Shetty Prakash
Institute for Human Nutrition, University of Southampton Medical School, Southampton, UK.
Nestle Nutr Workshop Ser Pediatr Program. 2009;63:227-54; discussion 254-7, 259-68. doi: 10.1159/000209984.
Community-based approaches have been the mainstay of interventions to address the problem of child malnutrition in developing societies. Many programs have been in operation in several countries for decades and originated largely as social welfare, food security and poverty eradication programs. Increasingly conceptual frameworks to guide this activity have been developed as our understanding of the complex nature of the determinants of undernutrition improves. Alongside this evolution, is the accumulation of evidence on the types of interventions in the community that are effective, practical and sustainable. The changing environment is probably determining the altering scenario of child nutrition in developing societies, with rapid developmental transition and urbanization being responsible for the emerging problems of obesity and other metabolic disorders that are largely the result of the now well-recognized linkages between child undernutrition and early onset adult chronic diseases. This dramatic change is contributing to the double burden of malnutrition in developing countries. Community interventions hence need to be integrated and joined up to reduce both aspects of malnutrition in societies. The evidence that community-based nutrition interventions can have a positive impact on pregnancy outcomes and child undernutrition needs to be evaluated to enable programs to prioritize and incorporate the interventions that work in the community. Programs that are operational and successful also need to be evaluated and disseminated in order to enable countries to generate their own programs tailored to tackling the changing nutritional problems of the children in their society.
基于社区的方法一直是发展中社会解决儿童营养不良问题干预措施的支柱。几十年来，许多项目已在多个国家开展，并且在很大程度上起源于社会福利、粮食安全和消除贫困项目。随着我们对营养不良决定因素复杂本质的理解不断提高，越来越多指导此类活动的概念框架得以发展。与此同时，关于社区中有效、实用且可持续的干预措施类型的证据也在不断积累。不断变化的环境可能正在决定发展中社会儿童营养状况的变化态势，快速的发展转型和城市化导致了肥胖及其他代谢紊乱等新出现的问题，这些问题很大程度上是由于现已得到充分认识的儿童营养不良与成人早发慢性病之间的联系所致。这种巨大变化正在导致发展中国家出现营养不良的双重负担。因此，社区干预需要整合起来，以减轻社会中营养不良的两个方面。需要对基于社区的营养干预措施能够对妊娠结局和儿童营养不良产生积极影响的证据进行评估，以便项目能够对在社区中有效的干预措施进行优先排序并加以采用。正在实施且取得成功的项目也需要进行评估和推广，以便各国能够制定适合解决本国社会儿童不断变化的营养问题的自身项目。
