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Batool M, Saleem J, Zakar R, Butt MS, Iqbal S, Haider S, Fischer F. Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan. BMC Public Health 2023; 23:2153. [PMID: 37924076 PMCID: PMC10625272 DOI: 10.1186/s12889-023-17135-z] [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: 12/28/2022] [Accepted: 11/02/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Reasons for undernutrition are food insufficiency, impaired child care, limited access to healthcare, and maternal lack of health literacy. In addition, there are several environmental factors, such as drinking water quality, poor sanitation, and hygienic practices that can lead to poor nutritional status in children. The present study aimed to compare household-associated risk factors, including water, sanitation, and hygiene (WASH) practices of mothers, with children's stunting under the age of five. METHODS A face-to-face cross-sectional survey was conducted with mothers of children under the age of five in the Dera Ghazi Khan district in southern Punjab, Pakistan. World Health Organization criteria for stunting were used to identify the participants. A sociodemographic questionnaire was used to collect information from consented parents/guardians on children's age, feeding, and WASH practices. Pearson's chi-square, simple regression, and hierarchical regression models were applied for data analysis. RESULTS A total of 204 mothers of children of both genders participated in this study. The children's mean (SD) age was 15.67 (± 10.2) months, their weight was 5.44 (± 1.45) kg, their height was 67.69 (± 10.05), and their mid-upper arm circumference was 9.75 (± 1.30) cm. Children's stunting was mild (z-score > -2) at 17.6%, moderate (z-score - 2 to -3) at 16.7%, and severe (z-score < -3) at 65.7% of participants. A simple regression model showed a strong association, r2 = 0.062, p = 0.013, with age as the most significant sociodemographic factor. The hierarchical regression model showed a combined value of r2 = 0.0128, p = 0.027, with hand pump and tank water as the significant source of drinking water that was related to stunting among children. CONCLUSION Stunting can be associated with several risk factors, including WASH parameters. This study concluded that children aged under five years are susceptible to stunting in southern Punjab, Pakistan. The contamination of hand pumps and tank water resources was found to be the major contributing factor to stunting.
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Affiliation(s)
- Munazza Batool
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Sanaullah Iqbal
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shahroz Haider
- Bakhtawar Amin Medical and Dental College Multan, Multan, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Abdulla F, Rahman A, Hossain MM. Prevalence and risk predictors of childhood stunting in Bangladesh. PLoS One 2023; 18:e0279901. [PMID: 36701381 PMCID: PMC9879476 DOI: 10.1371/journal.pone.0279901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh. METHODS AND MATERIALS In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution. RESULTS The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children. CONCLUSIONS To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.
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Affiliation(s)
- Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al-Kabir Technical University, Sylhet, Bangladesh
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Md. Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Yenita RN, Thamrin T, Amin B, Agrina A. Identification and Analysis of Stunting Risk Factors in Children under Three Years of Age in the Area of Kampar Watershed. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Growth and development that is not optimal is a form of chronic malnutrition, one of which is marked by height for age which is below the standard deviation (<-2 SD) and is called stunting. Stunting has a negative impact on children's motor development, reduces children's performance in school, increases the risk of excess nutrition, infectious diseases, and even death as well as reduces productivity in adulthood. The purpose of this study was to identify risk factors for stunting in people living in the Kampar watershed. This research is a mixed-method with an explanatory sequential design which is a modification of (1–3). The research was carried out on people living in the Kampar river basin. The priority areas for specific stunting reduction interventions in this study are the Work Areas of the Kampar Kiri Hulu II Health Center, the Koto Kampar XIII Health Center, and the Kampar Kiri Health Center. This study found that the dominant factors of the five variables were home sanitation and parenting, as both affected the incidence of stunting. The findings obtained are different from the results of data analysis obtained from interviews, observations, and descriptive statistics. Based on the results of data analysis from interviews, observations, and descriptive statistics, it was found that all variables of the three factors became the main factors that had a close relationship with the incidence of stunting in the community in the Kampar watershed.
