Determinants of malnutrition in Indian children: new evidence from IDHS through CIAF

Deconstructing the sex gap in child undernutrition in India: Are Indian boys at elevated risk of anthropometric failure than the girls?

BACKGROUNDS & OBJECTIVES

The privileging of boys in immunization coverage, breastfeeding, and other child care practices in Indian patriarchal society raises questions about whether there are sex differences in the prevalence of undernutrition among children. This study evaluates the sex gap in the prevalence of Composite Index of Anthropometric Failure (CIAF) among Indian children from 2015-16 to 2019-21. Additionally, it seeks to identify the sex-specific determinants and persistent sex gap at national and subnational levels (social, economic, religious, and geopolitical regions) in anthropometric failure among the children from 2015-16 to 2019-21.

MATERIALS AND METHODS

The study utilizes the 4th (2015-16) and 5th (2019-21) rounds of the National Family Health Survey data. Logistic regression models and the Fairlie decomposition technique were employed to explore the persistent and significant sex gap in the prevalence of CIAF, as well as the sex-specific determinants of CIAF among children in 2015-16 and 2019-21.

RESULTS

The study reveals a significant sex gap (approximately 4%-points), with boy's disadvantage in the prevalence of CIAF from 2015-16 to 2019-21 at both the national and subnational levels (social, religious, socioeconomic groups, and geopolitical regions). The gap is more pronounced in the first year of life and decreases in later stages. A comparatively faster CIAF decline among girls from 2016 to 2021 has widened the sex gap in final year than the previous. Child, mother, household, community, and geographic backgrounds explains about 5%-6% of the sex gap in the prevalence of CIAF from 2015-16 to 2019-21. The remaining 94%-95% of the unexplained sex gap may be attributed to biological factors or other factors. Currently, a heightened boy's disadvantage in CIAF risk is observed in ST community, wealthiest families, and the northern India.

CONCLUSION

The findings suggest a special attention for boys under 3 years to offset biological disadvantages like greater disease sensitivity and fragility compared to girls early on.

Effects of short birth interval on child malnutrition in the Asia-Pacific region: Evidence from a systematic review and meta-analysis

Child malnutrition remains a significant concern in the Asia-Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia-Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia-Pacific region between September 2000 and May 2023. Fixed-effects or random-effects meta-analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta-analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97-1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88-6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national-level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia-Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality.

Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia

OBJECTIVES

Concurrent wasting and stunting (WaSt) in a child is a health problem that leads to detrimental effects. However, to our knowledge, there is limited research regarding the prevalence and determinants of WaSt, including in Indonesia. The aim of this study was to analyze the prevalence and determinants of WaSt in children 6 to 23 mo of age.

METHODS

This cross-sectional study was conducted with data sets from the Indonesia Nutritional Status Survey (INSS). Data was collected between January and December 2021. About 15 641 children, ages 23 mo, were included. A χ2 analysis examined the association between the dependent and independent variables. A multivariate test analyzed the risk for the independent variable to the dependent, seen through the adjusted odds ratio (aOR).

RESULTS

The prevalence of WaSt was 2.4%. Higher odds for WaSt were seen in the following: • Boys: 2.15 times (95% confidence interval [CI], 1.72-2.68); • Children ages 12 to 23 mo 3.15 times (95% CI, 2.33-4.25); • Those with low birth weight 3.11 times (95% CI, 2.33-4.15) • Those with small birth size: 2 times (95% CI, 1.59-2.54) • Babies born from mothers >35 y of age: 1.5 times (95% CI, 1.19-1.89); • Children who experienced infection: 1.43 times (95% CI, 1.16-1.76); • Children not using the Integrated Health and Nutrition Services (Posyandu): 1.17 times (95% CI; 1.29-2.27); • Children from middle- income families:2.54 times higher odds (95% CI, 1.75-3.7); and • Children from rural areas: 1.37 times (95% CI, 1.1-1.71).

CONCLUSION

WaSt is associated with multiple factors in Indonesia. Hence, policymakers need to address this problem comprehensively.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey

BACKGROUND

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence.

