Critical examination of evidence for the nutritional status of children in Papua New Guinea - a systematic review

Peter J McGlynn ； Andre Μ Ν Renzaho ； Minh D Pham ； Mike Toole ； Jane Fisher ； Stanley Luchters

《Asia Pacific Journal of Clinical Nutrition》 預刊文章 Pp. 1-32

https://doi.org/10.6133/apjcn.042017.02

摘要

Background and Objectives: Undernutrition remains a neglected and significant cause of childhood illness, poor growth and development, and death in Papua New Guinea (PNG). We conducted a systematic review to collect evidence to add to PNG national data to estimate the prevalence of child undernutrition in PNG among different geographical locations and in different time periods. Methods and Study Design: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science and Global Health) and additional grey literature were searched for articles describing the nutritional status by wasting, stunting and underweight, of PNG children under five years of age, published between 1990 and April 2015. Prevalence data derived using different scales of measurement and reference populations were standardized using current World Health Organization (WHO) protocols. Due to differences in study designs, study populations, and the operationalisation of children's nutritional status, a meta-analysis was not possible. Results: The search yielded 566 articles, of which, 31 studies met the inclusion criteria. The prevalence of child undernutrition in community-based studies varied from 1% to 39% for wasting (median 11%), 10% to 91% for stunting (median 51%) and 14% to 59% for underweight (median 32%). Wide variations exist according to the index used for measurement, the population characteristics and the geographical region in which they live. Prevalence estimates from studies using different population references increased significantly when they are standardized to the current WHO protocols. Conclusions: Child undernutrition in PNG is a major contributor to preventable child illness requiring a complex mix of solutions for governments, health systems and communities to address. The wide variation and high prevalence of estimates of undernutrition from different studies and locations may reflect the diverse environments, population characteristics, lifestyles and cultural practices of different parts of PNG or may indicate the variation in study designs, population sampling methods or accuracy of anthropometric measurements. It impresses the need for area-specific surveys using standard WHO assessment and reporting protocols in order to compare the nutritional status of different populations with any confidence. Multiple measures over time using all available anthropometric indices would provide valuable trend data not available in single-measure cross-sectional studies and better inform the possible causes of the reported prevalence of undernutrition. There is an urgent need to increase monitoring, surveillance and evaluation of the nutritional and health status of PNG children and to implement programmes that can improve their nutritional status.

關鍵字

undernutrition ； stunting ； wasting ； Papua New Guinea ； systematic review