1
|
Sagastume D, Barrenechea-Pulache A, Ruiz-Alejos A, Polman K, Beňová L, Ramírez-Zea M, Peñalvo JL. Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates. Adv Nutr 2024; 15:100212. [PMID: 38493876 PMCID: PMC11015105 DOI: 10.1016/j.advnut.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.
Collapse
Affiliation(s)
- Diana Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | | | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
| |
Collapse
|
2
|
Sahiledengle B, Mwanri L, Agho KE. Association between maternal stature and household-level double burden of malnutrition: findings from a comprehensive analysis of Ethiopian Demographic and Health Survey. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:7. [PMID: 36691083 PMCID: PMC9872360 DOI: 10.1186/s41043-023-00347-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Undernutrition among under-five children is one of the intractable public health problems in Ethiopia. More recently, Ethiopia faced a rising problem of the double burden of malnutrition-where a mother may be overweight/obese, and a child is stated as having undernutrition (i.e., stunting, wasting, or underweight) under the same roof. The burden of double burden of malnutrition (DBM) and its association with maternal height are not yet fully understood in low-income countries including Ethiopia. The current analysis sought: (a) to determine the prevalence of double burden of malnutrition (i.e., overweight/obese mother paired with her child having one form of undernutrition) and (b) to examine the associations between the double burden of malnutrition and maternal height among mother-child pairs in Ethiopia. METHODS We used population-representative cross-sectional pooled data from four rounds of the Ethiopia Demographic and Health Survey (EDHS), conducted between 2000 and 2016. In our analysis, we included children aged 0-59 months born to mothers aged 15-49 years. A total of 33,454 mother-child pairs from four waves of EDHS were included in this study. The burden of DBM was the primary outcome, while the maternal stature was the exposure of interest. Anthropometric data were collected from children and their mothers. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. The association between the double burden of malnutrition and maternal stature was examined using hierarchical multilevel modeling. RESULTS Overall, the prevalence of the double burden of malnutrition was 1.52% (95% CI 1.39-1.65). The prevalence of overweight/obese mothers and stunted children was 1.31% (95% CI 1.19-1.44), for overweight/obese mothers and wasted children, it was 0.23% (95% CI 0.18-0.28), and for overweight/obese mothers and underweight children, it was 0.58% (95% CI 0.51-0.66). Children whose mothers had tall stature (height ≥ 155.0 cm) were more likely to be in the double burden of malnutrition dyads than children whose mothers' height ranged from 145 to 155 cm (AOR: 1.37, 95% CI 1.04-1.80). Similarly, the odds of the double burden of malnutrition was 2.98 times higher for children whose mothers had short stature (height < 145.0 cm) (AOR: 2.98, 95% CI 1.52-5.86) compared to those whose mothers had tall stature. CONCLUSIONS The overall prevalence of double burden of malnutrition among mother-child pairs in Ethiopia was less than 2%. Mothers with short stature were more likely to suffer from the double burden of malnutrition. As a result, nutrition interventions targeting households' level double burden of malnutrition should focus on mothers with short stature to address the nutritional problem of mother and their children, which also has long-term and intergenerational benefits.
Collapse
Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Lillian Mwanri
- grid.449625.80000 0004 4654 2104Centre for Public Health Research, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, SA 5000 Australia
| | - Kingsley Emwinyore Agho
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.1029.a0000 0000 9939 5719School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW 2571 Australia ,grid.16463.360000 0001 0723 4123African Vision Research Institute, University of KwaZulu-Natal, Durban, 4041 South Africa
| |
Collapse
|
3
|
Veiga GRS, da Silva GAP, Padilha BM, Lima MDC. Determining factors of child linear growth from the viewpoint of Bronfenbrenner's Bioecological Theory. J Pediatr (Rio J) 2022; 99:205-218. [PMID: 36572387 DOI: 10.1016/j.jped.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. DATA SOURCES Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. SUMMARY OF FINDINGS According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. CONCLUSION Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.
Collapse
Affiliation(s)
- Gabriela Rossiter Stux Veiga
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil; Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil.
| | | | | | - Marilia de Carvalho Lima
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
| |
Collapse
|
4
|
Otten HS, Seferidi P. Prevalence and socioeconomic determinants of the double burden of malnutrition in mother-child pairs in Latin America and the Caribbean. BMJ Nutr Prev Health 2022; 5:263-270. [PMID: 36619319 PMCID: PMC9813618 DOI: 10.1136/bmjnph-2022-000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/10/2022] [Indexed: 12/31/2022] Open
Abstract
Background The double burden of malnutrition (DBM), which refers to the coexistence of overnutrition and undernutrition among populations, households or individuals, is a growing problem in low/middle-income countries. The Latin America and the Caribbean (LAC) region has been particularly affected by the DBM, following a nutrition transition and a rapid increase in overweight, obesity and diet-related disease, while high levels of undernutrition persist. This study aims to describe the prevalence of four different DBM definitions in mother-child pairs across nine LAC countries and investigate the socioeconomic determinants of overweight mothers with at least one stunted child (SCOM). Methods We used cross-sectional data from the Demographic and Health Surveys for all analyses. We used descriptive statistics to obtain prevalence rates and conducted multiple logistic regression analyses to investigate the association between SCOM households and socioeconomic determinants, including wealth index, maternal education, place of residency and whether the mother was working, adjusted for a range of variables. Results Overweight/obese mothers with at least one anaemic child were the most common type of DBM, with a prevalence of 19.39%, followed by SCOM with a prevalence of 10.44%. Statistically significant socioeconomic predictors of SCOM were households with a lower wealth index, lower maternal education and living in rural areas. Conclusion This study showed that the overall prevalence of most DBM definitions examined was high, which points to the need for urgent interventions in the LAC region. The unique set of socioeconomic predictors of SCOM identified in this study calls for future double-duty policies that simultaneously target food affordability, nutrition education and access to healthy food.
Collapse
Affiliation(s)
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| |
Collapse
|
5
|
Arriaza A, Hambidge KM, Krebs NF, Garcés A, Channon AA. The trend in mean height of Guatemalan women born between 1945 and 1995: a century behind. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:43. [PMID: 36109796 PMCID: PMC9476692 DOI: 10.1186/s41043-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adult height is a cumulative indicator of living standards with mean height increasing with a greater socio-economic level. Guatemalan adult women have the lowest mean height worldwide. The country's population is ethnically divided between indigenous and non-indigenous groups. This study aims to identify trends in the mean height for indigenous and non-indigenous adult women born between 1945 and 1995 in Guatemala and the association with individual, household and environmental factors. METHODS We used pooled data of adult women from five Demographic and Health Surveys. Mixed-effects multilevel linear regression models estimate the mean height associated with the explanatory variables. Mean height was modelled as a function of birth year cohort, wealth, education, geo-administrative regions and elevation. RESULTS The mean height increased 0.021 cm per year on average. The annual increase for indigenous women was 0.027 cm, while 0.017 cm for non-indigenous women. Height is associated with household wealth and women's education level. We found an interaction effect between ethnicity and household wealth, with indigenous women at the lowest quintile 0.867 cm shorter than the corresponding non-indigenous group. Height is associated with the geo-administrative region, those women in western regions being shorter than those in the metropolis. Mean height is reduced 0.980 cm for each 1000 m increase in elevation. CONCLUSIONS Guatemalan women have grown only 1 cm over half century, a slow improvement between 1945 and 1995, a period characterised by political instability and civil war. There are persistent inequalities in women's height associated with socio-economic status, education and attributes of the geographical context. These aspects need to be considered when implementing strategies to encourage growth. Further research is required to understand the evolution of adult height and the standard of living in post-war Guatemala.