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Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C, Briend A, Myatt M, Garenne M, Sear R, Kerac M. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Health 2021; 5:bmjgh-2020-004030. [PMID: 33328202 PMCID: PMC7745319 DOI: 10.1136/bmjgh-2020-004030] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. METHODS We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0-59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random-effects model. RESULTS 74 studies were identified: 44/74 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13 to 1.40). 38 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.29 95% CI 1.22 to 1.37). 23 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.14, 95% CI 1.02 to 1.26). There was some limited evidence that the female advantage, indicated by a lower risk of stunting and underweight, was weaker in South Asia than other parts of the world. 43/74 (58%) studies discussed possible reasons for boy/girl differences; 10/74 (14%) cited studies with similar findings with no further discussion; 21/74 (28%) had no sex difference discussion. 6/43 studies (14%) postulated biological causes, 21/43 (49%) social causes and 16/43 (37%) to a combination. CONCLUSION Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice.
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Affiliation(s)
- Susan Thurstans
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Seal
- Institute for Global Health, University College London, London, UK
| | - Jonathan Wells
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - Carmel Dolan
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Kobenhavn, Denmark.,School of Medicine, Center for Child Health Research
| | | | - Michel Garenne
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.,Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France.,FERDI, Université d'Auvergne, Clermont-Ferrand, France.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for MARCH (Maternal, Adolescent & Reproductive Child Health), London School of Hygiene and Tropical Medicine, London, UK
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Lee C, Lakhanpaul M, Stern BM, Sarkar K, Parikh P. Associations between the household environment and stunted child growth in rural India: a cross-sectional analysis. UCL OPEN ENVIRONMENT 2021; 3:e014. [PMID: 37228801 PMCID: PMC10171403 DOI: 10.14324/111.444/ucloe.000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/25/2021] [Indexed: 05/27/2023]
Abstract
Stunting is a major unresolved and growing health issue for India. There is a need for a broader interdisciplinary cross-sectoral approach in which disciplines such as the environment and health have to work together to co-develop integrated socio-culturally tailored interventions. However, there remains scant evidence for the development and application of such integrated, multifactorial child health interventions across India's most rural communities. In this paper we explore and demonstrate the linkages between environmental factors and stunting thereby highlighting the scope for interdisciplinary research. We examine the associations between household environmental characteristics and stunting in children under 5 years of age across rural Rajasthan, India. We used Demographic and Health Survey (DHS)-3 India (2005-2006) data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (i) the primary source of drinking water, (ii) primary type of sanitation facilities, (iii) primary cooking fuel type, and (iv) agricultural land ownership and stunting adjusting for child age. The results suggest, after adjusting for child age, household access to (i) improved drinking water source was associated with 23% decreased odds [odds ratio (OR) = 0.77, 95% confidence interval (CI) 0.5-1.00], (ii) improved sanitation facility was associated with 41% decreased odds (OR = 0.51, 95% CI 0.3-0.82), and (iii) agricultural land ownership was associated with 30% decreased odds of childhood stunting (OR 0.70, 95% CI 0.51-0.94]. The cooking fuel source was not associated with stunting. Our findings indicate that a shift is needed from nutrition-specific to contextually appropriate interdisciplinary solutions, which incorporate environmental improvements. This will not only improve living conditions in deprived communities but also help to tackle the challenge of childhood malnutrition across India's most vulnerable communities.
