Household food insecurity is associated with higher child undernutrition in Bangladesh, Ethiopia, and Vietnam, but the effect is not mediated by child dietary diversity

Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review

Background

Household food insecurity (HFI) and poor dietary diversity (DD) are major public health challenges in Asia, greatly contributing to stunting among children under five. While previous research has focussed primarily on African regions, this systematic review provides novel insights into the association between HFI, DD, and stunting within the Asian context.

Methods

We searched across six major databases for studies published between 2019 and 2023 exploring the association between HFI, DD, and stunting in children under five across Asia. We then extracted their characteristics, evaluation methods, and outcomes related to stunting for analysis.

Results

From 3215 records, 37 met the inclusion criteria. Most studies were from South Asia (n = 22), followed by Southeast Asia (n = 8), with fewer from West (n = 4), East (n = 2), and Central Asia (n = 1), highlighting geographical research gaps. We found high stunting rates among children under five, especially in South and Southeast Asia. Stunting was strongly linked to HFI and poor DD, suggesting that these factors are critical in addressing malnutrition. Socioeconomic factors, maternal education, and access to clean water also influence stunting outcomes.

Conclusions

Current research on HFI, DD, and stunting in Asia shows substantial variation, with the highest stunting rates in South and Southeast Asia. Limited data from Central and East Asia highlights the need for more comprehensive research in these regions. Addressing HFI and improving DD is critical for reducing stunting and achieving global nutrition targets by 2030.

Predictors of anemia among infants at the age of one year attending health centers in the West Bank/Palestine: a retrospective study

BACKGROUND

Anemia is a major problem among infants aged under 1 year. There are limited studies in Palestine about anemia among infants. Thus, this study aimed to address this gap.

METHODS

A retrospective study was conducted. A review of 1249 infants recorded in primary health centers of the West Bank, Palestine was performed during the period from January to December 2022. The collected data included sociodemographic factors, feeding practices, and hemoglobin levels. Descriptive statistics, correlations, and binary logistic regression were performed to analyze the data.

RESULTS

The findings showed that 35.2% of infants were anemic, of which 67.2% had mild anemia. The detrimental predictors for anemia were introducing complementary feeding earlier than six months of age, receiving exclusive bottle feeding with complementary feeding (solid or semisolid) at 12 months, and low family income. While receiving exclusive breastfeeding and complementary feeding at 12 months was a protective predictor.

CONCLUSION

Healthcare professionals should develop intervention programs to enhance hemoglobin levels and decrease anemia among infants while considering correlating factors.

Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh

Background

Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity.

Methods

We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity.

Results

A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods.

Conclusions

Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh.

Dietary diversity and associated factors among households and children in internally displaced person camps in Southern Somalia: A cross-sectional study

The study aimed to assess household and child dietary diversity in Southern Somalia by identifying determinants of adequate dietary diversity in three internally displaced person (IDP) camps in Baidoa, Dayniile and Dharkanley. A total of 1655 female main caregivers with 2370 children (6-59 months old) were included. Data on household dietary diversity score and child dietary diversity score indicators were collected from all households. The questionnaire was read face-to-face to the female main caregivers. Multivariate logistic regression analysis was performed to identify factors associated with adequate dietary diversity, which was defined as the consumption of at least four food groups within 24 h before the survey. The proportion of households achieving adequate HDDS was high in all locations 95.8%, 96.9% and 89.0% in Baidoa, Dharkanley and Dayniile, respectively, and the total adequate household dietary diversity score (AHDDS) was 95.6%. The proportion of adequate child dietary diversity score (ACDDS) was achieved in 63.5%, 8.5% and 38.3%. The main factors associated with AHDDS were larger household size, greater wealth, attendance of antenatal care (ANC) and joint decision-making between husband and wife, while factors associated with ACDDS included ANC attendance, age, the consumption of ready-to-use therapeutic food and deworming tablets. These findings can guide future programmes and policies aimed at improving maternal and child nutrition in IDP camps in Somalia. By tackling these diverse factors, a promising pathway emerges to enhance the nutritional welfare of both households and children in IDP camps.

Machine Learning Approach for Predicting the Impact of Food Insecurity on Nutrient Consumption and Malnutrition in Children Aged 6 Months to 5 Years

BACKGROUND

Food insecurity significantly impacts children's health, affecting their development across cognitive, physical, and socio-emotional dimensions. This study explores the impact of food insecurity among children aged 6 months to 5 years, focusing on nutrient intake and its relationship with various forms of malnutrition.

METHODS

Utilizing machine learning algorithms, this study analyzed data from 819 children in the West Bank to investigate sociodemographic and health factors associated with food insecurity and its effects on nutritional status. The average age of the children was 33 months, with 52% boys and 48% girls.

RESULTS

The analysis revealed that 18.1% of children faced food insecurity, with household education, family income, locality, district, and age emerging as significant determinants. Children from food-insecure environments exhibited lower average weight, height, and mid-upper arm circumference compared to their food-secure counterparts, indicating a direct correlation between food insecurity and reduced nutritional and growth metrics. Moreover, the machine learning models observed vitamin B1 as a key indicator of all forms of malnutrition, alongside vitamin K1, vitamin A, and zinc. Specific nutrients like choline in the "underweight" category and carbohydrates in the "wasting" category were identified as unique nutritional priorities.

CONCLUSION

This study provides insights into the differential risks for growth issues among children, offering valuable information for targeted interventions and policymaking.

Household food insecurity, dietary diversity with undernutrition among children younger than five years in Indian subcontinent-a narrative review

The emerging predictors of childhood undernutrition include household food insecurity (HFI) and inadequate diet diversity (DD). Geographical, socio-cultural, economic, and demographic factors contribute to HFI. Earlier, HFI was often considered an outcome of hunger and poverty leading to undernutrition. The increasing availability of data related to childhood DD and its direct association with undernutrition indicates that DD could mediate the relationship between HFI and undernutrition. This narrative review examined the association of HFI and/or DD with undernutrition in children younger than 5 years in the Indian subcontinent; and the current programmes and policies. The current evidence showed a possible association between HFI and DD either independently or together with childhood undernutrition. Until now, nutrition-specific interventions to address moderate and severe forms of undernutrition were focused, with a limited attention on nutrition-sensitive approaches to improve HFI and DD. Interventions which improve HFI and DD may be included in the existing programmes and would help address the undernutrition in children younger than 5 years.

Underweight and Predictors Among Children Aged 6-59 Months in South Ethiopia

Objectives

Underweight remains the primary public health concern among under-five-year-old children in Ethiopia, despite numerous government-implemented nutrition-specific and sensitive interventions. Therefore, this study aimed to assess underweight and associated factors among children in South Ethiopia.