Collapse
Affiliation(s)
- Astrid Arriaza
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - K. Michael Hambidge
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Nancy F. Krebs
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Ana Garcés
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - Andrew Amos Channon
- Centre for Global Health and Policy, University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Abstract
OBJECTIVE To explore and provide contextual meaning around issues surrounding food insecurity, namely factors influencing food access, as one domain of food security. DESIGN A community-based, qualitative inquiry using semi-structured face-to-face interviews was conducted as part of a larger sequential mixed-methods study. SETTING Cayo District, Belize, May 2019-August 2019. PARTICIPANTS Thirty English-speaking individuals (eight males, twenty-two females) between the ages of 18-70, with varying family composition residing within the Cayo District. RESULTS Participants describe a complex interconnectedness between family- and individual-level barriers to food access. Specifically, family composition, income, education and employment influence individuals' ability to afford and access food for themselves or their families. Participants also cite challenges with transportation and distance to food sources and educational opportunities as barriers to accessing food. CONCLUSION These findings provide insight around food security and food access barriers in a middle-income country and provide avenues for further study and potential interventions. Increased and sustained investment in primary and secondary education, including programmes to support enrollment, should be a priority to decreasing food insecurity. Attention to building public infrastructure may also ease burdens around accessing foods.
Collapse
|
7
|
Socio-economic status and the double burden of malnutrition in Cambodia between 2000 and 2014: overweight mothers and stunted children. Public Health Nutr 2021; 24:1806-1817. [PMID: 33632364 PMCID: PMC8094435 DOI: 10.1017/s1368980021000689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time. DESIGN We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon. PARTICIPANTS We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers. SETTING Nationally representative household survey across all regions. RESULTS SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. CONCLUSIONS Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.
Collapse
|
8
|
Félix-Beltrán L, Macinko J, Kuhn R. Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers. Public Health Nutr 2021; 24:106-116. [PMID: 32867877 PMCID: PMC10049080 DOI: 10.1017/s136898002000292x 10.1017/s136898002000292x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.
Collapse
Affiliation(s)
- Lucía Félix-Beltrán
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
9
|
Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers. Public Health Nutr 2020; 24:106-116. [PMID: 32867877 PMCID: PMC10049080 DOI: 10.1017/s136898002000292x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.
Collapse
|
10
|
Blankenship JL, Gwavuya S, Palaniappan U, Alfred J, deBrum F, Erasmus W. High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12832. [PMID: 32835441 PMCID: PMC7706834 DOI: 10.1111/mcn.12832] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/07/2019] [Accepted: 04/23/2019] [Indexed: 01/29/2023]
Abstract
Many low‐ and middle‐income countries are faced with a double burden of malnutrition characterized by a stagnating burden of undernutrition and an increasing prevalence of overweight and obesity often observed both at population and household levels. We used data from the 2017 National Integrated Child Health and Nutrition Survey in the Republic of the Marshall Islands to explore the prevalence of overweight mother‐stunted child pairs (mother–child double burden, MCDB). We used bivariate analysis, multivariate logistic regression, and multinomial logistic regression analysis to explore associations between child‐, maternal‐, and household‐level variables and both stunting and MCDB and other types of maternal–child pairs. Our results indicate that nearly three out of four mothers were overweight or obese and one in four households is home to an overweight mother with a stunted child. The risk of child stunting and of MCDB were largely associated with maternal characteristics of lower maternal height, maternal age at birth, years of education, and marital status and household economic status as measured by wealth index and number of household members. These findings support the growing body of evidence showing that the coexistence of high maternal overweight and child stunting (MCDB) has linked root causes to early life undernutrition that are exacerbated by the nutrition transition.
Collapse
Affiliation(s)
| | | | | | - Julia Alfred
- Ministry of Health, Majuro, Republic of the Marshall Islands
| | - Frederick deBrum
- Economic, Policy, Planning and Statistics Office, Majuro, Republic of the Marshall Islands
| | | |
Collapse
|
11
|
Prevalence and regional variations of coexistence of child stunting and maternal overweight or obesity in Myanmar. Public Health Nutr 2020; 24:2248-2258. [PMID: 32677600 DOI: 10.1017/s136898002000186x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current study aimed to investigate double burden of malnutrition within households at the national and subnational levels and to identify its association with sociodemographic factors in Myanmar. DESIGN All the variables were extracted from children's file of the Myanmar Demographic and Health Survey 2015-2016. Children under five were identified as stunted based on a height-for-age < -2 sd below the WHO reference median. Maternal overweight/obesity was defined as a BMI ≥ 23 kg/m2. A stunted child with an overweight/obese mother (SCOM) was classified as a double-burden household. SETTING A national household survey in Myanmar. PARTICIPANTS Children under five and their mothers (n 3954 pairs). RESULTS Mean ages of children and mothers were 29 (se 0·14) months and 30·9 (se 0·32) years, respectively. National prevalence of childhood stunting and maternal overweight/obesity was 28·0 % and 39·4 %, respectively, and the prevalence of SCOM was 9·1 %. Significant regional differences were found in SCOM, ranging from 3·6 % in Naypyitaw to 12 % in Kachin and Mon and 14·6 % in Kayah. In the multinomial logistic regression analysis, relative to neither a stunted child nor an overweight/obese mother, child's age, maternal age, maternal experience of a teen birth, short mothers, mothers with primary education and in middle or rich wealth tertiles, and some regions (Kachin, Kayah, Shan, Sagaing, Taninthayi, Ayeyarwaddy, Mon and Yangon) were associated with greater odds of SCOM. CONCLUSIONS The current study showed a relatively high national prevalence of SCOM and significant regional variations. Overarching policies and programmes with culturally sensitive strategies need to be formulated and implemented.
Collapse
|
12
|
Acharya Y, Naz S, Galway LP, Jones AD. Deforestation and Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2020; 4. [PMID: 33912810 DOI: 10.3389/fsufs.2020.00033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Although forests and forest-based ecosystems have been shown to influence health and sustainable diets, there is limited evidence on how deforestation affects the current nutrition transition and the double burden of malnutrition. We examined the relationship between deforestation and the individual- and household-level double burden of malnutrition in 15 countries in Sub-Saharan Africa. Materials and methods We combined data from geolocated Demographic and Health Surveys and the Global Forest Change dataset. We defined household-level double burden of malnutrition as the co-occurrence of an overweight woman of childbearing age (WCBA) and a stunted pre-school child (PSC) within the same household. We defined individual-level double burden in two ways: 1) as the co-occurrence of overweight and anemia within an individual WCBA, and 2) as the co-occurrence of overweight and stunting within a PSC. We used logistic regression analysis to examine the association between forest cover loss and these three measures after adjusting for potential confounders. We also assessed the mechanisms linking forest cover loss and nutritional status, such as livestock ownership and access to clean water. Results In our sample, the prevalence rates of the three measures of the double burden were: overweight and anemic WCBA: 8.4%, overweight WCBA and stunted PSC: 6.9%, overweight and stunted PSC: 2.7%. After adjusting for the confounders as well as country fixed effects and the month of the survey, forest cover loss was marginally associated with a higher odds of an overweight WCBA and stunted PSC (odds ratio (95% CI): 4.80 (0.82, 28.25)). We found no association between forest cover loss and odds of an overweight and stunted PSC (odds ratio (95% CI): 2.47 (0.80, 7.60)) or the odds of an anemic and overweight WCBA (odds ratio (95% CI): 0.71 (0.15, 3.32)). Discussion Deforestation does not seem to be an important driver of the double burden of malnutrition in SSA. However, deforestation influences several intermediate factors which, in turn, may influence the double burden. The overall weak association between forest cover loss and double burden measures mask significant heterogeneity across regions within SSA. Future research should unpack the mechanisms behind these regional differences.
