Maternal and child undernutrition and overweight in low-income and middle-income countries

Trends in the prevalence of concurrent anaemia and stunting among infants and young children in Rwanda: a cross-sectional study from 2010 to 2020

BACKGROUND

Concurrent anaemia and stunting (CAS) pose severe public health risks in low- and middle-income countries, affecting child health and development.

OBJECTIVES

To determine trends in CAS prevalence and associated factors among infants and young children aged 6-23 months in Rwanda.

METHODS

Analyses of nationally representative samples from the Rwanda Demographic and Health Surveys (RDHS) of 2010, 2014/15, and 2019/20 were conducted. Participants' characteristics, trends, and prevalence of CAS were analysed using frequencies and percentages. Multivariable binary logistic regression analyses were used to assess factors associated with CAS.

RESULTS

The prevalence of CAS among children aged 6-23 months in Rwanda declined from 21.3% in 2010 to 16.9% in 2019/20 (p = 0.005). Significant factors associated with CAS included child's age above 12 months, male sex, small/very small birth size, breastfeeding initiation 1 day post-birth, inadequate minimum acceptable diet, history of cough 2 weeks prior to the survey, multiple births, being from a mother with no or only primary education, mother aged below 20 years, mother with no iron supplementation during pregnancy, maternal anaemia, resident of an eastern province, resident of high altitude areas (>2000 m), low household wealth and unimproved toilet facilities.

CONCLUSIONS

This study reveals persistent CAS among infants and young children in Rwanda. CAS was associated with various child, maternal, and household-related factors. Despite a notable decline in CAS prevalence in Rwanda over the past decade, CAS remains a significant public health issue, requiring targeted interventions.

Review of the facilitators and barriers to adoption of biofortified foods and food products

Biofortification - the process of increasing the concentrations of essential nutrients in staple crops - is a means of addressing the burden of micronutrient deficiencies at a population level via existing food systems, such as smallholder farms. To realise its potential for global impact, we need to understand the factors that are associated with decisions to adopt biofortified crops and food products. We searched the literature to identify adoption determinants, i.e. barriers to (factors negatively associated) or facilitators of (factors positively associated) adoption, of biofortified crops and food products. We found 41 studies reporting facilitator(s) and/or barrier(s) of adoption. We categorised the factors using the Consolidated Framework of Implementation Research 2.0, resulting in a set of factors that enable or constrain adoption of biofortified foods across twenty-four constructs and five domains of this meta-theoretical determinant framework from implementation science. Facilitators of orange sweet potato adoption included knowledge about importance, relative advantage, efficient production and management practices; barriers included lacking timely access to quality vines and market remoteness (28 studies total). Facilitators of vitamin A cassava adoption included awareness of its benefits and access to information; barriers included poor road networks and scarcity of improved technology including inadequate processing/storage facilities (8). Facilitators of high-iron bean adoption included farmers' networking and high farming experience; barriers included low knowledge of bean biofortification (8). Barriers to vitamin A maize adoption included low awareness and concerns regarding yield, texture and aflatoxin contamination (1). These barriers and facilitators may be a starting point for researchers to move towards testing implementation strategies and/or for policymakers to consider before planning scale-up and continuous optimisation of ongoing projects promoting adoption of biofortified crops and food products.

The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa)

OBJECTIVES

This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years.

METHODS

Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis.

RESULTS AND CONCLUSIONS

The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were -0.012 (-0.017, -0.007), -0.009 (-0.012, -0.005) and -0.020 (-0.025, -0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were -0.225 (-0.244, -0.207), 0.02 (-0.021, 0.024) and -0.223 (-0.249, -0.196), respectively among 5-year-olds and -0.265 (-0.295, -0.236), -0.020 (-0.029, -0.011) and -0.285 (-0.315, -0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

Epidemiological Study on Bodyweight Problems' Prevalence and Associated Factors among Primary Schoolchildren in Constantine, Algeria

This study aimed to determine diet, physical activities, and the frequency and risk factors for body weight problems in children aged between 5 and 13 who attend public primary schools in Constantine, Algeria. A total of 811 children (403 girls and 408 boys) enrolled in three random primary schools in Constantine took anthropometric measurements to calculate body mass index (BMI = weight/size). A questionnaire was created to collect information about the children's lifestyles, which was completed online by their parents. Obesity and overweight were determined according to the standards of the World Health Organization (WHO). A statistical analysis was conducted to identify risk factors for overweight and obesity. The results showed that overweight affects 1.726% of children (57.15% boys and 42.85% girls). The results also showed a 0.616% prevalence of obesity (60% boys, 40% girls). In addition to that, the results of this study revealed that 72.133% of the children are underweight (51.96% boys, 48.04% girls), and 25.524% of them have normal weight (44.92% boys, 55.08% girls). In risk factor analysis, the results show that body weight problems are associated with different factors like sex, age group (8-10 years old), number and composition of meals, and lack of physical activity. Body weight problems are a severe condition that deserves significant healthcare expenses, and for that, urgent protective measures are required. The promotion of a healthy diet and regular physical activity is a top priority in body weight problem prevention, especially for children.

Predictors of depression among caregivers of children with malnutrition in Gedeo zone public hospitals, Southern Ethiopia: case-control study

BACKGROUND

Depression is a leading cause of disability worldwide, significantly impacting global health, particularly for women. It accounts for 4.3% of the total disability-adjusted life years (DALYs), making it a major contributor to global disability. The high rate of depression in developing nations, the caregiving responsibilities of caregivers, their susceptibility to depression, and maternal mental health in these nations may significantly impact childhood development. Therefore, the study aimed to identify the predictors of depression among caregivers of children with malnutrition in Gedeo Zone public hospitals.

METHODS

A facility-based unmatched case-control study was conducted. A systematic sampling technique was used to select 226 caregivers (113 cases and 113 controls). Depression of caregivers was assessed using a patient health questionnaire (PHQ-9). Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analysis was conducted to identify predictors, and the association was presented with an adjusted odds ratio and a 95% confidence interval.

RESULTS

In this study, not attended formal education [AOR = 2.9(95%CI: 1.0-8.1)], unemployment [AOR = 3.7, (95% CI: 1.4-9.7)], low socioeconomic status [AOR = 3.3 (95% CI: 1.2-9.4)], physical abuse [AOR = 2.3(95% CI = 1.2-3.3)], poor social support [AOR = 2.6(95% CI: 1.0-6.5)], and stunting [AOR = 2.5, 95% CI: 1.3-3.4] were a significant positive predictors of depression.

