Departamento de Medicina y Ciencias de la Vida, Universidad Pompeu Fabra, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Soc Sci Med. 2024 Nov;361:117365. doi: 10.1016/j.socscimed.2024.117365. Epub 2024 Sep 26.
Low- and middle-income countries (LMICs) are particularly vulnerable to the adverse effects of economic downturns on the Prevalence of Undernourishment (PoU). Our study aimed to evaluate the impact of Social Protection and Labor Programs (SPL) on PoU in 46 LMICs from 2001 to 2019, and to estimate SPL mitigating effects during economic downturns.
This cohort study used a multi-country ecological design with two-ways fixed effects multivariable linear regression models, adjusted for relevant demographic, socioeconomic, and contextual variables. Interaction terms between economic downturns and SPL were used to evaluate SPL mitigating effects.
Our study cohort displayed an average 15.30% PoU and 34.34% SPL coverage in the initial year, contrasting with 8.58% PoU and 43.81% SPL coverage in the final year. A 10% SPL coverage was associated with a 0.51% PoU reduction (95%CI: 0.04-0.99) across all countries and 0.78% reduction within the poorest subgroup. SPL have been able to prevent an estimated 1.01 billion (95% UI: 0.16-1.86) cases of undernourishment over the study period in the 46 LMICs. Economic downturns were associated with a 4.55% PoU increase (95% CI: 1.28-7.81) in all countries, and a 6.06% PoU increase in the poorest subgroup. High SPL coverage during the downturns had significant mitigating effects, reducing an overall 1.17% PoU for every 10% SPL coverage in all countries, and 1.81% PoU in the poorest nations.
Amid the ongoing multiple global crises, expanding the coverage of social protection could effectively mitigate the potential increases in undernourishment during economic downturns, contributing to the achievement of nutrition-related Sustainable Development Goals in LMICs.
中低收入国家（LMICs）特别容易受到经济衰退对营养不足发生率（PoU）的不利影响。我们的研究旨在评估社会保护和劳工计划（SPL）对 2001 年至 2019 年 46 个 LMIC 营养不足发生率的影响，并估计 SPL 在经济衰退期间的缓解作用。
这项队列研究采用了多国生态设计，使用双向固定效应多变量线性回归模型，调整了相关的人口统计学、社会经济和背景变量。经济衰退和 SPL 之间的交互项用于评估 SPL 的缓解作用。
我们的研究队列在初始年份的平均营养不足发生率为 15.30%，社会保护和劳工计划覆盖率为 34.34%，而在最后一年分别为 8.58%和 43.81%。社会保护和劳工计划覆盖率增加 10%，与所有国家的营养不足发生率降低 0.51%（95%CI：0.04-0.99）和最贫困分组的降低 0.78%相关。在研究期间，社会保护和劳工计划能够预防估计为 4.61 亿（95% UI：0.16-1.86）例营养不足病例。在所有国家，经济衰退与营养不足发生率增加 4.55%（95% CI：1.28-7.81）相关，在最贫困分组中增加 6.06%。在经济衰退期间，高社会保护和劳工计划覆盖率具有显著的缓解作用，使所有国家的营养不足发生率总体降低了 1.17%，使最贫困国家的营养不足发生率降低了 1.81%。
在当前的多重全球危机中，扩大社会保护的覆盖范围可以有效地缓解经济衰退期间营养不足发生率的潜在增加，有助于在 LMIC 实现与营养有关的可持续发展目标。
