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首页> 外文期刊>BMC Pediatrics >Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis
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Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis

机译：秘鲁5岁以下发育迟缓成功故事背后的因素：区域生态多层次分析

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Background Stunting prevalence in children less than 5?years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (?2.31%), Amazonas (?1.57%), Puno (?1.54%), Huanuco (?1.52%), and Ancash (?1.44). Those with the lowest reduction were Ica (?0.67%), Ucayali (?0.64%), Tumbes (?0.45%), Lima (?0.37%), and Tacna (?0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition.
机译：背景从1992年到2007年，秘鲁5岁以下儿童的发育迟缓患病率一直处于停滞状态，此后迅速下降。我们旨在评估2000年至2012年间不同部门间不同发育迟缓的预测因子的作用。方法我们使用各种辅助数据源来描述发育迟缓和可能的预测因子的时间趋势，包括远端到近端的决定因素。我们根据发育迟缓和不同预测因素的年度变化确定了部门的排名。为了说明随时间推移以及跨部门的差异，我们使用了基于分层混合效应回归模型的生态分层方法，并将发育迟缓视为结果。我们的分析单位为一个部门年。结果所有部门的发育迟缓都呈下降趋势，斜率不同。从2007年至2008年，减排速度更高。年度发育迟缓减少最高的部门是库斯科（2.31％），亚马逊（1.57％），普诺（1.54％），华努科（1.52％）和安卡什（1.44）。减少量最低的是伊卡（0.67％），乌卡亚里（0.64％），通贝斯（0.45％），利马（0.37％）和塔克纳（0.31％）。基线贫困率最高且农村人口最多的亚马逊和安第斯山脉部门的发育迟缓减少率最高。在多层次分析中，当考虑到混淆因素时，社会决定因素似乎是影响每年发育迟缓减少的最重要因素，各部门之间差异很大。结论可以通过采取扶贫政策和持续实施公平的跨部门干预措施来解释发育迟缓的减少，重点放在最贫困地区。包括生殖，孕产妇，新生儿和儿童健康干预措施的质量指标，可以使进一步分析显示出这些因素的影响。在长期停滞之后，由于社会决定因素和跨领域因素的综合影响，秘鲁大幅减少了国家和部门的发育迟缓患病率。这项经验为其他试图改善孩子营养的国家提供了有益的教训。

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