Overweight, stunting, and anemia are public health problems among low socioeconomic groups in school adolescents (12-15 years) in the North Gaza Strip

Prevalence and Determinants of Stunting, Wasting, and Underweight Among School-Age Children Aged 6-12 Years in South Gondar Zone, Ethiopia

BACKGROUND

Underweight, wasting, and stunting are the commonest nutritional disorders among children, especially in developing countries. The aim of this study was to assess the prevalence and determinant factors of underweight, wasting, and stunting among school-age children in 2019.

METHODS

A cross-sectional study was conducted in the five special districts of South Gondar Zone, among 314 school-age children. WHO AnthroPlus software was used to build Z-scores from anthropometric measurement. The data were analyzed by SPSS Version 20. The degrees of association were assessed using adjusted odds ratio (AOR) and 95% confidence interval during multivariable logistic regression. A P-value less than 0.05 was considered to be statistically significant.

RESULTS

Of the total study participants, 232 (77.3%) were from public schools. The mean±standard deviation (SD) of height of children was 132.9±9.8 cm, and the mean±SD weight of children was 27.7±5.8 kg. The prevalence of stunting, wasting, and underweight was 11%, 6.3%, and 11.4%, respectively. Students who ate their breakfast rarely were 8-times more likely to be underweight than those who ate their breakfast always (AOR=7.9, 95% CI=4.8-14.8). Those who were sick in the past 2 weeks were more likely to be underweight than their counterparts (AOR=7.3, 95% CI=2.8-14.4). Those who never consume milk or milk products were 6.5 (AOR=6.5, 95% CI=1.7-23) times more likely to be stunted than those who consumed this always. Sickness in the past 2 weeks prior to data collection was significantly associated with thinness (AOR=6 0.9, 95% CI=4.1-10.1).

CONCLUSION

The overall prevalence of wasting, stunting, and underweight was a mild public health problem in the study area.

Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study

Background

In 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank.

Methods

We surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian Government. We randomly selected students from the first (mean age 6.7 years [SD 0.5]), sixth (11.8 years [0.6]), and ninth grades (14.8 years [0.6]). Data were obtained from 1484 (99%) of 1500 students planned for enrollment.

Results

Our results suggest that iodine intake appears adequate and there was essentially no iodine deficiency. As to the status of other micronutrients, the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high. The overall prevalence of anemia was 9.6%, but there were pockets of anemia in certain districts. Almost 42% of the anemia in our sample was explained by iron deficiency. There were significant differences in iron deficiency between girls and boys, 29.5% vs. 15.7%, respectively (p = 0.0001). There were no cases of lead toxicity in the studied sample.

Conclusions

Wheat flour and salt fortification has had a major influence on improving the micronutrient status of Palestinian children, for some but not all micronutrients. The recommended key blood and biochemical parameters to be incorporated in the surveillance system are iron, zinc, and vitamin B12.

Association between intestinal worm infection and malnutrition among rural children aged 9-11 years old in Guizhou Province, China

BACKGROUND

Intestinal worm infection adversely impacted child health and was one of the China's largest health burdens. However, yet little was known about associations between intestinal worm infection and malnutrition in school-aged children in rural China. This study aimed to fill into the gap.

METHODS

Data were from a survey of children aged 9-11 years old in Guizhou Province, China conducted in June 2013. Considering anemia and low intelligent quotient (IQ) as mediating factors, binomial logistic regression was used to estimate the associations of intestinal worm infection with thinness, underweight, and stunting. Moreover, the associations between socio-demographic factors and malnutrition were also explored.

RESULTS

Among 2179 children, part of children was infected by intestinal worm (41.85%). Stunting (28%), low memory IQ (87.52%), and low process IQ (62.59%) were highly prevalent in the sample. Socio-demographic factors were associated with thinness, underweight, stunting, low memory IQ, low process IQ, anaemia, and intestinal worm infection. Intestinal worm infection was associated with low IQ, anemia, and stunting. In addition, anemia and low IQ could not confound the other expected associations.

CONCLUSION

This study demonstrated the association between intestinal worm infections and stunting appeared to be largely mediated via low IQ. The study highlighted the importance of deworming and improving nutrition in the surveyed areas.

