Kismul Hallgeir, Acharya Pawan, Mapatano Mala Ali, Hatløy Anne
Centre for International Health, University of Bergen, 5009, Bergen, Norway.
Nepal Development Society, Bharatpur, Chitwan, Nepal.
BMC Public Health. 2017 Aug 1;18(1):74. doi: 10.1186/s12889-017-4621-0.
Prevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC.
This study used data from the DRC Demographic Health Survey 2013-14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression.
Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother's age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother's BMI, access to safe water, access to hygienic toilet, mother's education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence.
Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address modifiable determinants such as reducing socioeconomic disparity. Nutrition promotion intervention, including early initiation of breastfeeding should be an immediate priority.
刚果民主共和国（DRC）儿童发育迟缓的患病率位居世界前列。有必要系统地研究发育迟缓在不同决定因素层面的作用机制，并确定导致发育迟缓的主要因素。本研究的目的是寻找刚果民主共和国发育迟缓的关键决定因素。
本研究使用了2013 - 2014年刚果民主共和国人口与健康调查的数据，其中包括对9030名5岁以下儿童的人体测量。根据世界卫生组织的指南计算年龄别身高Z评分并进行分类。使用逻辑回归评估发育迟缓与生物人口学特征之间的关联。
发育迟缓的患病率男孩远高于女孩。发育迟缓的患病率存在显著的城乡差距，农村地区发育迟缓儿童的比例高于城市地区。6个月以上的男童、出生间隔小于24个月、来自较低财富五分位数家庭的儿童发育迟缓的几率最高。几个省份的发育迟缓几率尤其高。早期开始母乳喂养、母亲分娩时年龄超过20岁的儿童发育迟缓几率较低。母亲身高越高，孩子发育迟缓的可能性越小。同样，在二元逻辑回归中发现母亲的BMI、获得安全饮用水、使用卫生厕所、母亲的教育程度与儿童发育迟缓呈负相关，但在多变量分析中，它们与家庭儿童数量和居住地点一起失去了统计学意义。
刚果民主共和国儿童发育迟缓现象普遍，患病率上升令人担忧。本研究确定了刚果民主共和国发育迟缓高患病率的可改变因素。政策实施应特别针对发育迟缓患病率高的省份，并解决可改变的决定因素，如减少社会经济差距。营养促进干预措施，包括早期开始母乳喂养，应是当务之急。
