Beni Reshav, Ramroop Shaun, Habyarimana Faustin
School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
Front Public Health. 2025 May 26;13:1520191. doi: 10.3389/fpubh.2025.1520191. eCollection 2025.
BACKGROUND: Malnutrition remains one of the most pressing health challenges, particularly in developing nations across Africa, placing a significant burden on both public health agencies and the affected countries. In countries such as Gabon, Gambia, Mauritania, Liberia, and Nigeria, the burden of malnutrition exacerbates public health systems, strains economic resources, and hinders sustainable development, underscoring the urgent need for coordinated efforts at national and international levels. This study aimed to determine the scope and underlying factors contributing to the elevated incidence of malnutrition in West African countries, specifically Gabon, Gambia, Liberia, Mauritania, and Nigeria. METHOD: This study employed a quantile regression model to examine the determinants of malnutrition at various quantiles of interest across the Western African countries under consideration to facilitate focused policy measures and intervention strategies aimed at decreasing the prevalence. RESULTS: For the lower quantiles (0.1 and 0.25), which indicate severe malnutrition, significant variables included the child's weight [quantile = 0.1, 95% CI(0.0063, 0.0103), quantile = 0.25, 95% CI(0.0054, 0.0107)], mother's education level [No education: quantile = 0.1, 95% CI(-49.7471, -32.1376), quantile = 0.25, 95% CI(-38.1513, -22.4438) Primary: quantile = 0.1, 95% CI(-24.8095, -5.7693), quantile = 0.25, 95% CI(-19.5273, -6.3424) Higher: quantile = 0.1, 95% CI(5.6499, 40.3274), quantile = 0.25, 95% CI(21.8158, 40.278)], drinking water source [Natural Sources: quantile = 0.1, 95% CI(0.6877, 24.384),Piped: quantile = 0.1, 95% CI(25.578, 45.2368), quantile = 0.25, 95% CI(22.2782, 34.8212), Bottle/Sachet: quantile = 0.25, 95% CI(3.438, 98.1675)], toilet type [Flush: quantile = 0.25, 95% CI(2.2598, 18.3457),Other: quantile = 0.1, 95% CI(8.7863, 24.504), quantile = 0.25, 95% CI(7.0995, 20.1119)], household wealth index [Poorest: quantile = 0.1, 95% CI(-52.5112, -16.9197), quantile = 0.25, 95% CI(-48.3804, -23.0633),Poorer: quantile = 0.1, 95% CI(-38.8744, -4.7586), quantile = 0.25, 95% CI(-34.6993, -9.1766), Middle: quantile = 0.25, 95% CI(-28.9491, -6.5834)], health care visits [No: quantile = 0.1, 95% CI(-19.293, -3.6393), quantile = 0.25, 95% CI(-17.2342, -5.6411)], consumption of fortified foods and tubers [No: quantile = 0.1, 95% CI(-36.3898, -12.0378), quantile = 0.25, 95% CI(-17.8127, -1.2374)], anemia status [Anemic: quantile = 0.1, 95% CI(-15.9326, -1.1929), quantile = 0.25, 95% CI(-12.3361, -1.5516)], mosquito net usage [No: quantile = 0.1, 95% CI(-22.0323, -0.8033), quantile = 0.25, 95% CI(-13.8107, 1.1366)], child's age [0 to 12 months: quantile = 0.1, 95% CI(81.6424, 105.7155), quantile = 0.25, 95% CI(61.4817, 78.5194),12 to 24 months: quantile = 0.1, 95% CI(0.5592, 24.933), 24 to 36 months: quantile = 0.1, 95% CI(7.9128, 40.2828)] and gender [Female: quantile = 0.1, 95% CI(4.5351, 17.9783), quantile = 0.25, 95% CI(5.0076, 15.4735)], and recent fever [No: quantile = 0.1, 95% CI(11.5663, 29.5984), quantile = 0.25, 95% CI(7.0313, 20.8918)]. Residence type was significant for the 0.25 quantile but not the 0.1 quantile [Rural: quantile = 0.25, 95% CI(-14.7051, -2.1455)]. At higher quantiles (0.75, 0.85, 0.9, and 0.95), factors such as the use of mosquito nets, formula feeding, and access to piped water remain significant, while socioeconomic determinants like maternal education and wealth index lose their influence. Common variables across all quantiles were mother's age, child's age (0 to 12 months), child's gender, and recent fever. CONCLUSION: These findings underscore the critical role of primary health care interventions in identifying and managing malnutrition, particularly among lower quantiles where severe malnutrition dominates. High-risk groups, such as teenagers and low-income mothers, should receive targeted support, including prenatal classes and counseling. Community caregivers can monitor at-risk individuals and ensure timely referrals, while collaborations with nonprofits can improve access to food and supplements. Promoting community food gardens, clean water access, and public workshops can further aid prevention and education efforts.