Collapse
Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Saman Naz
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Lindsay P Galway
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
13
|
Rivadeneira MF, Moncayo AL, Tello B, Torres AL, Buitrón GJ, Astudillo F, Fredricks TR, Grijalva MJ. A Multi-causal Model for Chronic Malnutrition and Anemia in a Population of Rural Coastal Children in Ecuador. Matern Child Health J 2020; 24:472-482. [PMID: 31838668 PMCID: PMC7078138 DOI: 10.1007/s10995-019-02837-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Chronic malnutrition and anemia are prevalent in developing countries. This research aimed to determine the prevalence of chronic malnutrition and anemia and their associated factors in children under five using a multi-causal model in a rural community in the coast of Ecuador. METHODS The study included 314 children under 5 years old who were residents of San Isidro, Ecuador. Indicators of chronic malnutrition and anemia were identified. Mothers/caregivers were surveyed on socio-economic and environmental conditions, feeding and care practices, access to health services and biological characteristics. Bivariate and multivariable Poisson regression were performed. RESULTS The prevalence was 12.42% (n = 39) for chronic malnutrition and 16.98% (n = 54) for anemia. There was a significant and independent association between chronic malnutrition and family income less than $80 USD per month (Prevalence Ratio [PR] = 2.74, 95% CI 1.04, 7.20), maternal height less than 150 cm (PR 3.00, 95% CI 1.69, 5.32) and residence in a household with more than 4 children (PR 3.05, 95% CI 1.48, 6.29). Anemia was 2.57 times higher (95% CI 1.17, 5.65) in children with more than two episodes of diarrhea in the last 6 months. Prenatal care (5 to 8 visits) provided a protective effect for anemia (PR 0.48, 95% CI 0.27, 0.89). CONCLUSIONS FOR PRACTICE Findings support the need for comprehensive interventions targeted toward chronic malnutrition and anemia in children from rural coastal communities. Improvement of socioeconomic conditions, family planning, prenatal care and reduction of diarrheal diseases should be prioritized.
Collapse
Affiliation(s)
- María F Rivadeneira
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Ana L Moncayo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.
| | - Betzabé Tello
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Ana L Torres
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Gladys J Buitrón
- Escuela de Ciencias Físicas y Matemática, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Fabricio Astudillo
- Escuela de Geografía, Facultad de Ciencias Humanas, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Todd R Fredricks
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Mario J Grijalva
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| |
Collapse
|
14
|
Masibo PK, Humwa F, Macharia TN. The double burden of overnutrition and undernutrition in mother-child dyads in Kenya: demographic and health survey data, 2014. J Nutr Sci 2020; 9:e5. [PMID: 32042413 PMCID: PMC6984123 DOI: 10.1017/jns.2019.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/03/2023] Open
Abstract
The double burden of overnutrition and undernutrition is rapidly becoming a public health concern in low- and middle-income countries. We explored the occurrence of mother-child pairs of over- and undernutrition and the contributing factors using the 2014 Kenya Demographic and Health Survey data. A weighted sample of 7830 mother-child pairs was analysed. The children's nutritional status was determined using the WHO 2006 reference standards while maternal nutritional status was determined with BMI. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. The proportion of overweight and obese mothers was 26 % (18·8 % overweight and 7·2 % obese). The prevalence of child stunting, underweight and wasting was 26·3, 12·8 and 5·1 %, respectively. Out of the overweight/obese mothers (weighted n 2034), 20 % had stunted children, 5·4 % underweight children and 3·1 % wasted children. Overweight/obese mother-stunted child pairs and overweight/obese mother-underweight child pairs were less likely to occur in the rural areas (adjusted OR (aOR) = 0·43; P < 0·01) in comparison with those residing in the urban areas (aOR = 0·54; P = 0·01). Children aged more than 6 months were more likely to be in the double burden dyads compared with children below 6 months of age (P < 0·01). The double burden mother-child dyads were more likely to be observed in wealthier households. Mother-child double burden is a notable public health problem in Kenya. Household wealth and urban residence are determinants of the double burden. There is need for target-specific interventions to simultaneously address child undernutrition and maternal overweight/obesity.
Collapse
Affiliation(s)
- Peninah Kinya Masibo
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Nutrition, Moi University, School of Public Health, Nairobi, Kenya
| | - Felix Humwa
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Teresia Njoki Macharia
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
15
|
Thompson AL, Nicholas KM, Watson E, Terán E, Bentley ME. Water, food, and the dual burden of disease in Galápagos, Ecuador. Am J Hum Biol 2020; 32:e23344. [PMID: 31642150 PMCID: PMC7114884 DOI: 10.1002/ajhb.23344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Rapid development in low- and middle-income countries (LMIC) has led to changes in diet that have outpaced water and sanitation improvements, contributing to a dual burden of overweight and noncommunicable disease risk factors (OWT/NCD) and undernutrition and infectious disease symptoms (UND/ID) within individuals and households. Yet, little work has examined the joint impact of water and food exposures on the development of the dual burden. METHODS We use data from Ecuador's nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT-ECU) to test whether water access and quality and diet quality and security are associated with OWT/NCD and UND/ID among 1119 children and 1582 adults in Galápagos. Adjusted multinomial and logistic models were used to test the separate and joint associations between water and food exposures and the dual burden and its components at the individual and household levels. RESULTS The prevalence of the dual burden of OWT/NCD and UND/ID was 16% in children, 33% in adults, and 90% in households. Diet quality was associated with a higher risk of dual burden in individuals and households. Mild food insecurity was positively associated with the risk of dual burden at the household level. No water variable separately predicted the dual burden. Joint exposure to poor water access and food insecurity was associated with greater odds of dual burden in households. CONCLUSION Our results suggest that unhealthy diets and poor water quality contribute to the dual burden at the individual and household levels. Addressing both food and water limitations is important in LMIC.
Collapse
Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Khristopher M Nicholas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elijah Watson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad de San Francisco Quito, Quito, Ecuador
- Galapagos Science Center, San Cristobal, Ecuador
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
16
|
Socio-Ecological Model of Correlates of Double Burden of Malnutrition in Developing Countries: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193730. [PMID: 31623366 PMCID: PMC6801412 DOI: 10.3390/ijerph16193730] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
(1) Background: The double burden of malnutrition (DBM) is a complex problem involving the coexistence of under- and over-nutrition within the same individual, household or population. This review aimed to discuss the correlates of the double burden of malnutrition through the socio-ecological model (SEM); (2) Methods: The PubMed database was systematically searched for peer-reviewed articles related to the double burden of malnutrition. Information on correlates of the double burden of malnutrition was extracted for analysis and discussion in alignment with the levels of the socio-ecological model.; (3) Results and Discussion: The correlates of the double burden of malnutrition identified from previous literature were: Race/genetics; maternal short stature; breastfeeding status; low maternal education; family size; household food security; household dietary diversity; and rural and urban settings. In the absence of evidence linking factors in a certain level of the SEM and the double burden of malnutrition, we employed correlates of overweight status and obesity to complete this narrative. Potential intervention strategies were proposed in alignment with the targets and settings identified, based on the socio-ecological approach; (4) Conclusions: The double burden of malnutrition is a public health phenomenon associated with a variety of socio-ecological determinants. An integrated approach is needed to address the root causes of malnutrition in all its forms, and at all life stages.
Collapse
|
17
|
Weatherspoon DD, Miller S, Ngabitsinze JC, Weatherspoon LJ, Oehmke JF. Stunting, food security, markets and food policy in Rwanda. BMC Public Health 2019; 19:882. [PMID: 31272435 PMCID: PMC6610945 DOI: 10.1186/s12889-019-7208-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern. METHODS Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household. RESULTS Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production. CONCLUSIONS Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.