Methods

Between March and April 2021, 717 children in the South Ari district who were between the ages of 6 and 59 months participated in a cross-sectional study. To choose a sample of households containing a minimum of one child between the ages of 6 and 59 months, a multi-stage sampling procedure was used. Data were collected by interviewer-administered structured questionnaires from the mothers of the children. To determine the factors associated with being underweight, a binary logistic regression analysis was built. All variables with a p-value <0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. To assess the strength of the association, an adjusted odds ratio (AOR) with a 95% confidence interval was used. With a p-value below 0.05, statistical significance was declared.

Results

The prevalence of underweight was determined to be 29.7% (95% CI: 26.5%, 33.2%). Child age 6-23 months [adjusted odds ratio (AOR) = 0.28; 95% confidence interval (CI): 0.18, 0.44], food insecurity (AOR = 1.48; 95% CI: 1.04, 2.10), sub-optimal child dietary diversity (AOR = 1.44; 95% CI: 1.01, 2.03), birth interval <24 months (AOR = 2.49; 95% CI: 1.75, 3.54), and common childhood illness (AOR = 2.21; 95% CI: 1.52, 3.21) were associated with being underweight.

Conclusion

Underweight among children is predicted by household food insecurity, suboptimal dietary diversity, and common childhood illnesses, necessitating further efforts to improve food security and manage common illnesses.

Household food insecurity and associated factors among postpartum women in southern Ethiopia: a community based cross sectional study

Approximately two billion individuals, or 26.4% of the global population, live in moderate- to severely food-insecure circumstances. It was discovered that not receiving all recommended antenatal care throughout one's pregnancy is one of the effects of household insecurity. The majority of women in Ethiopia, one of the most food-insecure countries in the world, with 10% of the population facing food poverty, devote more of their time to household duties, making food insecurity in the home the primary effect of poor prenatal care utilization. The main objective this study was to assess the status of household food insecurity among postpartum women at Arba Minch town, southern Ethiopia. A community-based cross-sectional study was conducted among 381 mothers who were enrolled from December 1, 2022, to January 30, 2023. The total sample size was allocated proportionately to the number of postpartum women living in each kebeles taking from the town registry of health extension workers for immunization. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using the statistical package of Social Science Version 26 (SPSS). In this study, the prevalence of food insecurity was 30.2% (95% CI 25.5-34.5). The associated factors with household food-insecurity were maternal occupation (AOR = 0.5, 95% CI 0.27, 0.90), late antenatal care initiation (AOR = 3.5, 95% CI 2.13, 5.91), and low monthly income (AOR = 3.1, 95% CI 1.38, 6.93). Food insecurity among postpartum mothers in the study area is high. Families who are severely food insecure require quick assistance to lower poor maternal and neonate's outcomes. Furthermore, enhancing the occupation of mothers is crucial in reducing the morbidities and mortality of food insecure mothers, such as delayed prenatal care services, anemia, low birth weight, and stillbirth.

Prevalence of adolescent-reported food insecurity and the determinants including coping strategies living in urban slum communities of Bangladesh during the era of COVID-19: a cross-sectional study

BACKGROUND

As food insecurity (FI) continues to rise worldwide especially in developing countries like Bangladesh, adolescent experience of FI have received minimal attention globally. This study aimed to identify the prevalence of adolescent-reported FI and its association with individual and socio-environmental factors as well as coping strategies amongst a sample of adolescents living in urban slum areas of Bangladesh in the times of the Coronavirus 19 (COVID-19) pandemic.

METHODS

A descriptive cross sectional study was conducted amongst 326 adolescents (12-18 years) living in the urban slums of Narayanganj, Dhaka from April to May, 2022. Adolescent-reported FI was assessed using a structured questionnaire adopted from Household Food Insecurity Access Scale (HFIAS). Descriptive statistics, Chi-square tests and ordinal logistic regression were used to draw inference.

RESULTS

Prevalence of adolescent-reported FI was high (46.6% moderate and 29.8% severe). The likelihood of experiencing moderate or severe FI versus no/mild FI were 1.7 times (95% Confidence Interval (CI) [1.1, 2.5]) higher in younger adolescents and 5 times (95% CI [2.3, 12.7]) higher in unemployed youth. Socio-environmental factors determining the economic status of a household such as higher number of family members, only one earning family member, unemployed father, no household assets, food aid received by the family during pandemic and positive COVID-19 infection in family were associated with moderate and severe FI. Coping strategies such as a higher number of food seeking strategies (Adjusted Odds Ratio (AOR) 3.4, 95% CI [1.9, 5.9]), substance use (AOR 6.2, 95% CI [1.2, 31.7]) and stopping school (AOR 3.3, 95% CI [1.9, 5.7]) increased odds for moderate and severe FI. Stratified by drop-out of school status, an association between food seeking strategies and FI remained significant among those school-going, while there was no association among those dropping out of school.

CONCLUSION

This study showed that adolescents living in urban slum communities in Bangladesh are at very high risk of FI and resort to harmful coping strategies. Our study highlights the importance of further research in adolescent reported FI and coping strategies in low to middle income countries (LMICs) and create appropriate interventions to lower FI among this group and improve their state of health and wellbeing.

Is women's household decision-making autonomy associated with their higher dietary diversity in Bangladesh? Evidence from nationally representative survey

In Bangladesh, a low-quality repetitive diet characterized by starchy staple foods is typical, leading to disorders associated with micronutrient deficiencies, particularly among mothers and their children. The purpose of the study was to validate the link between women's decision-making autonomy and higher dietary diversity score. Participants were ever married women aged 15-49 years old with comprehensive dietary information (n = 17,842), selected from the Bangladesh Demographic and Health Survey, 2014. The dietary diversity score (DDS) was obtained from a 24-h recall of dietary intake from nine food groups, categorized into lower DDS (DDS ≤ 4) and higher DDS (DDS ≥ 5). Descriptive analysis, bivariate and multivariate logistic regression were conducted using STATA version 15. Almost all women consumed starchy foods, flesh (83.86%), and fruits (67.30%). Using logistic regression, the odds of achieving dietary diversity score were higher among women who participated in household purchases (OR 2.40; 95% CI: 1.52-3.83; p = 0.022). Women who had higher and secondary education were 2.72 (95% CI: 1.49-3.02; p = 0.025) and 1.31 (95% CI: 0.58-2.18; p = 0.029) times more likely to achieve higher DDS than women having no education, as well as women in the richest quintile (OR 6.49; 95% CI: 4.12-8.5; p = 0.037) compared to women in the lowest quintile. This study highlighted the association of several socioeconomic conditions of ever married women and their dietary diversity score in Bangladesh. Therefore, promoting the women's education status, improving the socioeconomic conditions, and prioritizing their decisions are recommended for the attainment of higher dietary diversity score.

A systematic review and meta-analysis of the association of dietary diversity with undernutrition in school-aged children

BACKGROUND

Malnutrition in childhood has lasting consequences; its effects not only last a lifetime but are also passed down from generation to generation such as short stature, school-aged children are the most vulnerable section of the population and require special attention, including nutrition.

