Household resources and seasonal patterns of child growth in rural Timor-Leste

Nutritional knowledge and practices of mothers/caregivers and its impact on the nutritional status of children 6-59 months in Sefwi Wiawso Municipality, Western-North Region, Ghana

Background

Good maternal/caregiver nutrition knowledge protects the child from events that lead to low weight-for-age z-score (WAZ) and low height-for-age z-score (HAZ). Indicators of good child nutritional status have traditionally been low in cocoa-growing areas. This paper aimed to explore the relationship between maternal nutrition knowledge and practices and its effect on the nutritional status of children 6-59 months in the Sefwi Wiawso municipality; a predominant cocoa-growing area in Ghana.

Methodology

A cross-sectional study design was used to assess nutrition knowledge, nutritional practices of mothers and dietary adequacy and nutritional status of their children using 24-hour dietary recall and anthropometric measures.

Results

A total of 226 caregiver-child pairs were recruited for the study. The level of nutritional knowledge was average (61.5%) among caregivers/mothers. Most caregivers (92.3%) initiated breastfeeding within 1 hour of giving birth. A total of 66% of mothers practiced exclusive breastfeeding. Complementary feeding was initiated at 6 months in 83.6% of the cases. The prevalence of underweight, wasting, and stunting were 8.29%, 10.23%, and 16.74% respectively. There was no significant association between mother/caregiver's nutrition knowledge and child malnutrition status although the risk of wasting reduced with increasing nutritional knowledge of caregivers (p = 0.118).

Conclusion

There was no association between maternal nutrition knowledge and the nutritional status of children even though wasting showed a pattern of decrease with increasing nutritional knowledge. The prevalence of malnutrition in children in the study was comparatively lower than the national average. Underweight was statistically significantly higher in children whose mothers/caregivers were farmers hence appropriate nutrition education with a focus on infant and young child feeding practices should be promoted during antennal care and child welfare clinic services within these communities. Family planning services targeted particularly at teenage girls should be instituted to prevent teenage pregnancies as malnutrition is more likely to occur in children born to teenage mothers.

Early childhood growth in Daasanach pastoralists of Northern Kenya: Distinct patterns of faltering in linear growth and weight gain

OBJECTIVES

Investigations of early childhood growth among small-scale populations are essential for understanding human life history variation and enhancing the ability to serve such communities through global public health initiatives. This study characterizes early childhood growth trajectories and identifies differences in growth patterns relative to international references among Daasanach semi-nomadic pastoralist children living in a hot, arid region of northern Kenya.

METHODS

A large sample of height and weight measures were collected from children (N = 1756; total observations = 4508; age = 0-5 years) between 2018 and 2020. Daasanach growth was compared to international reference standards and Daasanach-specific centile growth curves and pseudo-velocity models were generated using generalized additive models for location scale and size.

RESULTS

Compared to World Health Organization (WHO) reference, relatively few Daasanach children were stunted (14.3%), while a large proportion were underweight (38.5%) and wasted (53.6%). Additionally, Daasanach children had a distinctive pattern of growth, marked by an increase in linear growth velocity after 24 months of age and relatively high linear growth velocity throughout the rest of early childhood.

CONCLUSIONS

These results identify a unique pattern of early childhood growth faltering among children in a small-scale population and may reflect a thermoregulatory adaptation to their hot, arid environment. As linear growth and weight gain remain important indicators of health, the results of this study provide insight into growth velocity variations. This study has important implications for global public health efforts to identify and address sources of early growth faltering and undernutrition in small-scale populations.

The seasonal relationships between household dietary diversity and child growth in a rural Timor-Leste community

Both child growth and dietary diversity are poor in rural Timor-Leste. The rainy season is associated with food scarcity, yet the association between seasonal scarcity, food diversity, and child growth is underdocumented. This study assesses the relationship between household dietary diversity and children's standardized growth across the 2018 food-scarce (April-May; post-rainy period) and post-harvest (October) seasons in the agricultural community of Natarbora, on the south-coastal plains of Timor-Leste. We conducted household interviews and collected anthropometric data across 98 and 93 households in the post-rainy and post-harvest periods, respectively. Consumed household foods were obtained via 24-h diet recalls and were subsequently categorized into a nine-food-group dietary diversity score (DDS; number of different food groups consumed). The DDS was related to children's standardized short-term growth (z-weight, z-body mass index [BMI] and percent change in weight over the harvest season) via linear mixed models. Across seasons, DDS increased from 3.9 (standard deviation [SD] = 1.0) to 4.3 (SD = 1.4; p < 0.05). In the post-rainy season, children in high DDS households had higher z-weight than those in low DDS households and higher z-BMI than children in medium and low DDS households. In the post-harvest period, household DDS did not predict children's z-weight but predicted z-BMI. Consumption of protein-rich foods, particularly animal-source foods and legumes, in low- and medium-DDS households may be associated with improved child growth. While consuming more animal-source foods in the post-rainy season would be ideal, promoting the consumption of locally grown legumes, such as beans and pulses, may facilitate better nutritional outcomes for more children in rural Timor-Leste.