METHODS

The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models.

RESULTS

The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India.

CONCLUSION

Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Prevalence and associated factors of stunting among under-five children in Ethiopia: Application of marginal models analysis of 2016 Ethiopian demographic and health survey data

BACKGROUND

Stunting, short for age, affects the overall growth and development of the children. It occurs due to chronic under nutrition. Stunting vastly occurs in impoverished regions of the world, including Ethiopia.

OBJECTIVE

This study aimed to investigate the prevalence and correlates of stunting among under-five children in Ethiopia using marginal models.

METHODS

Data were taken from the 2016 Ethiopian Demographic Health Survey, which is a nationally representative survey of children in the 0-59 month age group. For marginal models, generalized estimating equations and alternating logistic regression models were used for the analysis.

RESULTS

The prevalence of stunting among the under-five children was 34.91% in the area. The proportion was slightly higher among male (36.01%) than female (33.76%) child. The Alternating Logistic Regression model analysis revealed that the child's age, the mother's education level, the mother's body mass index, the place of residence, the wealth index, and the previous birth interval were found to be significant determinants of childhood stunting, and the result shows that children born with a lower previous birth interval (less than 24 months) were more likely to be stunted than those born within a higher birth interval. Children in rural Ethiopia were more likely to be stunted than children in urban Ethiopia.

CONCLUSION

This study found that more than one third of children were stunted in the area. The study also determined that child's age, the mother's education, the mother's body mass index, the place of residence, the wealth index, and birth interval influence stunting. Therefore, it is better enhancing the nutritional intervention programs.

Undernutrition Among the Children from Different Social Groups in India: Prevalence, Determinants, and Transition Over Time (2005-2006 to 2019-2021)

Combating undernutrition among children under 5 years is presently an enormous challenge for India. The study aims to determine the prevalence of undernutrition by the Composite Index of Anthropometric Failure (CIAF) and the time-dependent significant determinants of undernutrition among children under 5 years from four recognized social groups, i.e., Scheduled Tribe (ST), Scheduled Caste (SC), Other Backward Class (OBC), and Others, or General group, between 2005-2006 and 2019-2021 in India. It also explains the transition in the probability of CIAF among ST, SC, OBC, and General children belonging to different socio-demographic, economic backgrounds, and geographic regions from 2005-2006 to 2015-2016, 2015-2016 to 2019-2021, and 2005-2006 to 2019-2021 in India. Time-dependent and time-independent logistic regression models are employed to identify the major determinants and predicted probabilities of CIAF, respectively, among four social groups. The predicted probabilities of CIAF among ST, SC, OBC, and General children belonging to various socio-demographic, economic backgrounds, and geographic regions are extracted from logistic regression models and represented graphically. The study outlines a higher prevalence of CIAF among ST children, followed by SC, OBC, and General children throughout the last 15 years. Since 2005-2006, the magnitude of CIAF risk elimination has been comparatively higher among socially marginalized children (ST, SC, OBC) than in General. The investigation also outlines a significant (p < 0.001), and consistent effect of child age, maternal nutritional level, education status, household economic status, and geographic regions on the prevalence of undernutrition among all four social groups in India from 2005-2006 to 2019-2021. The policymakers must focus much on the ST, SC, and OBC sections for eliminating childhood undernutrition. Specifically, more attention is needed for the ST, SC, and OBC children living with non- or less-educated mothers, belonging to poor families, living in central, western, and eastern Indian states for eliminating the childhood CIAF. This might contribute to lowering intergroup inequality (SDG 10.2) in India in terms of the incidence of hunger (SDG 2.2), undernutrition, and child mortality (SDG 3.2).

Exploring the risk factors of child malnutrition in Sub-Sahara Africa: A scoping review

Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub-Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.

