Boston College School of Social Work, Chestnut Hill, Massachusetts, US.
Ann Glob Health. 2020 Nov 17;86(1):145. doi: 10.5334/aogh.2836.
Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting.
To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under -2 standard deviations of the World Health Organization child growth standards' median) in Mexico.
Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6-35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors.
Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models.
According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.
在过去几十年中，全球儿童发育迟缓的患病率一直在下降。然而，在墨西哥等低收入和中等收入国家，发育迟缓仍然是最普遍的营养不良形式，影响了大量处于最脆弱处境的儿童。母乳喂养已被确定为预防儿童发育迟缓的一种关键的、负担得起的、可改变的母婴保健行为。
本研究旨在探讨母乳喂养（从未母乳喂养、母乳喂养<6 个月和母乳喂养≥6 个月）与其他个体、家庭和地区水平因素与墨西哥儿童发育迟缓（定义为长度/身高-年龄 z 分数<世界卫生组织儿童生长标准中位数的-2 个标准差）之间的关联。
利用 2012 年墨西哥健康和营养调查的二次数据分析，该调查允许在全国范围内以及墨西哥 4 个地区代表农村和城市地区。我们的子集中包括了 2089 名 6-35 月龄的墨西哥单胎儿童的数据，这些儿童的信息包括之前确定的发育迟缓风险和保护因素。我们依次对每个层面的因素进行固定效应和混合效应逻辑回归模型分析。
总体而言，12.3%的儿童发育迟缓，71.1%的儿童母乳喂养≥6 个月。任何母乳喂养和女性是所有模型中一致的儿童发育迟缓保护因素。相反，儿童低出生体重、母亲身材矮小、家庭中<5 岁儿童人数较多以及中重度粮食不安全是所有模型中一致的儿童发育迟缓风险因素。
根据我们的发现，墨西哥减少儿童发育迟缓的努力应包括旨在预防低出生体重后代的产前策略，特别是在身材矮小的妇女、中重度粮食不安全的家庭、有较多<5 岁儿童的家庭和土著社区中。产后部分应包括多层次策略以支持母乳喂养。