Collapse
Affiliation(s)
- Dave D. Weatherspoon
- Agricultural, Food & Resource Economics Department, Michigan State University, Rm. 213C Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Steve Miller
- Agricultural, Food & Resource Economics Department, Rm. 81 Morrill Hall of Agriculture, 446 W. Circle Dr, East Lansing, MI 48824 USA
| | - Jean Chrysostome Ngabitsinze
- Department of Rural Development and Agricultural Economics, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, 3971 Rwanda
| | - Lorraine J. Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, Rm 140 Trout Food Science Bldg, East Lansing, MI 48824-1224 USA
| | - James F. Oehmke
- United States Agency for International Development, Bureau For Food Security, Ronald Reagan Bldg., 1300 Pennsylvania Ave. NW, Washington, DC 20229 USA
| |
Collapse
|
18
|
Flood D, Petersen A, Martinez B, Chary A, Austad K, Rohloff P. Associations between contraception and stunting in Guatemala: secondary analysis of the 2014-2015 Demographic and Health Survey. BMJ Paediatr Open 2019; 3:e000510. [PMID: 31531407 PMCID: PMC6721081 DOI: 10.1136/bmjpo-2019-000510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There has been limited research on the relationship between contraception and child growth in low-income and middle-income countries (LMICs). This study examines the association between contraception and child linear growth in Guatemala, an LMIC with a very high prevalence of child stunting. We hypothesise that contraceptive use is associated with better child linear growth and less stunting in Guatemala. METHODS Using representative national data on 12 440 children 0-59 months of age from the 2014-2015 Demographic and Health Survey in Guatemala, we constructed multivariable linear and Poisson regression models to assess whether child linear growth and stunting were associated with contraception variables. All models were adjusted for a comprehensive set of prespecified confounding variables. RESULTS Contraceptive use was generally associated with modest, statistically significant greater height-for-age z-score. Current use of a modern method for at least 15 months was associated with a prevalence ratio of stunting of 0.87 (95% CI 0.81 to 0.94; p<0.001), and prior use of a modern method was associated with a prevalence ratio of stunting of 0.93 (95% CI 0.87 to 0.98; p<0.05). The severe stunting models found generally similar associations with modern contraceptive use as the stunting models. There was no significant association between use of a modern method for less than 15 months and the prevalence ratio of stunting or severe stunting. CONCLUSIONS Contraceptive use was associated with better child linear growth and less child stunting in Guatemala. In addition to the human rights imperative to expand contraceptive access and choice, family planning merits further study as a strategy to improve child growth in Guatemala and other countries with high prevalence of stunting.
Collapse
Affiliation(s)
- David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Anita Chary
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Kirsten Austad
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Peter Rohloff
- Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States
| |
Collapse
|
19
|
Intra-household double burden of malnutrition in a North African nutrition transition context: magnitude and associated factors of child anaemia with mother excess adiposity. Public Health Nutr 2018; 22:44-54. [DOI: 10.1017/s1368980018002495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractObjectiveIn the Middle East and North Africa region, the nutrition transition has resulted in drastic increases in excess adiposity, particularly among women, while some types of undernutrition remain prevalent, especially among pre-school children. We assessed the magnitude, nature and associated factors of the within-household co-occurrence of anaemia in children and excess adiposity in mothers.DesignCross-sectional survey using stratified two-stage random cluster sampling to survey households with women aged 20–49 years. BMI≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity, while anaemia for children was defined as Hb<110 g/l. The associations between child anaemia and mother excess adiposity, and sociodemographic and lifestyle factors were estimated by multinomial regression.SettingGreater Tunis area, Tunisia, in 2009–2010.SubjectsChildren aged 6–59 months living with their 20–49-year-old mothers (437 child–mother pairs).ResultsThe most prevalent double burden of malnutrition in child–mother pairs by far was the anaemic child and overweight mother (24·4 %; 95 % CI 20·1, 29·3 %). A significant proportion of pairs were anaemic child and obese mother (14·4 %; 95 % CI 11·0, 18·5 %). The co-occurrence of anaemia in child and excess adiposity in mother was neither synergetic nor antagonistic (P=0·59 and 0·40 for anaemia–overweight and anaemia–obesity, respectively). This double burden was more frequent among child–mother pairs with younger children, with mothers of higher parity and higher energy intakes.ConclusionsThe high prevalence of anaemic child and overweight or obese mother requires special attention e.g. through interventions which simultaneously target both types of malnutrition within the same household.
Collapse
|
20
|
Maternal and familial correlates of anthropometric typologies in the nutrition transition of Colombia, 2000-2010. Public Health Nutr 2018; 21:2584-2594. [PMID: 29852886 DOI: 10.1017/s1368980018001337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to assess the maternal and family determinants of four anthropometric typologies at the household level in Colombia for the years 2000, 2005 and 2010. DESIGN We classified children 2) to assess stunting and overweight/obesity, respectively; mothers were categorized according to BMI to assess underweight (<18·5 kg/m2) and overweight/obesity (≥25·0 kg/m2). At the household level, we established four final anthropometric typologies: normal, underweight, overweight and dual-burden households. Separate polytomous logistic regression models for each of the surveyed years were developed to examine several maternal and familial determinants of the different anthropometric typologies. SETTING National and sub-regional (urban and rural) representative samples from Colombia, South America. SUBJECTS Drawing on data from three waves of Colombia's Demographic and Health Survey/Encuesta Nacional de Salud (DHS/ENDS), we examined individual and household information from mothers (18-49 years) and their children (birth-5 years). RESULTS Higher parity was associated with an increased likelihood of overweight and dual burden. Higher levels of maternal education were correlated with lower prevalence of overweight, underweight and dual burden of malnutrition in all data collection waves. In 2010, participation in nutrition programmes for children <5 years, being an indigenous household, food purchase decisions by the mother and food security classification were also associated with the four anthropometric typologies. CONCLUSIONS Results suggest that maternal and family correlates of certain anthropometric typologies at the household level may be used to better frame policies aimed at improving social conditions and nutrition outcomes.
Collapse
|
21
|
Brabec M, Behrman JR, Emmett SD, Gibson E, Kidd C, Leonard W, Penny ME, Piantadosi ST, Sharma A, Tanner S, Undurraga EA, Godoy RA. Birth seasons and heights among girls and boys below 12 years of age: lasting effects and catch-up growth among native Amazonians in Bolivia. Ann Hum Biol 2018; 45:299-313. [PMID: 30328382 PMCID: PMC6191890 DOI: 10.1080/03014460.2018.1490453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Seasons affect many social, economic, and biological outcomes, particularly in low-resource settings, and some studies suggest that birth season affects child growth. AIM To study a predictor of stunting that has received limited attention: birth season. SUBJECTS AND METHODS This study uses cross-sectional data collected during 2008 in a low-resource society of horticulturists-foragers in the Bolivian Amazon, Tsimane'. It estimates the associations between birth months and height-for-age Z-scores (HAZ) for 562 girls and 546 boys separately, from birth until age 11 years or pre-puberty, which in this society occurs ∼13-14 years. RESULTS Children born during the rainy season (February-May) were shorter, while children born during the end of the dry season and the start of the rainy season (August-November) were taller, both compared with their age-sex peers born during the rest of the year. The correlations of birth season with HAZ were stronger for boys than for girls. Controlling for birth season, there is some evidence of eventual partial catch-up growth, with the HAZ of girls or boys worsening until ∼ age 4-5 years, but improving thereafter. By age 6 years, many girls and boys had ceased to be stunted, irrespective of birth season. CONCLUSION The results suggest that redressing stunting will require attention to conditions in utero, infancy and late childhood.
Collapse
Affiliation(s)
- Marek Brabec
- a Institute of Computer Science of the Czech Academy of Sciences, Department of Biostatistics and Informatics , National Institute of Public Health , Prague , Czech Republic
| | - Jere R Behrman
- b Department of Economics and Population Studies Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Susan D Emmett
- c Department of Surgery, Division of Head and Neck Surgery & Communication Sciences , Duke University School of Medicine and Duke Global Health Institute , Durham , NC , USA
| | - Edward Gibson
- d Department of Psychology , University of California , Berkeley , Berkeley, CA , USA
| | - Celeste Kidd
- e Department of Psychology , , University of California , Berkeley, Berkeley , CA , USA
| | - William Leonard
- f Department of Anthropology , Northwestern University , Evanston , IL , USA
| | - Mary E Penny
- g Instituto de Investigación Nutricional , Lima , Peru
| | - Steven T Piantadosi
- e Department of Psychology , , University of California , Berkeley, Berkeley , CA , USA
| | - Abhishek Sharma
- h Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - Susan Tanner
- i Anthropology , University of Georgia , Athens , GA , USA
| | - Eduardo A Undurraga
- j Pontificia Universidad Catolica de Chile, Escuela de Gobierno , Santiago , Chile
| | - Ricardo A Godoy
- k Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA
| |
Collapse
|
22
|
Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, Popkin BM, Ramirez-Zea M, Salvo D, Stein AD. Nutrition status of children in Latin America. Obes Rev 2017; 18 Suppl 2:7-18. [PMID: 28741907 PMCID: PMC5601284 DOI: 10.1111/obr.12571] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 12/30/2022]
Abstract
The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.