Relationships of Resource Strategies, Family Composition, and Child Growth in Two Rural Timor-Leste Communities

Subsistence and economic activities undertaken by households in the context of transition from subsistence farming to cash economies are sometimes seen as substitutable with only minimal reference to the households themselves. We use data from in-depth interviews of 190 householders in Ossu (mountains) and Natarbora (coastal plains), Timor-Leste, to query relationships of family composition, resource strategies, and their relationships to children’s growth. Principal component analyses of six household composition variables reveal “grandparent and fostered-in children”, “two generational households with numerous adults and children”, and “smaller households with few adults and fostered-out children”, explaining 72% of the variance. A similar procedure with 11 resource variables produced four components explaining 56% of resource variance. Households with grandparents have a pension income and engage in large animal husbandry, and are associated with better standardized BMI for resident children. Households with numerous members (but not grandparents) are more invested in subsistence gardening and are negatively associated with child stature. Salaried income is not associated with household composition, but children in these households are taller than their peers. Consistent differences between the two communities are partially a result of differences in socioecology, but there remain unexplained differences that may relate to cultural practices.

Are fathers a good substitute for mothers? Paternal care and growth rates in Shodagor children

Biparental care is a hallmark of human social organization, though paternal investment varies between and within societies. The facultative nature of paternal care in humans suggests males should invest when their care improves child survival and/or quality, though testing this prediction can be challenging because of the difficulties of empirically isolating paternal effects from those of other caregivers. Additionally, the broader context in which care is provided, vis-à-vis care from mothers and others, may lead to different child outcomes. Here, we examine the effects of paternal care on child growth among Shodagor fisher-traders, where fathers provide high levels of both additive and substitutive care, relative to mothers. We modeled seasonal z-scores and velocities for height, weight, and body mass index (BMI) outcomes using linear mixed models. Our evidence indicates that, as predicted, the context of paternal care is an important predictor of child outcomes. Results show that environmental seasonality and alloparental help contribute to a nuanced understanding of the impact of Shodagor paternal care on child physiology.

Evaluating the seasonality of growth in infants using a mobile phone application

It has been observed that growth velocity of toddlers and school children shows seasonal variation, while such seasonality is unknown in infants. The aim of this study was to examine whether growth velocity (length and weight) of infants differs by seasons. We assessed longitudinal measurement data obtained for 9,409 Japanese infants whose parents used the mobile phone application, "Papatto Ikuji", during the period from January 2014 to October 2017. On average, each infant had 4.8 entries for length and 5.4 entries for weight. The mean daily change in sex- and age-adjusted z-scores between two time points was estimated as the growth velocity during that period: ΔLAZ/day and ΔWAZ/day for length and weight, respectively. We analyzed 20,007 ΔLAZ/day (mean, -0.0022) and 33,236 ΔWAZ/day (mean, 0.0005) measurements, and found that ΔLAZ/day showed seasonal differences with increases during summer. We conducted a multilevel linear regression analysis, in which effects of age, sex, nutrition and season of birth were adjusted, showing significant difference in ΔLAZ/day between winter and summer with a mean ΔLAZ/day difference of 0.0026 (95%CI 0.0015 to 0.0036; P < 0.001). This seasonal difference corresponded to 13% of the average linear growth velocity in 6-month-old infants. A modest effect of nutrition on linear growth was observed with a mean ΔLAZ/day difference of 0.0015 (95%CI 0.0006 to 0.0025; P < 0.001) between predominantly formula-fed infants and breastfed infants. In conclusion, we observed that linear growth, but not weight gain, of Japanese infants showed significant seasonality effects represented by increases in summer and decreases in winter.

