Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Br J Nutr. 2024 Apr 14;131(7):1189-1195. doi: 10.1017/S0007114523002702. Epub 2023 Nov 28.
Undernutrition is a major public health problem in developing countries. Around 40·2 % of children are stunted in Pakistan. This longitudinal study aimed to assess the effectiveness of locally produced ready-to-use supplementary foods in the prevention of stunting by detecting change in of children in intervention . control arm against the 2006 WHO growth reference. A community-based non-randomised cluster-controlled trial was conducted from January 2018 to December 2020 in the district of Kurram, Khyber Pakhtunkhwa, Pakistan. A total of 80 clusters (each cluster comprising ≈ 250-300 households) were defined in the catchment population of twelve health facilities. Children aged 6-18 months were recruited 1680. The intervention included a daily ration of 50 g - locally produced ready-to-use-supplementary food (Wawa-Mum). The main outcome of this study was a change in length for age z-score (LAZ) . WHO growth standards. Comparison between the interventions was by test and ANOVA. Cox proportional hazard models were used to assess the association between stunting occurrence and the utilisation of locally produced supplement. Out of the total 1680, fifty-one out of the total 1680, 51·1 out of the total 1680 and 51·1 % ( 859) were male. Mean age 13·9 months (sd + 859) were male. Mean age 13·9 months (sd + -4·4). At baseline, 36·9 % ( 618) were stunted. In the intervention group, mean LAZ score significantly increased from -1·13(2·2 sd) at baseline to -0·93(1·8 sd) at 6-month follow-up ( value 0·01) compared with the control group. The incidence rate of stunting in the intervention arm was 1·3 . 3·4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (Hazard Ratio (HR) 1·7, 95 % CI 1·46, 2·05, value < 0·001) . the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below 2 years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan.
营养不良是发展中国家的一个主要公共卫生问题。在巴基斯坦，约有 40.2%的儿童发育迟缓。本纵向研究旨在通过检测干预组和对照组儿童的变化，评估当地生产的即食补充食品在预防发育迟缓方面的效果，以 2006 年世卫组织生长标准为参照。这项在巴基斯坦开伯尔-普赫图赫瓦省库拉姆区进行的社区为基础的非随机群组对照试验，从 2018 年 1 月至 2020 年 12 月进行。在 12 个卫生机构的集水区人口中，共确定了 80 个群组（每个群组包括约 250-300 户家庭）。招募了 1680 名 6-18 个月大的儿童。干预措施包括每天食用 50 克当地生产的即食补充食品（Wawa-Mum）。本研究的主要结果是年龄别身长 z 评分（LAZ）的变化，以世卫组织生长标准为参照。干预组之间的比较采用 t 检验和方差分析。Cox 比例风险模型用于评估当地补充品的使用与发育迟缓发生之间的关联。在总共 1680 名儿童中，有 51 名（占总数的 51.1%）是男性，平均年龄为 13.9 个月（标准差+4.4）。在基线时，有 36.9%（618 人）发育迟缓。在干预组中，LAZ 评分从基线时的-1.13（2.2 标准差）显著增加到 6 个月随访时的-0.93（1.8 标准差）（ 值 0.01），而对照组则没有。在干预组中，发育迟缓的发生率为 1.3 人/人年，在对照组中为 3.4 人/人年。对照组发生发育迟缓的可能性明显增加（风险比（HR）1.7，95%置信区间 1.46-2.05， 值<0.001）。当地生产的即食补充食品是减少 2 岁以下儿童发育迟缓的有效干预措施。这可以作为营养预防一揽子计划的一部分，以克服巴基斯坦令人震惊的发育迟缓率。
