Harvard T.H. Chan School of Public Health, Boston, MA;
Rand Corporation, Santa Monica, CA;
Am J Clin Nutr. 2016 Jul;104(1):104-12. doi: 10.3945/ajcn.115.123968.
The growth of >300 million children <5 y old was mildly, moderately, or severely stunted worldwide in 2010. However, national estimates of the human capital and financial losses due to growth faltering in early childhood are not available.
We quantified the economic cost of growth faltering in developing countries.
We combined the most recent country-level estimates of linear growth delays from the Nutrition Impact Model Study with estimates of returns to education in developing countries to estimate the impact of early-life growth faltering on educational attainment and future incomes. Primary outcomes were total years of educational attainment lost as well as the net present value of future wage earnings lost per child and birth cohort due to growth faltering in 137 developing countries. Bootstrapped standard errors were computed to account for uncertainty in modeling inputs.
Our estimates suggest that early-life growth faltering in developing countries caused a total loss of 69.4 million y of educational attainment (95% CI: 41.7 million, 92.6 million y) per birth cohort. Educational attainment losses were largest in South Asia (27.6 million y; 95% CI: 20.0 million, 35.8 million y) as well as in Eastern (10.3 million y; 95% CI: 7.2 million, 12.9 million y) and Western sub-Saharan Africa (8.8 million y; 95% CI: 6.4 million, 11.5 million y). Globally, growth faltering in developing countries caused a total economic cost of $176.8 billion (95% CI: $100.9 billion, $262.6 billion)/birth cohort at nominal exchange rates, and $616.5 billion (95% CI: $365.3 billion, $898.9 billion) at purchasing power parity-adjusted exchange rates. At the regional level, economic costs were largest in South Asia ($46.6 billion; 95% CI: $33.3 billion, $61.1 billion), followed by Latin America ($44.7 billion; 95% CI: $19.2 billion, $74.6 billion) and sub-Saharan Africa ($34.2 billion; 95% CI: $24.4 billion, $45.3 billion).
Our results indicate that the annual cost of early-childhood growth faltering is substantial. Further investment in scaling up effective interventions in this area is urgently needed and likely to yield long run benefits of $3 for every $1 invested.
2010 年，全世界有超过 3 亿 5 岁以下儿童生长迟缓，程度为轻度、中度或重度。然而，由于儿童早期生长迟缓造成的人力资本和经济损失的国家估计数尚不可用。
我们量化了发展中国家生长迟缓造成的经济成本。
我们将营养影响模型研究中最新的国家一级线性生长迟缓估计数与发展中国家教育回报估计数结合起来，以估计生命早期生长迟缓对教育程度和未来收入的影响。主要结果是由于 137 个发展中国家的生命早期生长迟缓，每个儿童和出生队列丧失的受教育年限以及丧失的未来工资收入的净现值。为了考虑模型输入的不确定性，采用了自举标准误差进行计算。
我们的估计表明，发展中国家儿童生命早期生长迟缓导致每个出生队列总共丧失 6940 万年的受教育年限（95%CI：4170 万，9260 万年）。南亚的教育程度损失最大（2760 万年；95%CI：2000 万，3580 万年），以及东非（1030 万年；95%CI：720 万，1290 万年）和西非撒哈拉以南非洲（880 万年；95%CI：640 万，1150 万年）。在全球范围内，发展中国家的生长迟缓导致每个出生队列在名义汇率下的总经济成本为 1768 亿美元（95%CI：1009 亿美元，2626 亿美元），在购买力平价调整后的汇率下为 6165 亿美元（95%CI：3653 亿美元，8989 亿美元）。在区域一级，经济成本在南亚最高（466 亿美元；95%CI：333 亿美元，611 亿美元），其次是拉丁美洲（447 亿美元；95%CI：192 亿美元，746 亿美元）和撒哈拉以南非洲（342 亿美元；95%CI：244 亿美元，453 亿美元）。
我们的研究结果表明，儿童早期生长迟缓的年度成本相当可观。迫切需要进一步投资扩大这一领域的有效干预措施，每投资 1 美元，可能会带来 3 美元的长期收益。
