Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross- sectional study

Predictors of poor nutritional status among children aged 6-24 months in agricultural regions of Mali: a cross-sectional study

BACKGROUND

The right nutrition during the first 2 years of life can positively impact a child's ability to develop, grow, and learn. Malnutrition remains a public health problem in Mali and little is known about the factors affecting the nutritional status of children. This study aims to assess the magnitude and the predictors of undernutrition in children aged 6-24 months in the poor rural regions of Mali.

METHODS

A community-based cross-sectional study was conducted in the villages in the Sikasso and Mopti regions in Mali from January to March 2016, comprising of 959 boys and 856 girls aged 6-24 months. A structured interviewer administered a questionnaire that was used to collect data from the mothers living in 1764 households. Anthropometric measurements were performed using standardized methods in order to identify the factors associated with children suffering from undernutrition (stunting and wasting). Bivariate and multivariate logistic regression analyses were conducted.

RESULTS

The results of our study indicated that 23.9 and 28.4% children were underweight and stunted; the prevalence of wasting was 13.9% using the W/H measurement and 16.5% with the MUAC. Overall, the presence of diarrhea in the past 2 weeks (p < 0.001), higher child age (p < 0.001), male sex (p < 0.001), households with the lowest household amenity score (p < 0.002), and households with a low dietary diversity score (p < 001) were significantly associated with chronic malnutrition. The factors significantly associated with acute malnutrition were male sex (p < 0.01), preterm birth (p < 0.03), lower child age (0.001), a high number of siblings (p < 0.03), and living in a household with more months of inadequate food provisioning (p < 0.03).

CONCLUSION

Child undernutrition is a critical public health problem in the agricultural regions of Mali. Future efforts should be directed at addressing the food insecurity and at improving the yearlong household availability and accessibility of nutritious food, as well as taking diseases prevention into account.

Nutritional Status of Under Five Children in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Undernutrition is the outcome of insufficient food intake and recurrent infectious diseases. The baseline levels of undernutrition remain so high that Ethiopia still needs to continue substantial investment in nutrition.Therefore, the aim of this study was to obtain estimates of over-time trends in the prevalence of undernutrition in Ethiopia and to determine risk factors for undernutrition among children of under five years of age.

METHODS

Cross-sectional studies published in English from 1997 to 2015 focusing the prevalence of stunting, wasting and underweight in children aged 0-5 years (n = 39,585) in Ethiopia were included in this systematic review and meta-analysis. We searched in PubMed and Scopus databases and other articles manually. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias in the included studies. The protocol number of the study is PROSPERO 2015: CRD42015027940.

RESULTS

Eighteen studies were included and the overall pooled prevalence estimate of stunting, underweight and wasting was 42.0% (95% CI: 37.0, 46.0), 33.0 % (95% CI: 27.0, 39.0) and 15.0% (95% CI: 12.0, 19.0), respectively. The sensitivity analyses resulted in the prevalence of stunting, 40% (95% CI: 32.0, 48.0; I2=99.19%), prevalence of underweight, 33%(95% CI: 24.0, 42.0; I²=99.34%) and wasting rate equal to 19%(95% CI: 14.0, 24.0; I2=99.19%). Cumulative analysis revealed a stabilization trend of stunting and underweight (1996-2010) followed by an upward trend (2010-2014). Child age, child sex, complementary food, poor dietary diversity, diarrheal diseases, maternal education, maternal height, residential area and socio- economic status were significant risk factors for undernutrition.

CONCLUSION

The result of the meta-analysis of thes observational studies revealed that the trend of undernutrition in Ethiopia indicates that there is an increment of chronic malnutrition cases in recent years, and the prevalence of undernutrition remains extremely high. Thus, the implementation of policies to reverse child undernutrition should get maximum emphasis.

Acute malnutrition among children aged 6-59 months of the nomadic population in Hadaleala district, Afar region, northeast Ethiopia

Background

Acute malnutrition to be a major health burden in the world, particularly in the developing world. Acute malnutrition is associated with more than one third of the global disease burden for children. Malnourished children are physically, emotionally and intellectually less productive and suffer more from chronic illnesses and disabilities. The nature, magnitude and determinants of acute malnutrition are determined among the general populations; however, there is a lack of evidence in the nomadic communities.

