Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany.
Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
PLoS One. 2021 Aug 4;16(8):e0255073. doi: 10.1371/journal.pone.0255073. eCollection 2021.
The burden of child under-nutrition still remains a global challenge, with greater severity being faced by low- and middle-income countries, despite the strategies in the Sustainable Development Goals (SDGs). Globally, malnutrition is the one of the most important risk factors associated with illness and death, affecting hundreds of millions of pregnant women and young children. Sub-Saharan Africa is one of the regions in the world struggling with the burden of chronic malnutrition. The 2018 Zambia Demographic and Health Survey (ZDHS) report estimated that 35% of the children under five years of age are stunted. The objective of this study was to analyse the distribution, and associated factors of stunting in Zambia.
We analysed the relationships between socio-economic, and remote sensed characteristics and anthropometric outcomes in under five children, using Bayesian distributional regression. Georeferenced data was available for 25,852 children from two waves of the ZDHS, 31% observation were from the 2007 and 69% were from the 2013/14. We assessed the linear, non-linear and spatial effects of covariates on the height-for-age z-score.
Stunting decreased between 2007 and 2013/14 from a mean z-score of 1.59 (credible interval (CI): -1.63; -1.55) to -1.47 (CI: -1.49; -1.44). We found a strong non-linear relationship for the education of the mother and the wealth of the household on the height-for-age z-score. Moreover, increasing levels of maternal education above the eighth grade were associated with a reduced variation of stunting. Our study finds that remote sensed covariates alone explain little of the variation of the height-for-age z-score, which highlights the importance to collect socio-economic characteristics, and to control for socio-economic characteristics of the individual and the household.
While stunting still remains unacceptably high in Zambia with remarkable regional inequalities, the decline is lagging behind goal two of the SDGs. This emphasises the need for policies that help to reduce the share of chronic malnourished children within Zambia.
儿童营养不足的负担仍然是一个全球性挑战，尽管可持续发展目标（SDGs）中有相关策略，但中低收入国家面临的情况更为严重。在全球范围内，营养不良是与疾病和死亡相关的最重要风险因素之一，影响着数亿孕妇和幼儿。撒哈拉以南非洲是世界上受慢性营养不良负担困扰的地区之一。2018 年赞比亚人口与健康调查（ZDHS）报告估计，五岁以下儿童中有 35%发育迟缓。本研究的目的是分析赞比亚儿童发育迟缓的分布及其相关因素。
我们使用贝叶斯分布回归分析了社会经济和遥感特征与五岁以下儿童人体测量结果之间的关系。来自 ZDHS 两波的数据可进行地理参考，共有 25852 名儿童，其中 31%的观察结果来自 2007 年，69%来自 2013/14 年。我们评估了协变量对身高年龄 z 分数的线性、非线性和空间效应。
2007 年至 2013/14 年期间，发育迟缓率从平均 z 分数 1.59（置信区间（CI）：-1.63；-1.55）下降到-1.47（CI：-1.49；-1.44）。我们发现母亲的教育程度和家庭的财富对身高年龄 z 分数存在很强的非线性关系。此外，母亲受教育程度高于八年级以上与发育迟缓的变化减少有关。我们的研究发现，单独使用遥感协变量只能解释身高年龄 z 分数变化的一小部分，这突出表明需要收集社会经济特征，并控制个人和家庭的社会经济特征。
尽管赞比亚发育迟缓的情况仍然高得令人无法接受，且存在显著的地区不平等，但下降速度落后于可持续发展目标的目标 2。这强调了需要制定政策，帮助减少赞比亚慢性营养不良儿童的比例。
