PDF(Pubmed)
Abstract：
Despite a remarkable reduction in global poverty and famines, substantial childhood malnutrition continues to persist. In 2017, over 50 million and 150 million young children suffered from acute malnutrition (wasting) and chronic malnutrition (stunting), respectively. Yet, the measurable impact of determinants is obscure. We evaluate proposed socio-environmental related determinants of stunting and wasting across Kenya and Nigeria and quantify their effectiveness. We combine health and demographic data from Kenya and Nigeria Demographic Health Surveys (2003, 2008-2009, 2013, 2014) with spatially explicit precipitation, temperature, and vegetation data. Geospatial and disaggregated data help to understand better who is at risk and where to target mitigation efforts. We evaluate the responsiveness of malnutrition indicators using a four-level random intercept hierarchical generalized logit model. We find that spatial and hierarchical relationships explain 28% to 36% of malnutrition outcome variation. Temporal variation in precipitation, temperature, and vegetation corresponds with more than a 50% change in malnutrition rates. Wasting is most impacted by mother\'s education, family wealth, clinical delivery, and vaccinations. Stunting is most impacted by family wealth, mother\'s education, clinical delivery, vaccinations, and children asymptomatic of fever, cough, or diarrhea. Remotely monitored climatic variables are powerful determinants, however, their effects are inconsistent across different indicators and locations.
摘要：
尽管全球贫困和饥荒显著减少，严重的儿童营养不良继续存在。2017年，超过5000万和1.5亿幼儿患有急性营养不良（消瘦）和慢性营养不良（发育迟缓）。分别。然而，决定因素的可衡量影响是模糊的。我们评估了肯尼亚和尼日利亚的发育迟缓和消瘦的社会环境相关决定因素，并量化了它们的有效性。我们将肯尼亚和尼日利亚人口健康调查（2003年，2008年-2009年，2013年，2014年）的健康和人口统计数据与空间明确的降水相结合，温度,和植被数据。地理空间和分类数据有助于更好地了解谁处于危险之中，以及在哪里开展缓解工作。我们使用四级随机截距分层广义Logit模型评估营养不良指标的反应性。我们发现空间和等级关系解释了28％至36％的营养不良结果变化。降水的时间变化，温度,植被的营养不良率变化超过50％。浪费受母亲教育的影响最大，家庭财富,临床分娩,和疫苗接种。发育迟缓受家庭财富的影响最大，母亲的教育，临床分娩,疫苗接种,和没有发烧症状的儿童，咳嗽,或腹泻。远程监测的气候变量是强大的决定因素，然而,它们的影响在不同的指标和地点是不一致的。