Association between socioeconomic status and obesity among 12-year-old Malaysian adolescents

The epidemic of obesity in developed countries is commonly associated with poor dietary habit and sedentary lifestyle. However, other determinants, including education background and family income, may contribute towards the problem especially in developing countries. This study aimed to determine the influence of socioeconomic status (SES) on obesity among 12-year-old school adolescents in Terengganu, Malaysia. Body weight and height were measured and BMI was categorised based on WHO z-score cut-off points. Information was obtained from self-reported questionnaire on parents' education background, family income and occupation. A total of 3,798 school adolescents aged 12 years (44% boys and 56% girls) were recruited. There was no significant difference in BMI status between boys and girls, or between rural and urban participants. There were significant differences between BMI categories and gender, household income and SES level within rural areas. In the urban areas, significant differences were found between BMI categories and gender, parents' occupational and educational level, household income and size, and SES level. A logistic regression model found several SES factors to be predictors of obesity in this population, namely, gender, household size, father's occupation level, household income level and SES level. Each component of SES has been significantly associated with the BMI category of school adolescents, particularly in the urban areas. This suggests the requirement of multifaceted approaches, including the role of family, society and authorities, in the effort to curtail adolescent obesity.

The gender gap among school children in poor rural areas of western China: evidence from a multi-province dataset

Background

The gender gap remains a major impediment in the path towards equality and it is especially wide in low-income countries. Up to the early 2000s, many studies documented extensive inequalities in China: girls had poorer health, less nutrition and less education than their male counterparts. The goal of this study is to examine whether the gender gap persists, given that China is now making the transition into the ranks of upper-middle income countries. We consider educational outcomes, mental and physical health status, as well as non-cognitive outcomes.

Methods

We draw on a dataset containing 69,565 observations constructed by combining data from 7 different school-level surveys spanning 5 provinces. The surveys were all conducted by the authors between 2008 and 2013 using uniform survey instruments and data collection protocols in randomly selected schools across western provinces in rural China. The sample children range in age from 9 to 14 years (with 79 % of the sample being aged 10 to 12). Our analysis compares rural girls with rural boys in terms of 13 different indicators.

Results

With the exception of anemia rates, the health outcomes of girls are equal to those of boys. Girls and boys are statistically identical in terms of weight-for-age, height-for-age, and prevalence of intestinal worm infections. Girls performed better than boys on five of six cognitive and educational performance indicators. Girls performed worse than boys on all mental health indicators. All estimates are robust to the inclusion of different age ranges, controlling for the level of household assets, ethnic minority status, as well as the addition of provincial dummies.

Conclusions

Our findings suggest that with the exception of non-cognitive outcomes, anemia and standardized math test scores, the gender gap in our study areas in China appears to be diminishing.

Assessing the nutritional status of Palestinian adolescents from East Jerusalem: a school-based study 2002-03

In Palestine, there is a little information about nutrition of adolescents compared to other age groups. This study was designed to assess the nutritional status of Palestinian school-aged children (11-16 years) in East Jerusalem during 2002-03. A school-based cross-sectional study targeted randomly 313 adolescents from public and private schools. A previously validated and reliable questionnaire was administered through interviews that included anthropometric and hemoglobin measurements, 24-h dietary intake recall and physical activity questionnaire. It was found that being overweight (24.3%) or obese (9.9%) coexisted with being underweight (4.8%) and/or anemic (23.3%). Only 22.4% of the study subject had physical activity for ≥5 days a week with boys being more physically active than girls (p < 0.01). Inadequate energy intake had 55.66% of boys and 64.81% of girls; inadequate protein intake was reported by 15.07% of boys and 43.08% of girls. The majority of them met <80% of the recommended daily allowances for most micronutrients. The whole sample and especially boys consumed more total, saturated fat, less monounsaturated fat and carbohydrates than what is advised. Obese and overweight adolescents had lower energy intake (p < 0.05) and a lower trend in being physically active than normal weight counterparts. School health education programs targeted at adolescents and parents need to be developed as part of overweight-obesity, malnutrition and anemia prevention.