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Affiliation(s)
- Charlotte Lee
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK
| | - Monica Lakhanpaul
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
- UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK
| | - Bernardo Maza Stern
- Engineering for International Development Centre, University College London, Bartlett School of Construction and Project Management, 1–19 Torrington Place, London WC1E 7HB, UK
| | - Kaushik Sarkar
- Aceso Global Health Consultants Limited, B-78-A FF Front Side, Chanakya Place–1, Uttam Nagar, New Delhi 110059, India
| | - Priti Parikh
- Engineering for International Development Centre, University College London, Bartlett School of Construction and Project Management, 1–19 Torrington Place, London WC1E 7HB, UK
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Kwami CS, Godfrey S, Gavilan H, Lakhanpaul M, Parikh P. Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3793. [PMID: 31600942 PMCID: PMC6843659 DOI: 10.3390/ijerph16203793] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 12/03/2022]
Abstract
Stunting is a global burden affecting nearly 160 million children younger than five years of age. Whilst the linkages between nutrition and stunting are well recognized, there is a need to explore environmental factors such as water and sanitation, which may influence feeding practices and result in potential infection pathways. This paper explores the linkages between stunting and water, sanitation and hygiene (WASH) factors in Ethiopia, which is a relatively understudied context. The research draws upon baseline data for children under the age of five from 3200 households across four regions in Ethiopia as part of a wider study and integrated program led by the United Nations Children's Fund (UNICEF). Using World Health Organization (WHO) z-scoring, the average stunting rate in the sample is 47.5%. This paper also takes into account demographic and social behavioural factors such as the age, gender of children, and gender of the primary caregiver, in addition to handwashing behaviour and drinking water facilities. The evidence recommends efforts to improve handwashing behaviour for mothers and children with a focus on access to clean water. Higher stunting rates with an increase in the age of children highlight the need for continued interventions, as efforts to improve nutrition and WASH behaviours are most effective early on in promoting long-term health outcomes for children.
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Affiliation(s)
- Corina Shika Kwami
- Department of Civil, Environment and Geomatic Engineering, University College London, Chadwick Building, London WC1E6BT, UK.
| | - Samuel Godfrey
- United Nations Children's Fund (UNICEF), Regional Water and Sanitation Advisor for East and Southern Africa, Nairobi 00100, Kenya.
| | - Hippolyte Gavilan
- Department of Civil, Environment and Geomatic Engineering, University College London, Chadwick Building, London WC1E6BT, UK.
| | - Monica Lakhanpaul
- UCL-Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.
- Whittington Health NHS Trust, London N19 5NF, UK.
| | - Priti Parikh
- Department of Civil, Environment and Geomatic Engineering, University College London, Chadwick Building, London WC1E6BT, UK.
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Prevalence of stunting in Iranian children under five years of age: Systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:103. [PMID: 30815398 PMCID: PMC6387800 DOI: 10.14196/mjiri.32.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Children in all countries, especially in developing countries, constitute a vulnerable group. Therefore, attention to their health issues is very important. The aim of this study was to determine the prevalence of stunting in Iranian children under-five years. Methods: All original studies were searched by complex search syntax from international databases including Medline (PubMed), Web of sciences, Google scholar, Scopus, CINHAL and the Iranian databases consist of SID (Scientific Information Database, www.sid.ir), Irandoc (Iranian Research Institute for Information Science and Technology, Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com) from January 1989 to August 2017. Two independent reviewers identified relevant studies in several steps. We employed a random effect model to generate a pooled prevalence. The reported prevalence is presented as percent and 95% confidence interval (CI). Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. Results: Finally, 16 studies from different settings remained for meta-analysis in order to have a pooled prevalence estimate, which prevalence of total stunting was 12% (95%CI: 10-14). Subgroup analysis for gender showed that the prevalence of stunting in both boys and girls children were equal to 10% (95%CI: 8-11) and 9% (CI 95% 8-10), respectively. Also pooled prevalence of stunting in southern provinces are higher than other provinces. Conclusion: The prevalence of stunting in some regions of Iran is higher than others. Although, in recent years much effort has been made to address deprivation such as economical, nutritional and social supporting, improvement of the quality of life, there are still nutritional problems in these areas of Iran.