Methods

A cross-sectional study was conducted to assess the magnitude and factors associated with acute malnutrition among children aged 6–59 months in Hadaleala district, Afar Region. A total of 591 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire and a simple anthropometric index so called mid-upper arm circumference (MUAC). The multivariable binary logistic regression analysis was used to identify factors associated with acute malnutrition on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05.

Results

The prevalence of acute malnutrition was 11.8% (95% CI = 9.3, 14.8%). The highest prevalence (50%) of acute malnutrition occurred among children aged between 12.0–23.0 months. Childhood acute malnutrition was associated with the presence of two (AOR = 2.49, p < 0.05) and three (AOR = 12.87, p < 0.001) children in each household, unprotected drinking water sources (AOR = 3.78, p < 0.05), absence of the latrine (AOR = 5.24, p < 0.05), hand washing with soap (AOR = 0.21, p < 0.05), childhood diarrheal disease (AOR = 2.72, p < 0.05), and child vaccination (AOR = 0.15, p < 0.001).

Conclusion

The prevalence of acute malnutrition among children aged 6-59 months was was higher than the national prevalence. The number of children in each household, drinking water sources, latrine availability, hand washing practice before food preparation and child feeding, childhood diarrheal disease, and child vaccination were identified as factors affecting the childhood acute malnutrition in the nomadic community. Protecting drinking water sources from possible contaminants, improving hand washing practices, utilization of latrine, preventing diarrheal diseases and vaccinating children integrated with the access of nutrition education is important to improve nutrition of children of the nomadic people.

Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review

Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.

Using the Uganda National Panel Survey to analyze the effect of staple food consumption on undernourishment in Ugandan children

BACKGROUND

The United Nations' Millennium Development Goals Report, 2015, documents that, since 1990, the number of stunted children in sub-Saharan Africa has increased by 33% even though it has fallen in all other world regions. Recognizing this, in 2011 the Government of Uganda implemented a 5-year Nutrition Action Plan. One important tenet of the Plan is to lessen malnutrition in young children by discouraging over-consumption of nutritionally deficient, but plentiful, staple foods, which it defines as a type of food insecurity.

METHODS

We use a sample of 6101 observations on 3427 children age five or less compiled from three annual waves of the Uganda National Panel Survey to measure undernourishment. We also use the World Health Organization's Child Growth Standards to create a binary variable indicating stunting and another indicating wasting for each child in each year. We then use random effects to estimate binary logistic regressions that show that greater staple food concentrations affect the probability of stunting and wasting.

RESULTS

The estimated coefficients are used to compute adjusted odds ratios (OR) that estimate the effect of greater staple food concentration on the likelihood of stunting and the likelihood of wasting. Controlling for other relevant covariates, these odds ratios show that a greater proportion of staple foods in a child's diet increases the likelihood of stunting (OR = 1.007, p = 0.005) as well as wasting (OR = 1.011, p = 0.034). Stunting is confirmed with subsamples of males only (OR = 1.006, p = 0.05) and females only (OR = 1.008, p = 0.027), suggesting that the finding is not gender specific. Another subsample of children aged 12 months or less, most of whom do not yet consume solid food, shows no statistically significant relationship, thus supporting the validity of the other findings.

CONCLUSION

Diets containing larger proportions of staple foods are associated with greater likelihoods of both stunting and wasting in Ugandan children. Other causes of stunting and wasting identified in past research are also confirmed with the Uganda data. Finally, the analysis provides clues to other possible causes of undernourishment in young children.

Care and not wealth is a predictor of wasting and stunting of 'The Coffee Kids' of Jimma Zone, southwest Ethiopia

BACKGROUND

The generation of cash from agricultural products is the mainstay of the livelihood of many households in developing countries. However, critics of cash cropping have highlighted its influence on dietary diversity and availability of food at the household level, eroding the potential for optimal child caring practices.

