Gausman Jewel, Kim Rockli, Subramanian S V
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, South Korea.
SSM Popul Health. 2021 Nov 17;16:100965. doi: 10.1016/j.ssmph.2021.100965. eCollection 2021 Dec.
BACKGROUND/OBJECTIVES: Stunting, underweight, and wasting are used to monitor nutritional status in children, but they do not identify children with concurrent anthropometric failures (AF). Our study estimates the association between AF and mortality in children with single versus multiple failures, then calculates the percentage of child deaths attributable to AF.
SUBJECTS/METHODS: Using data from a prospective, longitudinal study of 3605 children from age 1 to age 5 years in Ethiopia and India, we estimate the association between AF and mortality using conventional definitions (stunting, underweight, and wasting) and the mutually exclusive categories of stunted only underweight only, wasted only, stunted and underweight (SU), underweight and wasted, and stunted, underweight, and wasted (SUW), adjusting for socioeconomic status and other demographic variables. Last, we calculate the population attributable fraction.
Children who were SU and SUW had 3.20 (95% CI: 1.69, 6.06; p < 0.001) and 5.52 (95% CI: 2.25, 13.56; p < 0.001) times the odds of death in fully adjusted models by Round 2 compared to children with no failure, while no increased mortality risk was found among children with other categories of failure. We estimate that 42.69% of child deaths can be attributed to children who are SUW (17.02%) or SU (25.67%), accounting for nearly 80% of child deaths from AF.
This study provides new insight to programs and policy to better identify children most at risk of malnutrition-related mortality.
背景/目的：发育迟缓、体重不足和消瘦用于监测儿童营养状况，但无法识别同时存在人体测量指标不良（AF）的儿童。我们的研究估计了单一指标不良与多重指标不良儿童中AF与死亡率之间的关联，然后计算了可归因于AF的儿童死亡百分比。
对象/方法：利用埃塞俄比亚和印度3605名1至5岁儿童的前瞻性纵向研究数据，我们使用传统定义（发育迟缓、体重不足和消瘦）以及仅发育迟缓、仅体重不足、仅消瘦、发育迟缓和体重不足（SU）、体重不足和消瘦、发育迟缓、体重不足和消瘦（SUW）这些互斥类别，估计AF与死亡率之间的关联，并对社会经济状况和其他人口统计学变量进行了调整。最后，我们计算了人群归因分数。
在经过全面调整的模型中，与无指标不良的儿童相比，SU和SUW儿童在第二轮时死亡几率分别为3.20倍（95%置信区间：1.69，6.06；p<0.001）和5.52倍（95%置信区间：2.25，13.56；p<0.001），而其他类别指标不良的儿童未发现死亡风险增加。我们估计，42.69%的儿童死亡可归因于SUW（17.02%）或SU（25.67%）的儿童，占AF导致儿童死亡的近80%。
本研究为项目和政策提供了新的见解，以更好地识别营养不良相关死亡风险最高的儿童。