METHOD

We searched Medline through PubMed, Scopus, and Web of Science to identify all observational studies published before Jun 2022. Observational studies with a pediatric population aged 5-18 years that evaluated risk estimate with 95% confidence intervals the relationship between dietary diversity and undernutrition (wasting, stunting, and thinness) were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed.

RESULTS

This is a first systematic review and meta-analysis with a total of 20 studies were eligible (n = 18 388). Fourteen data evaluated stunting resulting in a pooled effect size estimated odds ratio of 1.43 (95% CI: 1.08-1.89; p = 0.013). Ten data evaluated Thinness resulting in a pooled effect size estimated odds ratio of 1.10 (95% CI: 0.81-1.49; P = 0.542). Two studies were revealed wasting with a odds ratio of 2.18 (95% CI: 1.41-3.36; p-value < 0.001).

CONCLUSION

According to the conclusions of this meta-analysis of cross-sectional studies, inadequate dietary diversity increases the risk of undernutrition in growth linear but not in thinness in school-aged children. The findings of this analysis suggest that initiatives that support improvements to the diversity of children's diets to reduce the risk of undernutrition may be warranted in LMICs.

Household Food Insecurity Negatively Impacts Diet Diversity in the Vietnamese Mekong Delta: A Cross-Sectional Study

Healthy, diverse diets are vital for life. In low/middle-income countries, however, the focus is more on food quantity rather than diet quality. This study assessed household diet diversity (HDD) in the Vietnamese Mekong Delta and its associations with household food insecurity (HFI) and household food availability (HFA) controlling for socioeconomic factors. Primary food-preparers in 552 randomly selected households in two rural provinces were interviewed about socioeconomic factors, HDD, HFI, and HFA. More than 80% of households predominantly consumed energy-dense foods, whereas less than 20% consumed nutrient-dense foods. Lower HDD was associated with HFI, lower HFA, for the Khmer ethnic minority, and low livelihood capitals (landlessness, low expenditure, debt) and low utensil scores. The study highlighted the need to provide improved food and nutrition policies that increase availability and access to diverse and healthy foods as well as reduce poverty and increase incomes for at-risk rural and ethnic minority groups.

Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa?

OBJECTIVE

We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship.

DESIGN

Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis.

SETTING

West Africa.

PARTICIPANTS

132 448 under-five children born within 5 years preceding the survey were included.

RESULTS

Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend P-values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship.

CONCLUSIONS

The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.

Seasonal variation in the association between household food insecurity and child undernutrition in Bangladesh: Mediating role of child dietary diversity

Household food insecurity (HFI) and child dietary diversity (CDD) are variable across seasons. We examined seasonal variation in HFI and child undernutrition association and tested how CDD mediates this association. We analyzed data for 26,353 children aged 6-59 months drawn from nationally representative cross-sectional Food Security and Nutrition Surveillance Project data collected during 2012-2014 in Bangladesh across three seasons annually: Post-Aman harvest (January-April); Monsoon (May-August); and Post-Aus harvest (September-December). Multivariable logistic regression analysis adjusted for individual, maternal, household and geographical characteristics reveals that children of food-insecure households were more likely than food-secure households to be stunted (adjusted odds ratio, AOR: 1.12; 95% confidence interval, CI: 1.02-1.23; p < 0.05), wasted (AOR: 1.21; 95% CI: 1.05-1.39; p < 0.01) and underweight (AOR: 1.16; 95% CI: 1.04-1.3; p < 0.01). CDD mediated 6.1% of the total effect of HFI on underweight. These findings varied across seasons. HFI was associated with greater odds of underweight during Monsoon (AOR: 1.32; 95% CI: 1.08-1.62; p < 0.01) and Post-Aus (AOR: 1.21; 95% CI: 1.06-1.37; p < 0.01) while wasting during Post-Aus (AOR: 1.65; 95% CI: 1.35-2.01; p < 0.001). CDD largely mediated the total effect of HFI on underweight during the Post-Aman in 2012-2014 (23.2%). CDD largely mediated the total effect of HFI on wasting (39.7%) during Post-Aman season in 2014 and on underweight (13.7%) during the same season in 2012. These findings demonstrate that HFI is seasonally associated with child undernutrition and mediated by CDD as well in Bangladesh and seasonality and diversity should be considered while designing appropriate population-level food-based interventions to resolve child undernutrition.

Knowledge, Attitudes and Practices of Pregnant Women and Healthcare Providers in Bangladesh regarding Multivitamin Supplements during Pregnancy

Micronutrient deficiencies are widespread among pregnant women in low- and middle-income countries (LMIC) and lead to potentially adverse effects for mother and baby. In Bangladesh, maternal malnutrition remains a severe problem, with high rates of anemia (49.6% of pregnant women and 47.8% of lactating women are anemic) and other nutritional deficiencies. A Knowledge, Attitudes, and Practices (KAP) study was conducted to assess Bangladeshi pregnant women's perceptions and related behaviors, as well as awareness and knowledge among pharmacists and healthcare professionals concerning prenatal multivitamin supplements. This was done in both rural and urban areas across Bangladesh. A total of 732 quantitative interviews were conducted (330 with providers and 402 with pregnant women, with an equal split between urban and rural areas for both sets of audiences; 200 women were users of prenatal multivitamin supplements, while 202 women were aware non-users). The study identified a few findings that can guide further research or market-based interventions to reduce micronutrient deficiencies. These include most pregnant women not knowing the right time to start multivitamin supplements (56.0%, [n = 225], stating that a woman should start taking supplements 'after the first trimester'), not knowing their benefits, and how they help both the mother and baby-only 29.5% [n = 59] stated that they believed the supplements helped their baby to grow well). Further, barriers to taking the supplements include women believing a nutritious diet is a substitute (88.7% [n = 293]), and a perceived lack of support from other family members (21.8%, [n = 72]). This suggests that there is a need for further awareness-raising among all pregnant women, their family members, and providers.

Dietary Diversity, Household Food Insecurity and Stunting among Children Aged 12 to 59 Months in N'Djamena-Chad

BACKGROUND

Household food insecurity is increasingly recognized as a global health problem, particularly in sub-Saharan Africa. This study aimed to contextualize the associations between household food insecurity, dietary diversity and stunting in N'Djamena.

METHODS

This study is a community-based cross-sectional study, and the SMART (Standardized Monitoring and Assessment of Relief and Transitions) methodology was used to calculate the sample size. A total of 881 households were selected for the survey. A 24-h recall evaluated the dietary diversity score (DDS), the Household Food Insecurity Access Scale (HFIAS) made it possible to assess household food insecurity (HFI), and stunting among children aged 12 to 59 months was assessed by anthropometric measurements. Logistic regression was constructed to determine the association between household food insecurity, dietary diversity, and stunting. The study was conducted from January to March 2022.

