Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana; College of Public Health, University of South Florida, Tampa, FL, USA.
College of Public Health, University of South Florida, Tampa, FL, USA.
Lancet Planet Health. 2021 Jun;5(6):e347-e355. doi: 10.1016/S2542-5196(21)00080-2.
Stunting rates in children younger than 5 years are among the most important health indicators globally. At the national level, malnutrition accounts for about 40% of under-5 deaths in Ghana. Disease risk mapping provides opportunities for disease surveillance and targeted interventions. We aimed to estimate and map under-5 stunting prevalence in Ghana, with the goal of identifying communities at higher risk where interventions and further research can be targeted.
For this modelling study, we used data from the 2014 Ghana Demographic and Health Survey. Analyses were done on 2734 children residing in 415 geographical clusters. The outcome variable was the number of stunted children younger than 5 years in each sampled cluster. We employed a Bayesian geostatistical model to investigate both measured and unmeasured spatial risk factors for child stunting, comparing the performance of non-spatial (adjusting for selected covariates without spatial correlation), spatial (including spatial correlation), and null spatial (without the selected covariates) models. We then visualised the stunting prevalence across Ghana by mapping the predicted prevalence and exceedance probabilities to resolutions as refined as 5 km × 5 km.
In 2014, 535 (19·6%) of 2734 children surveyed in Ghana were stunted. Elevation (log odds mean -0·0017, 95% credible interval -0·0034 to -0·0001), precipitation (0·0403, 0·0192 to 0·0615), and aridity (-3·7013, -6·5478 to -0·8723) were environmental and climatic factors associated with stunting in the non-spatial model, but were not significant in the spatial model. Substantial geographical variations in prevalence of childhood stunting were found. The predicted mean stunting prevalence was 27·7% (SD 3·7%) with predicted prevalence ranging from 4·2% to 45·1% across Ghana. Children residing in parts of the Northern region were at highest risk of stunting, whereas parts of the Greater Accra, Brong-Ahafo, Ashanti, and Eastern regions showed some of the lowest prevalence.
There are substantial geographical differences in childhood stunting across Ghana. Our prevalence maps can be used as an effective tool to identify communities that require targeted interventions by programme managers and implementers, as part of an overall strategy to reduce the burden of malnutrition in a country with limited public health resources.
None.
5 岁以下儿童发育迟缓率是全球最重要的健康指标之一。在国家层面上，加纳约有 40%的 5 岁以下儿童死亡是由营养不良导致的。疾病风险图为疾病监测和有针对性的干预措施提供了机会。我们旨在估计和绘制加纳 5 岁以下儿童发育迟缓的流行率，目的是确定处于较高风险的社区，以便有针对性地进行干预和进一步研究。
在这项建模研究中，我们使用了 2014 年加纳人口与健康调查的数据。对居住在 415 个地理群集中的 2734 名儿童进行了分析。因变量是每个抽样群集中发育迟缓的 5 岁以下儿童数量。我们采用贝叶斯地统计学模型来研究儿童发育迟缓的测量和未测量的空间风险因素，比较非空间（在没有空间相关性的情况下调整选定的协变量）、空间（包括空间相关性）和空值空间（没有选定的协变量）模型的性能。然后，我们通过将预测的流行率和超过概率映射到分辨率为 5 公里×5 公里的精细程度，来可视化加纳各地的发育迟缓流行率。
2014 年，在加纳接受调查的 2734 名儿童中，有 535 名（19.6%）发育迟缓。在非空间模型中，海拔（对数几率均值-0.0017，95%可信区间-0.0034 至-0.0001）、降水（0.0403，0.0192 至 0.0615）和干旱（-3.7013，-6.5478 至-0.8723）是与发育迟缓相关的环境和气候因素，但在空间模型中并不显著。我们发现儿童发育迟缓的流行率存在显著的地域差异。预测的平均发育迟缓流行率为 27.7%（标准差 3.7%），加纳各地的预测流行率范围为 4.2%至 45.1%。居住在北部地区的儿童发育迟缓的风险最高，而大阿克拉、布隆-阿哈福、阿散蒂和东部地区的部分地区发育迟缓的流行率则较低。
加纳各地儿童发育迟缓存在显著的地域差异。我们的流行率图可作为有效工具，帮助项目管理者和执行者确定需要有针对性干预的社区，作为在资源有限的国家减少营养不良负担的整体战略的一部分。
无。