CONCLUSION AND RECOMMENDATION

Nearly half of the study participants had a significant burden of depression among caregivers of malnourished children; particularly those facing not attended formal education, unemployment, low socioeconomic status, physical abuse, poor social support, and having a stunted child. Therefore, implementing early depression screening and interventions is crucial. Additionally, enhancing caregiver education, reducing unemployment, strengthening social support systems, preventing stunted physical growth, and boosting parents' financial stability with malnourished children are essential strategies for sustainable improvement.

Deficiency of B vitamins in women of childbearing age, pregnant, and lactating women in Brazil: a systematic review

OBJECTIVE

This study aimed to evaluate the prevalence of B-complex vitamin deficiencies in Brazilian women of childbearing age, pregnant women, and lactating women.

METHODS

This systematic review analyzed cross-sectional and cohort studies published up to August 2023 and indexed in MEDLINE, SciELO, LILACS, Scopus, Embase, Web of Science, and the Brazilian Digital Library of Theses and Dissertations. Additional data were obtained by contacting researchers from Brazilian public universities. Studies assessing deficiency rates using biochemical markers were included. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute tool.

RESULTS

Of the 3772 records identified, 13 studies were included. Only folate (n = 13), B12 (n = 11), and B6 (n = 1) deficiencies were investigated, and all studies were cross-sectional. B12 deficiency prevalence varied widely, reaching up to 29.4%. Folate deficiencies were generally low, with only one study reporting a rate as high as 37%. Other B-complex vitamins were insufficiently studied. Most studies had methodological limitations, particularly small sample sizes. The significant heterogeneity across studies limited the feasibility of a pooled quantitative meta-analysis.

CONCLUSION

There is a clear need for more robust studies across all Brazilian regions to improve understanding of vitamin deficiency rates and to support effective nutritional interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020188474.

Psychosocial Predictors of Infant and Young Child Feeding Practices Among Mother-Child Dyads in Malawi and South Africa

Maternal capacity to adhere to recommended infant and young child feeding (IYCF) practices may be influenced by psychosocial factors. However, research examining associations between psychosocial factors and IYCF practices, and in particular complementary feeding indicators, is limited. As part of the Khula birth cohort study, we aimed to investigate associations between maternal depression, exposure to intimate partner violence (IPV), social support and stimulating home environments with IYCF practices among mother-child dyads in Malawi (n = 153) and South Africa (n = 255). When children were 10-16 months of age, mothers completed a series of psychosocial and child diet questionnaires. Regression modelling assessed associations between maternal psychosocial measures and IYCF indicators, adjusting for maternal age, education, marital status and household socioeconomic status. IYCF practices were suboptimal in both settings, with 50%-54% meeting the minimum dietary diversity (MDD), 67%-73% the minimum meal frequency (MMF) and 39%-45% the minimum acceptable diet (MAD) indicators. In South Africa, mothers exposed to IPV in the previous 12 months were less likely to meet the MDD and MAD recommendations (MDD: OR 0.38, 95% CI: 0.19, 0.75; p = 0.006; MAD: OR 0.41, 95% CI: 0.20, 0.85; p = 0.02). There was a significant positive association between stimulation (i.e., more books/toys/play activities) and dietary diversity scores in South Africa. In adjusted analyses, maternal depression and social support were not significantly associated with IYCF indicators in either setting. IYCF programmes may benefit from supporting maternal psychosocial wellbeing and integrating nurturing care to improve children's dietary intakes, growth and development.

Explainable predictive models of short stature and exploration of related environmental growth factors: a case-control study

BACKGROUND

Short stature is a prevalent pediatric endocrine disorder for which early detection and prediction are pivotal for improving treatment outcomes. However, existing diagnostic criteria often lack the necessary sensitivity and specificity because of the complex etiology of the disorder. Hence, this study aims to employ machine learning techniques to develop an interpretable predictive model for normal-variant short stature and to explore how growth environments influence its development.

METHODS

We conducted a case‒control study including 100 patients with normal-variant short stature who were age-matched with 200 normal controls from the Endocrinology Department of Nanjing Children's Hospital from April to September 2021. Parental surveys were conducted to gather information on the children involved. We assessed 33 readily accessible medical characteristics and utilized conditional logistic regression to explore how growth environments influence the onset of normal-variant short stature. Additionally, we evaluated the performance of the nine machine learning algorithms to determine the optimal model. The Shapley additive explanation (SHAP) method was subsequently employed to prioritize factor importance and refine the final model.

RESULTS

In the multivariate logistic regression analysis, children's weight (OR = 0.92, 95% CI: 0.86, 0.99), maternal height (OR = 0.79, 95% CI: 0.72, 0.87), paternal height (OR = 0.83, 95% CI: 0.75, 0.91), sufficient nighttime sleep duration (OR = 0.48, 95% CI: 0.26, 0.89), and outdoor activity time exceeding three hours (OR = 0.02, 95% CI: 0.00, 0.66) were identified as protective factors for normal-variant short stature. This study revealed that parental height, caregiver education, and children's weight significantly influenced the prediction of normal-variant short stature risk, and both the random forest model and gradient boosting machine model exhibited the best discriminatory ability among the 9 machine learning models.

CONCLUSIONS

This study revealed a close correlation between environmental growth factors and the occurrence of normal-variant short stature, particularly anthropometric characteristics. The random forest model and gradient boosting machine model performed exceptionally well, demonstrating their potential for clinical applications. These findings provide theoretical support for clinical identification and preventive measures for short stature.

Strengthening the role of community health assistants in delivering primary health care: the case of maternal health services in Zambia

INTRODUCTION

Many low-and middle-income countries, including Zambia experience a huge deficit of human resource for health, which affects the delivery of primary health care services such as maternal and child health (MCH), nutrition, HIV and gender-based services. The Clinton Health Access Initiative in collaboration with the Zambian Ministry of Health implemented a community health systems (CHS) strengthening project to enhance the capacity of community health assistants (CHA) to provide MCH services from 2019 to 2021. The project activities included capacity building in supervision, provision of financial incentives and logistics. This study explores how these interventions strengthened the role of the CHAs in delivering MCH services.

