Ijaiya Mukhtar A, Anjorin Seun, Uthman Olalekan A
Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT, Nigeria.
Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Glob Health Res Policy. 2024 Jul 31;9(1):29. doi: 10.1186/s41256-024-00371-0.
Childhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity.
We performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort.
The IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively.
Our study revealed a correlation between specific childhood malnutrition subtypes-double-burden malnutrition and wasting-and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition.
儿童发病率和死亡率仍然是主要的公共卫生挑战。营养不良会增加儿童患急性呼吸道感染、腹泻、发烧和围产期疾病等疾病的发病和死亡风险。本研究探讨并估计了儿童营养不良形式与儿童发病率之间关联的程度。
我们进行了个体参与者数据（IPD）荟萃分析，并采用倾向得分匹配来检验粗（未调整）关联和调整后的关联。我们的分析利用了2015年至2020年期间在27个低收入和中等收入国家进行的调查中的人口和健康数据集。我们的目标是使用倾向得分匹配队列的自然实验设计来量化营养不良儿童的发病风险，并估计人群归因分数（PAF）。
对三种儿童营养不良形式的儿童发病率进行的IPD荟萃分析呈现出细微的结果。患有双重负担营养不良的儿童发病风险高5%，但无统计学意义。相比之下，消瘦儿童的发病风险高28%。超重儿童的发病风险低29%。使用匹配样本，患有双重负担营养不良的儿童和超重儿童的发病风险较低（分别为1.7%，RR：0.983（95%CI，0.95至1.02）和20%，RR：0.80（95%CI，0.76至0.85）），而消瘦与发病风险高1.1倍（RR：1.094（95%CI，1.05至1.14））相关。在四个和七个风险差异呈显著正相关的国家消除双重负担营养不良和消瘦，估计可分别将儿童发病负担平均降低2.8%和3.7%。
我们的研究揭示了特定儿童营养不良亚型——双重负担营养不良和消瘦——与发病风险增加之间的相关性。相反，超重儿童的近期发病风险较低，但他们可能面临潜在的长期健康挑战，这表明需要针对儿童营养采取细致入微的方法。
