School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
PLoS One. 2020 Feb 7;15(2):e0229011. doi: 10.1371/journal.pone.0229011. eCollection 2020.
Stunting continues to be a public health challenge with grave health, cognitive and economic consequences. Yet, its dynamics along the life course remain not well investigated in Ethiopia and beyond.
Longitudinal data generated by following two (younger and older) cohorts of about 3000 children for nearly 15 years were analyzed to investigate the longitudinal dynamics of stunting in Ethiopia. The cross-sectional prevalence of stunting in each round, longitudinal prevalence, and transition probabilities were determined. Multilevel mixed effects ordinal regression was applied to identify the determinants of stunting accounting for child-level and cluster-level variations.
The cross-sectional prevalence of severe stunting for the younger cohort fluctuated between 21% and 6%, while for the older cohort it fluctuated between 12% and 3%. Moderate stunting fluctuated between 23% and 16% for the younger cohort and between 22% and 8% for the older cohort. The longitudinal prevalence of severe stunting was 10% in both the younger and older cohorts, whereas that of moderate stunting was 20% for the younger cohort and 18% for the older cohort. Children not stunted at baseline had very high probabilities of remaining not stunted through youthhood (87% for the younger and 90% for the older cohorts). Conversely, children with moderate stunting at baseline had high probabilities either remaining moderately stunted or progressing to severe stunting. Furthermore, children who had severe stunting at baseline had high probabilities of either remaining severely stunted or transitioning to moderate stunting. In both cohorts, older age of the child, female sex, having an educated mother, and being from a household with educated head significantly reduced the risk of stunting. Children from households in the top wealth tertile had a significantly lower risk of stunting in the younger cohort, but not in the older cohort. Similarly, Productive Safety Net Programme reduced the risk of stunting in the younger cohort, but not in the older cohort.
Children not stunted early in life are highly likely to grow into non-stunted adults while children stunted early in life are highly likely to grow into stunted adults. Several child-level, maternal, household and programmatic factors affect the risk of stunting. Efforts to prevent stunting shall commence early in life.
发育迟缓仍然是一个公共卫生挑战，会对健康、认知和经济产生严重后果。然而，其在埃塞俄比亚及其他地区的生命历程动态仍未得到充分研究。
对近 15 年来跟踪约 3000 名儿童的两个队列（年轻组和年长组）的纵向数据进行了分析，以研究埃塞俄比亚发育迟缓的纵向动态。确定了各轮次的严重发育迟缓的横断面患病率、纵向患病率和转移概率。应用多水平混合效应有序回归来确定发育迟缓的决定因素，同时考虑到儿童层面和聚类层面的差异。
年轻组严重发育迟缓的横断面患病率在 21%至 6%之间波动，而年长组在 12%至 3%之间波动。年轻组中度发育迟缓在 23%至 16%之间波动，年长组在 22%至 8%之间波动。年轻组和年长组的严重发育迟缓纵向患病率均为 10%，而中度发育迟缓的纵向患病率分别为 20%和 18%。在基线时不发育迟缓的儿童在整个青少年期保持不发育迟缓的可能性非常高（年轻组为 87%，年长组为 90%）。相反，在基线时中度发育迟缓的儿童保持中度发育迟缓或进展为严重发育迟缓的可能性较高。此外，在基线时患有严重发育迟缓的儿童保持严重发育迟缓或进展为中度发育迟缓的可能性较高。在两个队列中，儿童年龄较大、女性、母亲受过教育以及家庭户主受过教育均显著降低了发育迟缓的风险。在年轻组中，来自上层财富三分位数家庭的儿童发育迟缓的风险显著降低，但在年长组中并非如此。同样，生产性安全网计划降低了年轻组儿童发育迟缓的风险，但在年长组中没有降低。
生命早期不发育迟缓的儿童很可能成长为不发育迟缓的成年人，而生命早期发育迟缓的儿童很可能成长为发育迟缓的成年人。一些儿童层面、母亲层面、家庭层面和计划层面的因素会影响发育迟缓的风险。预防发育迟缓的工作应尽早开始。
