Soofi Sajid Bashir, Khan Ahmad, Kureishy Sumra, Hussain Imtiaz, Habib Muhammad Atif, Umer Muhammad, Ariff Shabina, Sajid Muhammad, Rizvi Arjumand, Ahmed Imran, Iqbal Junaid, Ahmed Khawaja Masuood, Achakzai Abdul Baseer Khan, Bhutta Zulfiqar A
Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan.
Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan.
Nutrients. 2023 Aug 7;15(15):3480. doi: 10.3390/nu15153480.
Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1000 days of life. Across south Asia, Pakistan has the second-highest prevalence of stunting. This study assessed the most recent nationally representative data, the National Nutrition Survey (NNS) 2018, to identify the stunting prevalence and determinants among Pakistani children under five.
The NNS 2018, a cross-sectional household-level survey, was used to conduct a secondary analysis. Data on malnutrition, dietary practices, and food insecurity were used to identify the prevalence of stunting among children under five years in terms of demographic, socioeconomic, and geographic characteristics. The prevalence of stunting was calculated using the World Health Organization (WHO) height for age z-score references. Univariate and multivariable logistic regressions were conducted to identify the factors associated with child stunting.
The analysis showed that out of 52,602 children under five, 40.0% were found to be stunted. Male children living in rural areas were more susceptible to stunting. Furthermore, stunting was more prevalent among children whose mothers had no education, were between 20 and 34, and were employed. In the multivariable logistic regression, male children (AOR = 1.08, 95% CI [1.04-1.14], < 0.001) from rural areas (AOR = 1.07, 95% CI [1.01-1.14], = 0.014), with the presence of diarrhea in the last two weeks (AOR = 1.15, 95% CI [1.06-1.25], < 0.001) and mothers who had no education (AOR = 1.57, 95% CI [1.42-1.73], < 0.001) or lower levels of education (primary: AOR = 1.35, 95% CI [1.21-1.51], < 0.001; middle: AOR = 1.29, 95% CI [1.15-1.45], < 0.001), had higher odds of stunting. Younger children aged < 6 months (AOR = 0.53, 95% CI [0.48-0.58], < 0.001) and 6-23 months (AOR = 0.89, 95% CI [0.84-0.94], < 0.001), with mothers aged 35-49 years (AOR = 0.78, 95% CI [0.66-0.92], = 0.003), had lower odds of stunting. At the household level, the odds of child stunting were higher in lower-income households (AOR = 1.64, 95% CI [1.46-1.83], < 0.001) with ≥ 7 members (AOR = 1.09, 95% CI [1.04-1.15], < 0.001), with no access to improved sanitation facilities (AOR = 1.14, 95% CI [1.06-1.22], < 0.001) and experiencing severe food insecurity (AOR = 1.07, 95% CI [1.01-1.14], = 0.02).
Child stunting in Pakistan is strongly associated with various factors, including gender, age, diarrhea, residence, maternal age and education, household size, food and wealth status, and access to sanitation. To address this, interventions must be introduced to make locally available food and nutritious supplements more affordable, improve access to safe water and sanitation, and promote female education for long-term reductions in stunting rates.
儿童发育迟缓仍是一个公共卫生问题。它的特征是由于生命最初1000天营养不足导致儿童认知和身体发育不良。在南亚地区，巴基斯坦发育迟缓的患病率位居第二。本研究评估了最新的全国代表性数据——2018年全国营养调查（NNS），以确定巴基斯坦5岁以下儿童的发育迟缓患病率及其决定因素。
采用2018年全国营养调查这一家庭层面的横断面调查进行二次分析。利用关于营养不良、饮食习惯和粮食不安全的数据，根据人口、社会经济和地理特征确定5岁以下儿童发育迟缓的患病率。发育迟缓患病率采用世界卫生组织（WHO）年龄别身高Z评分标准计算。进行单变量和多变量逻辑回归以确定与儿童发育迟缓相关的因素。
分析显示，在52602名5岁以下儿童中，40.0%被发现发育迟缓。农村地区的男童更容易发育迟缓。此外，发育迟缓在母亲未受过教育、年龄在20至34岁且有工作的儿童中更为普遍。在多变量逻辑回归中，农村地区的男童（调整后比值比[AOR]=1.08，95%置信区间[CI][1.04 - 1.14]，P<0.001）、过去两周内有腹泻的儿童（AOR = 1.15，95% CI [1.06 - 1.25]，P<0.001）以及母亲未受过教育（AOR = 1.57，95% CI [1.42 - 1.73]，P<0.001）或受教育程度较低（小学：AOR = 1.35，95% CI [1.21 - 1.51]，P<0.001；初中：AOR = 1.29，95% CI [1.15 - 1.45]，P<0.001）的儿童发育迟缓的几率更高。6个月以下（AOR = 0.53，95% CI [0.48 - 0.58]，P<0.001）和6至23个月（AOR = 0.89，95% CI [0.84 - 0.94]，P<0.001）的幼儿以及母亲年龄在35至49岁的儿童（AOR = 0.78，95% CI [0.66 - 0.92]，P = 0.003）发育迟缓的几率较低。在家庭层面，低收入家庭（AOR = 1.64，95% CI [1.46 - 1.83]，P<0.001）、家庭成员≥7人的家庭（AOR = 1.09，95% CI [1.04 - 1.15]，P<0.001）、无法使用改善卫生设施的家庭（AOR = 1.14，95% CI [1.06 - 1.22]，P<0.001）以及经历严重粮食不安全的家庭（AOR = 1.07，95% CI [1.01 - 1.14]，P = 0.02）中儿童发育迟缓的几率更高。
巴基斯坦儿童发育迟缓与多种因素密切相关，包括性别、年龄、腹泻、居住地区、母亲年龄和教育程度、家庭规模、食物和财富状况以及卫生设施的使用情况。为解决这一问题，必须采取干预措施，使当地可得的食物和营养补充剂更具可承受性，改善安全饮用水和卫生设施的获取，并促进女性教育，以长期降低发育迟缓率。
