Nepali Sajama, Simkhada Padam, Davies Ian
1Central Department of Home Science, Tribhuvan University, Kathmandu, Nepal.
2Faculty of Education, Health and Community, Public Health Institute, Liverpool John Moores University, Liverpool, UK.
BMC Nutr. 2019 Mar 4;5:19. doi: 10.1186/s40795-019-0283-x. eCollection 2019.
The rate of stunting in Nepal is among the highest in the world, which is a major public health problem. The objective of this study was to present data on stunting prevalence according to socio-demographic and geographical circumstances and to determine the impact of those circumstances on the risk of stunting.
Data from Nepal Demographic and Health Surveys were used with the study population of children under 5 years old. The prevalence of stunting was determined by descriptive analysis and logistic regression analysis was used to determine risk factors for stunting.
The prevalence of stunting has declined in overall as well as in all groups and subgroups analysed. The percentage of stunted children from 2001 to 2016 decreased by 18 and 10.7% in the rural and urban areas respectively. The unadjusted analysis depicted association between stunting and children living in rural areas since children living in rural areas had higher odds of being stunted compared to their urban counterparts. However, the association was no longer observed when adjusted for other variables included in this study. Children born to mothers without any education had 2.27 (95% CI 1.70-3.05), 5.222 (95% CI 2.54-10.74), 1.81 (95% CI 0.92-3.55) and 1.92 (95% CI 1.28-2.89) odds of being stunted than those born to mothers with higher education for the year 2001, 2006, 2011 and 2016 respectively in the adjusted analysis. Similarly, children belonging to the poorest wealth quintile had 1.90 (95% CI 1.55-2.33), 1.87 (95% CI 1.36-2.58), 2.47 (95% CI 1.51-4.02) and 4.18 (95% CI 2.60-6.71) odds of being stunted than those belonging to the richest quintile in 2001, 2006, 2011 and 2016 respectively. The association between stunting and wealth quintile depicting children belonging to the poorest and poorer wealth quintile having higher odds of being stunted remain the same in both unadjusted and adjusted analysis.
At national level, stunting is decreasing in Nepal; however, the prevalence of stunting is different between groups and subgroups analysed. The substantial inequalities in stunting have been preserved. Therefore, special emphasis should be given to vulnerable groups such as children belonging to the poorest and poorer wealth quintile instead of using blanket approach for delivering nutrition interventions. A balanced approach to nutritional inequalities prevalent across different regions and subgroups is required.
尼泊尔的发育迟缓率位居世界前列，这是一个重大的公共卫生问题。本研究的目的是根据社会人口统计学和地理环境呈现发育迟缓患病率的数据，并确定这些环境因素对发育迟缓风险的影响。
使用尼泊尔人口与健康调查的数据，研究对象为5岁以下儿童。通过描述性分析确定发育迟缓的患病率，并使用逻辑回归分析确定发育迟缓的风险因素。
总体以及所有分析的组和亚组中，发育迟缓的患病率均有所下降。2001年至2016年，农村和城市地区发育迟缓儿童的比例分别下降了18%和10.7%。未经调整的分析表明发育迟缓与农村地区儿童之间存在关联，因为农村地区的儿童比城市儿童发育迟缓的几率更高。然而，在对本研究中纳入的其他变量进行调整后，这种关联不再存在。在调整后的分析中，2001年、2006年、2011年和2016年，母亲未接受任何教育的儿童发育迟缓的几率分别是母亲受过高等教育的儿童的2.27倍（95%置信区间1.70 - 3.05）、5.222倍（95%置信区间2.54 - 10.74）、1.81倍（95%置信区间0.92 - 3.55）和1.92倍（95%置信区间1.28 - 2.89）。同样，2001年、2006年、2011年和2016年，最贫困财富五分位数组的儿童发育迟缓的几率分别是最富有五分位数组儿童的1.90倍（95%置信区间1.55 - 2.33）、1.87倍（95%置信区间1.36 - 2.58）、2.47倍（95%置信区间1.51 - 4.02）和4.18倍（95%置信区间2.60 - 6.71）。在未经调整和调整后的分析中，发育迟缓与财富五分位数之间的关联表明，最贫困和较贫困财富五分位数组的儿童发育迟缓的几率更高，这种关联保持不变。
在国家层面，尼泊尔的发育迟缓现象正在减少；然而，在分析的组和亚组中，发育迟缓的患病率存在差异。发育迟缓方面的巨大不平等现象依然存在。因此，应特别关注弱势群体，如最贫困和较贫困财富五分位数组的儿童，而不是采用一刀切的方式提供营养干预措施。需要采取一种平衡的方法来应对不同地区和亚组中普遍存在的营养不平等问题。