METHODOLOGY

This was a qualitative study consisting of 189 KIIs and IDIs as well as 20 FGDs conducted in all the 10 provinces of Zambia with the CHAs, and their supervisors, health workers, neighbourhood health committees and community members. Data were analysed using thematic analysis.

RESULTS

The CHS strengthening interventions including provision of training manuals, streamlined recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration contributed to improved delivery and acceptability of MCH services. Further, the leveraging of community networks, linkages and partnerships when delivering these services, including the traditional and religious leaders contributed to improved coverage and acceptability of MCH services. Meanwhile, health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide by the CHA recruitment and selection criteria affected delivery and acceptability of MCH services.

CONCLUSION

This study builds on existing evidence on the importance of building a stronger community-based primary health care to effectively address maternal and child health related issues. We emphasize the need to integrate strategies such as provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA program to enhance the provision and acceptability of health services.

Unraveling the synergistic effects of Astaxanthin and DHA on perinatal undernutrition-induced oxidative stress and cognitive deficit

Perinatal undernutrition sensitizes offspring to the development of chronic adult metabolic diseases, including cognitive dysfunction, which poses significant public health issues. Undernutrition is the most powerful condition of physiological stress, and epidemiological studies indicate detrimental effects on cognitive function and behavior in human offspring exposed to inadequate perinatal nutrition, leading to increased peroxidation of PUFAs in the brain. To address these issues, the present study investigated the protective effects of the antioxidant nutraceuticals astaxanthin (AsX) and docosahexaenoic acid (DHA) on the protective effect of DHA in the presence of antioxidants on the cognitive dysfunction and oxidative stress induced by perinatal undernutrition. Using a Wistar rat model, AsX and DHA improved learning and memory skills in perinatally undernourished offspring. The cognitive parameters included the RAM and NOR tests, and the oxidative stress parameters were assessed by the estimation of GSH, MDA, total nitrite, and TAC. This study revealed spatial learning, memory dysfunction, and abnormal exploratory behavior in offspring exposed to perinatal undernutrition at different time points in postnatal life, and these effects were ameliorated by AsX and DHA. Similarly, oxidative stress induced by perinatal undernutrition was also ameliorated by AsX and DHA. Induced oxidative stress was significantly correlated with cognitive function. This study revealed the potential of AsX and DHA supplementation during the perinatal period for the future development of cognitive dysfunction.

Current impacts of elevated CO2 on crop nutritional quality: a review using wheat as a case study

This review synthesises current research findings and modelling approaches to explore the impact of elevated atmospheric carbon dioxide (eCO2) concentrations on crop productivity, water and nutrient use efficiency, plant nutritional quality, and the implications for global food security. Over recent decades, rising atmospheric CO2 levels have sparked significant concern due to their role in driving climate change. While some studies highlight the potential benefits of eCO2, such as increased crop yields and improved water-use efficiency, many recent investigations reveal a concerning decline in crop nutritional quality. eCO2 has been shown to reduce concentrations of key nutrients, including nitrogen, minerals, vitamins, polyphenols, and other non-nutrient compounds, as well as alter gene expression. These changes are further complicated by interactions with heat stress and drought, presenting significant challenges in predicting sustainable future crop productivity. These nutritional declines exacerbate the global crisis of malnutrition and hidden hunger, threatening the achievement of Sustainable Development Goal 2 (SDG2), which aims to end hunger and ensure food security. Addressing these challenges requires further research, interdisciplinary collaboration, and innovative approaches to mitigate the adverse effects of eCO2 on crop physiology and nutritional content while maximising agricultural sustainability. This review aims to provide insights into the complex mechanisms governing crop responses to eCO2 using wheat as a model and proposes pathways for future research and agricultural practices. These strategies are critical for tackling the intricate dynamics of climate variability, ensuring nutrient-rich food production, and securing food security in the face of a rapidly changing climate.

The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions

BACKGROUND/OBJECTIVES

Neonatal outcomes, including low birth weight, preterm birth, and neonatal mortality, pose significant global health challenges, particularly in low- and middle-income countries. Prenatal care has emerged as a critical intervention in mitigating these risks through medical, nutritional, and psychosocial support. This study aimed to systematically assess the effectiveness of prenatal care interventions in preventing neonatal outcomes across diverse settings.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines, with the protocol registered in PROSPERO (CRD42024601066). Fourteen peer-reviewed studies were included following a comprehensive search across five major databases. Eligible studies reported quantitative neonatal outcomes associated with prenatal care interventions, including nutritional supplementation, mental health services, telehealth, and routine antenatal care. Random-effects models were used for meta-analysis, and the risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale.

RESULTS

Nutritional interventions, especially folic acid and iron supplementation, significantly reduced neonatal mortality by up to 40% (RR = 0.60, 95% CI: 0.54-0.68). High-quality prenatal care was associated with a 41% reduction in neonatal mortality. Psychosocial support reduced the risk of low birth weight and preterm birth, while telehealth interventions lowered NICU admissions in low-risk populations (RR = 0.88, 95% CI: 0.75-1.03). Heterogeneity was substantial (I2 = 70%), and publication bias was suggested.

CONCLUSIONS

Comprehensive prenatal care, integrating medical, nutritional, and mental health interventions, significantly improves neonatal outcomes. The global implementation of accessible, high-quality prenatal services is essential, particularly in underserved populations, to reduce neonatal morbidity and mortality.

Hemoglobin during pregnancy does not mediate the relationship between nutrition supplements and intrauterine growth: A secondary data analysis of Women First Preconception Nutrition Trial

BACKGROUND

Nutrition supplements such as multiple micronutrient-fortified small-quantity lipid-based nutrient supplementation (SQ-LNS) consumed either before or during pregnancy have been shown to improve intrauterine growth but the mechanisms through which the supplements improve intrauterine growth remain unclear.

OBJECTIVE

We examined whether hemoglobin (Hb) during pregnancy could be a potential mechanism through which multiple micronutrient-fortified SQ-LNS improve intrauterine growth.