Determinants of Child Stunting, Wasting, and Underweight: Evidence from 2017 to 2018 Pakistan Demographic and Health Survey

Child malnutrition persists in low-resource countries such as Pakistan, indicating an urgent need for interventions and policies aimed to address this critical population health issue. The World Health Organization Global Target 2025 includes the reduction of malnourishment in the form of stunting, wasting, and low weight. This study aims to examine the prevalence of factors associated with three measures of child malnutrition, i.e., stunting, wasting, and low weight in Pakistan. This study uses a secondary data analysis design based on data from Pakistan Demographic and Health Survey (2017-18) that used a two-stage cluster sampling approach. National level data covering urban and rural areas were used for this study consisting of 4,226 children less than 5 years of age. Univariate and multivariable analyses using logistic regression models were conducted. Over 23% of the children were underweight, 8.0% suffered wasting, and 37.7% were stunted. Children with small size at birth (<45.7 cm), those who were average in size (45.7 to 60 cm) at birth were less likely to be stunted (AOR, 0.4890) and underweight (AOR, 0.538). Children with large size at birth (>60 cm) were also less likely to be stunted (AOR, 0.288) and underweight (AOR, 0.538). Children who consumed fresh milk were less likely to be classified as wasted (AOR, 0.524) than those children who did not consume fresh milk. The children in high- and middle-economic status families were less likely to be stunted, underweight, or wasted. Children of mothers who had secondary and higher education were less likely to be stunted (AOR, 0.584) and were less likely to be underweight (AOR, 0.668) than illiterate mothers' children. Children of working mothers were less likely to be wasted compared to children of nonworking mothers (AOR, 0.287). Maternal BMI is also inversely associated with being underweight because overweight and obese mothers were less likely to have underweight children (AOR, 0.585). Our findings reflect a need to design targeted public health policies and community-based education that emphasize the mother's education on nutrition health and provide socioeconomic resources that enable mothers to provide dietary needs that prevent malnutrition.

Prevalence and associated factors of stunting, wasting and underweight of children below five using quintile regression analysis (PDHS 2017-2018)

The objective of the current study is to identify the risk factors for malnutrition among the age of under-five children's in Pakistan. This is secondary data analysis for the data taken from Pakistan Demographic and Health Survey (PDHS 2017-18) and was analyzed by implementing quantile regression analysis. The sample size included 12,708 alive children in the study, for which the data collection period was from November 22, 2017, to April 30, 2018. The prevalence of malnutrition among boys is high (51.2%). Older age mother's children have more prevalence of malnutrition (20.7%). A child born with small body size (underweight: Q_0.25: - 0.625; Q_0.50: - 0.623; Q_0.75: - 0.426 and wasting: Q_0.50: - 0.513); having uneducated mother (underweight: Q_0.25: - 0.387; Q_0.50: - 0.247; Q_0.75: - 0.328), belonged to a poor household (underweight: Q_0.50: - 0.251),residing in rural areas (underweight: Q_0.25: - 0.443), not following properly breastfeeding practices (underweight: Q_0.50: - 0.439; Q_0.75: - 0.438) have negative effect on different measures of malnutrition and this effect is significantly raises across different quantiles of stunting , wasting and underweight (at p value < 0.01 and < 0.05). Older age mother (stunting: Q_0.50: 0.777; Q_0.75: 1.078; underweight Q_0.20: 0.568; Q_0.50: 0.429; Q_0.75: 0.524) and higher birth order number (stunting: Q_0.50: 0.415; Q_0.75: 0.535), have a positive effect on three measures of under-nutrition and this effect is gradual raises at different quantile of stunting, wasting and underweight. Elder and smoker mothers were proved associated risk factors of both stunting and being underweight in Pakistan. Moreover, Proper breastfeeding practices, better economic status, average or above the average birth weight of the child, and milk consumption are found protective factors against stunting, wasting, and underweight children in Pakistan.