RESULTS

The prevalence of severe food insecurity was 16.6%, and that of stunting was 25.3%. The mean DDS was 6.5 ± 1.6. Severe food insecurity (OR 2.505, CI: 1.670-3.756) was significantly associated with stunting. The association between DDS and stunting was not significant.

CONCLUSIONS

This study's prevalence of household food insecurity and stunting was very high. Household food insecurity and household size were significantly associated with stunting.

Household food insecurity and coping strategies among rural households in Kedida Gamela District, Kembata-Tembaro zone, Southern Ethiopia: mixed-methods concurrent triangulation design

BACKGROUND

Household food insecurity is a state in which household members experienced limited or uncertain physical and economic access to safe, plenty, and healthy food to meet the dietary needs for a fruitful, healthy, and active life. Food insecurity continues to be a major development and public health problem across the globe, having adverse consequences. This study was done to assess household food insecurity and to explore coping strategies in Kedida Gamela District, Southern Ethiopia.

METHOD

A cross-sectional study complemented with the qualitative inquiry was carried-out from August to November 2020. Multistage sampling was used to select study subjects. A total sample of 597 households was selected randomly using up to date family folder list in the district as a sampling frame. For the qualitative study, 16 food-insecure households were selected randomly from food in secured households. Quantitative data were entered using Ep-Data 3.1 and exported to SPSS 20 for analysis. Bivariate analysis was carried out to see the crude association between each independent variable and outcome variable. P-value < 0.05 and 95%CI for adjusted odds ratios (AOR) were used to declare the significance of the associations. The qualitative data were analyzed using thematic analysis.

RESULT

The findings of this study showed that 76% of the households were food insecure. Being female-headed households [AOR: 2.82:CI(1.10, 7.24)], absence of formal education [(AOR: 9.75:CI (3.7, 11.31)], lack of engagement in non-farm farm activities [(AOR; 3.30: CI (1.86, 5.96)], absence of credit service [AOR:4.04; C I (2.11,7.73)], presence of dependent household members [AOR: 3.47;(2.91,6.34)], poorest wealth status [AOR;9.86:CI (3.72, 15.85)] were factors significantly associated with food insecurity of the households. Food insecure households employed different coping strategies with the respective level of food insecurity.

CONCLUSION

The findings of this study indicated that household food insecurity was higher in the study area. Moreover, sex, educational status, wealth status of the households; engagement of households in off/non-farm farm activities, credit service, and active and inactive labor force were significantly associated with household food insecurity. Food insecure households practice different coping strategies with respective food insecurity levels from the less severe strategy of eating inedible, fewer-quality foods to the most severe of migrating and begging for food. Planning and exhaustively implementing sustainable food security programs should get due attention.

Coping Strategies to Mitigate Food Insecurity at Household Level: Evidence From Urban Setting in Addis Ababa, Ethiopia

Food insecurity is the limited or uncertain ability of households to acquire nutritionally adequate and safe foods in socially acceptable ways. There is paucity of empirical evidence on household food insecurity, level of expenditure, and coping strategies in urban setting of Ethiopia. The objective of this paper is to examine the coping strategies of food insecure households in an urban area setting of Addis Ababa, Ethiopia. This study is based on data collected from 632 mothers interviewed in 2017. Multi-stage sampling techniques were carried out to identify the study unit from selected sub-cites. From each sub-city, proportion to population sampling was applied to obtain the sample size. Simple random sampling method was used to select districts in each sub-city. Multivariable logistic regression model was used to identify factors associated with food security status. The most common coping strategies households used in response to food insecurity were: rely on less preferred and less expensive foods, borrow food, or borrow money to buy food and purchase of food on credit. Food insecure households were 3 times more likely to rely on help from a relative or friend outside the household [AOR = 2.37; 95% CI: (1.01, 5.53); P < .047] compared to food secure households. Similarly, food insecure households were approximately 4 times more likely to limit portions at mealtimes [AOR = 3.55; 95% CI: (1.36, 9.30); P < .010] compared to food secure households. Furthermore, households with no access to a bank or microfinance savings account were 3 times [AOR = 2.62; 95%: (1.21, 5.66); P < .014] more likely to become food insecure compared to those with access to financial services. Households rely on less preferred cheap foods or lending to cope with food insecurity in urban settings of Ethiopia. Encouraging households to practice urban gardening, social protection through integrated national safety net programs, and improving access to microfinance services would be vital to address food insecurity among urban households of the country to bring successful social and economic development.

The Migration Response to Food Insecurity and Household Shocks in Southwestern Ethiopia, 2005–2008

This article examines how severe food insecurity and other shocks impact internal and international migration in southwestern Ethiopia using longitudinal survey data collected between 2005 and 2008 from a random sample of urban and rural households. We found an elevated risk of internal and international migration among sons and daughters in households that experienced severe food insecurity or farm loss. A household member's illness or death also significantly increased the risk of internal migration regardless of a household member's relationship with the household head. We also found that the effects of severe food insecurity and the other shocks were additive. With each additional shock, the risks of migration incrementally increased. This article provides compelling evidence of an international and an internal migration response to food insecurity and other shocks in a context where the prevalence of international migration is increasing and the potential for future international migration is substantial. These results challenge conventional wisdom in the migration literature that food insecurity and other household shocks will have larger relative effects on internal compared to international migration.

Does income imply food security in coffee growing communities? A case study in Yayu, Southwestern Ethiopia

The impacts on food security of a transition from agriculture focused on local consumption to the participation in global markets are uncertain, with both positive and negative effects reported in the literature. In Ethiopia, coffee production for global markets has attracted growers from across the country to the coffee-forest zones. From a national perspective, the area is not a priority for food security enhancement, as financial indicators suggest food sufficiency. In this setting, we collected food security and dietary intake data from a total of 420 (3X140) units of households, non-breast-feeding children under 5 years, and women of reproductive age. Sampling was done in two-stages, a random selection of 300 households (out of a total of 4,300) Yayu, followed by sub-sampling of households with a child and woman meeting the above-mentioned criteria. Samples were used to determine a number of food and nutrition security indicators. More than 83% of the households were found to be hunger-free in the shortage season, but dietary diversity was suboptimal. More than 50% of children under 5 years of age and women lacked foods containing heme iron in the surplus season and 88% in the shortage season. Household food security during the surplus season did not depend on income, but wealth was significantly correlated (p &lt; 0.01) with all of the food insecurity indicators except the “Body Mass Index” of target women in the shortage season. The strongest and weakest correlation was with the “House Food Insecurity Access Scale” (−0.85), and “Weight-to-Age Z-Score” (0.25), respectively. Overall, Yayu is not fully food secure, though the situation is better than average for the country. While household income helps in achieving calorific sufficiency, greater awareness of the relevance of dietary diversity and the local means to achieve it is needed to further improve nutritional status, regardless of the participation in global markets.

Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe

Introduction

Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied.

Methods

We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18).