METHODS

We used data collected from women and newborns in a randomized controlled trial conducted in Pakistan, India, the Democratic Republic of Congo, and Guatemala. Women were randomized to consume multiple micronutrient-fortified SQ-LNS from preconception until birth (Arm 1); consume the SQ-LNS from the second trimester of pregnancy until birth (Arm 2); or no supplement (Arm 3). Intrauterine growth, expressed as birth length, weight, and head circumference Z-scores, was the outcome. The mediator was Hb (g/dL) measured at 12 (n=2,075) and 32 weeks of gestation (n=2,157). Causal mediation analysis was employed to estimate direct and indirect effects.

RESULTS

Hemoglobin levels at 12 or 32 weeks of gestation did not mediate the relation between the SQ-LNS and intrauterine growth. Indirect effects of preconception SQ-LNS (Arm 1) vs. Arm 3, mediated by Hb at 12 weeks of gestation, were 0.02 (95% CI: -0.02, 0.01), 0.01 (95% CI: -0.01, 0.02), and 0.01 (95% CI: -0.01, 0.02) for length, weight, and head circumference Z-scores, respectively. The corresponding direct effects (95% CIs), not mediated by Hb, were 0.18 (0.09, 0.33), 0.12 (0.03, 0.23), and 0.06 (-0.03, 0.20), respectively. Site-specific and gestational age-adjusted data analyses at 12 and 32 weeks of gestation confirmed the findings of no statistically significant mediated effects of Hb during pregnancy.

CONCLUSIONS

The observed main effect of multiple micronutrient-fortified SQ-LNS on intrauterine growth was not mediated by Hb levels at 12 or 32 weeks of gestation. The findings suggest exploring other pathways implicated in the association between the SQ-LNS and intrauterine growth.

TRIAL REGISTRATION

ClinicalTrials.gov #NCT01883193; https://clinicaltrials.gov/ct2/show/NCT01883193?term=01883193&rank=1.

A Large-Scale Nutrition- and Gender-Sensitive Poultry Market-Based Program Did Not Improve Maternal and Child Diets in Rural Burkina Faso: A Cluster-Randomized Controlled Trial

BACKGROUND

Livestock production interventions can improve consumption of animal-source foods and diet diversity, which may lead to improved micronutrient adequacy.

OBJECTIVES

We assessed the effectiveness on maternal and child dietary outcomes of "Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale" (SELEVER), a livestock intervention designed to improve diets in rural Burkina Faso through training and market facilitation to improve poultry production; females' empowerment activities; and nutrition and hygiene behavior change communication.

METHODS

For a nonblinded cluster-randomized controlled trial, we randomly assigned 30 communes to SELEVER and 30 communes to control, of which 15 communes served as control for a narrow sample. Fifteen households were randomly selected in 2 villages per commune; of which 12 were included in the narrow sample. In the wide sample, we used analyses of covariance to assess SELEVER's effectiveness on dietary diversity in index children aged 2-4 y at baseline and in their caregivers, and on minimum acceptable diet in their siblings aged 6-23 mo at measurement. In the narrow sample, we used difference-in-difference to assess SELEVER's effectiveness on vitamin A, iron, and zinc prevalence of adequate intakes (PA) and mean PA of 11 micronutrients in index children and caregivers.

RESULTS

We enrolled 1767 index children, 1766 caregivers, and 412 siblings aged 6-23 mo at endline in the wide sample, and 1054 caregiver-child dyads in the narrow sample. In the wide sample, exposure to program activities was higher but moderate in SELEVER communities, with limited effects on dietary knowledge and practices and no effects on diet outcomes. The narrow sample showed a negative effect on zinc PA in children (-26 percentage points, P = 0.020), and no effect on other outcomes.

CONCLUSIONS

A program focused on improving the productivity of and demand for nutritious foods did not improve micronutrient adequacy. Implementation strategy and bottlenecks may have limited the system transformations needed to produce measurable shifts toward healthier diets.

TRIAL REGISTRATION NUMBER

This study was registered at ISCRCTN with registration number ISRCTN16686478 (https://www.isrctn.com/ISRCTN16686478).

Pesticide exposure induces risks of gestational anemia by maternal gut microbiota: A prospective cohort study

Gut microbiota regulates host hematopoiesis, with notable alterations observed in individuals with gestational anemia (GA). Pregnancy-induced susceptibility to environmental stressors, including widespread pesticide residuals, may disrupt gut microbiota, further contributing to the development of GA. This study sought to investigate population-level associations between pesticide exposure and GA, with a focus on the mediating role of gut microbiota. Pregnant women were prospectively recruited with blood and stool samples collected in the second trimester. Red blood cell (RBC) count and hemoglobin (Hb) were assessed in the second and third trimesters. GA was diagnosed in 22.7 % of participants during the second trimester and 29.8 % during the third trimester. Robust associations were found between serum pesticides, such as atrazine and clomazone, and an increased risk of GA and reduced Hb and RBC count, both at a single time point and longitudinally. Pesticide exposure was linked to altered microbial Shannon index, with 24 significant associations identified between pesticides and individual taxa, nearly half of which involved Roseburia. Furthermore, both Shannon index and the Firmicutes/Bacteroidetes (F/B) ratio were negatively associated with RBC count. A total of 20 taxa showed associations with GA and hematological parameters. Finally, mediation analysis demonstrated that Shannon index and Roseburia mediated the relationships of pesticide exposure with RBC count and GA, respectively. These findings not only highlight the anemia-inducing effects of pesticides, but also inform microbiota-based interventions for managing GA and maternal health.

Prevalence and Correlates of Anthropometric Failure Among Children Aged 0-23 Months in India: Evidence from a Nationally Representative Cross-Sectional Survey (2019-2021)

The present study assesses the burden of anthropometric failure in Indian children aged 0-23 months using the Composite Index of Anthropometric Failure (CIAF). It additionally explores socio-economic, maternal, and child-specific determinants. Analyzing NFHS-5 (2019-2021) data, results show that 48% (95% CI: 47.6%, 48.3%) of children face at least one form of anthropometric failure, with stunting being the most prevalent. Children with low birth weight (AOR: 1.67, 95% CI: 1.60, 1.74), those born to undernourished mothers (AOR: 1.41, 95% CI: 1.36, 1.47), children from lower wealth quintiles (AOR: 1.76, 95% CI: 1.64, 1.88), and those who reportedly lack a minimum acceptable diet (AOR: 1.10, 95% CI: 1.01, 1.22) exhibited a higher prevalence of anthropometric failure. Addressing undernutrition necessitates multifaceted interventions targeting these determinants to improve child nutrition outcomes.

