Undernutrition Among Infants and Children in Nepal: Maternal Health Services and Their Roles to Prevent it

Factor associated with anthropometric failure among under-five Bengali children: A comparative study between Bangladesh and India

Background

Child undernutrition is a burden and the leading cause of child mortality in low-and middle-income countries like Bangladesh and India. Currently, this issue is a matter of great concern, inasmuch as achieving the Sustainable Development Goals (SDGs). The study intends to determine the factors of child undernutrition using a single composite index of anthropometric failure (CIAF) among the Bengali population.

Methods

Unit level data on 14055 under 5 children were extracted from the Bangladesh Demographic and Health Survey 2017–18 (BDHS) and the 4^th National Family Health Survey of India (NFHS-4). To understand child undernutrition and generate CIAF, data on height-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight) were used by WHO guidelines. These three undernutrition indicators were combined into a single undernutrition indicator called anthropometric failure (anth-failure) using the CIAF concept. Explanatory factors of anth-failure included data on maternal health, socio-demographic and birth-related variables. Differences of frequency were determined by Z-proportional and Chi-square tests; predictors of anth-failure were determined by binary logistic regression. Cut off point of p-value was taken as 0.05 to test the significance.

Results

Inter-country disparities were revealed, about half of Bengali children in India and two-fifths in Bangladesh being prone to anth-failure. Stunting and underweight were more prevalent in both countries than wasting. Maternal undernutrition, lack of maternal education, and poor wealth index were common factors of anth-failure for both countries. Children in Bangladesh developed anth-failure after the end of breastfeeding period, indicating a lack of nutritious food. Lack of antenatal care was another significant factor in Bangladesh. In India, the first child suffered from anth-failure due to lack of maternal education.

Conclusions

This study provides a better understanding of multifactorial impact on child undernutrition. It is proposed that the emphasis should be on initiatives that improve maternal education and nutrition, child food security, boost household wealth index, and enhance mothers’ access to health care. The study strongly recommends that the governments of Bangladesh and India invest financially in preventing child malnutrition, which will contribute to achieving the first four SDGs.

The Role of Vitamin D in Stunting Prevention: A Literature Review

BACKGROUND: Nutritional problems in infants under the age of two can inhibit growth and development. This has a negative impact on their subsequent life, increasing the risk of stunting. Vitamins are essential micronutrients in the body’s metabolic processes and they have a multi-complex role. One of the micronutrients that affect stunting are vitamin D. It plays an important role in stunting prevention. Stunting countermeasures are carried out by fulfilling the need of adequate nutrition where both macronutrients and micronutrients are needed to avoid the risk of stunting. AIM: The aim of this literature review was to analyze the role of vitamin D in preventing stunting. METHODS: The articles were collected through the Google Scholar, PubMed, Proquest, and Ebsco databases using the keywords Vitamin D and Stunting, consisting of both quantitative and qualitative studies. The articles used were only articles with a full text available that were written in English and Indonesian published from 2015 to 2019. Fifteen articles were found that met the criteria. RESULTS: The literature review results indicate that vitamin D plays an important role in the metabolism of bone formation and growth. It also has the role of increasing the level of immunity in children. Both roles contribute to stunting prevention. Vitamin D is key in regulating the immune function during pregnancy regarding the fetus-mother interaction, representing an important target. Among its non-classical actions include the emphasis of strong immunomodulators, including the induction of antibacterial responses and the modulation of T-lymphocytes to suppress inflammation and increase tolerogenesis. Vitamin D plays an important role in the innate immune function in the decidua by promoting the infection response while simultaneously preventing the excessive elaboration of immune inflammation. The research to date has focused on the potential role of vitamin D in preventing infectious diseases such as tuberculosis, as well as possibly suppressing autoimmune diseases. CONCLUSION: Vitamin D can also affect the immune function in a manner that is not immediately related to the primary innate response. Stunting can be prevented early on through the adequate intake of macro and micronutrient nutrients. The need for micronutrients is especially important, inclusive of vitamin D as an important element in bone metabolism. It also increases the body’s defenses so as to prevent infectious diseases in children.

Drivers of stunting reduction in Nepal: a country case study

BACKGROUND

Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting - a physical manifestation of chronic malnutrition - despite only modest economic growth and significant political instability.

OBJECTIVE

This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country.

METHODS

Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses.

RESULTS

Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction.

CONCLUSIONS

Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.

Infant and young child feeding practices, sociodemographic factors and their association with nutritional status of children aged <3 years in India: findings of the National Nutrition Monitoring Bureau survey, 2011-2012

OBJECTIVE

To study infant and young child feeding (IYCF) practices and their association with nutritional status among young children.

DESIGN

A community-based, cross-sectional study was carried out in ten states of India, using a multistage random sampling method. Anthropometric measurements such as length/height and weight were conducted and nutritional assessment was done using the WHO child growth standards.

SETTING

National Nutrition Monitoring Bureau survey, 2011-2012.ParticipantsChildren aged <3 years and their mothers.

RESULTS

Only 36 % of infants received breast-feeding within an hour of birth and 50 % were exclusively breast-fed up to 6 months. Prevalence of underweight, stunting and wasting was 38, 41 and 22 %, respectively. The chance of undernutrition among <3-year-old children was significantly higher among those from scheduled caste/scheduled tribe communities, the lowest-income group, with illiterate mothers and lack of sanitary latrine. Among infants, the chance of undernutrition was significantly higher among low-birth-weight babies, and among children whose mother had not consumed iron-folic acid tablets during pregnancy. Immunization practices and minimum dietary diversity were observed to be associated with undernutrition among 12-23-month-old children.

CONCLUSIONS

Undernutrition is still an important public health problem in India and observed to be associated with low socio-economic status, illiteracy of mother, low birth weight and dietary diversity. Improving socio-economic and literacy status of mothers can help in improving maternal nutrition during pregnancy and thus low birth weight. Also, improving knowledge of mothers about IYCF practices will help in improving children's nutritional status.