Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
Ann Nutr Metab. 2012;61 Suppl 1:19-27. doi: 10.1159/000345167. Epub 2013 Jan 21.
In the year 2011, 6.9 million children under the age of 5 years died worldwide, one third of them related to increased susceptibility to illnesses due to undernutrition. An estimated 178 million children under 5 years are stunted, 55 million are wasted, and 19 million of these are severely affected and are at a higher risk of premature death, the vast majority being from sub-Saharan Africa and South-Central Asia. Globally, over 2 billion people are at risk for vitamin A, iodine, and/or iron deficiency. Other micronutrient deficiencies of public health concern include zinc, folate, and the B vitamins. The risk factors for undernutrition include low birth weight, inadequate breastfeeding, improper complementary feeding, and recurrent infections. Infectious diseases often coexist with micronutrient deficiencies and exhibit complex interactions leading to the vicious cycle of malnutrition and infections. Diarrhea along with the poor selection and intake of complementary food are the major contributors to undernutrition. Possible strategies to combat malnutrition include promotion of breastfeeding, dietary supplementation of micronutrients, prevention of protein-energy malnutrition, and improvement in the standard of preparation and hygiene of available weaning foods. The universal coverage with the full package of these proven interventions at observed levels of program effectiveness could prevent about one quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one third. The median coverage rate of interventions along the continuum of care for Countdown countries has however been ≥80% for vaccination and vitamin A supplementation. However, for several interventions, including early initiation and exclusive breastfeeding below 6 months of age and case management of childhood illnesses, the median coverage rate hovers at or below 50%. This suggests that interventions requiring strong health systems or behavior change appear to be stalled and need to be re-examined to find more effective ways of delivery.
在 2011 年，全世界有 690 万 5 岁以下儿童死亡，其中三分之一与因营养不良而增加患病易感性有关。估计有 1.78 亿 5 岁以下儿童发育迟缓，5500 万儿童消瘦，其中 1900 万儿童受到严重影响，死亡风险更高，其中绝大多数来自撒哈拉以南非洲和南亚。全球有超过 20 亿人面临维生素 A、碘和/或铁缺乏的风险。其他受到关注的微量营养素缺乏症包括锌、叶酸和 B 族维生素。营养不良的风险因素包括低出生体重、母乳喂养不足、补充喂养不当和反复感染。传染病常与微量营养素缺乏并存，并表现出复杂的相互作用，导致营养不良和感染的恶性循环。腹泻以及补充食物选择不当和摄入不足是导致营养不良的主要原因。可能的应对营养不良的策略包括促进母乳喂养、补充微量营养素、预防蛋白质能量营养不良以及改善可获得的断奶食品的准备和卫生标准。在观察到的方案效果水平上，普遍采用这些经证实的干预措施的全面措施，可预防 36 个月以下儿童死亡的四分之一左右，并将 36 个月时发育迟缓的流行率降低约三分之一。然而，倒计时国家的连续护理中，各种干预措施的中位覆盖率已达到 80%以上，用于疫苗接种和维生素 A 补充。然而，对于一些干预措施，包括 6 个月以下婴儿的早期启动和纯母乳喂养以及儿童疾病的病例管理，中位覆盖率徘徊在 50%或以下。这表明，需要强大的卫生系统或行为改变的干预措施似乎停滞不前，需要重新审查，以找到更有效的交付方式。