Nutrient Content and Sensory Acceptability of Home-Based Therapeutic Food to Treat Children 6-59 Months With Moderate Acute Malnutrition

Moderate acute malnutrition (MAM) among children under 5 years old has been a daunting problem of public health significance in Ethiopia over the past half century, with its magnitude increasing over time. With dwindling global resources, the preparation of local solutions that can help to curb this problem is critically important. The objective of this study was to develop and analyze eight home-based therapeutic foods to treat MAM in children aged 6-59 months. One-way analysis of variance (ANOVA) was used to analyze differences in means with ± standard deviation of nutrient measurements among the samples. The nutrient contents ranged from 4.56% to 8.79% for moisture, 28.06% to 34.62% for fat, 10.03% to 13.91% for protein, and for energy, 498.31 kcal to 529.81 kcal/100 g of edible portion. The mineral contents ranged from 100.47 mg to 115.51 mg for calcium, 5.01 mg to 6.74 mg for zinc, 8.39 mg to 11.34 mg for iron, 544.15 mg to 661.54 mg for potassium, and 442.54 mg to 451.84 mg for phosphorus contents is adequate. The peanut (P), chickpea (C), maize (M), and orange flesh sweet potato (OFSP) (PCMOFSP4) with the highest portion of peanut seed flour had significantly the highest amounts of protein, fat, calories, iron, zinc, and potassium. These results were within the recommended range of required nutrients for the treatment of children with MAM. Therefore, home-based therapeutic food may be used for the management of children with MAM. Enrich the formulation with micronutrients such as ascorbic acid (vitamin C) and calcium. Policies should prioritize advancing the creation of locally sourced, home-based therapeutic foods to address MAM in children, while also fostering stronger collaboration between agricultural and nutrition sectors to ensure that sustainable, accessible solutions are recommended.

Treatment decision algorithms for tuberculosis screening and diagnosis in children below 5 years hospitalised with severe acute malnutrition: a cost-effectiveness analysis

Background

Children with severe acute malnutrition (SAM) are an important risk group for underdiagnosis and death from tuberculosis. In 2022, the World Health Organization (WHO) recommended use of treatment decision algorithms (TDAs) for tuberculosis diagnosis in children. There is currently no cost-effectiveness evidence for TDA-based approaches compared to routine practice.

Methods

The TB-Speed SAM study developed i) a one-step TDA including Xpert, clinical, radiological and echography features, and ii) a two-step TDA, which also included a screening phase, for children under 5 years hospitalised with SAM at three tertiary hospitals in Uganda and Zambia from 4th November 2019 to 20th June 2022. This study is registered with ClinicalTrials.gov, NCT04240990. We assessed the diagnostic accuracy and cost-effectiveness of deploying TB-Speed and WHO TDA-based approaches compared to the standard of care (SOC). Estimated outcomes included children started on tuberculosis treatment, false positive rates, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs).

Findings

Per 100 children hospitalised with SAM, averaging 19 children with tuberculosis, the one-step TDA initiated 17 true positive children (95% uncertainty intervals [UI]: 12-23) on tuberculosis treatment, the two-step TDA 15 (95%UI: 10-22), the WHO TDA 14 (95%UI: 9-19), and SOC 4 (95%UI: 2-9). The WHO TDA generated the most false positives (35, 95%UI: 24-46), followed by the one-step TDA (18, 95%UI: 6-29), the two-step TDA (14, 95%UI: 1-25), and SOC (11, 95%UI: 3-17). All TDA-based approaches had ICERs below plausible country cost-effectiveness thresholds compared to SOC (one-step: $44-51/DALY averted, two-step: $34-39/DALY averted, WHO: $40-46/DALY averted).

Interpretation

Our findings show that these TDA-based approaches are highly cost-effective for the vulnerable group of children hospitalised with SAM, compared to current practice.

Funding

Unitaid Grant number: 2017-15-UBx-TB-SPEED.

Unveiling subgroup trends of stunting and wasting in Indian children: a serial cross-sectional analysis from National Family Health Surveys 3-5

BACKGROUND

India grapples with a dual burden of child wasting and stunting and stark socio-economic and regional disparities.

OBJECTIVES

We aimed to better understand trends in the prevalence of childhood stunting and wasting, with an emphasis on its disproportionate effects on marginalized populations, by analyzing National Family Health Surveys (NFHS) data from 2005 to 2020.

METHODS

We analyzed trends in the distribution of childhood height-for-age Z (HAZ) and weight-for-height Z (WHZ) scores using anthropometric data from 3 surveys, NFHS 3, 4, and 5. We examined disparities by wealth, caste, tribe, area of residence (rural compared with urban), and sex and mapped trends against India's evolving policy landscape. We also conducted a regression analysis of HAZ and WHZ risk factors.

RESULTS

In the context of an evolving nutrition-centered policy landscape, disparities by level of wealth in both HAZ and WHZ decreased in the study period (HAZ: estimate = 0.27, confidence interval [CI]: 0.16, 0.38; and WHZ: estimate = 0.11, CI: 0.01, 0.22), though there were no improvements in disparities for marginalized castes (HAZ: estimate = 0.07, CI: 0.00, 0.13; and WHZ: estimate = 0.02, CI: -0.04, 0.08). Though they have narrowed, disparities by wealth, caste, tribe, and area of residence persist, with undernutrition at birth, as measured by HAZ and WHZ, a particularly acute problem.

CONCLUSIONS

Although there have been significant reductions in disparities by wealth in mean HAZ and WHZ scores in India, persistent disparities by caste, tribe, and area of residence necessitate reinvestments in targeted interventions. Further, despite this narrowing of disparities and overall progress against stunting, anthropometric scores in early childhood continue to be low in India, especially with regard to wasting, indicating the importance of not only maternal nutrition and care for newborns but more comprehensive efforts to address poverty and other factors that contribute to undernutrition, with a focus on vulnerable populations.

Infant-level and child-level predictors of mortality in low-resource settings: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort

BACKGROUND

Despite impressive reductions in overall global child mortality, the rate of decline has slowed during the past decade. Current guidelines for the care of paediatric patients in low-resource settings mostly focus on broad clinical syndromes or undernutrition rather than children's individual contextualised risk. We aimed to identify readily assessable child-level characteristics that can predict mortality risk in a range of community and health-care settings in high-burden settings.