METHODS

A community-based cross-sectional survey was carried out in three randomly selected coffee-producing districts of Jimma Zone in southwest Ethiopia. The underlying causes of malnutrition, food access, hygiene and care were assessed using the household food insecurity access scale, morbidity reports and infant and young child feeding practice core indicators of the World Health Organization. Anthropometric data were converted into weight for age, height for age, body mass index for age and weight for height Z-scores to determine child nutritional outcomes.

RESULTS

Prevalence of underweight, wasting, stunting and thinness were 14.2%, 9.1%, 24.1% and 9.9%, respectively. Multivariable logistic regression showed that children with suboptimal meal frequency were more than three times more likely to develop wasting (AOR = 3.3, p < 0.0001). Female children were twice as likely to develop wasting compared with males (AOR = 2.00, 4.1, p = 0.05). Children with suboptimal dietary diversity were almost four times as likely to develop stunting (AOR = 3.95, p < 0.0001). Those who were not exclusively breastfed during their first 6 months were almost five times as likely to develop stunting (AOR = 4.66, p < 0.0001).

CONCLUSIONS

The findings imply that in coffee-producing areas, child caring practices are stronger independent predictors of nutritional status than wealth or economic indicators alone.

Child wasting is a severe public health problem in the predominantly rural population of Ethiopia: A community based cross-sectional study

Background

In Ethiopia, child wasting has remained a public health problem for a decade’s, suggesting the need to further monitoring of the problem. Hence, this study aimed at assessing the prevalence of wasting and associated factors among children aged 6–59 months at Dabat District, northwest Ethiopia.

Methods

A Community based cross-sectional study was undertaken from May to June, 2015, in Dabat District, northwest Ethiopia. A total of 1184 children aged under five years and their mothers/caretakers were included in the study. An interviewer-administered, pre-tested, and structured questionnaire was used to collect data. Standardized anthropometric body measurements were employed to assess the height and weight of the participants. Anthropometric body measurements were analyzed by the WHO Anthro Plus software version 1.0.4. Wasting was defined as having a weight–for–height of Z–score lower than two standard deviations (WHZ < −2 SD) compared to the WHO reference population of the same age and sex group. In the binary logistic regression, both bivariate and multivariate analyses were done to list out factors associated with wasting. All variables with P–values of < 0.2 in the bivariate analysis were earmarked for the multivariate analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) at 95% Confidence Interval (CI) were computed to determine the strength of association. In the multivariate analysis, variables at P–values of < 0.05 were identified as determinants of wasting.

Results

The overall prevalence of wasting was 18.2%; 10.3% and 7.9% of the children were moderately and severely wasted, respectively. Poor dietary diversity [AOR = 2.08, 95% CI: 1.53, 4.46], late initiation of breastfeeding [AOR = 1.43, 95% CI: 1.04, 1.95], no postnatal vitamin-A supplementation [AOR = 1.55, 95% CI: 1.04, 2.30], and maternal occupational status [AOR = 2.31, 95% CI: 1.56, 3.42] were independently associated with wasting in the study area.

Conclusion

Wasting is a severe public health problem in Dabat District. Therefore, there is a need to strengthen the implementation of optimal breastfeeding practice and dietary diversity. In addition, improving the coverage of mothers^’ postnatal vitamin-A supplementation is essential to address the burden of child wasting.

Underweight, Stunting and Wasting among Children in Kilimanjaro Region, Tanzania; a Population-Based Cross-Sectional Study

This study assessed the prevalence and risk factors associated with underweight, stunting and wasting among children aged 0-24 months in six districts of Kilimanjaro region, northern Tanzania. A cross-sectional population-based study using a multistage, proportionate to size sampling was conducted from June 2010 to March 2011. A structured questionnaire was used to collect sociodemographic, economic, feeding and child information. Anthropometric data were collected by trained field workers, and the data were used to assess child nutritional status. A total of 1870 children were enrolled in this study. The prevalence of children classified as underweight was 46.0%, stunting was 41.9%, and wasting was 24.7%. About 33% were both underweight and stunted, and 12% had all three conditions. In a multivariate logistic regression, child age, child being ill and birth weight were associated with all anthropometric indices. Child being breastfed was associated with being underweight and wasting. Mother's education was associated with being underweight and stunting. Fathers aged 35+ years, and living in the Hai district was associated with stunting, and being female was associated with wasting. The prevalence of child undernutrition is high in this region. Strategies that target each risk factor for child undernutrition may help to reduce the problem in the region.

