Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
Lancet Glob Health. 2018 Apr;6(4):e447-e459. doi: 10.1016/S2214-109X(18)30025-1. Epub 2018 Feb 14.
Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan.
The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother-child pairs using Bayesian spatial and generalised least squares regression models accounting for the complex survey design.
We noted that childhood stunting, underweight, and combined stunting and wasting were consistently highest in districts in Farah, Nangarhar, Nuristan, Kunar, Paktia, and Badakhshan provinces. District prevalence ranged from 4% to 84% for childhood stunting and 5% to 66% for underweight. Child wasting exceeded 20% in central and high-conflict regions that bordered Pakistan including east, southeast, and south. Among mothers, dual burden of underweight and overweight or obesity existed in districts of north, northeast, central, and central highlands (prevalence of 15-20%). Linear growth and weight of children were independently associated with household wealth, maternal literacy, maternal anthropometry, child age, food security, geography, and improved hygiene and sanitation conditions. The mother's body-mass index was determined by many of the same factors, in addition to ethnolinguistic status and parity. Younger mothers (<20 years old) were more underweight and shorter than older mothers (aged 20-49 years).
Afghanistan's rapidly changing political, socioeconomic, and insecurity landscape has both direct and indirect implications on population nutrition. Novel evidence from our study can be used to understand these multifactorial determinants and to identify granular disparities for local level tracking, planning, and implementation of nutritional interventions.
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在阿富汗，营养不良是一种普遍存在的情况，其流行率位居世界之首。我们旨在全面评估阿富汗妇女和儿童的地区营养不良状况（发育迟缓、消瘦或体重不足）的地理差异和决定因素。
本研究使用了 2013 年阿富汗国家营养调查的个体数据。结果变量基于生长和体重人体测量数据，我们将其线性分析为 Z 分数和二分类别。我们分析了来自近 14000 对指数母子对的数据，使用贝叶斯空间和广义最小二乘回归模型，考虑到复杂的调查设计。
我们注意到，在法拉赫、楠格哈尔、努尔斯坦、库纳尔、帕克蒂亚和巴达赫尚等省份的地区，儿童发育迟缓、体重不足和消瘦与超重或肥胖并存的比例一直最高。儿童发育迟缓的地区流行率从 4%到 84%不等，体重不足的地区流行率从 5%到 66%不等。在与巴基斯坦接壤的中部和高冲突地区，包括东部、东南部和南部，儿童消瘦的比例超过 20%。在北部、东北部、中部和高地中部地区，母亲体重不足和超重或肥胖的双重负担（流行率为 15-20%）。儿童线性生长和体重与家庭财富、母亲文化程度、母亲人体测量、儿童年龄、粮食安全、地理位置以及改善的卫生和环境卫生条件独立相关。母亲的身体质量指数也受许多相同因素的影响，除了民族语言状况和生育次数。年轻的母亲（<20 岁）比年长的母亲（20-49 岁）体重更轻、身高更矮。
阿富汗快速变化的政治、社会经济和不安全状况对人口营养状况既有直接影响，也有间接影响。我们研究的新证据可用于了解这些多因素决定因素，并确定粒度差异，以便对营养干预措施进行地方层面的跟踪、规划和实施。
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