Collapse
Affiliation(s)
- C Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - M L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L S Pedraza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - D Salvo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, Austin, TX, USA
| | - A D Stein
- Hubert Department of Global Health of the Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
23
|
A systematic review of the prevalence and predictors of the double burden of malnutrition within households. Br J Nutr 2017; 117:1118-1127. [PMID: 28514987 DOI: 10.1017/s0007114517000812] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recently, increasing attention has been paid to the emergence of the double burden of malnutrition within households. We provide an overview of the literature regarding this phenomenon by reviewing previous studies of the prevalence of double-burden households and associated factors together with the research methods used. Studies were identified from the electronic databases PubMed and Web of Science, using the same search terms for both. A total of thirty-five articles met the eligibility criteria, and 367 sets of prevalence data were extracted. In all, thirty-four articles were published in 2000 or later; twenty-four used secondary data and twenty-five focused on mother-child pairs. The ages of children varied from 0 to 19 years. All the studies used BMI as a nutritional indicator for adults. For children, height-for-age was most frequently used, whereas weight-for-age, weight-for-height and BMI-for-age were also used in multiple studies. The reported national prevalence of double-burden households varied from 0·0 to 26·8 % by country and year; however, few studies were directly comparable, because of differences in the combinations of undernourished and overweight persons, age ranges, nutritional indicators and cut-off points. Whereas many focused on African countries, a few involved Asian countries. Although urban residence, income and education were frequently assessed, the role of intermediate factors in nutritional status, such as diet and physical activity, remains unclear. It is recommended that future studies use comparable indicators and cut-off points, involve Asian countries, and investigate individual diet and physical activity.
Collapse
|
24
|
Soto-Méndez MJ, Aguilera CM, Mesa MD, Campaña-Martín L, Martín-Laguna V, Solomons NW, Schümann K, Gil Á. Interaction of Giardia intestinalis and Systemic Oxidation in Preschool Children in the Western Highlands of Guatemala. J Pediatr Gastroenterol Nutr 2016; 63:118-22. [PMID: 26111297 DOI: 10.1097/mpg.0000000000000891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Guatemala is a country with the highest prevalence of stunting in under-5 children in the Americas, with a national average of 49.8%. Asymptomatic intestinal colonization with Giardia intestinalis is common in Guatemalan preschoolers and has been implicated as a factor in linear growth retardation. The potential mechanisms of any giardiasis-growth interaction have not been exhaustively explored. OBJECTIVES The aim of the present study was to describe urine oxidative stress biomarkers and erythrocyte antioxidant enzyme activity, and to explore any association with prevalence or intensity of G intestinalis infection in preschoolers attending 3 government-subsidized day care centers in the Guatemalan Western Highlands. METHODS Samples of feces, urine, and red blood cell (RBC) hemolysate were collected in a total of 74 preschoolers enrolled in 3 day care centers. Giardia prevalence and a proxy index for intensity were assessed by enzyme-linked immunosorbent assay (ELISA). Urinary biomarkers of oxidative damage to DNA (8-hydroxydeoxyguanosine [8-OHdG]) and to lipid (F2t 15-Isoprostane [F2-Iso]) were measured by ELISA. The erythrocyte activity of catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GSR), and glutathione peroxidase (GPX) were measured by respective spectroscopic substrate-based reaction assays. RESULTS Median values of RBC CAT activity (P = 0.016) and urine F2-Iso (P = 0.023) differed between children who were positive (n = 39) and negative (n = 35) for Giardia. Similarly, G intestinalis intensity was significantly and positively associated with urinary F2-Iso (r = 0.446, P < 0.001), RBC SOD (r = 283, P = 0.014), and RBC CAT (r = 0.260, P = 0.025). CONCLUSION The optical density reading of the fecal ELISA assay for G intestinalis has potential as a proxy for the intensity of infestation. In this respect, there exists an association of this intensity with indicators of the systemic oxidation.
Collapse
Affiliation(s)
- María J Soto-Méndez
- *Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala†Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain‡Molecular Nutrition Unit, ZIEL, Research Center for Nutrition and Food Science, Technische Universität München, Freising, Germany
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Factors associated with nutritional outcomes in the mother–child dyad: a population-based cross-sectional study. Public Health Nutr 2016; 19:2725-33. [DOI: 10.1017/s136898001600080x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractObjectiveTo estimate factors associated with double burden of nutritional outcomes in the mother–child dyad at the household level (child stunting and/or maternal overweight).DesignCross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-ageZ-score was <−2 and the mother as overweight when BMI was ≥25·00 kg/m2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child’s food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations.SettingNational Demographic and Health Survey of Children and Women conducted in Brazil, 2006–2007.SubjectsMother–child dyads (n3676).ResultsAfter adjustments, lower maternal educational level (OR=3·53; 95 % CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95 % CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother’s short stature (OR=3·41; 95 % CI 1·76, 6·61), child’s vegetable intake on less than or equal to 4 d/week (OR=2·21; 95 % CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95 % CI 1·36, 3·87) were associated with child’s short stature. The lack of breast-feeding (OR=2·00; 95 % CI 1·07, 3·72) was associated with maternal overweight.ConclusionsThe present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly.
Collapse
|
26
|
Onarheim KH, Iversen JH, Bloom DE. Economic Benefits of Investing in Women's Health: A Systematic Review. PLoS One 2016; 11:e0150120. [PMID: 27028199 PMCID: PMC4814064 DOI: 10.1371/journal.pone.0150120] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/09/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Globally, the status of women's health falls short of its potential. In addition to the deleterious ethical and human rights implications of this deficit, the negative economic impact may also be consequential, but these mechanisms are poorly understood. Building on the literature that highlights health as a driver of economic growth and poverty alleviation, we aim to systematically investigate the broader economic benefits of investing in women's health. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed health, gender, and economic literature to identify studies that investigate the impact of women's health on micro- and macroeconomic outcomes. We developed an extensive search algorithm and conducted searches using 10 unique databases spanning the timeframe 01/01/1970 to 01/04/2013. Articles were included if they reported on economic impacts stemming from changes in women's health (table of outcome measures included in full review, Table 1). In total, the two lead investigators independently screened 20,832 abstracts and extracted 438 records for full text review. The final review reflects the inclusion of 124 articles. RESULTS The existing literature indicates that healthier women and their children contribute to more productive and better-educated societies. This study documents an extensive literature confirming that women's health is tied to long-term productivity: the development and economic performance of nations depends, in part, upon how each country protects and promotes the health of women. Providing opportunities for deliberate family planning; healthy mothers before, during, and after childbirth, and the health and productivity of subsequent generations can catalyze a cycle of positive societal development. CONCLUSIONS This review highlights the untapped potential of initiatives that aim to address women's health. Societies that prioritize women's health will likely have better population health overall, and will remain more productive for generations to come.
Collapse
Affiliation(s)
- Kristine Husøy Onarheim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Johanne Helene Iversen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| |
Collapse
|
27
|
Griffen AS. Height and calories in early childhood. ECONOMICS AND HUMAN BIOLOGY 2016; 20:55-69. [PMID: 26656205 DOI: 10.1016/j.ehb.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
This paper estimates a height production function using data from a randomized nutrition intervention conducted in rural Guatemala from 1969 to 1977. Using the experimental intervention as an instrument, the IV estimates of the effect of calories on height are an order of magnitude larger than the OLS estimates. Information from a unique measurement error process in the calorie data, counterfactuals results from the estimated model and external evidence from migration studies suggest that IV is not identifying a policy relevant average marginal impact of calories on height. The preferred, attenuation bias corrected OLS estimates from the height production function suggest that, averaging over ages, a 100 calorie increase in average daily calorie intake over the course of a year would increase height by 0.06 cm. Counterfactuals from the model imply that calories gaps in early childhood can explain at most 16% of the height gap between Guatemalan children and the US born children of Guatemalan immigrants.
