MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.
Lancet Glob Health. 2015 Apr;3(4):e229-39. doi: 10.1016/S2214-109X(15)70001-X.
Pakistan has one of the highest levels of child and maternal undernutrition worldwide, but little information about geographical and socioeconomic inequalities is available. We aimed to analyse anthropometric indicators for childhood and maternal nutrition at a district level in Pakistan and assess the association of nutritional status with food security and maternal and household socioeconomic factors.
We used data from the 2011 Pakistan National Nutrition Survey, which included anthropometric measurements for 33 638 children younger than 5 years and 24 826 women of childbearing age. We estimated the prevalences of stunting, wasting, and underweight among children and of underweight, overweight, and obesity in women for all 143 districts of Pakistan using a Bayesian spatial technique. We used a mixed-effect linear model to analyse the association of nutritional status with individual and household sociodemographic factors and food security.
Stunting prevalence in Pakistan's districts ranged between 22% (95% credible interval 19-26) and 76% (69-83); the lowest figures for wasting and underweight were both less than 2·5% and the highest were 42% (34-50) for wasting and 54% (49-59) for underweight. In 106 districts, more women were overweight than were underweight; in 49 of these districts more women were obese than were underweight. Children were better nourished if their mothers were taller or had higher weight, if they lived in wealthier households, and if their mothers had 10 or more years of education. Severe food insecurity was associated with worse nutritional outcomes for both children and women.
We noted large social and geographical inequalities in child and maternal nutrition in Pakistan, masked by national and provincial averages. Pakistan is also beginning to face the concurrent challenge of high burden of childhood undernutrition and overweight and obesity among women of reproductive age. Planning, implementation, and evaluation of programmes for food and nutrition should be based on district-level needs and outcomes.
Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.
巴基斯坦是全球儿童和孕产妇营养水平最低的国家之一，但关于其地理和社会经济不平等的信息却很少。本研究旨在分析巴基斯坦地区儿童和孕产妇营养的人体测量指标，并评估营养状况与食物安全以及孕产妇和家庭社会经济因素的关联。
我们使用了 2011 年巴基斯坦国家营养调查的数据，其中包括 33838 名 5 岁以下儿童和 24826 名育龄妇女的人体测量数据。我们使用贝叶斯空间技术估计了巴基斯坦所有 143 个地区儿童发育迟缓、消瘦和体重不足的流行率以及妇女体重不足、超重和肥胖的流行率。我们使用混合效应线性模型分析了营养状况与个体和家庭社会人口统计学因素以及食物安全之间的关联。
巴基斯坦各地区的发育迟缓率在 22%（95%可信区间 19-26）至 76%（69-83）之间；消瘦和体重不足的最低发生率均小于 2.5%，最高发生率分别为 42%（34-50）的消瘦和 54%（49-59）的体重不足。在 106 个地区，超重妇女多于体重不足妇女；在这 49 个地区中，肥胖妇女多于体重不足妇女。如果母亲更高或体重更大、家庭更富裕以及母亲受教育 10 年或以上，那么儿童的营养状况会更好。严重的食物不安全与儿童和妇女的营养状况恶化有关。
我们注意到，巴基斯坦儿童和孕产妇营养存在巨大的社会和地理不平等现象，被国家和省级平均水平所掩盖。巴基斯坦也开始面临儿童营养不足负担沉重以及育龄妇女肥胖的双重挑战。规划、实施和评估食物和营养方案应基于地区需求和结果。
比尔及梅琳达·盖茨基金会、加拿大大挑战、英国医学研究理事会。
Zotero 插件
