Malnutrition in developing countries

Prevalence of non-communicable disease among displaced Rohingya in southern Bangladesh: a first look at a persecuted ethnic minority from Myanmar

BACKGROUND

In Cox's Bazar, Bangladesh, 860 356 Rohingya living in refugee camps have experienced decades of persecution. Little is known about disease burden in this population.

METHODS

A retrospective review of deidentified electronic health records (EHR) of 51 270 Rohingya attending two primary health clinics in Kutupalong and Balukahli from October 2017 to October 2019 was performed. A novel EHR system named NIROG was used for patients' medical records'.

RESULTS

Females comprised 53.8% of patients. The median age of females was 25 y and for males it was 19 y. Prevalence of adult hypertension and diabetes was 14.1% and 11.0%, respectively. Also, 16.6% of children aged <5 y had moderate or severe acute malnutrition, while 36.6% were at risk of malnutrition. Body mass index (BMI) analysis showed that 34.4% of adults were underweight. Females were more likely to be hypertensive, diabetic, overweight/obese and malnourished. BMI had a statistically significant positive correlation with fasting blood glucose levels and systolic blood pressure.

CONCLUSIONS

The use of a portable EHR system was highly effective at providing longitudinal care in a humanitarian setting. Significant proportions of the adult population appear to have hypertension or diabetes, pointing to a critical need for management of chronic non-communicable diseases (NCDs). The findings of the current study will help stakeholders to plan effective prevention and management of NCDs among displaced Rohingya and other displaced populations.

Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren

Introduction

Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors.

Methods

This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets.

Results

Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods.

Discussion

Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.

The seasonal relationships between household dietary diversity and child growth in a rural Timor-Leste community

Both child growth and dietary diversity are poor in rural Timor-Leste. The rainy season is associated with food scarcity, yet the association between seasonal scarcity, food diversity, and child growth is underdocumented. This study assesses the relationship between household dietary diversity and children's standardized growth across the 2018 food-scarce (April-May; post-rainy period) and post-harvest (October) seasons in the agricultural community of Natarbora, on the south-coastal plains of Timor-Leste. We conducted household interviews and collected anthropometric data across 98 and 93 households in the post-rainy and post-harvest periods, respectively. Consumed household foods were obtained via 24-h diet recalls and were subsequently categorized into a nine-food-group dietary diversity score (DDS; number of different food groups consumed). The DDS was related to children's standardized short-term growth (z-weight, z-body mass index [BMI] and percent change in weight over the harvest season) via linear mixed models. Across seasons, DDS increased from 3.9 (standard deviation [SD] = 1.0) to 4.3 (SD = 1.4; p < 0.05). In the post-rainy season, children in high DDS households had higher z-weight than those in low DDS households and higher z-BMI than children in medium and low DDS households. In the post-harvest period, household DDS did not predict children's z-weight but predicted z-BMI. Consumption of protein-rich foods, particularly animal-source foods and legumes, in low- and medium-DDS households may be associated with improved child growth. While consuming more animal-source foods in the post-rainy season would be ideal, promoting the consumption of locally grown legumes, such as beans and pulses, may facilitate better nutritional outcomes for more children in rural Timor-Leste.

Global, Regional, and National Burden of Protein–Energy Malnutrition: A Systematic Analysis for the Global Burden of Disease Study

Background: Statistical data on the prevalence, mortality, and disability-adjusted life years (DALYs) of protein–energy malnutrition are valuable for health resource planning and policy-making. We aimed to estimate protein–energy malnutrition burdens worldwide according to gender, age, and sociodemographic index (SDI) between 1990 and 2019. Methods: Detailed data on protein–energy malnutrition from 1990 to 2019 was extracted from the Global Burden of Disease (GBD) database. The global prevalence, deaths, and DALYs attributable to protein–energy malnutrition and the corresponding age-standardized rates (ASRs) were analyzed. Results: In 2019, the global prevalence of protein–energy malnutrition increased to 14,767,275 cases. The age-standardized prevalence rate (ASPR) showed an increasing trend between 1990 and 2019, while the age-standardized deaths rate (ASDR) and age-standardized DALYs rate presented a significantly decreasing trend in the same period. Meanwhile, there was a clearly ASPR, ASDR, and age-standardized DALYs rate downtrend of the prediction curve when the SDI went up. Conclusions: PEM still has a relatively serious disease burden in the world, especially in children and the elderly. At the same time, this phenomenon will be more obvious due to the aging of the world’s population. Effective prevention measures should be strengthened to continuously improve public health conditions.

