2017年-世界发展银行全球_Childhood_Stunting_in_Tajikistan___Quantifying_the_Association_with_WASH_Food_Security_Health_and_Care_Practices_36页_1mb

Summary of Childhood Stunting in Tajikistan: Quantifying the Association with WASH, Food Security, Health, and Care Practices

Core Content

This discussion paper examines the prevalence and determinants of childhood stunting in Tajikistan, highlighting the significant role of water, sanitation, hygiene (WASH), food security, health, and care practices. It analyzes data from two integrated nationally representative surveys conducted in late 2016, providing a more comprehensive understanding of the factors contributing to undernutrition than previously available.

Main Points

• Prevalence of Stunting: Over 20 percent of children under five in Tajikistan are stunted, the highest rate in Europe and Central Asia (ECA). In 2016, the national prevalence was 20.9 percent, with severe stunting at 6.4 percent.
• Multi-dimensional Determinants: Stunting is influenced by multiple factors including food security, food diversity, WASH access, health services, and care practices. The study emphasizes that these factors interact synergistically to affect child nutrition.
• Synergies in Interventions: The findings suggest that interventions targeting multiple risk factors (e.g., food security, WASH, health, and care) are more effective in reducing stunting than interventions focused on a single factor.
• Regional and Rural Disparities: Rural areas face higher risks of malnutrition compared to urban areas. The DRS region had the highest stunting prevalence (24%), while Dushanbe had the lowest (10.5%).
• Seasonal Food Poverty: Seasonal fluctuations in food poverty are significant, with higher rates in winter and spring. The food poverty rate in the first quarter of 2014 was 4 percentage points above the annual average, due to reduced consumption of cereals and oils/fats.
• Micronutrient Deficiencies: The study identifies widespread micronutrient deficiencies, including iron, vitamin A, and vitamin D, particularly in the Sughd region. Iron deficiency anemia is a major issue, affecting 53.2 percent of children, with severe cases at 66.4 percent in Sughd.
• Breastfeeding Practices: Breastfeeding is common in Tajikistan, with 90.8 percent of children under two years being breastfed. Exclusive breastfeeding for the first three months is practiced by 78.0 percent of mothers, but this declines sharply after five months.
• Integrated Data Approach: The study integrates data from two surveys to analyze the complex interactions between WASH, food security, health, and care practices, which is crucial for developing effective nutrition interventions.

Key Findings

• Strong Associations: There are strong associations between stunting and food calorie consumption, food diversity, access to WASH services, health care, and care practices.
• Overlapping Adequacies: Overlapping adequacies in these areas are strongly associated with reduced stunting risk, indicating the importance of multi-faceted interventions.
• Rural Focus: Interventions should predominantly focus on rural areas where the risk of malnutrition is significantly higher.
• Empirical Evidence: The paper provides empirical evidence on the drivers of undernutrition in Tajikistan, filling a gap in the literature and supporting policy and program development.

Data and Indicators

• Survey Integration: The study integrates data from two surveys, enhancing the depth and breadth of the analysis.
• Calorie Intake: Food consumption data is converted into calorie equivalents using a standard FAO concordance. Adjustments are made to adult equivalents based on age and gender.
• Food Diversity: An index of food diversity is used to assess the variety of food consumed by households, which is a key indicator of nutrition adequacy.
• WASH Indicators: Access to safe water and sanitation facilities is measured, with notable improvements in water access from 2000 to 2016, though disparities remain between urban and rural areas.

Methodology and Results

• Estimation Strategy: The study uses regression models (OLS and Probit) to assess the associations between undernutrition and various determinants.
• Results: The results show that the number of adequate components (food, WASH, health, care) is strongly associated with higher height-for-age z-scores. Individual indicators also have significant associations, but the combined effect is more pronounced.
• Policy Relevance: The findings align with the Government of Tajikistan's National Development Strategy 2030, which emphasizes the need to address environmental, food security, and nutritional deficits.

Conclusion and Recommendations

• Integrated Approach: The study recommends a more integrated and multi-sectoral approach to addressing childhood stunting.
• Program Focus: Programs should focus on both food inadequacy (calorie intake and diversity) and WASH, health, and care practices.
• Targeting Rural Areas: Rural areas should be a primary focus for interventions due to higher malnutrition risks.
• Need for Empirical Data: The paper highlights the need for more empirical data to inform effective nutrition programs and policies.

Keywords

Tajikistan, Nutrition, Stunting, WASH, Health, Food Security, Care Practices