METHODS

The WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort (WHO-CMRS) included pooled data from individual children enrolled in observational or randomised controlled trials in low-income and middle-income countries. The criteria for inclusion of a dataset were documentation of age, weight, vital status, and date of death, and at least two observations per participant younger than 60 months. To calculate odds ratios, we built generalised linear mixed effects regression (glmer) models with each child and each study as random intercepts and time interval as the offset. In all analyses, the outcome was defined as death within the respective observation period of the child. From the glmer models, we predicted absolute risk of death per child-month associated with risk exposures separately and combined with anthropometry according to the following age groups: 0-5 months, 6-11 months, 12-23 months, and 24-59 months. Studies were grouped according to population types studied: the general population, populations selected based on anthropometric criteria, and populations selected based on the presence of illness.

FINDINGS

We analysed pooled data from WHO-CMRS, including 75 287 children from 33 studies done in 17 countries between Jan 1, 2001, and Dec 31, 2021. During a total of 69 085 child-years of follow-up, 2805 (3·7%) children died. Age younger than 24 months, low anthropometry, preterm birth, low birthweight, and absence of breastfeeding (either was breastfeeding not offered or an underlying illness interfered with breastfeeding practices) were each associated with increased mortality: risks declined with increasing age. The highest absolute mortality risk was among the youngest children (age 0-5 months), with a weight-for-age Z score of less than -3 (ie, a predicted absolute risk of 11·0 [95% CI 6·2-19·5] per 1000 child-months in general population studies). Risks were additive: underlying risk exposures such as low birthweight and preterm birth added to the mortality risks in children with anthropometric deficit. For example, children aged 0-5 months with a weight-for-age Z score of less than -3 and a history of preterm birth had a predicted absolute mortality risk of 40·1 (95% CI 22·0-72·1). However, overall mortality and the association between child-level characteristics and mortality differed according to the type of study population and child age.

INTERPRETATION

Risk assessments combining individual child-level characteristics including anthropometry can enable programmes to identify children at high and lower risk of mortality and, thereafter, differentiate care accordingly. Such a strategy could reduce mortality and optimise health system efficiency and effectiveness.

FUNDING

US Agency for International Development.

TRANSLATIONS

For the Spanish and French translations of the abstract see Supplementary Materials section.

Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs

Importance

Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages.

Objective

To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups.

Design, Setting, and Participants

This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births.

Exposure

Age in days, weeks, months, or years.

Main Outcomes and Measures

The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval.

Results

In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates.

Conclusions and Relevance

The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.

The Association Between an Individual's Local Food Environment and Diet Quality among Postpartum Women Living in Rural Bangladesh

Background

The food environment is a driver of the double burden of malnutrition, influencing dietary intake by increasing or restricting access to foods.

Objectives

The objective of this study was to assess the association between geospatial food environment indicators and the diet quality among postpartum women in rural Bangladesh.

Methods

Participants were women of infants enrolled in a cluster-randomized controlled trial from 2018 to 2020. Food vendor availability was defined as the number of food vendors within a specific household radius, and proximity was defined as the distance to the nearest vendor. Dietary intake was measured using a 7-d food frequency questionnaire collected at 3 mo, 6 mo, and 12 mo postpartum. Our primary outcome was nonstarchy staple food variety scores (FVS). Secondary outcomes included dietary diversity scores and individual food group consumption. To assess the association between food environment indicators and diet quality indicators, we fit linear regression models for the FVS outcome, Poisson regression models for the dietary diversity outcome, and logistic regression models for individual food group outcomes.

Results

A total of 5064 women were included in this analysis. Women reported consuming an average of 9.7 (standard deviation: 3.7) nonstarchy staple foods in the previous week. Women who lived in households with the highest market availability (≥7 markets within 1600 m) had an average of 0.84-unit (95% confidence interval: 0.53, 1.16) higher FVS compared with those in households with the lowest market availability (≤ 2 markets) (P < 0.001). Geospatial food environment indicators were not significantly associated with the odds of consuming less healthy food options.

Conclusions

We found a positive relationship between market availability and diet quality for postpartum women in rural Bangladesh. However, more research is needed to understand which components of the food environment are associated with increased consumption of less healthy foods.

Prevention and Management of Growth Failure During the First 6 Months of Life: Recommendations by the Joint Committee of the Pediatric and Adolescent Nutrition Society and the IAP Infant and Young Child Feeding Chapter

OBJECTIVE

To develop evidence-based guidelines for the prevention, identification, and management of growth failure in infants under 6 months (U6M), ensuring early detection and intervention to improve health outcomes.

JUSTIFICATION

Growth failure in the first 6 months of life significantly increases the risk of acute malnutrition and stunting in later childhood. Unlike older children, management in this age group prioritizes establishing exclusive breastfeeding and addressing feeding challenges. There are no standardized guidelines for identifying and managing growth failure in this vulnerable population.

PROCESS

A national consultative committee of experts was convened to formulate these guidelines. The committee conducted extensive discussions, dividing key areas among six working groups. The process included four virtual and one in-person meeting between August and October 2024. A draft guideline was developed, reviewed, and approved by all committee members.

RECOMMENDATIONS

Early growth failure is a significant public health concern. Timely identification of at-risk infants through mother-infant dyad assessments during routine health visits is essential. Weight-for-age is the most reliable anthropometric indicator for recognizing at-risk infants U6M. The term "infant at risk of poor growth and development" is recommended to identify at-risk infants needing intensified support. Community-based interventions should support at-risk infants without medical complications, while those with complications need facility-based care with skilled lactation support. Severely wasted infants require close monitoring for hypothermia, hypoglycemia, and sepsis. Establishing exclusive breastfeeding should be prioritized in all cases, and when not feasible, F-100D (Catch-up D) should be used to ensure safe nutritional rehabilitation while minimizing renal solute load.

Plant-based diets and child growth

PURPOSE OF REVIEW

The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems recommended a diet that is higher in plant-based food in 2019. Whilst plant-based diets have been followed in many regions of the world, the planetary concern and the published health benefits has increased the uptake of such diets. This review sets out to explore the impact on growth in children following a plant-based diet.