Under-nutrition and its determinants among school-aged children in northwest Ethiopia

Background

Malnutrition among children has lifelong implications, its outcomes not only cover the whole life but also transfer from one generation to another generation. Most studies conducted before focused on undernutrition in pregnant mothers and children less than 5 years of age, whereas school-age children are often omitted from health and nutrition surveys or surveillance. In Northwest Ethiopia, particularly in the study area, the community levels nutritional status of school-age is not well studied and documented. Therefore, this study aimed to assess the prevalence and determinants of the under-nutritional status of school-age children in Gondar Zuria District, Northwest Ethiopia.

Methods

A community-based cross-sectional study design was employed with 364 respondents from January to April 2020. Data entered using Epi Data software version 3.1. Standard deviation scores were obtained by the world health organization Anthro Plus software to determine the nutritional status of children, and further analysis was done by using STATA version 14 software. Adjusted odds ratio with its corresponding 95 % confidence interval was used to declare statistically significant variables.

Results

The prevalence of overall under-nutrition was 71.98% (95%, CI: 67%–76%) from which, 43.13% (95%, CI: 38%–48%) were stunted, 40.93% (95%, CI: 35%–46%) were under-weight, and 35.44% (95%, CI: 30%–40%) were wasted. Child age [AOR = 0.30, 95% CI (0.13–0.68)], food insecurity [AOR = 2.24, 95% CI (1.03–4.83)], good knowledge of mother/care giver [AOR = 0.40, 95% CI (0.17–0.92)], having larger family size (Tzioumis and Adair, 2014; Wolde et al., 2015; Mohammed et al., 2019) [6-8] [AOR = 2.92, 95% CI (1.29–6.58)], and unprotected drinking water sources [AOR = 2.84, 95% CI (1.00–8.06)] were the predictors of under-nutrition.

Conclusion

According to the world health organization cut-offs, the prevalence of overall under-nutrition in the study area was very high. Child age, food insecurity, knowledge of mother/caregiver, having a larger family size, and unprotected drinking water sources were the predictors of under-nutrition. The district offices should give attention to the improvement of the food security status of the community, and give priority to the availability and accessibility of drinking water sources, particularly pipe water sources. Special attention to older age groups of children is important to control the prevalence of under-nutrition.

Application of quantile regression to examine changes in the distribution of Height for Age (HAZ) of Indian children aged 0–36 months using four rounds of NFHS data

Background

The prevalence of stunting among under- three Indian children though decreased, still it is considered to be alarmingly high. In most of the previous studies, traditional (linear and logistic) regression analyses were applied. They were limited to encapsulated cross-distribution variations. The objective of the current study was to examine how the different determinants were heterogeneous in various percentiles of height for age (HAZ) distribution.

Methods and findings

This article examined the change in the HAZ distribution of children and examined the relationships between the key co-variate trends and patterns in HAZ among children aged <3 years over a period of 24 years. Four successive rounds of the National Family Health Survey data 1992–93, 1998–99, 2005–06, and 2015–16 were used for analysis. The final study included 206579 children aged <3 years (N = 106136 male, 100443 female). To explain and analyse differences in the HAZ distribution, the lambda-mu-sigma (LMS) method was used. Trends in height for age (HAZ) distribution over time were analysed using separate gender-stratified quantile regression (QR). The selected socio-economic, demographic and other predictors were considered for this analysis. The quantile regressions have indicated that mothers who have higher than primary level education were more proactive in mitigating malnutrition among children at the lower end of the distribution. The age, birth order, mother’s body-mass-index (BMI) and economic status, among children, were some more determining factors for HAZ. Results of selected quantile regression were estimated at the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantiles.

Conclusions

The outcome of various covariates working differently across the HAZ distribution was suggested by quantile regression. The major discrepancies in different aspects were underlined by socioeconomic and demographic aspects among the Indian population. The heterogeneity of this effect was shown using quantile regression. Policymakers may choose to concentrate on the most important factors when formulating policies to lessen the prevalence of stunting in India.

Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries

OBJECTIVE

This study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA).

DESIGN

Data of 127, 487 under-5 children from 31 countries in SSA were pooled from the Demographic and Health Surveys collected between 2010 and 2019. We examined the risk of coexistence of stunting, underweight, and wasting using multinomial logistic regression models. The results were presented using relative risk ratios (RRR) with corresponding confidence intervals (CIs).