Factors influencing undernutrition among children under 5 years from cocoa-growing communities in Bougainville

Half the children under the age of 5 years in Papua New Guinea (PNG) are undernourished, more than double the global average with rural areas disproportionately affected. This study examines factors associated with stunting, wasting and underweight in cocoa growers' children (<5 years) in the Autonomous Region of Bougainville (ARoB), using data from a comprehensive 2017 cross-sectional livelihoods survey. Sixteen independent predictors for stunting, wasting and underweight were selected based on the UNICEF Conceptual Framework of Determinants of Undernutrition. We used multilevel logistic mixed regression models to measure the association of the explanatory variables with stunting, wasting and underweight. At the household level, the adjusted OR (aOR) of stunting (aOR=1.71,95% CI 1.14 to 2.55) and underweight (aOR=2.11, 95% CI 1.16 to 3.82) increased significantly among children from households with unimproved toilet facilities. The aOR for underweight also increased among children from households without access to clean drinking water (aOR=1.97, 95% CI 1.19 to 3.29). Short maternal stature was significantly associated with child stunting, the odds increased as maternal height decreased (from 150 to <155 cm, aOR=1.52, 95% CI 1.02 to 2.26) (<150 cm, aOR=2.37, 95% CI 1.29 to 4.35). At the individual level, the odds of a child being underweight increased with birth order (second born, aOR=1.92, 95% CI 1.09 to 3.36; third born, aOR=6.77, 95% CI 2.00 to 22.82). Compared with children less than 6 months, children aged 6-23 months and 24-59 months had a higher odds of being stunted (aOR=3.27, 95% CI 1.57 to 6.78 and aOR=2.82, 95% CI 1.40 to 5.67) and underweight (aOR=4.83, 95% CI 1.36 to 17.24 and aOR=4.59, 95% CI 1.29 to 16.26). No variables were found to be significant for wasting. Interventions that simultaneously target key life stages for women and children and the underlying social and environmental determinants are required for sustained improvements to undernutrition.

Ethnic Group Differences in Dietary Diversity of School-Aged Children in Indonesia: The Roles of Gender and Household SES

Background:

Despite the importance of dietary diversity for nutritional status, studies on issues surrounding ethnicity and dietary diversity in developing countries are limited.

Objective:

We analyzed cross-ethnic differences in dietary diversity and examined the roles of gender and household socioeconomic status (SES) in 3 Indonesian ethnic groups with different kinship systems: Javanese (bilateral), Batak (patrilineal), and Minangkabau (matrilineal).

Methods:

Data were from the Indonesian Family Life Survey 2000-2015 that consisted of 6478 school-aged children (7-12 years of age) born to 3878 mothers. The children’s dietary diversity was measured using a Berry-Index. We used cluster-robust multivariate linear regression models.

Results:

Gendered dietary diversity occurred for ethnic groups with unilineal kinship but was less evident for ethnic with bilateral kinship. Batak and Minangkabau girls, rather than boys, had higher dietary diversity because boys from these 2 ethnic groups consumed low-status foods (eg, tubers and vegetables) less often. Household SES influenced ethnic-related dietary diversity differently, perhaps because of food culture. Batak children from lower SES households consumed fruits and dairy products less often, most likely to enable them to consume the pricier but culturally preferable animal-source foods. This lowered their dietary diversity.

Conclusion:

The overall results indicate gendered and household SES-related effects of ethnicity on dietary diversity. Nutrition interventions targeting boys should be on policy-makers’ agendas. Boys should be advised to consume healthy low-status foods more often to improve their dietary diversity. The Batak case shows that children from lower SES backgrounds should depend less on the pricier foods to enable them varying their diet better.

Determinants of objectively measured physical activity in rural East Timorese children

OBJECTIVES

The human juvenile period evolved as a period of learning and physical development in a family environment that subsidizes the costs of these processes. Children allocate energy to physical activity, maintenance, and growth. How energy is allocated has consequences for adult body size and other life-history traits. In subsistence agriculture populations, where child contributions to the household economy are common and energy availability is low, trade-offs in energy expenditure between activity and growth may help explain poor growth.

METHODS

Using accelerometry, we measured physical activity over 2 years in 88 free-living children aged 5-19 years in two ecologically varying communities in rural Timor-Leste. We model characteristics related to variation in activity, and subsequently, activity is modeled against growth, illness, and aspects of household and local ecology using linear mixed models.

RESULTS

Physical activity in Timorese children is characterized by high levels of moderate ( x ¯ = 8.8 h/day), no sustained vigorous, and little sedentary activity ( x ¯ = 4.6 h/day). Children in the mountainous community show a slight trade-off between activity and growth (P = .077). Males down-regulate both growth and activity relative to females. Variation in household characteristics does not predict child activity. Both activity and growth are lower in the mountainous community than in the flat, coastal community.

CONCLUSIONS

Household demands on child behavior may constrain children's ability to moderate activity relative to nutritional status. Activity in this population is high relative to other subsistence populations, possibly because children face the dual pressures of contributing to household subsistence and attending school.