African Population and Health Research Center, Nairobi, Kenya.
University of the Witwatersrand, School of Public Health, Parktown, Johannesburg, South Africa.
PLoS One. 2019 Apr 18;14(4):e0215488. doi: 10.1371/journal.pone.0215488. eCollection 2019.
Childhood stunting is a public health concern in many low-and-middle income countries, as it is associated with both short-term and long-term negative effects on child cognitive development, physical health, and schooling outcomes. There is paucity of studies on recovery from stunting among under five children in these countries. Most studies focused on the recovery much later in adolescence. We used longitudinal data from two Nairobi urban settlements to determine the incidence of recovery from stunting and understand the factors associated with post-stunting linear growth among under-five children. A total of 1,816 children were recruited between birth and 23 months and were followed-up until they reached five years. We first looked at the time to recover from stunting using event history analysis and Cox regression. Second, we used height-for-age z-score slope modelling to estimate the change in linear growth among children who were stunted. Finally, we fitted a linear regression model of the variation in HAZ on a second degree fractional polynomials in child's age to identify the factors associated with post-stunting linear growth. The principal findings are: i) the incidence of recovery from stunting was 45% among stunted under-five children in the two settlements; ii) timely child immunization, age at stunting, mother's parity and household socioeconomic status are important factors associated with time to recover from stunting within the first five years of life; and iii) child illness status and age at first stunting, mother's parity and age have a strong influence on child post-stunting linear growth. Access to child health services and increased awareness among health professionals and child caregivers, would be critical in improving child growth outcomes in the study settings. Additionally, specific maternal and reproductive health interventions targeting young mothers in the slums may be needed to reduce adolescent and young mother's vulnerability and improve their child health outcomes.
儿童发育迟缓是许多中低收入国家的一个公共卫生关注点，因为它与儿童认知发展、身体健康和受教育程度的短期和长期负面影响都有关系。这些国家针对五岁以下儿童发育迟缓康复的研究很少。大多数研究都集中在青春期以后的康复上。我们使用内罗毕两个城市住区的纵向数据来确定从发育迟缓中恢复的发生率，并了解与五岁以下儿童发育迟缓后线性生长相关的因素。总共招募了 1816 名儿童，他们在出生到 23 个月之间接受了招募，并一直随访到他们五岁。我们首先使用事件历史分析和 Cox 回归来观察从发育迟缓中恢复的时间。其次，我们使用身高年龄 z 分数斜率模型来估计发育迟缓儿童的线性生长变化。最后，我们拟合了一个线性回归模型，以二次分数多项式的形式来表示儿童年龄对 HAZ 的变化，以确定与发育迟缓后线性生长相关的因素。主要发现如下：i）在两个住区中，5 岁以下发育迟缓儿童的恢复发生率为 45%；ii）及时的儿童免疫接种、发育迟缓时的年龄、母亲的产次和家庭社会经济地位是与生命前五年内从发育迟缓中恢复的时间相关的重要因素；iii）儿童疾病状况和首次发育迟缓的年龄、母亲的产次和年龄对儿童发育迟缓后的线性生长有很大影响。在研究环境中，获得儿童保健服务以及提高卫生专业人员和儿童照顾者的认识将是改善儿童生长结果的关键。此外，可能需要针对贫民窟年轻母亲的特定母婴健康干预措施，以降低青少年和年轻母亲的脆弱性并改善其儿童健康结果。
