Kerac Marko, James Philip T, McGrath Marie, Brennan Eilise, Cole Tim, Opondo Charles, Frison Séverine
Population Health, London School of Hygiene & Tropical Medicine, London, UK
ENN, Kidlington, UK.
BMJ Glob Health. 2025 May 29;10(5):e016121. doi: 10.1136/bmjgh-2024-016121.
Tackling malnutrition in infants aged under 6 months (u6m) is a major global priority yet evidence around this vulnerable group is weak. We aimed to support the rollout of new 2023 WHO guidelines by examining the burden of infant malnutrition and potential programme caseloads with new enrolment criteria.
Secondary analysis of Demographic and Health Survey (DHS) datasets. We calculated the number of underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age) and low birth weight (LBW) infants. We assessed data quality by recording extreme or missing values. We calculated the population-weighted prevalence of anthropometric deficit and extrapolated to all low- and middle-income countries (LMICs). We regressed being underweight and wasti on infant, maternal and household characteristics using logistic regression.
We analysed 56 DHS surveys. There were more extreme (flagged) values for length-based measures (7.5% flagged for weight-for-length, 3.8% for length-for-age) than for weight-for-age (0.6% flagged). Overall, 17.4% of infants (95% CI: 16.9 to 18.0) were underweight, 15.5% (15.0-16.0) were wasted, 19.9% (19.3-20.5) were stunted and 15.0% (14.5-15.5) were LBW. This corresponds to an estimated burden in LMICs of 10.3 million underweight infants (4.1 million severely underweight), 9.2 million wasted (4.0 million severely wasted), 11.8 million stunted (5.4 million severely stunted) and 8.9 million LBW infants. Overlap of the indicators varied markedly in different regions/countries. Numerous factors were associated with both underweight and wasting; associations tended to be stronger and have greater biological plausibility with being underweight.
Malnutrition in infants u6m is a major problem in LMICs. Local epidemiology should inform case identification in contextualised care services across health and nutrition. Data quality and stronger associations with health and social characteristics support the use of underweight as a key enrolment criterion. Since vulnerability may be due to or exacerbated by multiple factors, management must go beyond feeding support to address wider infant, maternal and mental health and social circumstances through integrated, multidisciplinary care systems.
解决6个月以下婴儿（u6m）的营养不良问题是全球的一项重大优先事项，但关于这一弱势群体的证据却很薄弱。我们旨在通过研究婴儿营养不良负担以及采用新的登记标准后的潜在项目案例数量，来支持2023年世界卫生组织新指南的推广。
对人口与健康调查（DHS）数据集进行二次分析。我们计算了体重不足（年龄别体重低）、消瘦（身长别体重低）、发育迟缓（年龄别身长低）和低出生体重（LBW）婴儿的数量。我们通过记录极端值或缺失值来评估数据质量。我们计算了人体测量缺陷的人口加权患病率，并推算至所有低收入和中等收入国家（LMICs）。我们使用逻辑回归分析体重不足和消瘦与婴儿、母亲和家庭特征之间的关系。
我们分析了56项DHS调查。基于身长的测量指标的极端（标记）值（身长别体重7.5%被标记，年龄别身长3.8%被标记）比年龄别体重（0.6%被标记）更多。总体而言，17.4%的婴儿（95%置信区间：16.9至18.0）体重不足，15.5%（15.0 - 16.0）消瘦，19.9%（19.3 - 20.5）发育迟缓，15.0%（14.5 - 15.5）低出生体重。这相当于低收入和中等收入国家估计有1030万体重不足的婴儿（410万严重体重不足），920万消瘦婴儿（400万严重消瘦），1180万发育迟缓婴儿（540万严重发育迟缓）和890万低出生体重婴儿。不同地区/国家的指标重叠情况差异显著。许多因素与体重不足和消瘦都有关联；与体重不足的关联往往更强，且在生物学上更具合理性。
6个月以下婴儿的营养不良是低收入和中等收入国家的一个主要问题。当地的流行病学情况应在跨卫生和营养领域的情境化护理服务中为病例识别提供依据。数据质量以及与健康和社会特征更强的关联支持将体重不足作为关键的登记标准。由于脆弱性可能由多种因素导致或加剧管理必须超越喂养支持，通过综合、多学科的护理系统来解决更广泛的婴儿、母亲和心理健康以及社会状况问题。