Dietary habits of Palestinian adolescents and associated sociodemographic characteristics in Ramallah, Nablus and Hebron governorates

OBJECTIVE

To describe food habits and associated sociodemographic factors.

DESIGN

Cross-sectional survey in 2005.

SETTING

Ninety-six school classes in Ramallah, Nablus and Hebron governorates, Occupied Palestinian Territory.

SUBJECTS

Grade 8 and 9 students aged 13-15 years (n 2952).

METHODS

Self-administered student and parent questionnaires.

RESULTS

High standard of living (STL) index and residence in Ramallah were positively associated with intake of animal foods, Western-style foods, dairy products, fruits and vegetables, sweets and salty snacks. Only 26.1 % of the students ate three main meals daily; 26.2 % of the boys and 51.0 % of the girls had breakfast one to two times per week or less often (P < 0.001). Only one-quarter of students drank milk daily (32.9 % of boys and 18.3 % of girls, P < 0.001). The majority of students, boys and girls in similar proportions, consumed vegetables daily (72.8 % v. 73.8 %, respectively). Daily fruit consumption was also equally common among boys and girls (58.9 % v. 55.2 %, respectively), but with clear differences by STL, region and parents' education. Daily intake of sweets and salty snacks was common among girls, and daily intake of soft drinks was common among boys.

CONCLUSIONS

Irregular meal patterns were common among Palestinian adolescents. High STL and residence in Ramallah were associated with frequent intake of foods high in sugar and fat, but also with frequent intake of fruits and vegetables. Effective interventions are needed to establish healthy dietary habits.

Prevalence and sociodemographic correlates of stunting, underweight, and overweight among Palestinian school adolescents (13-15 years) in two major governorates in the West Bank

BACKGROUND

There is little information about height and weight status of Palestinian adolescents. The objective of this paper was to assess the prevalence of stunting, underweight, and overweight/obesity among Palestinian school adolescents (13-15 years) and associated sociodemographic factors in 2 major governorates in the West Bank.

METHODS

A Cross-sectional survey was conducted in 2005 comprising 1942 students in 65 schools in Ramallah and Hebron governorates. Data was collected through self-administered questionnaires from students and parents. Weights and heights were measured. Overweight and obesity were assessed using the 2000 Centers for Disease Control and Prevention (CDC) reference and the International Obesity Task Force (IOTF) criteria. Stunting and underweight were assessed using the 2000 CDC reference.

RESULTS

Overweight/obesity was more prevalent in Ramallah than in Hebron and affected more girls than boys. Using the 2000 CDC reference, the prevalence of overweight and obesity in Ramallah among boys was 9.6% and 8.2%, respectively versus 15.6% and 6.0% among girls (P < 0.01). In Hebron, the corresponding figures were 8.5% and 4.9% for boys and 13.5% and 3.4% for girls (P < 0.01). Using the IOTF criteria, the prevalence of overweight and obesity among boys in Ramallah was 13.3% and 5.2%, respectively versus 18.9% and 3.3% for girls. The prevalence of overweight and obesity among boys in Hebron was 10.9% and 2.2%, respectively versus 14.9% and 2.0% for girls. Overweight/obesity was associated with high standard of living (STL) among boys and with the onset of puberty among girls. More boys were underweight than girls, and the prevalence was higher in Hebron (12.9% and 6.0% in boys and girls, respectively (P < 0.01)) than in Ramallah (9.7% and 3.1% in boys and girls, respectively (p < 0.01)). The prevalence of stunting was similar in both governorates, and was higher among boys (9.2% and 9.4% in Ramallah and Hebron, respectively) than among girls (5.9% and 4.2% in Ramallah and Hebron, respectively). Stunting was negatively associated with father's education among boys and with urban residence, medium STL and onset of puberty among girls.

CONCLUSION

Under- and overnutrition co-exist among Palestinian adolescents, with differences between sexes. Region, residence, STL, and onset of puberty were associated factors.