背景：营养不良仍然是最紧迫的健康挑战之一，尤其是在非洲的发展中国家，给公共卫生机构和受影响国家都带来了巨大负担。在加蓬、冈比亚、毛里塔尼亚、利比里亚和尼日利亚等国家，营养不良的负担加剧了公共卫生系统的压力，消耗了经济资源，并阻碍了可持续发展，凸显了在国家和国际层面进行协调努力的迫切需求。本研究旨在确定西非国家（特别是加蓬、冈比亚、利比里亚、毛里塔尼亚和尼日利亚）营养不良发病率上升的范围及潜在因素。 方法：本研究采用分位数回归模型，考察所涉西非国家不同感兴趣分位数下营养不良的决定因素，以促进制定针对性的政策措施和干预策略，降低患病率。 结果：对于表示严重营养不良的较低分位数（0.1和0.25），显著变量包括儿童体重[分位数 = 0.1，95%置信区间(0.0063, 0.0103)，分位数 = 0.25，95%置信区间(0.0054, 0.0107)]、母亲教育水平[未受过教育：分位数 = 0.1，95%置信区间(-49.7471, -32.1376)，分位数 = 0.25，95%置信区间(-38.1513, -22.4438)；小学：分位数 = 0.1，95%置信区间(-24.8095, -5.7693)，分位数 = 0.25，95%置信区间(-19.5273, -6.3424)；高中及以上：分位数 = 0.1，95%置信区间(5.6499, 40.3274)，分位数 = 0.25，95%置信区间(21.8158, 40.278)]、饮用水源[天然水源：分位数 = 0.1，95%置信区间(0.6877, 24.384)，管道供水：分位数 = 0.1，95%置信区间(25.578, 45.2368)，分位数 = 0.25，95%置信区间(22.2782, 34.8212)，瓶装/袋装：分位数 = 0.25，95%置信区间(3.438, 98.1675)]、厕所类型[冲水式：分位数 = 0.25，95%置信区间(2.2598, 18.3457)，其他：分位数 = 0.1，95%置信区间(8.7863, 24.504)，分位数 = 0.25，95%置信区间(7.0995, 20.1119)]、家庭财富指数[最贫困：分位数 = 0.1，95%置信区间(-52.5112, -16.9197)，分位数 = 0.25，95%置信区间(-48.3804, -23.0633)；较贫困：分位数 = 0.1，95%置信区间(-38.8744, -4.7586)，分位数 = 0.25，95%置信区间(-34.6993, -9.1766)；中等：分位数 = 0.25，95%置信区间(-28.9491, -6.5834)]、医疗保健就诊次数[未就诊：分位数 = 0.1，95%置信区间(-19.293, -3.6393)，分位数 = 0.25，95%置信区间(-17.2342, -5.6411)]、强化食品和块茎类食物的消费情况[未消费：分位数 = 0.1，95%置信区间(-36.3898, -12.0378)，分位数 = 0.25，95%置信区间(-17.8127, -1.2374)]、贫血状况[贫血：分位数 = 0.1，95%置信区间(-15.9326, -1.1929)，分位数 = 0.25，95%置信区间(-12.3361, -1.5516)]、蚊帐使用情况[未使用：分位数 = 0.1，95%置信区间(-22.0323, -0.8033)，分位数 = 0.25，95%置信区间(-13.8107, 1.1366)]、儿童年龄[0至12个月：分位数 = 0.1，95%置信区间(81.6424, 105.7155)分位数 = 0.25，95%置信区间(61.4817, 78.5194)；12至24个月：分位数 = 0.1，95%置信区间(0.5592, 24.933)，24至36个月：分位数 = 0.1，95%置信区间(7.9128, 40.2828)]以及性别[女性：分位数 = 0.1，95%置信区间(4.5351, 17.9783)，分位数 = 0.25，95%置信区间(5.0076, 15.4735)]，还有近期发烧情况[未发烧：分位数 = 0.1，95%置信区间(11.5663, 29.5984)，分位数 = 0.25，95%置信区间(7.0313, 20.8918)]。居住类型在分位数0.25时显著，但在分位数0.1时不显著[农村：分位数 = 0.25，95%置信区间(-14.7051, -2.1455)]。在较高分位数（0.75、0.85、0.9和0.95）时，蚊帐使用、配方奶喂养和管道供水等因素仍然显著，而母亲教育程度和财富指数等社会经济决定因素则失去了影响力。所有分位数的共同变量包括母亲年龄、儿童年龄（0至12个月）、儿童性别和近期发烧情况。 结论：这些发现强调了初级卫生保健干预在识别和管理营养不良方面的关键作用，特别是在严重营养不良占主导的较低分位数人群中。青少年和低收入母亲等高风险群体应获得有针对性的支持，包括产前课程和咨询。社区护理人员可以监测高危个体并确保及时转诊，与非营利组织的合作可以改善食品和补充剂的获取。推广社区菜园、清洁水供应和公共讲习班可以进一步助力预防和教育工作。
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