Results

A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time.

Conclusion

FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.

Determinants of stunting in children aged between 6-23 months in Musanze region, Rwanda

Under-nutrition causes approximately half of all deaths in young children every year globally which is exacerbated by the multiple malnutrition burden. Infant and young child feeding practices pose immediate effects on the nutrition status of under 2 years aged children and greatly influence the survival of a child. This study aimed at determining the implication of the infant and young child feeding practices in evaluating stunting in young children among other stunting risk factors. Analytical cross-section study was carried out in Musanze, a district of Rwanda and involved 241 mothers having children aged between 6 and 23 months. Data was collected using a validated semi-structured questionnaire with observations and check list guides. Chi-square test and logistic regressions were used to determine the associations and risk factors of various variables. The results show that minimum meal frequency (MMF) was attained at 83% rate, minimum dietary diversity (MDD) at 57%, minimum acceptable diet (MAD) at 53% with consumption of iron rich foods at 29%. Stunting prevalence was 28%. The MAD had a significant (p = 0.021) association with height-for-age Z-score of a child and was found to be the stunting's predictor. The child's sex, consumption of animal sourced foods, child underweight status and income type were revealed as other stunting risk factors. A holistic approach that promotes infant and young child feeding practices and complementary feeding in particular can contribute to the alleviation of the stunting burden in Rwanda. Further, other associated factors that influence child nutrition status should be taken into consideration by the policy decision makers and development partners when developing food and nutrition sensitive programs and interventions.

Stunting among children aged 24-59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24-59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24-59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

Patient perception of doctor communication skills and patient trust in rural primary health care: the mediating role of health service quality

Background

This study aimed to explore the relationship between communication skills, health service quality, and patient trust in primary health services.

Method

This study was conducted in village clinics in rural China. A simple random sampling method was used to select volunteer village clinics and patients. In total, 574 participants from 25 village clinics were selected with the help of local health officers and village doctors. The response rate was 90%. Statistical analyses (hierarchical linear regression analysis and a structural equation model) were performed to analyze the data.

Results

Patient trust in doctors in rural primary health was influenced by patient perceptions of doctors’ communication skills and health service quality. However, health service quality fully mediated the relationship between doctors’ communication skills and patient trust in village clinics. In other words, doctors’ communication skills indirectly influence patients’ trust in doctors.

Conclusions

This study found a link between doctors’ communication skills and patient trust. The findings suggest that health managers and doctors should attach great value to communication skills and health service quality in promoting the rural doctor-patient relationship. Moreover, the relationship between doctors and patients should be considered when reforming the primary health system.

Malnutrition among under-five children in St. Martin's Island, Bangladesh: A cross-sectional study on prevalence and associated factors

Objectives

Early childhood nutrition is critical for physical and mental development, and any hindrance (malnutrition) at this stage adversely affects adulthood which makes them more susceptible to a variety of communicable and non-communicable diseases. St. Martin's Island was the focus of this study, which examined the prevalence and risk factors for malnutrition among under-five children.

Methods

In this cross-sectional study, 256 children aged under five were assessed for anthropometry, and multiple logistic regression models were fitted to identify potential predictors of malnutrition. For analysis, SPSS and WHO Anthro software were used.

Results

The prevalence of stunting, wasting, underweight, and overweight were 34.4%, 17.6%, 18.9%, and 6.9% respectively among children under-five years of age in St. Martin's Island. An increase in child's age decreases their risk of being stunted (AOR = 0.97, p = 0.006). Males were more likely than females to be wasted (AOR = 2.03, p = 0.001). Both stunting (AOR = 2.42, p = 0.004) and wasting (AOR = 2.82, p = 0.015) rate were higher among the poorer section as compared to the richest. On the contrary, underweight was low among the poorest section (AOR = 0.37, p = 0.024). Other socio-economic factors, for example, household food insecurity, and parental occupation affect these forms of malnutrition significantly.

Conclusion

Prevalence of all forms of malnutrition except underweight was higher as compared to the national perspective in St. Martin's Island among the under-five children. Community-based approaches by the local government in collaboration with various non-government organizations should be taken to reduce and prevent malnutrition among children.

Determinants of Feeding Patterns with Stunting in Children in the Coastal Area of Bengkulu City

BACKGROUND: The age of 0–2 years is a golden period for human growth and development known as the “golden age,” characterized by rapid growth. This period is the First 1000 Days of Life (HPK). The proper diet greatly affects the nutritional status of children. AIM: The purpose of the study was to determine child feeding patterns with the incidence of stunting in children in the Coastal area of Bengkulu City. METHODS: This study was an analytical observational study with a cross-sectional design. The research sample was children under five aged 6–24 months in the coastal area of Bengkulu City as many as 75 children were selected using the accidental sampling technique. Children’s nutritional intake using the Semi Food Frequency questionnaire for energy, protein, fat, carbohydrates, calcium, iron, zinc, and phosphorus. Nutritional intake data were processed by nutrisurvey. Data analysis with Chi-square test and the level of significant 0.05. RESULTS: The frequency of food consumed by children 6–24 months in the form of mashed food 2 times a day was 54.2%, soft food 3 times a day was 54.5%, and family food 3 times a day was 82.5%. The percentage of children with energy, protein, fat, and carbohydrate intake below the recommendation was much higher in normal children (in sequence 84.6%, 81.8%, 84.9%, and 86.3%) compare to stunted children (in sequence 15.4%, 18.2%, 15.1%, and 13.7%). Likewise, calcium, fe, zinc, and phosphor intake below the recommendation was much higher in normal children (in sequence 82%, 85.5%, 80.6%, and 82.1%) compare to stunted children (in sequence 18%, 14.5%, 19.4%, and 17.9%). CONCLUSIONS: There was no relationship between the type of food, macronutrient and micronutrient intake with stunting. Education and counseling at Integrated Healthcare Center need to be carried out, regarding the importance of consuming the proper food and the proper frequency of eating, surveys of nutritional consumption and routine health checks for pregnant women and children under five.

Dietary diversity and associated factors among preschool children in selected kindergarten school of Horo Guduru Wollega Zone, Oromia Region, Ethiopia

BACKGROUND

Preschool children are the most vulnerable group because of their high nutritional needs for growth and development. The study assessed dietary diversity scores and associated factors among preschool children in selected kindergarten schools of Horo Guduru Wollega Zone, Western Ethiopia.

METHODS

The institutional-based cross-sectional study design was conducted on a total 440 of preschool children. A semi-structured questionnaire was used to collect information on the dietary diversity score of preschool children using a 24 h dietary recall method. Binary logistic regression was used to identify variables associated with dietary diversity scores of preschool children.

RESULTS

The result showed that the majority (87.3%) of preschool children in the selected kindergarten school practiced a low dietary diversity score (less than four food groups). The result obtained from multivariate logistic regression analysis indicated that the age of preschool children [AOR 9.58(2.26-40.60)], sex of child [AOR 3.21(1.71-5.99)], and work of mother [AOR 7.49(2.33-24.07)] were significantly (p < 0.05 associated) with dietary diversity of children.

