Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh.
J Nutr. 2021 Apr 8;151(4):987-998. doi: 10.1093/jn/nxaa425.
Bangladesh has experienced rapid reductions in child undernutrition and poverty, increases in maternal education, and dietary change over the past 3 decades.
We aimed to quantify the determinants of the improvement in child nutritional status among preschool-aged children in Bangladesh from 1992 to 2005.
We utilized data from 4 rounds of 2 linked and seasonally balanced survey systems: the Bangladesh Household [Income and] Expenditure Surveys (H[I]ES) and the Child [and Mother] Nutrition Survey (C[M]NS). We analyzed 10,780 children aged 6-59 mo, divided into 2 age groups (6-23 mo and 24-59 mo). We used Blinder-Oaxaca decomposition to assess the impact of changing determinants on nutritional status over time, guided by the UNICEF conceptual framework for the causes of child malnutrition.
There were significant improvements in child growth over time for all z-score measures-length/height-for-age (LAZ/HAZ), weight-for-length/height (WLZ/WHZ), and weight-for-age (WAZ)-and in many potential determinants of child growth across domains of the UNICEF framework. Among younger children, decomposition explained 67% of the observed change in LAZ, 130% of WLZ, and 73% of WAZ. Among older children, decomposition explained 41% of the observed change in HAZ and 36% of WAZ. Drivers varied, with improvements in care of children as the only driver in both age groups and for all growth measures. Declines in disease prevalence drove improvements in weight-based measures. For younger children, household diets and household environments were significant drivers of improvement in LAZ and WAZ. For older children, increasing income was the largest driver of HAZ and WAZ.
Increasing income did not independently drive improvements for younger children but drove improved growth among children aged 2-4 y. This points to the need to focus on nutrition-specific and nutrition-sensitive interventions to decrease child undernutrition in the vulnerable first 1000 days of life.
在过去的 30 年里，孟加拉国经历了儿童营养不足和贫困率的快速下降、母亲教育程度的提高以及饮食结构的改变。
我们旨在量化 1992 年至 2005 年期间孟加拉国学龄前儿童营养状况改善的决定因素。
我们利用来自 4 轮两两关联且季节性均衡的调查系统的数据：孟加拉国家庭（收入和）支出调查（H[I]ES）和儿童（和母亲）营养调查（C[M]NS）。我们分析了 10780 名 6-59 月龄的儿童，分为两个年龄组（6-23 月龄和 24-59 月龄）。我们使用 Blinder-Oaxaca 分解法来评估随着时间的推移，变化的决定因素对营养状况的影响，该方法由儿童营养不良原因的儿基会概念框架指导。
所有 Z 分数衡量指标（年龄别身长/身高 Z 评分、身长/身高别体重 Z 评分和年龄别体重 Z 评分）的儿童生长均有显著改善，儿基会框架各个领域中许多潜在的儿童生长决定因素也有显著改善。在年龄较小的儿童中，分解法解释了观察到的 LAZ 变化的 67%、WLZ 的 130%和 WAZ 的 73%。在年龄较大的儿童中，分解法解释了观察到的 HAZ 变化的 41%和 WAZ 的 36%。驱动因素各不相同，在两个年龄组和所有生长指标中，对儿童的照护改善是唯一的驱动因素。疾病流行率的下降推动了体重指标的改善。对于年龄较小的儿童，家庭饮食和家庭环境是改善 LAZ 和 WAZ 的重要驱动因素。对于年龄较大的儿童，收入增加是 HAZ 和 WAZ 的最大驱动因素。
收入的增加并没有独立地促进年龄较小的儿童的改善，但却推动了 2-4 岁儿童的生长发育。这表明需要关注营养特定和营养敏感的干预措施，以减少生命最初 1000 天内儿童的营养不足。