Collapse
Affiliation(s)
- Andrew S Griffen
- Economics Research Building, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| |
Collapse
|
28
|
Doak CM, Campos Ponce M, Vossenaar M, Solomons NW. The stunted child with an overweight mother as a growing public health concern in resource-poor environments: a case study from Guatemala. Ann Hum Biol 2016; 43:122-30. [DOI: 10.3109/03014460.2015.1136356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
29
|
Sekiyama M, Jiang HW, Gunawan B, Dewanti L, Honda R, Shimizu-Furusawa H, Abdoellah OS, Watanabe C. Double Burden of Malnutrition in Rural West Java: Household-Level Analysis for Father-Child and Mother-Child Pairs and the Association with Dietary Intake. Nutrients 2015; 7:8376-91. [PMID: 26445058 PMCID: PMC4632419 DOI: 10.3390/nu7105399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/28/2015] [Accepted: 09/23/2015] [Indexed: 12/12/2022] Open
Abstract
Indonesia is facing household-level double burden malnutrition. This study aimed at examining (1) household-level double burden for the mother-child and father-child pairs; (2) risk of adiposity of double burden households; and (3) associated dietary factors. Subjects were 5th and 6th grade elementary school children (n = 242), their mothers (n = 242), and their fathers (n = 225) in five communities (1 = urban, 4 = rural) in the Bandung District. Questionnaires on socioeconomic factors, blood hemoglobin measurements, and anthropometric measurements were administered. For adults, body fat percentage (BF%) was estimated by bioelectrical impedance (BF%-BI) and by converting skinfold thickness (ST) data using Durnin and Womersley's (1974) formula (BF%-ST). Food frequency questionnaires were also completed. Double burden was defined as coexistence of maternal or paternal overweight (Body mass index (BMI) ≥ 23) and child stunting (height-for-age z-score <-2) within households. Maternal-child double burden occurred in 30.6% of total households, whereas paternal-child double burden was only in 8.4%. Mothers from double burden households showed high adiposity; 87.3% with BF%-BI and 66.2% with BF%-ST had BF% >35%, and 60.6% had waists >80 cm. The major dietary patterns identified were "Modern" and "High-animal products". After controlling for confounding factors, children in the highest quartile of the "High-animal products" dietary pattern had a lower risk of maternal-child double burden (Adjusted OR: 0.46, 95% CI: 0.21-1.04) than those in the lowest quartile. Given that the "High-animal products" dietary pattern was associated with the decreased risk of maternal-child double burden through a strong negative correlation with child stunting, improving child stunting through adequate intake of animal products is critical to solve the problem of maternal-child double burden in Indonesia.
Collapse
Affiliation(s)
- Makiko Sekiyama
- Graduate Program in Sustainability Science-Global Leadership Initiative (GPSS-GLI), Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa City 277-8563, Japan.
| | - Hong Wei Jiang
- Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku, Kyoto 603-8047, Japan.
| | - Budhi Gunawan
- Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I, Bandung 40132, Indonesia.
| | - Linda Dewanti
- Faculty of Medicine, Airlangga University, Jl. Mayjen. Prof. Dr. Moestopo 47, Surabaya 60132, Indonesia.
| | - Ryo Honda
- RSET, Institute of Science and Engineering, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan.
| | - Hana Shimizu-Furusawa
- Department of Human Ecology, School of International Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Oekan S Abdoellah
- Institute of Ecology, Research Institute, Padjadjaran University, Jl. Sekeloa Selatan I, Bandung 40132, Indonesia.
| | - Chiho Watanabe
- Department of Human Ecology, School of International Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| |
Collapse
|
30
|
Wong CY, Zalilah MS, Chua EY, Norhasmah S, Chin YS, Siti Nur'Asyura A. Double-burden of malnutrition among the indigenous peoples (Orang Asli) of Peninsular Malaysia. BMC Public Health 2015; 15:680. [PMID: 26194643 PMCID: PMC4508822 DOI: 10.1186/s12889-015-2058-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Double-burden of malnutrition (DBM) is an emerging public health concern among the Orang Asli (indigenous peoples) of Peninsular Malaysia. This study aimed to identify the presence of DBM at the community and household levels in Orang Asli population and its associated demographic and socio-economic factors. METHODS This cross-sectional study was conducted in 11 Orang Asli villages surrounding the Krau Wildlife Reserve, Peninsular of Malaysia from October 2011 to January 2012. Of 438 households, a total of 981 adults and 304 children who met the study criteria agreed to participate. About 160 households were further selected with pairs of children aged 3-59 months and non-pregnant mothers aged 15-55 years. Demographic and socio-economic data were obtained using interviewer-administered questionnaire while weight and height were measured using standard procedures. Double-burden of malnutrition was defined as overweight/obese mother-underweight child (OWOBM/UWC), overweight/obese mother-stunted child (OWOBM/STC) or overweight/obese mother-underweight or/and stunted child (OWOBM/UWSTC). Binary logistic regression identified the demographic and socio-economic factors associated with double-burden households. RESULTS About 26 % of overweight and obese adults coexisting with high proportions of underweight (49%) and stunted (64%) children in these Orang Asli villages. There was a higher prevalence of households with OWOBM/UWSTC (20%) and OWOBM/STC (19.4%) than households with OWOBM/UWC (12.5%). Boys (P < 0.05), older age mothers (P < 0.05), mothers with higher education (P < 0.05) and households with income per capita less than USD 29.01 (RM 97.00) (P < 0.01) were associated with higher odds of OWOBM/STC. Jah Hut (P < 0.05) and higher number of children (P < 0.05) were significantly associated with lower odds of OWOBM/UWC. CONCLUSIONS The occurrence of double-burden of malnutrition in Orang Asli population deserves attention. Poverty reduction, access to quality diet and improved health and nutrition literacy are among strategies that could address the coexistence of DBM in this population.
Collapse
Affiliation(s)
- C Y Wong
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - M S Zalilah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - E Y Chua
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - S Norhasmah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - Y S Chin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| | - A Siti Nur'Asyura
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor Darul Ehsan, Malaysia.
| |
Collapse
|
31
|
Parra DC, Iannotti L, Gomez LF, Pachón H, Haire-Joshu D, Sarmiento OL, Kuhlmann AS, Brownson RC. The nutrition transition in Colombia over a decade: a novel household classification system of anthropometric measures. Arch Public Health 2015; 73:12. [PMID: 25780562 PMCID: PMC4361151 DOI: 10.1186/s13690-014-0057-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/05/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished. METHODS This study used data from the Demographic and Health Survey and the Colombian National Nutrition Survey [2000 n = 2,876, 2005 n = 8,598, and 2010 n = 11,349]. Four mutually exclusive household (HH) anthropometric typologies - normal, undernourished, overweight/obese, and dual burden - were created. Anthropometric information of height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIz) in children under the age of 5 y, and on body mass index (BMI) in mothers, 18-49 y was used. RESULTS Prevalence of overweight/obese HHs increased between 2000 (38.2%) and 2010 (43.1%) (p < 0.05), while undernourished and dual burden HHs significantly decreased between 2005 (13.7% and 10.6%, respectively) and 2010 (3.5% and 5.1%, respectively) (p < 0.05). A greater increase of overweight/obesity was observed for the lowest quintile of wealth index (WI), with an increase of almost 10% between 2000 and 2010, compared to 2% and 4% for the fourth and highest WI, respectively. Although in 2010 there is still a higher prevalence of overweight/obesity HHs in urban areas (43.7%), the prevalence of overweight/obesity HHs in rural areas increased sharply between 2000 (34.3%) and 2010 (41.6%) (p < 0.05). CONCLUSION The observed prevalence of dual burden households was not different from the expected prevalence. Results from this study indicate that although overweight/obesity continues to be more prevalent among high-income Colombian households, it is growing at a faster pace among the most economically disadvantaged.