SETTING

Thirty-one sub-Saharan African countries.

PARTICIPANTS

Children under age 5.

OUTCOME MEASURES

The outcome variables were three child anthropometrics: stunting (height-for-age z-scores); underweight (weight-for-age z-scores) and wasting (weight-for-height z-scores).

RESULTS

The prevalence of coexistence of stunting, underweight, and wasting varied across countries, with the highest (12.14%) and lowest (0.58%) prevalences of coexistence of stunting, underweight and wasting in Benin and Gambia respectively. The risk of coexistence of the three indicators of undernutrition was higher among children aged 1 year (RRR=3.714; 95% CI 3.319 to 4.156) compared with those aged 0. The risk of coexistence of the three dimensions was lower among female children (RRR=0.468 95% CI 0.420 to 0.51), but higher for those with small size at birth (RRR=3.818; CI 3.383 to 4.308), those whose mothers had no education (RRR=3.291; 95% CI 1.961 to 5.522), not working (RRR=1.195; 95% CI 1.086 to 1.314), had no antenatal visits during pregnancy (RRR=1.364; 95% CI 1.20 to 1.541), children delivered at home (RRR=1.372; CI 1.232 to 1.529), those from poor households (RRR=1.408; 95% CI 1.235 to 1.605), those whose mothers had no access to media (RRR=1.255; 95% CI 1.144 to 1.377) and living in households with an unimproved toilet facility (RRR=1.158; 95% CI 1.032 to 1.300).

CONCLUSIONS

Findings suggest the urgent need for consideration of the coexistence of stunting, wasting and underweight among under-5 children in policy design and programming of interventions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics.

Prevalence and Potential Determinants of Aggregate Anthropometric Failure among Pakistani Children: Findings from a Community Health Survey

Malnutrition among children is an important public health problem in Pakistan. Conventional indicators (stunting, wasting and underweight) are well known. However, there is a need for aggregate indicators in this perspective. The goal of this study is to assess the prevalence and trends of malnutrition among Pakistani children under the age of five using the so-called composite index of anthropometric failure (CIAF), a tool for calculating the whole aggregate burden of malnutrition. The data were extracted from the Pakistan Demographic and Health Survey 2012-2013. Mothers' education and socioeconomic statuses (SES) were assessed as important factors in malnutrition. Chi-squared analysis was used to check the bivariate association, and multiple logistic regression was used to identify the significant correlates of child malnutrition. Moreover, multiple correspondence analysis (MCA) was applied to strengthen the use of CIAF as an outcome variable. The study looked at 3071 children under the age of five, with 52.2% of them falling into the CIAF. Children of educated mothers had 43% fewer odds of being malnourished (OR (Odd Ratio) = 0.57, 95% CI (Confidence Interval) = 0.44-0.73). Additionally, a decreasing trend in malnutrition was found with increasing SES. There is a need to improve maternal education. Such programs focusing on increasing women's autonomy in making home decisions should be established. Furthermore, long-term interventions for improving home SES and effective nutritional methods should be examined. For policymakers, the use of CIAF is suggested since it provides an estimate of the entire burden of undernutrition.

Prevalence of undernutrition and potential risk factors among children below five years of age in Somali region, Ethiopia: evidence from 2016 Ethiopian demographic and health survey

BACKGROUND

Childhood under-nutrition is far-reaching in low and middle-income nations. Undernutrition is one of the major open wellbeing concerns among newborn children and youthful children in Ethiopia. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Somali Region, Ethiopia.

METHODS

The data for this study was extricated from the Ethiopian Demographic and Health Survey (EDHS) 2016. The data collected from 1339 children born 5 years before was considered within the analysis. A multivariable binary logistic regression analysis was utilized at a 5% level of significance to decide the individual and community-level variables related to childhood malnutrition.