RECENT FINDINGS

Twelve observational studies were published between 2017 and 2024, assessing the impact of vegan and vegetarian diets compared to omnivorous diets in children. Ten studies found no significant difference in growth parameters between children on the plant-based diet vs. the omnivorous diet, however there is a trend of lower growth parameters including undernutrition, but also lower rates of overweight in children on a plant-based diet. One study found that that children were shorter on a vegan diet and another found that infants born to mothers following a vegan diet had significantly lower weight. None of the studies assessed children that received professional dietary advice.

SUMMARY

Overall, growth is comparable in children following a plant-based diet, but a higher risk for undernutrition has been highlighted. Children can follow a plant-based diet and establish good growth with the help of a qualified healthcare professional understanding macro and micronutrient provision on such a diet.

Determinants of height-for-age Z-score (HAZ) among Ethiopian children aged 0-59 months: a multilevel mixed-effects analysis

BACKGROUND

Height-for-age z-score (HAZ), based on WHO Child Growth Standards, measures linear growth in children, with lower values indicating potential undernutrition. This study examines HAZ as a continuous measure to explore its proximal and distal determinants.

METHODS

Data from 5,045 children aged 0-59 months from the 2019 Ethiopian Mini Demographic and Health Survey were used. The survey employed a stratified two-stage cluster design. A multilevel mixed-effects linear regression model was applied to estimate the associations between HAZ and various proximal (individual and household-level) and distal (community-level) factors. Proximal factors included child age, sex, early breastfeeding, maternal age, education, age at first birth, maternal literacy, delivery place, number of children under-five, household size, wealth index, media access, household head sex, cooking fuel, toilet type, and water source. Distal factors included urban/rural residence, altitude, and capital city residence. Effect sizes were reported as unstandardized beta coefficients (β) with 95% confidence intervals (CI).

RESULTS

The mean HAZ was - 1.26 (SD = 1.47). The mean age of the children was 28.9 months, and 36.23% of mothers were literate. Child age was inversely associated with HAZ, with each additional month linked to a 0.02 unit reduction (β = -0.02; 95% CI: -0.024, -0.016; p < 0.001). Maternal age and education were positively associated with HAZ, with each additional year of maternal age linked to a 0.015 unit increase (β = 0.015; 95% CI: 0.003, 0.026; p = 0.012) and each additional year of education associated with a 0.036 unit increase (β = 0.036; 95% CI: 0.009, 0.062; p = 0.008). Higher altitude was associated with a 0.21 unit reduction in HAZ per 1000 m increase (β = -0.21; 95% CI: -0.34, -0.07; p = 0.003). Residence in the capital city was associated with a 0.388 unit increase in HAZ (β = 0.388; 95% CI: 0.093, 0.683; p = 0.01).

CONCLUSION

Key determinants of HAZ include child age, maternal age, education, altitude, and capital city residence. These findings highlight the need for multifaceted interventions to improve child linear growth. Enhancing maternal education is a crucial strategy to improve child HAZ scores in Ethiopia.

Maternal socioeconomic status and early childhood growth and nutrition in the PERSIAN Birth Cohort with insights into the double burden of malnutrition

In low- and middle-income countries, undernutrition often coexists with rising obesity, creating a double burden of malnutrition (DBM). Our study employs a mathematical approach to examine how maternal socioeconomic status (SES) impacts child growth in Iranian children from infancy to age two, offering new insights into strategies for tackling both undernutrition and obesity. We used data from the PERSIAN Birth Cohort. SES was divided into quintiles using multiple correspondence analysis (MCA), and child growth was assessed with eight indicators. Missing data were handled via multiple imputation (MI). SES impacts on growth were analyzed using Generalized Estimating Equations (GEE), and BMI-Z was predicted from WAZ and HAZ through linear regression by SES and age. We explored obesity risk by comparing HAZ-to-WAZ ratios from GEE models with WAZ-to-HAZ beta ratios from regressions. Sensitivity analyses compared MI with complete-case analyses (CCA). 7169 neonates were assessed at 2, 4, 6, 12, and 24 months. SES increasingly improved WAZ with age, preventing underweight in higher SES groups. SES consistently improved HAZ, significantly enhancing stunting prevention in higher SES groups. The impact on BMI-Z increased with age, peaking in Very High SES, which shows a significant rise in obesity risk by 24 months. Comparing ratios from GEE and regression models, we found that GEE ratios were lower where BMI-Z increased. Sensitivity analysis confirmed MI and CCA consistency. Addressing DBM requires understanding how imbalanced increases in HAZ and WAZ heighten obesity risk. Future research should focus on targeted interventions to manage DBM effectively.

Undernutrition and Intestinal Infections in Children: A Narrative Review

Undernutrition affects thousands of children under five years old worldwide, and various factors are related to its onset, among which we highlight enteric infections and gastrointestinal barrier dysfunction. The cycle of intestinal infections and undernutrition has long-term consequences, such as cognitive deficits, poor growth, and metabolic diseases in adulthood. This review explores factors linked to childhood undernutrition, focusing on intestinal infections and markers of intestinal permeability that affect child development. This narrative review was conducted using Medline/PubMed, Web of Science, and Scopus, from July 2024 to March 2025. Studies involving children under five years old and addressing undernutrition, intestinal infections, or intestinal permeability markers were included. Exclusion criteria comprised studies without therapeutic focus, and books, case reports, or academic theses. No language restrictions were applied, and registration on global platforms was not required. Overall, the studies reported a close relationship between enteric pathogens, diarrheal and non-diarrheal stools, and undernutrition. Among the pathogens most frequently found in the feces of malnourished children were Shigella, enterotoxigenic Escherichia coli, enteroaggregative E. coli (EAEC), and Cryptosporidium. The studies also showed the relationship between gastrointestinal barrier function and undernutrition, with the deterioration of nutrient absorption and, consequently, repercussions on development, linear growth, and weight in children. Although the studies analyzed had different designs and heterogeneity in the age range of the studied children, it was possible to observe the relationship between the infection/undernutrition cycle. Future studies should optimize personalized nutrient-based therapies, assess long-term effects on gut health and growth, and explore the gut microbiome's role in enteric infection susceptibility and undernutrition.

