International Institute for Population Sciences, Mumbai, India.
J Biosoc Sci. 2022 Jan;54(1):106-123. doi: 10.1017/S002193202000070X. Epub 2020 Dec 14.
This study used a series of individual-level datasets from National Family Health Surveys conducted in 1998-99, 2005-06 and 2015-16 to assess the factors behind the reduction in childhood stunting and underweight in India between the years 1998-99 and 2015-16. A multivariable decomposition regression analysis was performed. Results showed that the prevalence of childhood stunting declined from 49.4% in 1998-99 to 34.9% in 2015-16. Over the same period, the prevalence of childhood underweight declined from 41.9% in 1998-99 to 33.1% in 2015-16. The reduction in the prevalence of stunting was found to be contributed largely by a reduction in the combined prevalence of stunting and underweight (60%), followed by stunted only (21%) and the combined prevalence of stunting, underweight and wasting (19%). Likewise, the reduction in the prevalence of underweight was contributed by a reduction in the combined prevalence of stunting and underweight and the combined prevalence of stunting, underweight and wasting. Results of the decomposition analysis showed that over the period 1998-99 to 2015-16, improvement in wealth status and maternal education led to 13% and 12% declines, respectively, in childhood stunting and to 31% and 19% declines, respectively, in childhood underweight. Furthermore, reductions in childhood stunting and underweight were due to an increased average number of antenatal care visits, lower average birth order, decreased share of children with below-average birth size, increased use of clean fuel for cooking and a reduction in the practice of open defecation. These findings suggest that further reduction in the prevalence of childhood stunting and underweight could be attained through more equitable household economic growth, investment in girl's education, greater access to improved toilet facilities, more widespread use of clean fuel for cooking, reduction in average birth order, increased antenatal care visits and greater consumption of IFA tablets by pregnant women. Policymakers need to prioritize these measures to further reduce malnutrition among Indian children.
本研究使用了来自 1998-99 年、2005-06 年和 2015-16 年的国家家庭健康调查的一系列个人层面数据集，评估了 1998-99 年至 2015-16 年期间印度儿童发育迟缓率和消瘦率下降的原因。采用多变量分解回归分析。结果显示，儿童发育迟缓率从 1998-99 年的 49.4%下降到 2015-16 年的 34.9%。同期，儿童消瘦率从 1998-99 年的 41.9%下降到 2015-16 年的 33.1%。发育迟缓率的下降主要归因于发育迟缓与消瘦综合患病率的下降（60%），其次是单纯发育迟缓（21%）和发育迟缓、消瘦和消瘦综合患病率（19%）。同样，消瘦率的下降归因于发育迟缓与消瘦综合患病率和发育迟缓、消瘦和消瘦综合患病率的下降。分解分析结果表明，1998-99 年至 2015-16 年期间，财富状况和孕产妇教育的改善分别导致儿童发育迟缓率下降 13%和 12%，儿童消瘦率下降 31%和 19%。此外，儿童发育迟缓率和消瘦率的下降归因于产前保健次数的增加、出生顺序的降低、低于平均出生体重儿童比例的降低、清洁燃料在烹饪中的使用增加以及露天排便习惯的减少。这些发现表明，通过更公平的家庭经济增长、对女孩教育的投资、更多地获得改善的卫生设施、更广泛地使用清洁燃料烹饪、降低平均出生顺序、增加产前保健次数以及增加孕妇对 IFA 片剂的消费，可以进一步降低儿童发育迟缓率和消瘦率。政策制定者需要优先考虑这些措施，以进一步减少印度儿童的营养不良。