Collapse
Affiliation(s)
- Diana C Parra
- />Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Lora Iannotti
- />George Warren Brown School of Social Work, Institute for Public Health, Washington University in St. Louis, St. Louis, MO USA
| | - Luis F Gomez
- />Departamento de Medicina Preventiva y Social. Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Helena Pachón
- />Food Fortification Initiative, Atlanta, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Debra Haire-Joshu
- />Center for Diabetes Translation Research and Center for Obesity Prevention & Policy Research, Washington University in St. Louis, St. Louis, MO USA
| | - Olga L Sarmiento
- />Department of Public Health, School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Anne Sebert Kuhlmann
- />George Warren Brown School of Social Work, Institute for Public Health, Washington University in St. Louis, St. Louis, MO USA
| | - Ross C Brownson
- />Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- />Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO USA
| |
Collapse
|
32
|
Ramirez-Zea M, Kroker-Lobos MF, Close-Fernandez R, Kanter R. The double burden of malnutrition in indigenous and nonindigenous Guatemalan populations. Am J Clin Nutr 2014; 100:1644S-51S. [PMID: 25411307 DOI: 10.3945/ajcn.114.083857] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As the prevalence of obesity increases in developing countries, the double burden of malnutrition (DBM) has become a public health problem, particularly in countries such as Guatemala with a high concentration of indigenous communities where the prevalence of stunting remains high. OBJECTIVE The aim was to describe and analyze the prevalence of DBM over time (1998-2008) in indigenous and nonindigenous Guatemalan populations. DESIGN We used 3 National Maternal and Child Health Surveys conducted in Guatemala between 1998 and 2008 that include anthropometric data from children aged 0-60 mo and women of reproductive age (15-49 y). We assessed the prevalence of childhood stunting and both child and adult female overweight and obesity between 1998 and 2008. For the year 2008, we assessed the prevalence of DBM at the household (a stunted child and an overweight mother) and individual (stunting/short stature and overweight or anemia and overweight in the same individual) levels and compared the expected and observed prevalence rates to test if the coexistence of the DBM conditions corresponded to expected values. RESULTS Between 1998 and 2008, the prevalence of childhood stunting decreased in both indigenous and nonindigenous populations, whereas overweight and obesity in women increased faster in indigenous populations than in nonindigenous populations (0.91% compared with 0.38%/y; P-trend < 0.01). In 2008, the prevalence of stunted children was 28.8 percentage points higher and of overweight women 4.6 percentage points lower in indigenous compared with nonindigenous populations (63.7% compared with 34.9% and 46.7% compared with 51.3%, respectively). DBM at the household and individual levels was higher in indigenous populations and was higher in geographic areas in which most of the population was indigenous, where there was also a greater prevalence of stunting and DBM at the individual level, both in women and children. CONCLUSIONS In Guatemala, DBM is more prevalent in indigenous than in nonindigenous populations at the household and individual levels. To enhance effectiveness, current strategies of national policies and programs should consider DBM and focus on indigenous populations.
Collapse
Affiliation(s)
- Manuel Ramirez-Zea
- From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L)
| | - Maria F Kroker-Lobos
- From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L)
| | - Regina Close-Fernandez
- From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L)
| | - Rebecca Kanter
- From the Centro de Investigación del INCAP para la Prevención de las Enfermedades Crónicas (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala (MR-Z, RC-F, and RK), and the Instituto Nacional de Salud Pública, Cuernavaca, Mexico (MFK-L)
| |
Collapse
|
33
|
Atalah E, Amigo H, Bustos P. Does Chile's nutritional situation constitute a double burden? Am J Clin Nutr 2014; 100:1623S-7S. [PMID: 25411304 DOI: 10.3945/ajcn.114.083790] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chile has probably experienced Latin America's fastest nutritional transition, as evidenced by very low rates of stunting, but the country shows a high prevalence of obesity in most population groups. OBJECTIVE The aim was to assess the existence of a double burden of nutritional problems in Chile on the basis of available data. DESIGN Secondary analyses were conducted on data collected by the Health Ministry (height and weight for children aged <6 y and for adults aged ≥65 y), the Education Ministry (height and weight in the first year of primary school and the first year of high school), the 2003 and 2009-2010 National Health Surveys [body mass index (BMI) and anemia prevalence], the 2010-2011 National Food Consumption Survey (ENCA; food consumption, height, and weight), and a Food Insecurity Survey of elderly adults (aged 65-74 y) in Santiago (height, weight, and food insecurity). RESULTS In 2011 the prevalence of stunting (height-for-age < -2 z scores) was 1.9% for children <6 y old and 3.6% among children in the first year of primary school. This situation was in contrast with a high prevalence of obesity in children (22.1% of children in the first year of primary school; BMI ≥2 z scores) and among adults, especially women, increasing with age (44.8% of women 45-64 y old had a BMI ≥30 kg/m(2)). The prevalence of anemia in women aged 15-64 y was low (5.1%). In the ENCA survey, women showed a high prevalence of below-average intakes of vitamin A, vitamin B-12, vitamin C, calcium, and zinc, irrespective of BMI. Elderly persons who were underweight and those who were obese had a significantly greater perception of food insecurity in relation to those with a normal weight (61%, 50%, and 33%, respectively). CONCLUSIONS The data showed high rates of obesity with very low frequency of stunting and, although more information is needed, the double burden of malnutrition probably does not exist in Chile, unlike in other countries in the region. Among specific groups there are low intakes of critical nutrients and food insecurity. Surveys that include anthropometric and biochemical measurements at the family level are needed to correctly evaluate the double burden of malnutrition in Chile.
Collapse
Affiliation(s)
- Eduardo Atalah
- From the Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hugo Amigo
- From the Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Patricia Bustos
- From the Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
34
|
Roemling C, Qaim M. Dual burden households and intra-household nutritional inequality in Indonesia. ECONOMICS AND HUMAN BIOLOGY 2013; 11:563-73. [PMID: 23890671 DOI: 10.1016/j.ehb.2013.07.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 07/05/2013] [Accepted: 07/05/2013] [Indexed: 05/09/2023]
Abstract
Overweight is an increasing problem in many developing countries, coexisting with underweight and contributing to a dual burden of malnutrition, sometimes in the same households. We analyze the phenomenon of dual burden households in Indonesia, using 15-year panel data. Currently, 16 percent of Indonesian households are classified as dual burden. In these households, children are often underweight, whereas adults are overweight. The nutrition transition seems to have differential impacts on the body mass index of different age cohorts. Dual burden households are a transitory phenomenon. This phenomenon started in the richer segments, but now the prevalence of dual burden households is highest in the poorest population groups. Most households that move out of the dual burden category end up as overweight. We also develop a continuous Theil index of intra-household nutritional inequality. While the overall prevalence of dual burden households has hardly changed over the last 10 years, the Theil index increased steadily. This underlines that the dual burden classification has limitations in terms of capturing nutritional dynamics. Socioeconomic determinants of dual burden and nutritional inequality are analyzed with regression models.
Collapse
Affiliation(s)
- Cornelia Roemling
- Department of Agricultural Economics and Rural Development, Georg-August-University of Goettingen, Platz der Goettinger Sieben 5, 37073 Goettingen, Germany.
| | | |
Collapse
|
35
|
Reurings M, Vossenaar M, Doak CM, Solomons NW. Stunting rates in infants and toddlers born in metropolitan Quetzaltenango, Guatemala. Nutrition 2013; 29:655-60. [PMID: 23466051 DOI: 10.1016/j.nut.2012.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 10/05/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Guatemala has the highest prevalence of stunting (54% of children under age 5 years) in the Americas and the fifth highest in the world. The aim of this study was to describe the stunting prevalence and the association with early feeding practices, morbidity patterns, and socioeconomic status (SES) in a sample of infants and toddlers from urban Quetzaltenango. METHODS We recruited 299 children (149 boys), ages 6-23 mo from two public health clinics in metropolitan Quetzaltenango. Data on SES, early feeding practices, and morbidity were collected by means of a single face-to-face interview. Recumbent spine length was measured according to standardized procedures and height-for-age (HAZ) z-scores were calculated. HAZ <-2 SD of the World Health Organization's 2006 Growth Standards was considered stunting. Multiple logistic regression analysis was used to examine determinants of stunting. RESULTS The overall mean HAZ z-score was -1.89 ± 1.11 and 135 (45%) children were stunted. The results of the crude odds ratios showed that place of interview (suburban), being male, being ages 13-18 mo, being born at home, having a mother with a low level of education, being of Mayan (indigenous) ethnicity, having a mother with short stature, and having ever received iron supplementation were strongly and significantly (P < 0.05) associated with stunting. None of the other variables, such as supplement use and morbidity rates, contributed to the predictive model. We did not observe an association between early feeding practices or morbidity and stunting. CONCLUSION The stunting prevalence exceeds the cut-off of 40% stunting, indicating a community with a high level of malnutrition.
