Seretew Wullo Sisay, Tesema Getayeneh Antehunegn, Yirsaw Bantie Getnet, Argaw Girum Shibeshi
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
Department of Nursing, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia.
PLoS One. 2024 Jun 13;19(6):e0299310. doi: 10.1371/journal.pone.0299310. eCollection 2024.
Stunting is still a major public health problem all over the world, it affecting more than one-third of under-five children in the world that leads to growth retardation, life-threatening complication and accelerate mortality and morbidity. The evidence is scarce on prevalence and associated factors of stunting among under-five children in Sub-Saharan Africa for incorporated intervention. Therefore this study aimed to investigate the prevalence and determinants of stunting among under-five children in Sub-Saharan Africa using recent demographic and health surveys of each country.
This study was based on the most recent Demographic and Health Survey data of 36 sub-Saharan African countries. A total of 203,852(weighted sample) under-five children were included in the analysis. The multi-level ordinal logistic regression was fitted to identify determinants of stunting. Parallel line (proportional odds) assumption was cheeked by Brant test and it is satisfied (p-value = 0.68) which is greater than 0.05. Due to the nested nature of the dataset deviance was used model comparison rather than AIC and BIC. Finally the adjusted odds ratio (AOR) with 95% CI was reported identify statistical significant determinants of stunting among under-five children.
In this study, the prevalence of stunting among under-five children in Sub-Saharan Africa 34.04% (95% CI: 33.83%, 34.24%) with a large difference between specific countries which ranges from 16.14% in Gabon to 56.17% in Burundi. In the multi-level ordinal logistic regression good maternal education, born from mothers aged above 35 years, high household wealth status, small family size, being female child, being female household head, having media exposure and having consecutive ANC visit were significantly associated with lower odds of stunting. Whereas, living from rural residence, being 24-59 month children age, single or divorced marital status, higher birth order and having diarrhea in the last two weeks were significantly associated with higher odds of stunting.
Stunting among under-five children is still public health problem in Sub-Saharan Africa. Therefore designing interventions to address diarrhea and other infectious disease, improving the literacy level of the area and increase the economic level of the family to reduce the prevalence of stunting in the study area.
发育迟缓仍是全球主要的公共卫生问题，影响着全球超过三分之一的五岁以下儿童，导致生长发育迟缓、危及生命的并发症，并加速死亡率和发病率。关于撒哈拉以南非洲五岁以下儿童发育迟缓的患病率及相关因素的证据稀少，难以进行综合干预。因此，本研究旨在利用各国近期的人口与健康调查，调查撒哈拉以南非洲五岁以下儿童发育迟缓的患病率及决定因素。
本研究基于36个撒哈拉以南非洲国家的最新人口与健康调查数据。共有203,852名（加权样本）五岁以下儿童纳入分析。采用多水平有序逻辑回归来确定发育迟缓的决定因素。通过布兰特检验检验平行直线（比例优势）假设，该假设得到满足（p值 = 0.68），大于0.05。由于数据集的嵌套性质，使用偏差进行模型比较，而不是AIC和BIC。最后报告调整后的优势比（AOR）及95%置信区间，以确定五岁以下儿童发育迟缓的统计学显著决定因素。
在本研究中，撒哈拉以南非洲五岁以下儿童发育迟缓的患病率为34.04%（95%置信区间：33.83%，34.24%），不同国家之间存在较大差异，从加蓬的16.14%到布隆迪的56.17%不等。在多水平有序逻辑回归中，母亲受教育程度高、母亲年龄在35岁以上、家庭财富状况高、家庭规模小、为女童、为女性户主、有媒体接触以及接受连续的产前检查与发育迟缓几率较低显著相关。而居住在农村、年龄在24 - 59个月、单身或离异婚姻状况、出生顺序较高以及在过去两周内腹泻与发育迟缓几率较高显著相关。
撒哈拉以南非洲五岁以下儿童发育迟缓仍然是一个公共卫生问题。因此，设计干预措施以解决腹泻和其他传染病问题，提高该地区的识字水平，并提高家庭经济水平，以降低研究地区发育迟缓的患病率。