CONCLUSIONS

The findings indicated that many preschool children in the study area did not get a minimum dietary diversity score. Therefore, health extension workers must organize community-based behavior change nutritional education for mothers or caregivers to create awareness of preschool child dietary diversity practices.

Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: A repeated cross-sectional assessment

The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (β = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (β = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress.

Household food insecurity and unimproved toilet facilities associate with child morbidity: evidence from a cross-sectional study in Bangladesh

BACKGROUND

Despite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh.

METHODS

We used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6-59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders.

RESULTS

A total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95).

CONCLUSIONS

Our study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Impact of lockdown due to COVID-19 on nutrition and food security of the selected low-income households in Bangladesh

This study aims to explore the impact of COVID-19 pandemic lockdown on household food security and the nutritional status of the children and identify the risk factors associated with it. A cross-sectional study was conducted in 220 households having at least one under 5 children of Narayanganj district in Bangladesh. Household food insecurity, coping strategies and nutritional status of children were the main outcome variables. Multivariate logistic regression analysis was performed to investigate the significant determinants. A total of 93.2 % of households were food insecure, with 32.3% experiencing mild, 18.6% facing moderate, and 42.3% undergoing severe food insecurity. Forty seven percent households used high coping strategies and 93.2% of households consumed less expensive/preferable food as the common coping technique. Logistic regression analysis showed the variables significantly associated with moderate to severe food insecurity were low household income before COVID-19 (AOR = 46.07, CI: 13.68-155.10), more reduction of family income (AOR = 32.47, 95% CI: 9.29-113.41), maternal occupation as housewife (AOR = 7.73, CI: 2.59-23.07), losses of job (AOR = 4.28, CI: 1.31-13.98) and higher family members (AOR = 3.39, CI: 1.07-10.71). The prevalence of stunting, underweight and wasting in children under 5 years of age were 29.0%, 23.4% and 15.6%, respectively. Significantly the independent predictors of stunting were maternal occupation, education, age, household head occupation, child age, and the coping strategy score. Household dietary diversity score was an important independent predictor of underweight and wasting. In conclusion, social safety net initiatives for vulnerable households along with maternal education and employment should be strengthened to reduce hunger and malnutrition.

The Household Food Security Implications of Disrupted Access to Basic Services in Five Cities in the Global South

COVID-19 has caused significant disruptions regarding the extent to which households can access basic services and resources in cities around the world. Previous studies have indicated a predictive relationship between the consistency of resource access and food access among urban households. These investigations, however, have predominantly been isolated to Southern Africa and have not accounted for other dimensions of food security. To test whether these results are observable outside Southern Africa, and with a more multidimensional measure of food security, this investigation proposes a method for building an index of urban household food access, utilization and stability. The scores for the constructed index are then compared across household survey samples collected from five cities in the Global South. The investigation then assesses the predictive relationship between the consistency of household resource access and this more multidimensional index of food insecurity. While the general trend of inconsistent resource access predicting food insecurity is confirmed, there are geographic differences in the strength and quality of this relationship. These findings suggest that the resource access disruptions inflicted by COVID-19 will likely have a heterogeneous impact on urban food security dependent upon the affected resource and the city in which a given household resides.

Characterizing Undernourished Children Under-Five Years Old with Diarrhoea in Mozambique: A Hospital Based Cross-Sectional Study, 2015-2019

Diarrhoea is associated with undernutrition and this association is related to increased morbidity and mortality in children under-five. In this analysis we aimed to assess the frequency and associated factors of undernutrition in children under-five with diarrhoea. A hospital-based cross-sectional study was conducted from January 2015 to December 2019 through a surveillance system in five sentinel hospitals in Mozambique. Sociodemographic and clinical information was collected, including anthropometry. A total of 963 children were analysed. The overall undernutrition frequency was 54.1% (95% CI: 50.9−57.2), with 32.5% (95% CI: 29.6−35.5) stunting, 26.6% (95% CI: 23.9−29.6) wasting and 24.7% (95% CI: 22.1−27.5) underweight. Children from Nampula province had 4.7 (p = 0.016) higher odds for stunting compared with children from Maputo. Children whose caregiver was illiterate had higher odds of being underweight 5.24 (p < 0.001), and the wet season was associated with higher odds 1.70 (p = 0.012) of being wasted. Children born under 2500 g of weight had 2.8 (p = 0.001), 2.7 (p < 0.001) and 2.6 (p = 0.010) higher odds for being underweighted, wasted and stunted, respectively. The HIV positive status of the children was associated with higher odds of being underweight 2.6 (p = 0.006), and stunted 3.4 (p = 0.004). The province, caregiver education level, wet season, child’s birthweight and HIV status were factors associated with undernutrition in children with diarrhoea. These findings emphasise the need for additional caregiver’s education on the child’s nutrition and associated infectious diseases. More studies are needed to better understand the social context in which a child with diarrhoea and undernutrition is inserted.

Community-level environmental characteristics predictive of childhood stunting in Bangladesh - a study based on the repeated cross-sectional surveys

Coastal morphology makes Bangladesh vulnerable to environmental hazards and climate change. Therefore, environmental characteristics may shape population health, including child health. The prevalence of stunting among under-five aged (U5) children is high in Bangladesh. However, there is a lack of research on environmental predictors of stunting. This study aimed to assess the association between community-level environmental characteristics and stunting using pooled data from the three latest Bangladesh demographic and health surveys (BDHS). According to the multilevel model, rainfall, distance to protected areas, and vegetation index showed a nonlinear association with stunting. The temperature was inversely, and distance to water bodies was positively related to stunting. Overall, results evidence the environmental characteristics are predictive of stunting, and these characteristics should be taken into account during intervention design to minimise the negative effects of environmental change on child health. Further research is also necessary to comprehend the causal pathways between environmental characteristics and stunting in Bangladesh.

Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review

BACKGROUND

The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting.

METHODS

This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020.

RESULTS

Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity.

CONCLUSIONS

This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

Food Access, Food Consumption, and Children's Nutritional Status of Smallholder Farmer in Sinabung's Eruptions-Prone Areas, Indonesia

Destructive impacts resulting from volcanic eruptions affect food production severely, leading to the deterioration of food access and food consumption. Thus, we spotted the urgency of researching food access, household food consumption, and nutritional status of children in Sinabung's eruptions-prone areas, Indonesia. A cross-sectional study was carried out among 368 (158 farmers only and 228 farmers plus farm laborers) households headed by farmers. An interviewer-administered questionnaire was used for data collection. Three indices were used for assessing the nutritional status of children namely weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Data on household food consumption were collected by using the food consumption score (FCS). The household food consumption among the two groups of farmers was significantly different. Farmers plus farm laborers had a slightly better variety of food since they could collect free vegetables and fruits from the fields where they were working as a farm laborers. Household food consumption was significantly associated with the nutritional status of children. But in the group of farmers-only, the correlation between household food consumption and underweight was not significantly associated. To improve food access and food consumption, the policymakers should provide information about other job opportunities (as an agricultural laborer on another farm) to the farmers, and help them to reach out to those jobs, especially during unpredictable circumstances like Sinabung's eruptions.