RESULTS

The prevalence of stunting, underweight and wasting were 27.4, 28.7 and 22.7%, respectively. About 16.1% of children were both stunted and underweight; the extent of both being underweight and wasted was 11.7%, the prevalence of both stunted and wasted children was 5.5%, and all three malnutrition conditions were 4.7% children. Among the variables considered in this study, age of the child in months, type of birth, anemia level, size of child at birth, sex of the child, mothers' BMI and sources of drinking water were significantly related to stunting, underweight and wasting in Somali Region.

CONCLUSIONS

The prevalence of stunting, underweight and wasting was relatively high. Undernutrition is one of the major open wellbeing concerns among children in Somali region. The impact of these variables ought to be considered to develop strategies for decreasing the lack of healthy sustenance due to undernutrition in the study areas. Hence, intercession should be centered on making strides for the under-nutrition determinant variables of the children to be solid, to improve the child's wholesome status, and decrease child mortality quickly.

Trends in child growth failure among children under five years of age in Ethiopia: Evidence from the 2000 to 2016 Demographic and Health Surveys

INTRODUCTION

In a majority of low- and middle-income countries (LMICs), levels of child growth failure (CGF) have steadily declined since 2000. However, some countries show a different trend. Despite continued investment from the government of Ethiopia as well as donors, CGF levels are still high in Ethiopia. This study aimed to assess trends in CGF and associated sociodemographic, economic and water, sanitation, and hygiene (WASH) factors from 2000 to 2016 in Ethiopia.

METHODS

Data were taken from four rounds of the Ethiopia Demographic and Health Survey (EDHS). Children aged between 0 to 59 months were included. CGF indicators were categorised based on height-for-age z-score (HAZ) < -2 Standard deviation (SD), weight-for-age z-score (WAZ) < -2 SD and weight-for-height z-score (WHZ) < -2 SD. CGF trends were estimated for predicted probabilities and odds ratios (ORs) between 2000 and 2016.

RESULTS

A total sample size of 31978 for HAZ, 32045 for WAZ and 32246 for WHZ were included in the current study. Stunting decreased from an adjusted odds ratio (AOR) = 0.77 (95% CI: 0.67 to 0.88) in 2005 to an AOR = 0.45 (95% CI: 0.39 to 0.53) in 2016 compared with the year 2000. Compared with data in 2000, underweight decreased from an AOR of 0.70 (95% CI: 0.61 to 0.80) in 2005 to an AOR of 0.43 (95% CI: 0.36 to 0.50) in 2016. Wasting declined from an AOR of 0.91 (95% CI: 0.75 to 1.10) in 2005 to an AOR of 0.76 (95% CI: 0.61 to 0.94) in 2016, compared with data in 2000.

CONCLUSIONS

Between 2000 to 2016, there was a decline in CGF levels albeit the levels are still relatively high compared with the World Health Organization (WHO) cut-off levels for public health concern. Observed rates of change varied across sociodemographic, economic and WASH factors which suggest that interventions tailored towards addressing the imbalances across those factors are required.

Differences in the socio-demographic determinants of undernutrition in children aged <5 years in urban and rural areas of Bangladesh measured by the Composite Index of Anthropometric Failure

OBJECTIVES

This study investigates the prevalence and determinants of undernutrition among children <5 years living in Bangladesh using the Composite Index of Anthropometric Failure (CIAF) and highlights the differences between urban and rural areas.

STUDY DESIGN

Data are drawn from three cross-sectional Bangladesh Demographic Health Surveys conducted from 2007 to 2014.

METHODS

A Chi-square test was used to assess the prevalence of <5 years child undernutrition. Logistic regression analysis was performed to identify various sociodemographic risk factors.

RESULTS

The prevalence of undernutrition based on the CIAF was 52% among children <5 years in Bangladesh. The prevalence of undernutrition in children living in urban areas and rural areas were found to be 45% and 54%, respectively. As per the CIAF, undernutrition was highly prevalent among children in the older age group, children of uneducated and currently working mothers, those of underweight mothers, children of fourth and above in the birth order, children of fathers who were manual labourers, children of households who had no access to television and those in the poorest households whether in urban or rural areas. Children in the older age group, children of uneducated mothers, those with underweight mothers and those from the poorest households provided common key risk factors for undernutrition in both urban and rural areas. Children of fourth and above birth order and not watching television at all were additional risk factors of child undernutrition in rural areas.