Nutritional, Biochemical and Haematological Indices of White Albino Rats Fed Complementary Diets Developed from Selected Cereals and Legumes

Background:

Childhood malnutrition is a common public health problem in Ethiopia. This animal study aims to evaluate the haematological, biochemical, and nutritional indices of weanling albino rats fed on complementary diets developed from selected cereals and legumes.

Methods:

The nutritional qualities of the formulated blends were assessed biologically by feeding white albino rats in order to determine feed intake, the growth rate, protein quality parameters, biochemical and haematological properties. The commercial weaning diet (cerifam) and casein were used as control diets. On the 28th day, blood samples were collected from three randomly selected rats by decapitation. Full blood count analysis was carried out using the Automated Haematologic Analyzer to determine haematological parameters. All the biochemical parameters were determined using Mindray diagnostic kits.

Results and Discussion:

The food intake pattern showed that animals placed on diet 3, diet 4, casein, and cerifam consumed more food than those fed on diet 1, diet 2, and diet 7. The mean growth rate of animals fed on diet 3 and diet 4 was significantly (p<0.05) higher than those placed on diet 1, diet 2, and diet 7 but similar to those fed with commercial diet and casein. The protein quality evaluation of the diets showed that the protein efficiency ratio ranged from 1.20 to 2.43 while the biological value was in the range of 54.53 to 69.48%. The net protein utilization and true digestibility were 65.62 to 70.21% and 59.01 to 64.01%, respectively. Serum total protein, albumin, and globulin levels in rats given diet 3 and diet 4 were comparable to the controls and within the normal range. Comparatively, the creatinine and urea levels of rats fed on the control and formulated diets were within the normal range. The serum alanine aminotransferase values of rats fed on the control and formulated diets ranged from 22.03 IU/L in diet 2 to 37.76 IU/L in diet 4 and were not significantly different from each other. In this study, the packed cell volume and haemoglobin values of the control and formulated diets were within the recommended range. Evidently, diet 3 and diet 4 gave the best growth performance after the feeding trials.

Conclusion:

The haematological and biochemical indices indicate that these diets can support effective growth and development in rats, and consumption of these diets has no detrimental effects on the liver and renal function.

Persistent Malnutrition and Associated Factors among Children under Five Years Attending Primary Health Care Facilities in Limpopo Province, South Africa

Despite years of interventions intended to reduce child malnutrition in South Africa, its negative effects, stunting in particular, persist mainly among children under five years old living in under-resourced regions. A cross-sectional study was conducted to determine the prevalence of malnutrition and associated factors among 404 children under age five attending childcare services with their mothers in selected healthcare facilities of Limpopo Province, South Africa. Anthropometry, socio-demographics and obstetric history were collected. Height-for-age, weight-for-age and body mass index-for-age Z-scores were used to determine stunting, underweight and thinness among children, respectively. Logistic regression analyses were performed to generate the factors associated with malnutrition. Stunting (45.3%) was the prevalent form of malnutrition among children under age five, affecting boys (51.7%) more than girls (38.8%) and children aged 12–23 months (62.4%) more than those <11 months old (40.1%), in addition to the overall prevalence of underweight (29.0%) and thinness (12.6%). Boys had increased odds of stunting (adjusted odds ratio, AOR = 2.07, 95% CI: 1.26–3.41, p = 0.004) and underweight (AOR = 2.17, 95% CI: 1.32–3.57, p = 0.002) than girls. Children aged 12–23 months were more likely to be stunted (AOR = 4.79, 95% CI: 2.36–9.75, p ≤ 0.0001) than children aged ≤11 months. Delayed introduction of solid foods increased the odds of stunting (AOR = 5.77, 95% CI: 2.63–12.64, p ≤ 0.0001) and underweight (AOR = 2.05, 95% CI: 1.08–3.89, p = 0.028). Children with normal birth weight were less likely to be thin (AOR = 0.42, 95% CI: 0.19–0.92, p = 0.029) and underweight (AOR = 0.34, 95% CI: 0.17–0.68, p = 0.003) than children who had low birth weight. Children whose mothers had obtained secondary school education (AOR = 0.39, 95% CI: 0.16–0.97, p = 0.044), and Grade 12 or post-Grade 12 education (AOR = 0.32, 95% CI: 0.12–0.83, p = 0.020) were less likely to be stunted than were children of mothers who had only primary school education. Suboptimal complementary feeding predisposed children to stunting and underweight. National nutrition programs should be context-specific to improve the introduction of complementary foods among children, especially in the remote and poor areas.

Infant and child health status ahead of implementation of an integrated intervention to improve nutrition and survival: a cross-sectional baseline assessment

Background

Burundi has one of the poorest child health outcomes in the world. With an acute malnutrition rate of 5% and a chronic malnutrition rate of 56%, under five death is 78 per 1000 live births and 47 children for every 1000 children will live until their first birthday. In response to this grim statistics, Village Health Works, a Burundian-American organisation has invested in an integrated clinical and community intervention model to improve child health outcomes. The aim of this study is to measure and report on child health indicator ahead of implementing this model.

Methods

A cross sectional design was employed, adopting the Demographic Health Survey methodology. We reached out to a sample of 952 households comprising of 2675 birth, in our study area. Mortality data was analysed with R package for mortality computation and other outcomes using SPSS. Principal component analysis was used to classify households into wealth quintiles. Logistic regression was used to assess strength of associations and significance of association was considered at 95% confidence level.

Results

The incidence of low birth weight (LBW) was 6.4% at the study area compared to 10% at the national level with the strongest predictor being malnourished women (OR 1.4 95%CI 1.2–7.2 p = 0.043). Fever incidence was higher in the study area (50.5%) in comparison to 39.5% nationally. Consumption of minimum acceptable diet was showed a significant protection against fever (OR 0.64 95%CI 0.41–0.94 p = 0.042). Global Acute Malnutrition rate was 7.6% and this significantly reduced with increasing age of child. Under-five mortality rate was 32.1 per 1000 live births and infant mortality was 25.7 per 1000 in the catchment with most deaths happening within the first 28 days of life (57.3%).

Conclusion

Improving child health status is complex, therefore, investing into an integrated intervention for both mother and child could yield best results. Given that most under-five deaths occurred in the neonatal period, implementing integrated clinical and community newborn care interventions are critical.

Exploring the impact of COVID-19 pandemic lockdown on informal settlements in Tshwane Gauteng Province, South Africa

Informal settlements remain a public health problem as they lack basic infrastructure. Furthermore, it is challenging to enforce public health regulations and protocols to prevent the spread of infection during a pandemic. This paper was set out to explore the impact of lockdown during COVID-19 among people living in informal settlements. An exploratory qualitative design was utilised. Purposive sampling was used to select research participants. In-depth one-to-one interviews were held involving 30 research participants through a WhatsApp online telephone platform. A thematic approach underpinned by the four stages of data analysis in interpretive phenomenological analysis was utilised to analyse the data. The study found that during the the research participants were affected by lack of space to practice social distancing, over-burdened infrastructure, lack of savings, loss of income and shortage of food, hunger and diseases, anxiety and depression and poor access to education. There is a need to prioritise the needs of informal settlers and endeavour to establish permanent homes. Health promotion and communication initiatives and pandemic awareness programmes are needed to mitigate the impact of lockdown during a pandemic in informal settlements.

Relationship between breakfast consumption, BMI status and physical fitness of Ghanaian school-aged children

BACKGROUND

Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana.

METHOD

The sample consisted of 438 pupils (boys = 213; girls = 225; mean age 11.1 ± 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50 metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns.

RESULTS

The mean BMI-for-age z-score for participants was - 0.24 ± 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p = 0.003. Similarly, mean MUAC was significantly (p = 0.021) higher in the girls (22.0 ± 3.2 cm) than the boys (20.7 ± 7.3 cm). For physical fitness, the girls scored higher in forward jump (p < 0.0001), 50-m run (p = 0.002) and overall fitness score than the boys (21.0 ± 6.2 versus 19.2 ± 8.3, p = 0.012). However, a larger proportion of boys performed excellently and poorly than girls (p = 0.019). A positive correlation was observed between BMI z-score and hand grip (r = 0.21, p < 0.001), while sit up (r = - 0.11, p = 0.018) showed a negative correlation with BMI z-score. No other fitness test varied by BMI. Overweight children performed best in handgrip. Majority of children said they engaged in exercise (89.9%) and consumed breakfast (78.9%). Breakfast consumption was not associated with BMI z-score (x2 0.0359, p = 0.549) but non-breakfast consumers performed better in 50 m run compared to consumers (7.0 seconds ± 2.3 vrs 6.3 seconds ± 2.5, p = 0.022). Children who reported to exercise were physically fitter than those who did not.

CONCLUSION

Underweight levels were low while overweight was over 10% in these children. Girls were more than 3 times affected by overweight than boys, and were also physically fitter than boys. Breakfast consumption was not related to weight or fitness.

Determinants of Household Food Insecurity and Its Association with Child Malnutrition in Sub-Saharan Africa: A Review of the Literature

Food insecurity is a global public health challenge. Household food insecurity is the leading risk factor of malnutrition, claiming approximately 300,000 deaths each year. Whether directly or indirectly, due to inadequate food consumption and poor diet quality, it is also accountable for over half of all deaths among children in Sub-Saharan Africa. It is estimated that the prevalence of food-insecure individuals in the area will reach 17 million by the year 2021. Inadequate nutrition may result in low immunity, impaired physical and mental development and reduced productivity among children under five years and throughout the life course. This review article attempts to discuss the various household food insecurity determinants and their association with child malnutrition in a Sub-Saharan Africa context. The purposes of this article are to inform governments, policymakers and service providers regarding the importance of household food security and its determinants on child malnutrition, and to plan strategies to improve the household food security status in Sub-Saharan Africa.

Patterns of Frequently Diagnosed Pediatric Morbidities in Hospitalized Children in the Volta Region of Ghana

Background. The aim of this study was to identify the frequently diagnosed pediatric diseases in the Volta Region of Ghana, as well as to examine the burden of these diseases. The top pediatric diseases that were frequently diagnosed were malaria, gastroenteritis, systemic infection, anemia, pneumonia, and respiratory tract infection. Methods. Clearance was obtained from the Volta Regional Directorate of the Ghana Health Service to collect primary data on pediatric hospitalizations in the major hospitals in the Region. Diseases with more than 1000 recorded cases of hospitalizations were considered among the top frequently diagnosed childhood morbidities. Results. The data suggest that the Northern sector had different seasonal patterns of recorded diagnosed pediatric cases compared with the Central and Southern sectors, which had similar patterns of the reported diseases. Most of the pediatric diseases in the Volta Region were more prevalent during the dry seasons compared with the rainy seasons and resulting in seasonal patterns of hospitalizations. Conclusion. Although the frequently diagnosed pediatric diseases can be prevented and/or treated, many children are hospitalized, with a proportion of them dying. It is, therefore, important that efforts are made to reduce the burden of pediatric hospitalization.

Peanuts, Aflatoxins and Undernutrition in Children in Sub-Saharan Africa

Peanuts (Arachis hypogaea) is an important and affordable source of protein in most of Sub-Saharan Africa (SSA) and a popular commodity and raw material for peanut butter, paste and cooking oil. It is a popular ingredient for foods used at the point of weaning infants from mother's milk. It is at this critical point that childhood undernutrition occurs and the condition manifests as stunting, wasting and growth restriction and accounts for nearly half of all deaths in children under five years of age in SSA. Undernutrition is multi-factorial but weaning foods contaminated with microbiological agents (bacteria and fungi) and natural toxins have been shown to play a big part. While peanuts may provide good nutrition, they are also highly prone to contamination with mycotoxigenic fungi. The high nutritive value of peanuts makes them a perfect substrate for fungal growth and potential aflatoxin contamination. Aflatoxins are highly carcinogenic and mutagenic mycotoxins. This article reviews the nutritional value and aflatoxin contamination of peanuts, the role they play in the development of childhood malnutrition (including the different theories of aetiology) and immunological problems in children. We also discuss the control strategies that have been explored and advocacy work currently taking shape in Africa to create more awareness of aflatoxins and thus combat their occurrence with the goal of reducing exposure and enhancing trade and food safety.

Influence of malnutrition upon all-cause mortality among children in Swaziland

OBJECTIVE

To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age.

MATERIAL AND METHODS

A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ² test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality.

RESULTS

The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk.

CONCLUSIONS

Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only.

Valorisation of post-sorption materials: Opportunities, strategies, and challenges

Adsorption is a facile, economic, eco-friendly and low-energy requiring technology that aims to separate diverse compounds (ions and molecules) from one phase to another using a wide variety of adsorbent materials. To date, this technology has been used most often for removal/recovery of pollutants from aqueous solutions; however, emerging post-sorption technologies are now enabling the manufacture of value-added key adsorption products that can subsequently be used for (i) fertilizers, (ii) catalysis, (iii) carbonaceous metal nanoparticle synthesis, (iv) feed additives, and (v) biologically active compounds. These new strategies ensure the sustainable valorisation of post-sorption materials as an economically viable alternative to the engineering of other green chemical products because of the ecological affability, biocompatibility, and widespread accessibility of post-sorption materials. Fertilizers and feed additives manufactured using sorption technology contain elements such as N, P, Cu, Mn, and Zn, which improve soil fertility and provide essential nutrients to animals and humans. This green and effective approach to managing post-sorption materials is an important step in reaching the global goals of sustainability and healthy human nutrition. Post-sorbents have also been utilized for the harvesting of metal nanoparticles via modern catalytic pyrolysis techniques. The resulting materials exhibited a high surface area (>1000m²/g) and are further used as catalysts and adsorbents. Together with the above possibilities, energy production from post-sorbents is under exploration. Many of the vital 3E (energy, environment, and economy) problems can be addressed using post-sorption materials. In this review, we summarize a new generation of applications of post-adsorbents as value-added green chemical products. At the end of each section, scientific challenges, further opportunities, and issues related to toxicity are discussed. We believe this critical evaluation not only delivers essential contextual information to researchers in the field but also stimulates new ideas and applications to further advance post-sorbent applications.

Is an ecological school-based nutrition intervention effective to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural areas of China?

PURPOSE

The purpose of this article is to examine the effect of a school-based nutrition intervention using an ecological approach to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural China.

METHODS

A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to the school that was conducting a holistic school-based intervention using health-promoting school (HPS) framework, 'HPS School', or to the 'Control School' in Mi Yun County, Beijing. From each school we randomly selected 65 seventh-grade students to participate in the study. Their nutrition-related knowledge, attitudes and behaviour were measured by pre- and post-intervention surveys with the same instrument. The nutrition intervention lasted for six months.

RESULTS

Adolescents in the intervention school were more likely to know the nutrition knowledge items, with an odds ratio (OR) ranging from 1.86 (95% confidence interval (CI): 1.11-3.09) to 6.34 (95% CI: 3.83-10.47); more likely to think nutrition is very important to health, developing healthy dietary habits is very important, and that expired foods should be thrown away, with ORs of 3.03 (95% CI: 1.60-5.76), 2.76 (95% CI: 1.66-4.59) and 2.35 (95% CI: 1.33-4.17) respectively, and more likely to consume no soft drinks, desserts or fried food, and to eat vegetables every day of the last week, with ORs of 1.99 (95% CI: 1.31-3.04), 3.96 (95% CI: 2.43-6.46), 3.63 (95% CI: 2.26-5.85), and 2.51 (95% CI: 1.41-4.48) respectively, as compared with those in the control school after interventions.

CONCLUSIONS

Our intervention using the HPS framework, an ecological approach, was an appropriate model to promote nutrition among adolescents in rural China and its use should be advocated in future school-based nutrition promotion programmes for adolescents.

Growth data of underprivileged children living in rural areas of Chin State, Burma/Myanmar, compared to the WHO reference growth standards: an observational study

OBJECTIVES

To explore growth data (height-for-age, weight-for-age and BMI-for-age) of children living in poor socioeconomic conditions in rural areas of Chin State, Burma/Myanmar; and to compare these data with the growth and development z-score (GDZ) values for school-aged children and adolescents, provided by the WHO.

SETTING

A support and educational programme, run by the Swedish association Chin Development and Research Society (CDRS), was carried out among underprivileged school-aged children, unable to attend school without economic and practical support, living in villages and remote areas in Chin State.

PARTICIPANTS

Community leaders who were well familiar with the citizens in the community identified children in need of this support. Other community members could also suggest or apply for this. The sample includes all participating children in the CDRS programme at the time of the data collection in six townships. The children were placed in host families, close to a suitable school. Two samples with a total of 639 children from 144 villages and remote areas were obtained:1. Children in the CDRS Chin Programme (CCP) (2007-2010) comprised 558 children: 50% girls and boys.2. Children in the Chin Society (CCS) (2010) comprised 81 children: 44% girls and 56% boys.

PRIMARY OUTCOME MEASURES

Growth data.

RESULTS

All growth data from both groups deviated significantly from the WHO standard references (p ≤ 0.001). The prevalence of stunting (height-for-age ≤-2SD) was 52% among girls and 68% among boys. High levels of wasting (weight-for-age ≤-2SD) were found among girls 29% and boys 36% aged 5-10 years. In addition, severe thinness (BMI-for-age ≤-2SD) was found among girls 31% and boys 44%, all results to be compared to the expected 2.27%.

CONCLUSIONS

Many more than expected-according to the WHO reference values-in CCP and CCS suffered from stunting, wasting and thinness.

Prevalence of stunting, wasting and underweight in Grade 1-learners: The NW-CHILD Study

Background: Child undernutrition remains a major public health concern in developing countries, with many negative consequences to child development.Objectives: To determine the prevalence of stunting, wasting and underweight amongst Grade 1-learners in the North West Province (NWP) of South Africa (SA), taking into account gender, race and school type.Method: Eight hundred and sixteen (419 boys, 397 girls) learners participated in the study (567 black, 218 white, 31 other races). Underweight, stunting and wasting (Weight-for-age, height-for-age, BMI-for-age) were determined using the z-scores of the 2007 WHO reference sample (-2 SD).Results: A higher prevalence of wasting and underweight were found amongst the boys (8.35%; 5.97%) compared with the girls (6.30%; 2.52%), although this was only significant for underweight (p = 0.02), whilst stunting percentages were very similar amongst girls (4.53%) and boys (4.06%). Underweight was the highest in the black group (5.47%; p < 0.01), compared with the white group (0.46%) and the prevalence of the conditions is associated with school types which represent low socio-economic circumstances (Quintile 1–3 schools). Only black learners showed stunting (p < 0.01) and more black learners were wasted (n = 39) compared with white (n = 15; p = 0.08) learners. Quintile 1–3 schools had a significantly higher prevalence of underweight (5.14% – 8.18%) and stunting (3.88% – 10.7%) (p < 0.01) compared with Quintile 4 and 5 schools.Conclusion: The prevalence of stunting, wasting and underweight need improvement amongst school beginners, especially in Quintile 1–3 type schools but also amongst black learners living in the NWP of SA as it can have significant hampering effects on the future development and well-being of children.Agtergrond: Ondervoeding is steeds ‘n publieke gesondheidsgevaar by kinders in ontwikklende lande, met heelwat negatiewe gevolge vir kinderontwikkeling. Doel: Om te bepaal wat die voorkoms van groei-inperking, ondervoeding en ondergewig by Graad 1-leerders in die Noordwes-Provinsie (NWP) van Suid-Afrika (SA) is, met in ag neming van geslag, ras en skooltipe.Metode: Agt honderd en sestien leerders (419 seuns; 397 meisies) is ewekansig geselekteer vir deelname aan die studie (567 swart, 218 wit, 31 ander rasgroepe). Ondergewig, groei-inperking en ondervoeding is bepaal deur z-tellings vir massa-vir-ouderdom, lengte-vir-ouderdom en LMI-vir-ouderdom volgens die 2007 WHO verwysings (-2 SA).Resultate: ‘n Hoër voorkoms vir ondervoeding en ondergewig is by seuns (8.35%; 5.97%) teenoor meisies (6.30%; 2.52%) gevind, alhoewel slegs betekenisvol vir ondergewig (p = 0.02), terrwyl persentasies van groei-inperking redelik dieselfde was by meisies (4.53%) en seuns (4.06%). Ondergewig het die hoogste voorkoms in die swart groep (5.47%; p < 0.01) getoon, en die voorkoms word geassosieer met skooltipes wat lae sosio-ekonomiese omstandighede verteenwoordig. Slegs swart leerders het groei-inperking getoon (p < 0.01) en meer swart leerders was ondervoed (n = 39) teenoor blanke (n = 15) leerders. Kwintiel 1–3 skole het ‘n betekenisvolle hoër voorkoms vir ondergewig (5.14% – 8.18%) en groei-inperking (3.88% – 10.7%) getoon (p < 0.01) as die Kwintiel 4 en 5 skole.Gevolgtrekking: Groei-inperking, ondervoeding en ondergewig moet by skoolbeginners verbeter word, veral in Kwintiel 1–3 skooltipes en by Swart leerlinge in die NWP van SA, veral weens die negatiewe uitwerking wat dit op die toekomstige ontwikkeling en welstand van leerders wat daaronder gebuk gaan, kan uitoefen.

Malnutrition and brain development: an analysis of the effects of inadequate diet during different stages of life in rat

Protein malnutrition or undernutrition can result in abnormal development of the brain. Depending on type, age at onset and duration, different structural and functional deficits can be observed. In the present review, we discuss the neuroanatomical, behavioral, neurochemical and oxidative status changes associated with protein malnutrition or undernutrition at different ages during prenatal and immediately postnatal periods as well as in adult rat. Analysis of all data suggests that protein malnutrition as well as undernutrition induced impaired learning and retention when imposed during the immediately postnatal period and in adulthood, whereas hyperactivity including increased impulsiveness and greater reactivity to aversive stimuli occurred when malnutrition or undernutrition was imposed either pre or postnatally. This general state of hyperreactivity may be linked essentially to an alteration in dopaminergic system. Hence, the present review shows that in spite of the attention devoted in the literature to prenatal effects, cognitive deficits are more serious following malnutrition or undernutrition after birth. We thus clearly establish a special vulnerability to malnutrition after weaning in rats.