Tusting Lucy S, Mishra Swapnil, Gibson Harry S, Lindsay Steven W, Weiss Daniel J, Flaxman Seth, Bhatt Samir
Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Hospital, Singapore, Singapore.
PLOS Glob Public Health. 2024 Dec 31;4(12):e0003067. doi: 10.1371/journal.pgph.0003067. eCollection 2024.
Child anthropometric deficits remain a major public health problem in Sub-Saharan Africa (SSA) and are a key target of the UN Sustainable Development Goals (SDGs). The SDGs recommend disaggregation of health indicators by ethnic group. However, few studies have assessed how ethnicity is associated with anthropometric deficits across SSA. Data were extracted from 37 georeferenced Demographic and Health Surveys carried out during 2006-2019 across SSA that recorded anthropometric data for children aged <5 years. In a cross-sectional analysis, the odds of stunting (low height-for-age), wasting (low weight-for-height) and underweight (low weight-for-age) were modelled in relation to ethnic group using a generalised linear hierarchical mixed-effects model, controlling for survey design and environmental, socioeconomic and clinical variables. The study population comprised 138,312 children spanning 45 ethnic groups across 18 countries. In pairwise comparisons (accounting for multiple comparisons) between ethnic groups, height-for-age z-scores differed by at least 0.5 standard deviations in 29% of comparisons, weight-for-height z-scores in 36% of comparisons and weight-for-age z-scores in 20% of comparisons. Compared to a reference group of Fula children (the largest ethnic group), ethnic group membership was associated with both increases and decreases in growth faltering, ranging from a 69% reduction to a 32% increase in odds of stunting (Igbo: adjusted odds ratio (aOR) 0.31, 95% confidence intervals (CI) 0.27-0.35, p<0.0001; Hausa: aOR 1.32, 95% CI 1.21-1.44, p<0.0001); a 13% to 87% reduction in odds of wasting (Mandinka: aOR 0.87, 95% CI 0.76-0.99, p = 0.034; Bamileke: aOR 0.13, 95% CI 0.05-0.32, p<0.0001) and an 85% reduction to 13% increase in odds of underweight (Bamileke: aOR 0.15, 95% CI 0.08-0.29, p<0.0001; Hausa: aOR 1.13, 95% CI 1.03-1.24, p = 0.010). Major ethnic disparities in stunting, wasting and underweight were observed across 18 countries in SSA. Understanding and accounting for these differences is essential to support progress monitoring and targeting of nutrition interventions in children.
儿童人体测量指标不足仍是撒哈拉以南非洲地区（SSA）的一个主要公共卫生问题，也是联合国可持续发展目标（SDGs）的一个关键目标。可持续发展目标建议按族裔群体对健康指标进行分类。然而，很少有研究评估族裔与整个撒哈拉以南非洲地区人体测量指标不足之间的关联。数据来自2006年至2019年期间在撒哈拉以南非洲地区开展的37项地理定位的人口与健康调查，这些调查记录了5岁以下儿童的人体测量数据。在一项横断面分析中，使用广义线性分层混合效应模型，针对族裔群体对发育迟缓（年龄别身高低）、消瘦（身高别体重低）和体重不足（年龄别体重低）的几率进行建模，并控制调查设计以及环境、社会经济和临床变量。研究人群包括来自18个国家45个族裔群体的138,312名儿童。在族裔群体之间的两两比较（考虑多重比较）中，29%的比较中年龄别身高z评分差异至少为0.5个标准差，36%的比较中身高别体重z评分差异至少为0.5个标准差，20%的比较中年龄别体重z评分差异至少为0.5个标准差。与富拉儿童（最大的族裔群体）这一参照组相比，族裔群体成员身份与生长发育迟缓的增加和减少均有关联，发育迟缓几率从降低69%到增加32%不等（伊博族：调整后比值比（aOR）0.31，95%置信区间（CI）0.27 - 0.35，p<0.0001；豪萨族：aOR 1.32，95% CI 1.21 - 1.44，p<0.0001）；消瘦几率降低13%至87%（曼丁卡族：aOR 0.87，95% CI 0.76 - 0.99，p = 0.034；巴米累克族：aOR 0.13，95% CI 0.05 - 0.32，p<0.0001），体重不足几率降低85%至增加13%（巴米累克族：aOR 0.15，95% CI 0.08 - 0.29，p<0.0001；豪萨族：aOR 1.13，95% CI 1.03 - 1.24，p = 0.010）。在撒哈拉以南非洲地区的18个国家中，观察到发育迟缓、消瘦和体重不足方面存在主要的族裔差异。了解并考虑这些差异对于支持儿童营养干预措施的进展监测和目标设定至关重要。