Household cooking fuel type and childhood anaemia in sub-Saharan Africa: analysis of cross-sectional surveys of 123, 186 children from 29 countries

OBJECTIVE

This study sought to investigate the joint effect of household cooking fuel type and urbanicity (rural-urban residency) on anaemia among children under the age of five in sub-Saharan Africa.

DESIGN

We analysed cross-sectional data of 123, 186 children under the age of five from 29 sub-Saharan African countries gathered between 2010 and 2019 by the Demographic and Health Survey programme. Bivariate (χ² test of independence) and multilevel logistic regression were used to examine the effect of urbanicity-household cooking fuel type on childhood anaemia. Results were reported as adjusted odds ratios (aORs) with 95% CIs at p<0.05.

OUTCOME MEASURES

Anaemia status of children.

RESULTS

More than half (64%) of children had anaemia. The percentage of children who suffered from anaemia was high in those born to mothers in Western Africa (75%) and low among those born in Southern Africa (54%). Children from rural households that depend on unclean cooking fuels (aOR=1.120; 95% CI 1.033 to 1.214) and rural households that depend on clean cooking fuels (aOR=1.256; 95% CI 1.080 to 1.460) were more likely to be anaemic as compared with children from urban households using clean cooking fuel. Child's age, sex of child, birth order, perceived birth size, age of mother, body mass index of mother, education, marital status, employment status, antenatal care, wealth quintile, household size, access to electricity, type of toilet facility, source of drinking water and geographic region had significant associations with childhood anaemia status.

CONCLUSIONS

Our study has established a joint effect of type of household cooking fuel and urbanicity on anaemia among children under the age of five in sub-Saharan Africa. It is therefore critical to promote the usage of clean cooking fuels among households and women in rural areas. These should be done taking into consideration the significant child, maternal, household, and contextual factors identified in this study.

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa

BACKGROUND

The United Nations' 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for "leaving no one behind". However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa's and India's Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children's health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition.

METHODS

Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities.

RESULTS

The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (-0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother's education, and mother's age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries.

CONCLUSIONS

The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother's education, and mother's age. In conclusion, if socioeconomic inequalities in children's health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely "some under-five children will be left behind".

Grain security assessment in Bangladesh based on supply-demand balance analysis

Ensuring the grain supply-demand balance and achieving grain security had been the main tasks for the government of Bangladesh. On the supply side, Bangladesh's supply of grain products has increased substantially, with an average annual growth rate of 1.99 million tons in 1998-2018. Domestic grain production, especially rice production, accounted for the largest proportion in its structure. However, under the constraints of resources and environment, imports and international aid were needed to ensure a stable and sustainable grain supply. On the demand side, Bangladesh's demand for grain products continued to grow at an average annual rate of 2.09 million tons and its structure was constantly diversified. In recent years, domestic grain production has fully met the grain demand for food use, but the overall grain supply dependence on foreign gradually increased. From the analysis of the influencing factors, the grain supply, especially the domestic production of rice and maize, had the greatest impact on the balance of grain supply-demand in Bangladesh. Moreover, multiple cropping index, chemical fertilizer application per hectare and irrigation rate were the three main factors affecting grain production. As a typical agricultural country, Bangladesh's grain security was faced with challenges, such as high population density, insufficient cultivated land resources, international grain trade and frequent natural disasters. It is suggested that its government should strengthen scientific and technological research, adjust agricultural structure, improve the efficient utilization of agricultural resources and grain circulation systems, and balance the grain demand between food use and indirect use, so as to achieve complete grain self-sufficiency and overall grain security.

Factors associated with dietary diversity among adolescents in Woldia, Northeast Ethiopia

Background

Consuming diversified food during the adolescent period is essential to build a healthy and active mind for their later life. Food prices increased in the local market due to fewer production of crops. Thus, exploring the dietary diversity of adolescents in this area is crucial to estimate diet quality. So the aim of the study was to identify determinant factors of dietary diversity.

Methods

An institution-based cross-sectional study was conducted among adolescent students in Woldia town. A total of four hundred eleven students were included in the study. A simple random sampling technique was used to select the participants. The outcome variable was dietary diversity; it was calculated by summing of the number of food group consumed by individuals in the given reference period. Bivariable and multivariable logistic analysis was done. The odds ratio with a 95% confidence interval was computed to measure an association. A variable with a P-value less than 0.05 is considered a significant factor.

Results

The proportion of inadequate dietary diversity was 49.1% (95% CI 44.5–53.8). Being female (AOR =5.53, 95% CI 3.447–8.859), secondary and above mothers’ education level (AOR=0. 27, 95%CI 0.153–0.477), living in a family size five and above (AOR= 2.09, 95CI% 1.31–3.34), and poor knowledge about nutrition (AOR=4.56, 95% CI 2.727–7.639) were significantly associated with inadequate dietary diversity.

Conclusions and recommendations

Inadequate dietary diversity was associated with sex, knowledge of nutrition, maternal education level, and family size. It is better to design a nutrition intervention program that focus on nutrition education to scale up diversified food consumption among adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00430-6.

Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study

BACKGROUND

Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user.

OBJECTIVE

To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia.

METHODS

A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.

RESULTS

The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever.

CONCLUSION

The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.

Food insecurity and the extremes of childhood weight: defining windows of vulnerability

BACKGROUND

Weight extremes and food insecurity (FIS) represent public-health challenges, yet their associations in childhood remain unclear. We aimed to investigate the longitudinal time-specific relationship between FIS and risk of overweight/obesity and underweight in kindergarten through 8th grade.

METHODS

In the prospective Early Childhood Longitudinal Study-Kindergarten Cohort (1998-2007) of 6368 children, household FIS was assessed by the validated US Household Food Security Survey Module in kindergarten, 3rd, 5th and 8th grades. Multivariable linear-regression and Poisson-regression models were computed.

RESULTS

Compared with children experiencing food security (FS), children exposed to FIS in 5th grade had 0.19 [95% confidence interval (CI): 0.07-0.30] and 0.17 (0.06-0.27) higher body mass index z-score (BMIZ) in the 5th and 8th grades, respectively, whereas FIS in the 8th grade was associated with a 0.29 (0.19-0.40) higher BMIZ at the same wave, after adjusting for covariates and FIS at earlier waves. Children with FIS vs FS had 27% (relative risk: 1.27, 95% CI: 1.07-1.51), 21% (1.21, 1.08-1.35) and 28% (1.28, 1.07-1.53) higher risk of overweight/obesity in the 3rd, 5th and 8th grades, respectively, adjusting for covariates and FIS at prior wave(s). Children with FIS vs FS in kindergarten had a 2.76-fold (1.22-6.25) higher risk of underweight in the 8th grade.