CONCLUSION

Half of the children in rural areas and two-fifths of them in urban areas are suffering undernutrition in Bangladesh, and several sociodemographic factors heighten the risks. Also, birth order and watching television were identified as the differential risk factors. This study therefore concludes that evidence-based interventions are needed to reduce the burden of undernutrition in children in the country.

Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015-2016 National Family Health Survey, India

Despite the broad consensus that investments in nutrition-sensitive programmes are required to reduce child undernutrition, in practice empirical studies and interventions tend to focus on few nutrition-specific risk factors in isolation. The 2015-16 National Family Health Survey provides the first opportunity in more than a decade to conduct an up-to-date comprehensive evaluation of the relative importance of various maternal and child health and nutrition (MCHN) factors in respect to child anthropometric failures in India. The primary analysis included 140,444 children aged 6-59 months with complete data on 20 MCHN factors, and the secondary analysis included a subset of 25,603 children with additional paternal data. Outcome variables were stunting, underweight and wasting. We conducted logistic regression models to first evaluate each correlate separately in age- and sex-adjusted models, and then jointly in a mutually adjusted model. For all anthropometric failures, indicators of past and present socioeconomic conditions showed the most robust associations. The strongest correlates for stunting were short maternal stature (OR: 4.39; 95%CI: 4.00, 4.81), lack of maternal education (OR: 1.74; 95%CI: 1.60, 1.89), low maternal BMI (OR: 1.64; 95%CI: 1.54, 1.75), poor household wealth (OR: 1.25; 95%CI: 1.15, 1.35) and poor household air quality (OR: 1.22; 95%CI: 1.16, 1.29). Weaker associations were found for other correlates, including dietary diversity, vitamin A supplementation and breastfeeding initiation. Paternal factors were also important predictors of anthropometric failures, but to a lesser degree than maternal factors. The results remained consistent when stratified by children's age (6-23 vs 24-59 months) and sex (girls vs boys), and when low birth weight was additionally considered. Our findings indicate the limitation of nutrition-specific interventions. Breaking multi-generational poverty and improving environmental factors are promising investments to prevent anthropometric failures in early childhood.

Determinants of stunting among under-five children in Ethiopia: a multilevel mixed-effects analysis of 2016 Ethiopian demographic and health survey data

BACKGROUND

Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the individual-level factors of childhood stunting are well documented, community-level factors have not been given much attention in the country. This study aimed to identify individual- and community-level factors associated with stunting among under-five children in Ethiopia.

METHODS

Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855 under-five children and 640 community clusters were included in the current analysis. A multilevel logistic regression model was used at 5% level of significance to determine the individual- and community-level factors associated with childhood stunting.

RESULTS

The prevalence of stunting was found to be 38.39% in Ethiopian under-five children. The study showed that the percentage change in variance of the full model accounted for about 53.6% in odds of childhood stunting across the communities. At individual-level, ages of the child above 12 months, male gender, small size of the child at birth, children from poor households, low maternal education, and being multiple birth had significantly increased the odds of childhood stunting. At community-level, children from communities of Amhara, Tigray, and Benishangul more suffer from childhood stunting as compared to Addis Ababa's community children. Similarly, children from Muslim, Orthodox and other traditional religion followers had higher log odds of stunting relative to children of the protestant community.

CONCLUSIONS

This study showed individual- and community-level factors determined childhood stunting in Ethiopian children. Promotion of girl education, improving the economic status of households, improving maternal nutrition, improving age-specific child feeding practices, nutritional care of low birth weight babies, promotion of context-specific child feeding practices and narrowing rural-urban disparities are recommended.

Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia

BACKGROUND

Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0-59 months in rural Ethiopia.

METHODS

Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13.

RESULT

The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia.

CONCLUSION

The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished.