (iii) malnutrition as a whole, in addition to micronutrient deficiencies. An equity lens should be used in developing policies and plans and implementing and monitoring programmes. Capacity building, cross-sectoral action, improved data collection within adequate legal frameworks and community engagement should be the pillars of redirected strategies.
1990年至2005年间，独立国家联合体各国在儿童营养和死亡率方面进展甚微。本文评估了5岁以下儿童的营养状况，并探讨了可能的改善策略。
从现有报告和数据库中收集低出生体重、婴幼儿喂养、体重不足、超重和微量营养素缺乏的数据，并通过向联合国儿童基金会国家办事处发放问卷进行补充，然后按国家、年龄、性别、城乡居住地、母亲教育程度和财富五分位数进行分析。
前6个月纯母乳喂养以及持续母乳喂养至2岁的情况未达到世界卫生组织和联合国儿童基金会的建议。辅食添加过早，且蛋白质和微量营养素含量可能较低。发育迟缓及体重不足现象普遍，尤其是在12至35个月大的儿童中；超重现象更为普遍。尽管目前已采取防控措施，但某些国家仍存在维生素A和碘缺乏的情况。贫血率在20%至40%之间。农村地区、母亲受教育程度较低的儿童以及低收入家庭的营养不良发生率较高。
当前的公共卫生策略应重新调整方向，以解决以下问题：（i）除母乳喂养外，对婴幼儿喂养进行全面保护、促进和支持；（ii）除体重不足和发育迟缓外，关注超重问题；（iii）除微量营养素缺乏外，关注整体营养不良问题。在制定政策和计划以及实施和监测项目时应采用公平视角。能力建设、跨部门行动、在适当法律框架内改进数据收集以及社区参与应成为重新调整后的策略的支柱。
