Research Center for Integral and Sustainable Development, Cayetano Heredia University, Lima, Peru.
Maternal and Child Health Research Center, Cayetano Heredia University, Lima, Peru.
Am J Clin Nutr. 2020 Sep 14;112(Suppl 2):816S-829S. doi: 10.1093/ajcn/nqaa164.
Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016.
We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016.
Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru.
The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation.
Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.
秘鲁将五岁以下儿童发育迟缓率从 2000 年的 31.3%显著降低到 2016 年的 13.1%。
我们旨在研究 2000-2016 年秘鲁儿童发育迟缓率降低的因素和关键促成因素。
采用人口与健康调查进行描述性分析[身高年龄 z 分数（HAZ）均值和分布、公平分析、通过多项式回归预测儿童生长曲线]和高级回归分析。在部门层面进行生态（部门层面）多水平回归分析，以确定 2000 年至 2016 年发育迟缓下降的主要预测因素，并进行 Oaxaca-Blinder 分解，以确定每个因素对儿童 HAZ 变化的相对贡献。进行系统文献综述、政策和方案分析，并与利益相关者进行访谈，以了解秘鲁发育迟缓下降的主要驱动因素。
HAZ 评分的分布显示，从 2000 年到 2007/2008 年略有右移，从 2007/2008 年到 2016 年有更大的右移。在最贫穷的五分之一、农村地区和母亲受教育程度最低的儿童中，发育迟缓的减少幅度更大。对预测变化进行分解表明，最重要的因素是母亲 BMI 和母亲身高增加、改善孕产妇和新生儿保健、增加父母教育、向城市地区迁移以及降低生育率。关键驱动因素包括 21 世纪初以来民间社会和政治领导人围绕贫困和发育迟缓减少的倡导作用。主要促成因素包括 21 世纪初以来的经济增长和民主巩固，以及认识到减少发育迟缓需要的不仅仅是食物补充。
秘鲁通过改善社会经济决定因素、持续实施非卫生部门和卫生部门内部的变化以及实施卫生干预措施，减少了儿童发育迟缓。这些努力是通过多部门方法、强大的民间社会倡导和敏锐的政治领导来推动的。秘鲁的经验为如何在不同情况下、在多个部门的参与下解决发育迟缓问题提供了有益的经验。