Effects of a community-based nutrition promotion programme on child feeding and hygiene practices among caregivers in rural Eastern Ethiopia

OBJECTIVE

To evaluate the effectiveness of a community-based participatory nutrition promotion (CPNP) programme involving a 2-week group nutrition session in improving child feeding and hygiene practices among caregivers.

DESIGN

Cluster randomized trial. In the intervention area (six clusters), the CPNP programme was added to the context of government nutrition programmes; the control area (six clusters) received the government programme only. Child feeding practices were assessed every 3 months using a 24 h dietary recall questionnaire, and hand washing with soap was assessed every 6 months, over a period of 12 months. Feeding and hygiene measures at each visit were scored and the scores summed up for the entire follow-up period.

SETTING

Habro and Melka Bello districts, Ethiopia.

SUBJECTS

Randomly selected mothers with a child aged 6-12 months (n 1790).

RESULTS

A total of 1199 mothers, 629 in the control and 570 in the intervention areas, were assessed at all visits and included in the analysis. Mothers in the intervention area showed higher scores than those in the control area regarding meal frequency (difference: 1·04, 95 % CI 0·35, 1·73), composite feeding score_1 (difference: 1·25, 95 % CI 0·37, 2·13; a summing score of currently breast-feeding, meal frequency and dietary diversity) and composite feeding score_2 (difference: 1·40, 95 % CI 0·49, 2·32; a summing score of meal frequency and dietary diversity). However, there were no differences in the scores of breast-feeding, dietary diversity and hand washing between the two areas (all P>0·05).

CONCLUSIONS

The CPNP programme was effective in improving some child feeding behaviours in rural Eastern Ethiopia.

Association between socioeconomic status of mothers, food security, food safety practices and the double burden of malnutrition in the Lalitpur district, Nepal

Background

The prevalence of childhood overweight and obesity is increasing in low-and middle income countries such as Nepal. At the same time, high prevalence of chronic undernutrition persists leading to a double burden of malnutrition.

Aim

To identify associations between the socioeconomic status of mothers, food security, the food safety environment within the household, and prevalence of stunting and overweight of the children.

Methods

Statistical analysis of socioeconomic, food safety-related and anthropometric data from 289 mother-child dyads in an urban area of the Kathmandu Valley, Nepal.

Results

According to WHO standards, 26 % of the children, aged 0–59 months, were stunted, 10 % were underweight, and 6.6 % were either overweight or obese. Significantly more boys than girls were underweight (p = 0.004) and stunted (p < 0.001). The higher education level of mothers was associated with a higher height-for-age (HAZ) score in girls, but not with HAZ in boys. Irrespective of sex, children of mothers with highest education level had significantly lower BMI-for-age scores (BAZ) than those of mothers with low education levels. None of the food safety indicators were associated with either HAZ or the BAZ.

Conclusion

The education level of mothers seems to be relevant to help reduce the double burden of malnutrition at least in some regions of Nepal. This should be taken into consideration when designing programmes to prevent both chronic undernutrition and non-communicable diseases.

Environmental Enteropathy: Elusive but Significant Subclinical Abnormalities in Developing Countries

Environmental enteropathy/Environmental enteric dysfunction (EE/EED) is a chronic disease of small intestine characterized by gut inflammation and barrier disruption, malabsorption and systemic inflammation in the absence of diarrhea. It is predominantly diseases of children in low income countries and is hypothesized to be caused by continuous exposure to fecally contaminated food, water and fomites. It had not been recognized as a priority health issue because it does not cause overt symptoms and was seen in apparently healthy individuals. However, there is a growing concern of EE/EED because of its impact on longitudinal public health issues, such as growth faltering, oral vaccine low efficacy and poor neurocognitive development. Recent works have provided important clues to unravel its complex pathogenesis, and suggest possible strategies for controlling EE/EED. However, effective diagnostic methods and interventions remain unsettled. Here, we review the existing literature, especially about its pathogenesis, and discuss a solution for children living in the developing world.

