Worku Misganaw Gebrie, Mohanty Itismita, Mengesha Zelalem, Niyonsenga Theo
Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia.
Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia.
Nutrients. 2025 Jan 11;17(2):252. doi: 10.3390/nu17020252.
Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors.
Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect.
The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35-34.82). Additionally, 20.49% (95% CI: 20.30-20.69) and 14.09% (95% CI: 13.92-14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother's educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0-23-month-old children. For 24-59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition.
Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.
低收入和中等收入国家（LMICs）的营养不良仍然是一项主要的公共卫生挑战。它占撒哈拉以南非洲（SSA）五岁以下儿童死亡率的三分之一。本研究应用人体测量失败综合指数（CIAF）来评估各种单独存在和并存的营养不良形式的患病率，并确定相关风险因素。
使用了来自26个撒哈拉以南非洲国家具有全国代表性的人口健康调查（DHS）数据。考虑到DHS数据的分层性质和超过两类的结果变量，进行了多水平多项逻辑回归分析。拟合了四个模型，并选择对数似然值最高且偏差最低的模型作为最佳拟合模型。呈现调整后的相对风险比（aRRR）及其相应的95%置信区间（CI）作为效应的度量。
撒哈拉以南非洲五岁以下儿童营养不良的总体患病率为34.59%（95%CI：34.35 - 34.82）。此外，分别有20.49%（95%CI：20.30 - 20.69）和14.09%（95%CI：13.92 - 14.26）的五岁以下儿童存在单独存在的营养不良和并存的营养不良。母亲的教育水平和家庭财富状况是单独存在的营养不良和并存的营养不良最主要的共同驱动因素。另一方面，儿童和卫生服务因素是单独存在的营养不良和并存的营养不良之间的区分因素。儿童年龄、儿童性别、出生类型、出生体重、坚持适龄喂养、产前检查次数（ANC）、分娩地点和母亲教育状况是0 - 23个月儿童各种营养不良形式的最主要决定因素。对于24 - 59个月的儿童，儿童年龄、儿童性别、出生类型、家庭财富状况和母亲教育被确定为不同形式营养不良的主要决定因素。
我们的分析表明，远端因素是单独存在和并存的营养不良形式之间的共同风险因素。然而，近端和中间因素在单独存在的营养不良和并存的营养不良之间的关联类型和强度方面有所不同。这意味着需要采取全面的和针对特定类别的策略，以显著降低撒哈拉以南非洲五岁以下儿童的营养不良状况。