Collapse
Affiliation(s)
- Marieke Reurings
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | | | | | | |
Collapse
|
36
|
Sweeney S, Davenport F, Grace K. Combining insights from quantile and ordinal regression: child malnutrition in Guatemala. ECONOMICS AND HUMAN BIOLOGY 2013; 11:164-177. [PMID: 23040879 DOI: 10.1016/j.ehb.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 05/26/2012] [Accepted: 06/01/2012] [Indexed: 06/01/2023]
Abstract
Chronic child undernutrition is a persistent problem in developing countries and has been the focus of hundreds of studies where the primary intent is to improve targeting of public health and economic development policies. In national level cross-sectional studies undernutrition is measured as child stunting and the goal is to assess differences in prevalence among population subgroups. Several types of regression modeling frameworks have been used to study childhood stunting but the literature provides little guidance in terms of statistical properties and the ease with which the results can be communicated to the policy community. We compare the results from quantile regression and ordinal regression models. The two frameworks can be linked analytically and together yield complementary insights. We find that reflecting on interpretations from both models leads to a more thorough analysis and forces the analyst to consider the policy utility of the findings. Guatemala is used as the country focus for the study.
Collapse
Affiliation(s)
- Stuart Sweeney
- Department of Geography, University of California, Santa Barbara, CA 93106-4060, United States.
| | | | | |
Collapse
|
37
|
Campos Ponce M, Incani RN, Pinelli E, ten Kulve N, Ramak R, Polman K, Doak CM. Are intestinal parasites fuelling the rise in dual burden households in Venezuela? Trans R Soc Trop Med Hyg 2012; 107:119-23. [DOI: 10.1093/trstmh/trs014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
38
|
Lee J, Houser RF, Must A, de Fulladolsa PP, Bermudez OI. Socioeconomic disparities and the familial coexistence of child stunting and maternal overweight in Guatemala. ECONOMICS AND HUMAN BIOLOGY 2012; 10:232-41. [PMID: 21889428 PMCID: PMC3586429 DOI: 10.1016/j.ehb.2011.08.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 08/07/2011] [Accepted: 08/07/2011] [Indexed: 05/24/2023]
Abstract
The double burden of malnutrition, defined here as households with a stunted child and an overweight mother (SCOM), is a growing problem in Guatemala. We explored the magnitude of SCOM and the identification of socio-economic factors associated with this malnutrition duality. From the 2000 Living Standards Measurement Study from Guatemala, we obtained a sample of 2492 households with pairs of children 6-60 months and their mothers (18-49 years) and estimated the prevalence of SCOM. Economic characteristics of this sample were assessed with the Concentration Index (CI). Results revealed higher prevalence of child stunting, but a lower prevalence of maternal overweight among the poor compared to the rich households. Economic inequality in child stunting was greater than economic inequality in maternal overweight (CI=-0.22 vs. +0.14). SCOM pairs were more prevalent among the poor and middle SES groups as compared to the rich households. A multivariate logistic regression model showed that SCOM was more likely to occur in households from the middle consumption quintile than in those from the first quintile (odds ratio=1.7). The findings reported here add new insights into the complex phenomenon observed in households with both extremes of the malnutrition continuum, and support the need for the identification of economic, social and biological interventions aimed at, on the one hand, the prevention of this duality of the malnutrition in those households where it is still non-existent, and on the other hand, to deter or correct the economic, social and biological environments where those mother-child dyads are already affected by such phenomena.
Collapse
Affiliation(s)
- Jounghee Lee
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, United States
| | - Robert F. Houser
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, United States
| | - Aviva Must
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, United States
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, United States
| | - Patricia Palma de Fulladolsa
- Regional Food and Nutrition Security Program for Central America, Boulevard del Hipodromo No. 523, Colonia San Benito, San Salvador, El Salvador
| | - Odilia I. Bermudez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, United States
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, United States
| |
Collapse
|
39
|
Dieffenbach S, Stein AD. Stunted child/overweight mother pairs represent a statistical artifact, not a distinct entity. J Nutr 2012; 142:771-3. [PMID: 22378330 DOI: 10.3945/jn.111.153387] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Stunted child/overweight mother (SCOWT) pairs have been viewed as a distinct phenomenon and much effort has been expended to characterize the environments that create these dual burden households. We hypothesized that the prevalence of SCOWT pairs is not independent of the prevalence of overweight mothers and stunted children in the general population. We analyzed data from the Demographic and Health Surveys (DHS) from 1991 to 2009. Datasets were included if the maternal BMI and the height-for-age Z-scores for children were reported. Mothers were included if they had a living child between 2 and 5 y old and were not currently pregnant. In 121 datasets from 54 countries, 339,202 households met the inclusion criteria. The median prevalences of maternal overweight, childhood stunting, and SCOWT pairs were 19.6% (range 1.6-70.7%), 27.3% (range 6.65-50.8%), and 3.3% (range 0.5-16.0%), respectively. The mean difference between the observed and expected prevalence of SCOWT pairs was -1.18% (95% CI -1.32%, -1.04%). Only two datasets had an observed prevalence of SCOWT pairs that was higher than the expected prevalence, but both were within the 95% CI for the observed prevalence. SCOWT prevalence was more strongly associated with maternal overweight than with child stunting. SCOWT pairs are not independent and their prevalence depends primarily on the prevalence of maternal overweight.
Collapse
Affiliation(s)
- Sara Dieffenbach
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
40
|
Oddo VM, Rah JH, Semba RD, Sun K, Akhter N, Sari M, de Pee S, Moench-Pfanner R, Bloem M, Kraemer K. Predictors of maternal and child double burden of malnutrition in rural Indonesia and Bangladesh. Am J Clin Nutr 2012; 95:951-8. [PMID: 22357721 DOI: 10.3945/ajcn.111.026070] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many developing countries now face the double burden of malnutrition, defined as the coexistence of a stunted child and overweight mother within the same household. OBJECTIVE This study sought to estimate the prevalence of the double burden of malnutrition and to identify associated maternal, child, and household characteristics in rural Indonesia and Bangladesh. DESIGN A total of 247,126 rural households that participated in the Indonesia Nutrition Surveillance System (2000-2003) and 168,317 rural households in the Bangladesh Nutritional Surveillance Project (2003-2006) were included in the analysis. Maternal and child double burden (MCDB) and its association with individual and household characteristics were determined by using logistic regression models. RESULTS MCDB was observed in 11% and 4% of the households in rural Indonesia and Bangladesh, respectively. Maternal short stature [Indonesia (OR: 2.32; 95% CI: 2.25, 2.40); Bangladesh (OR: 2.11; 95% CI: 1.96, 2.26)], and older age were strong predictors of MCDB. Child characteristics such as older age and being female were associated with an increased odds of MCDB, whereas currently being breastfed was protective against MCDB [Indonesia (OR: 0.84; 95% CI: 0.81, 0.84); Bangladesh (OR: 0.55; 95% CI: 0.52, 0.58)]. A large family size and higher weekly per capita household expenditure predicted MCDB [Indonesia (OR: 1.34; 95% CI: 1.28, 1.40); Bangladesh (OR: 1.94; 95% CI: 1.77, 2.12)]. CONCLUSIONS Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings.
Collapse
Affiliation(s)
- Vanessa M Oddo
- Mathematica Policy Research Inc, Cambridge, MA 02139, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|