Rich Kate, Engelbrecht Liezel, Wills Gabrielle, Mphaphuli Edzani
Research on Socio-Economic Policy, Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa.
Matern Child Nutr. 2025 Apr;21(2):e13765. doi: 10.1111/mcn.13765. Epub 2024 Nov 24.
A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.
大量研究探讨了幼儿发育迟缓的决定因素，但很少有研究考虑哪些因素是发育迟缓最重要的预测指标。我们利用2022年“成长伟大社区发育迟缓调查”的数据，研究了南非七个粮食最不安全地区5岁以下儿童年龄别身高Z评分（HAZ）和发育迟缓预测指标的相对重要性。我们使用了条件随机森林模型中的优势分析和变量重要性度量来评估预测指标的相对重要性。我们发现，代际和社会经济因素，特别是母亲身高（HAZ：系数0.02，95%置信区间0.01 - 0.03；发育迟缓：比值比0.96，95%置信区间0.94 - 0.98）、出生体重（HAZ：系数0.3，95%置信区间0.16 - 0.43；发育迟缓：比值比0.5，95%置信区间0.35 - 0.72）以及基于资产的社会经济地位度量（HAZ：系数0.17，95%置信区间0.10 - 0.24；发育迟缓：比值比0.77，95%置信区间0.67 - 0.89）是这些地区HAZ和发育迟缓最重要的预测指标。我们使用条件推断树和调节分析，探讨了是否有其他因素调节（削弱）了这些代际因素与儿童身高之间的关系。我们发现，维生素A和驱虫、充足的卫生设施、多样化饮食以及良好的母亲心理健康状况对出生体重或母亲身高的影响起到了调节作用。尽管相对于代际风险因素的影响，这些调节因素的影响可能较小，但这些调节因素可能为帮助减轻南非发育迟缓风险的代际传播提供有前景的途径。