•

EE/EED is acquired by the close contact with unsanitary condition, and abnormalities of EE/EED are reversible over time.

•

EE/EED should be diagnosed as young as possible because poor growth is often evident within 1-2 years of life.

•

EE/EED should be diagnosed by simple, noninvasive and low-cost methods, such as fecal biomarkers.

•

It is hard to diagnose EE/EED and to predict consequences by a single marker/test due to the complexity in pathogenesis.

•

Interventions for EE/EED other than sanitary reform are under investigation although no reports showed favorable outcomes currently.

The role of mother's education in the nutritional status of children in Serbia

OBJECTIVE

The present study aimed to identify the role of mother's education in the nutritional status of children aged 2-5 years in Serbia.

DESIGN

Nationally representative population-based study. Age- and gender-specific BMI percentiles of children were analysed. In accordance with the WHO growth reference, children with BMI less than the 5th percentile were considered undernourished. Logistic regression was used to calculate the association between mother's education and other socio-economic determinants as possible confounders.

SETTING

UNICEF's fourth Multiple Indicator Cluster Survey, conducted in both Roma and non-Roma settlements in Serbia.

SUBJECTS

Children (n 2603) aged 2-5 years (mean age 3·05 years).

RESULTS

Less than 5 % of children aged 2-5 years were undernourished. There were significantly more undernourished children among the Roma population, in the capital of Serbia and among those whose mothers were less educated. There were statistically significant differences according to mother's education in all socio-economic characteristics (ethnicity, area, region of living and wealth index). Mother's level of education proved to be the most important factor for child's nutritional status; place of living (region) was also associated.

CONCLUSIONS

Mother's education is the most significant predictor of children's undernutrition. It confirms that investment in females' education will bring benefits and progress not only for women and their children, but also for society as a whole.

Nearly half of preschool children are stunted in Dembia district, Northwest Ethiopia: a community based cross-sectional study

Background

Stunting has been the most pressing public health problem throughout the developing countries. It is the major causes of child mortality and global disease burden, where 80 % of this burden is found in developing countries. In the future, stunting alone would result in 22 % of loss in adult income. About 40 % of children under five-years were stunted in Ethiopia. In the country, about 28 % of child mortality is related to undernutrition. Thus, the aim of this study was to determine the prevalence and determinants of stunting among preschool children in Dembia district, Northwest Ethiopia.

Methods

A community based cross–sectional study was carried out in Dembia district, Northwest Ethiopia from January 01 to February 29, 2015. A multi-stage sampling followed by a systematic sampling technique was employed to reach 681 mother-child pairs. A pretested and structured questionnaire was used to collect data. After exporting anthropometric data to ENA/SMART software version 2012, nutritional status (stunting) of a child was determined using the WHO Multicenter Growth Reference Standard. In binary logistic regression, a multivariable analysis was carried out to identify determinants of stunting. The Adjusted Odds Ratio (AOR) with a 95 % confidence interval was computed to assess the strength of the association, and variables with a P-value of <0.05 in multivariable analysis were considered as statistically significant.

Results

A total 681 of mother-child pairs were included in the study. The overall prevalence of stunting was 46 % [95 % CI: 38.7, 53.3 %]. In multivariable analysis, the odds of stunting was higher among children whose families had no latrine [AOR = 1.6, 95 % CI: 1.1, 2.2)]. Likewise, children living in household with more than four family size [AOR =1.4, 95 % CI: 1.1, 1.9)] were more likely to be stunted.

Conclusions

This study confirms that stunting is a very high public health problem in Dembia district. The family size and latrine availability were significantly associated with stunting. Hence, emphasis should be given to improve the latrine coverage and utilization of family planning in the district.