摘要：Objectives. To estimate trends of undernutrition (stunting and underweight) among children younger than 5 years covered by the universal health coverage programs Plan Nacer and Programa Sumar. Methods. From 2005 to 2013, Plan Nacer and Programa Sumar collected high-quality information on birth and visit dates, age (in days), gender, weight (in kg), and height (in cm) for 1.4 million children in 6386 health centers (13 million records) with broad coverage of vulnerable populations in Argentina. Results. The prevalence of stunting and underweight decreased 45.0% (from 20.6% to 11.3%) and 38.0% (from 4.0% to 2.5%), respectively, with differences between rural versus urban areas, gender, regions, age, and seasons. Conclusions. Undernutrition prevalence substantially decreased in 2 programs in Argentina as a result of universal health coverage. Unequal access to health care, inadequate nutrition, and higher levels of exposure to infections are the major causes of disparities in morbidity and mortality in children. 1,2 Inequalities in early life are expressed as restricted growth (stunting) and underweight, which not only impair children’s development physically, cognitively, socially, and emotionally but also lead to poorer educational and economic outcomes later in life. 3–5 Stunting has been considered the best proxy for child health inequalities because it reflects cumulative linear growth faltering during the prenatal period and the first years of life. 6 During the past decade, most Latin American countries implemented innovative programs to improve population health outcomes and to reduce inequalities in health access focusing on universal health coverage (UHC) for vulnerable populations. 7,8 Faced with deteriorating health indicators, in October 2004 Argentina’s government implemented Plan Nacer to strengthen a fragmented national health system plagued by strong jurisdictional asymmetries after the 2001 economic crisis. The program introduced innovative changes in the incentive framework of health care providers to equitably increase the access and quality of prioritized health services for pregnant women and children younger than 5 years. 9,10 Moving forward toward effective UHC, the follow-up program Programa Sumar was launched in 2013, expanding the strategy and extending health care coverage to 5.7 million children and adolescents (0–19 years) and 3.8 million women younger than 64 years. Both programs were implemented synergistically with the main conditional cash transfer programs Asignación Universal por Hijo and Asignación Universal por Embarazo. 11 Under both conditional cash transfer programs, the enrollment of beneficiaries in the UHC programs is a requisite that increases development options of vulnerable families and promotes preventive health care, nutrition, and education (more details available as a supplement to the online version of this article at http://www.ajph.org as Text S1). Several studies assessed the effects of UHC strategies coupled to conditional cash transfer programs introduced by Latin American countries. Improvements in anthropometric measures of growth and health statuses in children younger than 5 years were observed after the implementation of Bolsa de Familia in Brazil, 12 Oportunidades in Mexico, 13 and Familias en Acción in Colombia, 14 along with varied results in other countries. 7,15–17 Plan Nacer and Programa Sumar achieved significant improvements in birth outcomes by reducing the risk of neonatal death and increasing birth weight and contributed to a 22% reduction in infant mortality and a 10% reduction in maternal mortality between 2005 and 2012. 10,18 However, the outcome of these program implementations on the prevalence of undernutrition has not been analyzed before. We analyzed trends for the prevalence of stunting and underweight among the overall population of children younger than 5 years, who were beneficiaries of the UHC programs Plan Nacer and Programa Sumar during the 9-year period since their implementation (2005–2013). We assessed the impact of the programs’ implementation and contributed to developing a statistical model that generates updated population-based information to follow health progress on and challenges to child growth and development issues.