CONCLUSIONS

Proximal exposure to household FIS was associated with a higher risk of overweight/obesity in the 3rd, 5th and 8th grades. FIS in kindergarten was associated with a risk of underweight in the 8th grade. Thus, FIS coexists in weight extremes during vulnerable early-life windows in the USA, similarly to the global burden of FIS.

Factors associated with child malnutrition in mountainous ethnic minority communities in Lao PDR

Background

Although in many low- and middle-income countries undernutrition is steadily decreasing, nutritional challenges persist in remote communities, such as those in mountainous areas of Lao PDR. Isolated, with limited access to food and to health care and other public services, local diets are low in both quantity and diversity. Data needed to guide policy and planning are lacking.

Objectives

The study aimed to identify the extent of malnutrition and associated factors among children aged 12–47 months in remote mountainous communities in Lao PDR.

Methods

A cross-sectional survey was conducted in Nong district, Savannakhet province, covering 173 households, involving heads of households, mothers and their children aged 12–47 months.

Results

The prevalence of undernutrition was very high among the 173 children studied: 72.8% were stunted, 50.3% underweight and 10.4% wasted. Key factors showing significant positive associations with nutritional status were assets (mobile phone or electric rice mill), collection of non-timber forest products, and household dietary diversity. Negative associations were found with experience of malaria and consuming high amounts of white roots and tubers. Immediate causes of malnutrition were prevalent; half the children had insufficient consumption of all micro- and macronutrients. Diseases were highly prevalent; 30% had recently experienced fever. The households in these villages were quite homogeneous. All scored high on causes of malnutrition; 90% of households experienced food insecurity, nearly all lived below the poverty line, and almost two-thirds of household heads and nearly all mothers had had no education.

Conclusion

This study identified multiple factors influencing child malnutrition, including low household food diversity, food insecurity, and poor feeding practices among ethnic minority people living in a difficult environment with limited resources. Child undernutrition in these poor communities is complex. Interventions are needed in different sectors, including agricultural production, knowledge on feeding and health services.

Complementary feeding practices and associated factors among children aged 6-23 months in Pakistan

Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey (2017–18). The results show that only 12% of children consume a minimum acceptable diet, 21% achieve minimum dietary diversity, and 38% reach minimum meal frequency. Multivariate regression analysis shows that child age, child weight at birth, mother’s access to newspapers/magazines at the individual level, wealth at the household level, and prenatal visits at the community level are significant predictors of complementary feeding practices among children aged 6–23 months in Pakistan. These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.

Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

Background

Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies' qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger's test, and Begg's test were used to assess publication bias. The I² statistic, forest plot, and Cochran's Q-test were used to deal with heterogeneity.

Results

In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I² = 97.6%, p < 0.001, Q = 1461.93). However, no publication bias was detected (Egger's test p=0.26 and Begg's test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I² = 63.8%, p < 0.001, Q = 44.21 and I² = 78.3%, p < 0.001, Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg's test, p > 0.05).

Conclusions

The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.

Acute food insecurity and short-term coping strategies of urban and rural households of Bangladesh during the lockdown period of COVID-19 pandemic of 2020: report of a cross-sectional survey

INTRODUCTION

We conducted a cross-sectional survey to assess the extent and to identify the determinants of food insecurity and coping strategies in urban and rural households of Bangladesh during the month-long, COVID-19 lockdown period.

SETTING

Selected urban and rural areas of Bangladesh.

PARTICIPANTS

106 urban and 106 rural households.

OUTCOME VARIABLES AND METHOD

Household food insecurity status and the types of coping strategies were the outcome variables for the analyses. Multinomial logistic regression analyses were done to identify the determinants.

RESULTS

We found that around 90% of the households were suffering from different grades of food insecurity. Severe food insecurity was higher in urban (42%) than rural (15%) households. The rural households with mild/moderate food insecurity adopted either financial (27%) or both financial and food compromised (32%) coping strategies, but 61% of urban mild/moderate food insecure households applied both forms of coping strategies. Similarly, nearly 90% of severely food insecure households implemented both types of coping strategies. Living in poorest households was significantly associated (p value <0.05) with mild/moderate (regression coefficient, β: 15.13, 95% CI 14.43 to 15.82), and severe food insecurity (β: 16.28, 95% CI 15.58 to 16.97). The statistically significant (p <0.05) determinants of both food compromised and financial coping strategies were living in urban areas (β: 1.8, 95% CI 0.44 to 3.09), living in poorest (β: 2.7, 95% CI 1 to 4.45), poorer (β: 2.6, 95% CI 0.75 to 4.4) and even in the richer (β: 1.6, 95% CI 0.2 to 2.9) households and age of the respondent (β: 0.1, 95% CI 0.02 to 0.21).

CONCLUSION

Both urban and rural households suffered from moderate to severe food insecurity during the month-long lockdown period in Bangladesh. But, poorest, poorer and even the richer households adopted different coping strategies that might result in long-term economic and nutritional consequences.

A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia

Background

Anemia is a wide-spread public health problem characterized by a decrease in hemoglobin concentration and/ or red blood cell volume below an established cut-off value. In developing countries including Ethiopia, about half of children are estimated to be anemic. Therefore, the purpose of this study was to determine the pooled prevalence of anemia and its predictor factors among children in Ethiopia.

Method

The studies were identified through explicit and exhaustive search of reputable databases (PubMed, Google scholar, Science Direct, EMBASE, Cochrane library, and the hand search of reference lists of previous prevalence studies to retrieve more related articles. Thirty-nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used. In our analysis, considerable heterogeneity was observed. Therefore, a random effect meta-analysis model was used to estimate the pooled prevalence of anemia. Moreover, the predictor factors of anemia were examined.

Results

The forest plot of 39 included studies revealed that the overall pooled prevalence of anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%). Sub-group analysis showed that the highest anemia prevalence was observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9, 77.8). Also, anemia in children was found to be highest in the age group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status: 1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5 (95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were found to be predictors of anemia among children.

Conclusion

In this study, one in three children were anemic in Ethiopia. It is a moderate public health problem in children in this study. Low literacy, low socioeconomic status as well as rural residence of the families and helminthic infection of the children were found to be predictors of anemia in the children. Community and school-based interventions should be strengthened to improve the problem.

Association between wasting and food insecurity among children under five years: findings from Nepal demographic health survey 2016

Background

Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics.

Methods

This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age (n = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals.

Results

The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72–2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65–1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01–4.19) and Province 2 (AOR 2.45, 95%CI 1.22–4.95) were significantly associated with wasting.

Conclusion

Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions.