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Soni A, Fahey N, Ash A, Bhutta Z, Li W, Simas TM, Nimbalkar S, Allison J. Predictive algorithm to stratify newborns at-risk for child undernutrition in India: Secondary analysis of the National Family Health Survey-4. J Glob Health 2022; 12:04040. [PMID: 35567579 PMCID: PMC9107290 DOI: 10.7189/jogh.12.04040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background India is at the epicentre of global child undernutrition. Strategies to identify at-risk populations are needed in the context of limited resources Methods Data from children under the age of five surveyed in the 2015-2016 National Family Health Survey were used. Child undernutrition was assessed using anthropometric measurements. Predictor variables were identified from the extant literature and included if they could be measured at the time of delivery. Survey-weighted logistic regression was applied to model the outcome. Internal validation of the model was performed using 200 bootstrapped samples representing half of the total data sets. Results In 2016, 54.4% (95% CI = 54.0%-54.8%) of Indian children were undernourished, according to a composite index of anthropometric failure. The predictive model for overall undernutrition included maternal (height, education, reproductive history, number of antenatal visits), child (sex, birthweight), and household characteristics (district of residence, caste, rural residence, toilet availability, presence of a separate kitchen). The model demonstrated reasonable discrimination ability (optimism-adjusted c = 0.67). The group of children classified in the lowest decile for risk of undernutrition had a prevalence of 25.9%, while the group classified in the highest decile had a prevalence of 77.4%. Conclusions It is possible to stratify newborns at the time of delivery based on their risk for undernutrition in the first five years of life. The model developed by this study represents a first step in adopting a risk-score based approach for the most vulnerable population to receive services in a timely manner.
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Affiliation(s)
- Apurv Soni
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, Bhaikaka University, Karamsad, Gujarat, India
| | - Nisha Fahey
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, Bhaikaka University, Karamsad, Gujarat, India.,Department of Pediatrics, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Arlene Ash
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Zulfiqar Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada
| | - Wenjun Li
- Program in Digital Medicine, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany M Simas
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA.,Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, Massachusetts, USA
| | | | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
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Do tribal children experience elevated risk of poor nutritional status in India? A multilevel analysis. J Biosoc Sci 2020; 53:683-708. [PMID: 32873356 DOI: 10.1017/s0021932020000474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015-2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting ('anthropometric failure') across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.
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Rautela G, Ali MK, Prabhakaran D, Narayan KMV, Tandon N, Mohan V, Jaacks LM. Prevalence and correlates of household food insecurity in Delhi and Chennai, India. Food Secur 2020; 12:391-404. [PMID: 33456633 DOI: 10.1007/s12571-020-01015-0] [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: 11/24/2022]
Abstract
India is home to nearly 200 million undernourished people, yet little is known about the characteristics of those experiencing food insecurity, especially among urban households. The objectives of this study were: (1) to report the prevalence of food insecurity in two large, population-based representative samples in urban India, (2) to describe socio-economic correlates of food insecurity in this context, and (3) to compare the dietary intake of adults living in food insecure households to that of adults living in food secure households. Data are from 4334 households participating in an ongoing population-based cohort study of a representative sample of Delhi and Chennai, India. The most recent wave of data (2017-2018) were analysed. Food insecurity was measured using the 9-item Household Food Insecurity Access Scale (HFIAS) and dietary intake using a 33-item semi-quantitative food frequency questionnaire. The overall prevalence of food insecurity was 8.5% (95% confidence interval [CI], 6.8-10.2); 15.2% (95% CI 12.0-18.4) of the poorest households (lowest wealth index tertile) were food insecure compared to 1.7% (95% CI 1.0-2.3) of the wealthiest households (highest wealth index tertile). Participants experiencing food insecurity were significantly younger and more likely to be from Delhi compared to Chennai. After adjustment for socio-economic factors (city, age, sex, education, wealth index, fuel used for cooking, and source of drinking water), participants experiencing food insecurity had significantly higher meat, poultry, roots and tubers (potato), and sugar sweetened beverage intakes, and lower vegetables, fruit, dairy, and nut intakes. Food insecurity is highly prevalent among the poorest households in urban India and is associated with intake of a number of unhealthy dietary items.
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Affiliation(s)
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, Haryana, India
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Sustainable food security in India-Domestic production and macronutrient availability. PLoS One 2018; 13:e0193766. [PMID: 29570702 PMCID: PMC5865708 DOI: 10.1371/journal.pone.0193766] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/17/2018] [Indexed: 11/19/2022] Open
Abstract
India has been perceived as a development enigma: Recent rates of economic growth have not been matched by similar rates in health and nutritional improvements. To meet the second Sustainable Development Goal (SDG2) of achieving zero hunger by 2030, India faces a substantial challenge in meeting basic nutritional needs in addition to addressing population, environmental and dietary pressures. Here we have mapped-for the first time-the Indian food system from crop production to household-level availability across three key macronutrients categories of 'calories', 'digestible protein' and 'fat'. To better understand the potential of reduced food chain losses and improved crop yields to close future food deficits, scenario analysis was conducted to 2030 and 2050. Under India's current self-sufficiency model, our analysis indicates severe shortfalls in availability of all macronutrients across a large proportion (>60%) of the Indian population. The extent of projected shortfalls continues to grow such that, even in ambitious waste reduction and yield scenarios, enhanced domestic production alone will be inadequate in closing the nutrition supply gap. We suggest that to meet SDG2 India will need to take a combined approach of optimising domestic production and increasing its participation in global trade.
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Bhutta ZA, Guerrant RL, Nelson CA. Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape. Pediatrics 2017; 139:S12-S22. [PMID: 28562245 DOI: 10.1542/peds.2016-2828d] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/24/2022] Open
Abstract
The last decade has witnessed major reductions in child mortality and a focus on saving lives with key interventions targeting major causes of child deaths, such as neonatal deaths and those due to childhood diarrhea and pneumonia. With the transition to Sustainable Development Goals, the global health community is expanding child health initiatives to address not only the ongoing need for reduced mortality, but also to decrease morbidity and adverse exposures toward improving health and developmental outcomes. The relationship between adverse environmental exposures frequently associated with factors operating in the prepregnancy period and during fetal development is well established. Also well appreciated are the developmental impacts (both short- and long-term) associated with postnatal factors, such as immunostimulation and environmental enteropathy, and the additional risks posed by the confluence of factors related to malnutrition, poor living conditions, and the high burden of infections. This article provides our current thinking on the pathogenesis and risk factors for adverse developmental outcomes among young children, setting the scene for potential interventions that can ameliorate these adversities among families and children at risk.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; .,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Human Development Program, Harvard Graduate School of Education, Cambridge, Massachusetts
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Bhandari N, Mohan SB, Bose A, Iyengar SD, Taneja S, Mazumder S, Pricilla RA, Iyengar K, Sachdev HS, Mohan VR, Suhalka V, Yoshida S, Martines J, Bahl R. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India. BMJ Glob Health 2016; 1:e000144. [PMID: 28588982 PMCID: PMC5321385 DOI: 10.1136/bmjgh-2016-000144] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the efficacy of ready-to-use therapeutic food (RUTF), centrally produced RUTF (RUTF-C) or locally prepared RUTF (RUTF-L) for home-based management of uncomplicated severe acute malnutrition (SAM) compared with micronutrient-enriched (augmented) energy-dense home-prepared foods (A-HPF, the comparison group). METHODS In an individually randomised multicentre trial, we enrolled 906 children aged 6-59 months with uncomplicated SAM. The children enrolled were randomised to receive RUTF-C, RUTF-L or A-HPF. We provided foods, counselling and feeding support until recovery or 16 weeks, whichever was earlier and measured outcomes weekly (treatment phase). We subsequently facilitated access to government nutrition services and measured outcomes once 16 weeks later (sustenance phase). The primary outcome was recovery during treatment phase (weight-for-height ≥-2 SD and absence of oedema of feet). RESULTS Recovery rates with RUTF-L, RUTF-C and A-HPF were 56.9%, 47.5% and 42.8%, respectively. The adjusted OR was 1.71 (95% CI 1.20 to 2.43; p=0.003) for RUTF-L and 1.28 (95% CI 0.90 to 1.82; p=0.164) for RUTF-C compared with A-HPF. Weight gain in the RUTF-L group was higher than in the A-HPF group (adjusted difference 0.90 g/kg/day, 95% CI 0.30 to 1.50; p=0.003). Time to recovery was shorter in both RUTF groups. Morbidity was high and similar across groups. At the end of the study, the proportion of children with weight-for-height Z-score (WHZ) >-2 was similar (adjusted OR 1.12, 95% CI 0.74 to 1.95; p=0.464), higher for moderate malnutrition (WHZ<-2 and ≥-3; adjusted OR 1.46, 95% CI 1.02 to 2.08; p=0.039), and lower for those with SAM (adjusted OR 0.58, 95% CI 0.40 to 0.85; p=0.005) in the RUTF-L when compared with the A-HPF group. CONCLUSIONS This first randomised trial comparing options for home management of uncomplicated SAM confirms that RUTF-L is more efficacious than A-HPF at home. Recovery rates were lower than in African studies, despite longer treatment and greater support for feeding. TRIAL REGISTRATION NUMBER NCT01705769; Pre-results.
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Affiliation(s)
- Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Anuradha Bose
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Sharad D Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Kirti Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | | | | | - Virendra Suhalka
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
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Corsi DJ, Mejía-Guevara I, Subramanian SV. Improving household-level nutrition-specific and nutrition-sensitive conditions key to reducing child undernutrition in India. Soc Sci Med 2016; 157:189-92. [PMID: 26975835 DOI: 10.1016/j.socscimed.2016.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Iván Mejía-Guevara
- Harvard Center for Population & Development Studies, Cambridge, MA, USA.
| | - S V Subramanian
- Harvard Center for Population & Development Studies, Cambridge, MA, USA; Department of Social and Behavioural Sciences, Harvard T H Chan School of Public Health, Harvard Center for Population and Development Studies, Boston, MA, USA.
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