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UNHEALTHY WEIGHT IN INDIAN FAMILIES: THE ROLE OF THE FAMILY ENVIRONMENT IN THE CONTEXT OF THE NUTRITION TRANSITION. POPULATION RESEARCH AND POLICY REVIEW 2018; 37:157-180. [PMID: 29962562 DOI: 10.1007/s11113-017-9455-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
India faces a dual burden of increasing obesity and persistent underweight as it experiences the nutrition transition-the dietary and lifestyle changes that accompany globalization, economic development, and technological change. Yet, the nutrition transition is not solely a top-down process; rather, global forces converge with local practices at multiple levels of the social ecology. The family environment, a key site for the transmission of local customs and norms, remains largely unexplored in India. We examined the extent to which opposite-gender siblings and mother-child pairs were concordant or discordant in body weight, and whether domains of the family environment, specifically, food practices, food-related gender norms, and household resources, were associated with patterns of unhealthy weight within and between families. Multilevel dyadic analysis and logistic regression were conducted using survey data from a representative sample of 400 families in a Southern Indian city. We identified substantial clustering of weight among opposite-gender sibling pairs (ICC=0.43) and mother-child pairs, as well as important patterns of discordance, including 11% of families experiencing a dual burden of underweight and overweight. Household resources, including mother's education and income, were salient in explaining the distribution of body weight within and between families. Importantly, less examined domains of the family environment were also relevant, including food practices (e.g. grocery shopping frequency), and food-related gender norms (e.g. mother's control of food served at home). Continued exploration of how global and local practices converge in households will be necessary to develop programming that effectively addresses India's dual burden of unhealthy weight.
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Khan REA, Raza MA. Determinants of malnutrition in Indian children: new evidence from IDHS through CIAF. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s11135-014-0149-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Das S, Bapat U, More NS, Alcock G, Fernandez A, Osrin D. Nutritional status of young children in Mumbai slums: a follow-up anthropometric study. Nutr J 2012; 11:100. [PMID: 23173787 PMCID: PMC3546020 DOI: 10.1186/1475-2891-11-100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 11/20/2012] [Indexed: 11/21/2022] Open
Abstract
Background Chronic childhood malnutrition remains common in India. As part of an initiative to improve maternal and child health in urban slums, we collected anthropometric data from a sample of children followed up from birth. We described the proportions of underweight, stunting, and wasting in young children, and examined their relationships with age. Methods We used two linked datasets: one based on institutional birth weight records for 17 318 infants, collected prospectively, and one based on follow-up of a subsample of 1941 children under five, collected in early 2010. Results Mean birth weight was 2736 g (SD 530 g), with a low birth weight (<2500 g) proportion of 22%. 21% of infants had low weight for age standard deviation (z) scores at birth (<−2 SD). At follow-up, 35% of young children had low weight for age, 17% low weight for height, and 47% low height for age. Downward change in weight for age was greater in children who had been born with higher z scores. Discussion Our data support the idea that much of growth faltering was explained by faltering in height for age, rather than by wasting. Stunting appeared to be established early and the subsequent decline in height for age was limited. Our findings suggest a focus on a younger age-group than the children over the age of three who are prioritized by existing support systems. Funding The trial during which the birth weight data were collected was funded by the ICICI Foundation for Inclusive Growth (Centre for Child Health and Nutrition), and The Wellcome Trust (081052/Z/06/Z). Subsequent collection, analysis and development of the manuscript was funded by a Wellcome Trust Strategic Award: Population Science of Maternal and Child Survival (085417ma/Z/08/Z). D Osrin is funded by The Wellcome Trust (091561/Z/10/Z).
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Affiliation(s)
- Sushmita Das
- Society for Nutrition, Education and Health Action (SNEHA), Urban HealthCentre, Chota Sion Hospital, 60 Feet Road, Shahunagar, Dharavi, Mumbai, 400017 Maharashtra, India
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Mondal PR, Biswas S, Bose K. Gender discrimination in undernutrition with mediating factors among Bengalee school children from Eastern India. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2012; 63:126-35. [DOI: 10.1016/j.jchb.2012.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 01/21/2012] [Indexed: 11/25/2022]
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Massad SG, Nieto FJ, Palta M, Smith M, Clark R, Thabet AA. Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study. BMC Public Health 2012; 12:27. [PMID: 22236142 PMCID: PMC3268107 DOI: 10.1186/1471-2458-12-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/15/2011] [Accepted: 01/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread. METHODS This cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition. RESULTS Approximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health. CONCLUSIONS Children with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.
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Affiliation(s)
- Salwa G Massad
- Department of Economics, BirZeit University, BirZeit, Palestinian Territory.
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