Socioeconomic and gender differences in adolescents' nutritional status in urban Cameroon, Africa

The aim of this study was to assess adolescents' nutritional status according to socioeconomic status (SES) and sex using anthropometry in urban Cameroon, Africa. Adolescent boys (n = 248) and girls (n = 333) 12 to 16 years old were recruited from randomly selected schools in a cross sectional study in Yaoundé city and grouped according to SES. Weight, height, skinfold thickness, and circumferences were measured, and body mass index, waist/hip ratio, arm muscle, and arm fat areas were calculated. Stunting, underweight, and overweight were determined using international cutoff points. Adolescents with medium and high SES were less likely to be stunted than adolescents with low SES (odds ratio [OR], 0.40; P < .01). Prevalences of stunting (12%, 6%, and 5%) and underweight (3%, 4%, and 1%) were higher among the adolescents with low and medium SES than those with high SES. Overweight prevalence was high among the adolescents with low (8%), medium (11%), and high (9%) SES. The OR for overweight was higher among girls than boys (OR, 4.13; P < .001). Girls were less likely to be stunted and underweight than boys (OR, 0.29 [P < .001] and OR, 0.20 [P < .01], respectively). Prevalences of stunting (15% and 6%) and underweight (5% and 2%) were higher among boys than girls. Pubescent adolescents were less likely to be stunted than nonpubescent (OR, 0.53; P < .05). Adolescents with low and medium SES were more underweight and stunted than adolescents with high SES. Girls were more overweight, less stunted, and underweight than boys.

Sociodemographic correlates of food habits among school adolescents (12-15 year) in North Gaza Strip

BACKGROUND

There is little information about meal patterns and food consumption of adolescents in Palestine. The objective of this study was to describe the association between sociodemographic factors and food intake, and meal patterns among Palestinian school adolescents (12-15 year) in North Gaza Strip.

METHODS

A cross-sectional study was conducted in 2002 comprising 944 subjects in 10 schools in Gaza city, Jabalia village and Jabalia refugee camp. Self-administered questionnaires were filled in by students and parents to obtain data on frequency of meals, food intake and sociodemographic characteristics.

RESULTS

High household socioeconomic status (SES) was associated with the increased number of meals and the increased intakes of many nutritious foods such as; animal food items, fruits and vegetables and dairy foods. The percentage of adolescents having breakfast daily of high and low SES was 74.5% vs 55% in boys and 65.6% vs 45% in girls. The percentage of girls with refugee status who had lunch was higher (90.2%) compared to the local citizen girls (83.9%), (p = 0.03). Girls were less likely to skip daily lunch (OR = 0.55, 95% CI = 0.36-0.87, p = 0.01) compared to boys. Risk of skipping lunch was three times higher among adolescents living in the village compared to Gaza well-off area (OR = 3.3, 95% CI = 1.72-6.31, p < 0.001). Adolescents who were having lunch daily were less likely to skip breakfast or dinner. Only 11.6% of boys and 16.2% of girls consumed fruits daily. In multivariate analysis, SES was positively associated with food frequency intake scores in both genders. Boys from the refugee camp and the village had a significant higher consumption of fruits and vegetables than boys from high and low income area in Gaza City, while it was the opposite in girls.

CONCLUSION

Meal skipping is common, particularly among those of low SES and the intakes of many nutritious foods such as animal food items, fruits and vegetables and dairy foods seem to be low among adolescents of low SES. The results of this study could be used as an important base-line for future monitoring of the nutritional situation of adolescents.

Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory

Heart disease, cerebrovascular disease, and cancer are the major causes of morbidity and mortality in the occupied Palestinian territory, resulting in a high direct cost of care, high indirect cost in loss of production, and much societal stress. The rates of the classic risk factors for atherosclerotic disease-namely, hypertension, diabetes mellitus, tobacco smoking, and dyslipidaemia-are high and similar to those in neighbouring countries. The urbanisation and continuing nutritional change from a healthy Mediterranean diet to an increasingly western-style diet is associated with reduced activity, obesity, and a loss of the protective effect of the traditional diet. Rates of cancer seem to be lower than those in neighbouring countries, with the leading causes of death being lung cancer in Palestinian men and breast cancer in women. The response of society and the health-care system to this epidemic is inadequate. A large proportion of health-care expenditure is on expensive curative care outside the area. Effective comprehensive prevention programmes should be implemented, and the health-care system should be redesigned to address these diseases.