Probability of Children in Each state Being Next.

BackgroundEthiopia faces a high burden of undernutrition prevalence, ranking among the 15 worst-affected nations globally. So, this study aimed to find out how often and how long under-five children (U5C) in Ethiopia’s Amhara and Oromia regions move between different states of Composite Index Anthropometry Failure (CIAF) as well as what factors influence these changes.MethodsThe data used for this study was extracted from the International Food Policy Research Institute. The institute conducted a follow-up survey in three consecutive rounds: February 8, 2018–April 25, 2018; July 25, 2019–October 23, 2019; and February 8, 2021–April 25, 2021, respectively. The inclusion criteria were households that had children between the ages of 0 and 35 months, were participants in the safety net program, and had the mother or primary female caregiver during the baseline survey. A total of 3,044 households having children with at least two complete anthropometric measurements were included. A continuous-time multi-state Markov model was used to estimate transitions and their probability between CIAF’s states.ResultsNourished children had a 71% probability of becoming undernourished. Time taken to recover from undernourished state for U5C was 41 months on average. 75% of the U5C’s life is spent in the undernourished state. Girls had a 1.824 times higher likelihood of recovering from an overnourished state and were less likely to transit from a nourished state to an undernourished state compared to boys (HR: 0.8013). Children older than two years were more likely to recover from undernourished and overnourished states respectively (HR: 1.013 & 1.036), to a nourished state and less likely to transit back to the malnutrition states (HR: 0.9693 & 0.9662). Children of educated mothers and residents in the Oromia region had lower risk of transition from a healthy to an undernourished state respectively (HR: 0.8171& 0.8074).ConclusionUndernutrition will affect most U5Cs. Children whose mothers had no education and live in the Amhara region are more susceptible to undernutrition. The Ministry of Health and other relevant stakeholders should develop a practical intervention to enhance adult and maternal education programs.背景 埃塞俄比亚营养不良患病率居高不下，位列全球受营养不良影响最严重的15个国家之一。本研究旨在探明埃塞俄比亚阿姆哈拉州与奥罗米亚州境内五岁以下儿童（under-five children, U5C）在人体测量综合失败指数（Composite Index Anthropometry Failure, CIAF）不同状态间的转移频率与持续时长，以及影响这些状态转移的相关因素。 方法 本研究使用的数据提取自国际粮食政策研究所（International Food Policy Research Institute）。该机构先后开展了三轮连续随访调查，分别为：2018年2月8日—2018年4月25日、2019年7月25日—2019年10月23日，以及2021年2月8日—2021年4月25日。本研究的纳入标准为：家中拥有0~35月龄儿童、参与社会安全网项目，且在基线调查时有母亲或主要女性照护者参与的家庭。最终纳入3044户拥有至少完成两次完整人体测量的儿童的家庭。本研究采用连续时间多状态马尔可夫模型（continuous-time multi-state Markov model）估算CIAF各状态间的转移情况及其转移概率。 结果 营养正常儿童出现营养不良的概率为71%。五岁以下儿童从营养不良状态恢复所需的平均时长为41个月，75%的该类儿童生命周期处于营养不良状态。与男孩相比，女孩从营养过剩状态恢复的概率高1.824倍，且从营养正常状态向营养不良状态转移的可能性更低（风险比Hazard Ratio, HR：0.8013）。年龄超过2岁的儿童分别更易从营养不良、营养过剩状态恢复至营养正常状态（HR分别为1.013与1.036），且更不易反向转回营养不良状态（HR分别为0.9693与0.9662）。母亲受教育程度较高的儿童，以及居住在奥罗米亚州的儿童，分别具有更低的从健康状态向营养不良状态转移的风险（HR分别为0.8171与0.8074）。 结论 营养不良将影响绝大多数五岁以下儿童。母亲未接受教育且居住在阿姆哈拉州的儿童更易罹患营养不良。埃塞俄比亚卫生部及其他相关利益相关方应制定切实可行的干预措施，以完善成人教育与母亲教育项目。