Long-term trends in the global burden of maternal abortion and miscarriage from 1990 to 2021: joinpoint regression and age-period-cohort analysis

BACKGROUND

Maternal abortion and miscarriage are significant contributors to the global burden of maternal health conditions. Iron deficiency remains a critical risk factor, significantly impacting reproductive health outcomes, particularly in low socio-demographic index (SDI) regions. This study aims to assess long-term trends in the incidence, mortality, and disability-adjusted life years (DALYs) of maternal abortion and miscarriage from 1990 to 2021 using the Global Burden of Disease (GBD) 2021. Additionally, we evaluate the role of iron deficiency as a risk factor and project future burden estimates up to 2051.

METHODS

Utilizing the GBD 2021 dataset across 204 countries and territories, the study retrospectively analyzed long-term trends in maternal abortion and miscarriage from 1990 to 2021. Joinpoint regression was applied to identify temporal trends in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). An age-period-cohort (APC) model was used to assess the independent effects of age, period, and cohort, while future projections were generated using Bayesian age-period-cohort (BAPC) modeling.

RESULTS

In 2021, the global ASIR of maternal abortion and miscarriage was 1001.64 per 100,000 population (95% UI: 775.97-1261.67), with the highest burden in low SDI regions (ASIR = 1715.1 per 100,000 population). The ASMR, reflecting maternal mortality due to abortion and miscarriage, was 0.42 per 100,000 population (95% UI: 0.36-0.52). The ASDR, capturing the total burden including both premature mortality and disability, was 25.73 per 100,000 population (95% UI: 21.82-31.02). The global ASIR declined at an annual percentage change (APC) of -2.32% from 1990 to 1994 and by -2.00% from 2015 to 2019.

CONCLUSION

The global burden of maternal abortion and miscarriage has decreased, with iron deficiency remaining a critical risk factor in low SDI regions, particularly among women aged 20-34. Projections suggest declines in ASIR over the next 30 years.

Zinc agronomic biofortification in wheat and its drivers: a global meta-analysis

Zinc (Zn) deficiency affects 17% of the world's population, particularly those consuming large cereal grains with low Zn concentration and poor bioavailability. Here, we synthesize data from four field trials along with 139 studies from the literature, to evaluate the impact of management practices and soil properties on improving grain Zn concentration in wheat through applying Zn fertilizers. Soil application of Zn fertilizer improves grain Zn concentration by only 29.1%, below the biofortification target of 40 mg kg-1 required for human nutrition. Foliar Zn application and soil+foliar applications increase grain Zn concentration by 55.2% and 62.3%, respectively, surpassing the 40 mg kg-1 threshold. Factors such as the rate of Zn application, initial grain Zn concentration (prior to Zn application), and timing of Zn spraying are identified as principal factors influencing the response of grain Zn concentration to Zn fertilization. In search of desirable grain Zn concentration in wheat while minimizing potential environmental risks, our study proposes a method for assessing rates of Zn fertilizer application based on the Zn biofortification target, the Zn agronomic biofortification index, and the contribution of principal factors influencing the improvement in grain Zn concentration.

Community-Based Child Food Interventions/Supplements for the Prevention of Wasting in Children Up to 5 Years at Risk of Wasting and Nutritional Oedema: A Systematic Review and Meta-Analysis

CONTEXT

Malnutrition poses a significant threat to child health, with millions of children worldwide affected by wasting, which increases the risk of morbidity and mortality.

OBJECTIVE

In this study we sought to evaluate the effectiveness of community-based infant/child food interventions and supplements for preventing wasting among children up to 5 years at risk of wasting and nutritional oedema. The World Health Organization commissioned this review to update their guidelines on wasting due to malnutrition in children.

DATA SOURCES

Nine databases were searched from inception until July 2021 and an updated search was carried out on MEDLINE and Ovid MEDLINE until April 13, 2023, and included 24 studies (98 articles) evaluating the impact of community-based infant/child food interventions/supplements for the prevention of wasting among children up to 5 years.

DATA EXTRACTION

Two review authors independently extracted data and assessed the quality of included studies using the Cochrane Risk of Bias Tool 2.0. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to assess the quality of evidence.

DATA ANALYSIS

This review included 19 cluster-randomized controlled trials (cRCTs) and 5 RCTs evaluating the impact of community-based infant/child food interventions/supplements including fortified blended foods (FBFs), small-quantity (SQ), medium-quantity (MQ), or large-quantity (LQ) lipid-based nutrient supplements (LNS), and multiple micronutrient powder (MNP) for the prevention of wasting among children up to 5 years of age. The analysis showed that infants/children given supplementation with LNS (either SQ, MQ, or LQ) had significantly reduced wasting and significant improvements in weight-for-age z-score, mid-upper-arm circumference (MUAC), and underweight prevalence, along with significant reductions in mortality. The MNP supplementation had little or no impact on wasting but was associated with increased incidences of rapid breathing/chest indrawing and diarrhea morbidity. Overall, the studies were judged to have raised some concerns for the outcomes of wasting and adverse anthropometric indices. However, the GRADE analysis suggested low-to-moderate certainty of outcomes.

CONCLUSIONS

The findings of this review highlight the effectiveness of SQ-LNS and MQ/LQ-LNS supplementation in decreasing rates of wasting, underweight, and mortality and increasing MUAC and weight-for-age z-scores. Methodological limitations in most studies emphasize the need for future trials with direct comparisons of various dietary supplementation strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021277429.

Family planning and nutrition: systematic review of the effects of family planning on nutritional status of adolescent girls and women of reproductive age

INTRODUCTION

Contraceptive use may affect women's nutritional status through birth spacing, parity, age at first birth, menstruation changes, and increased income. To inform the integration of family planning with nutrition interventions, we synthesised evidence linking the use of family planning to nutritional outcomes in women of reproductive age (15-49 years) and adolescents (10-19 years) in low- and middle-income countries (LMICs).

METHODS

We searched PubMed, Embase, Web of Science and Cochrane Library for randomised controlled trials (RCTs), cluster RCTs, non-randomised trials and cohort studies published from 2000 onwards. Family planning exposure included any contraception type with no restrictions by comparison arms. Outcomes were maternal anthropometry and iron-status indicators. Random effects meta-analyses were done for comparisons with a minimum of three studies sharing intervention arms, outcomes and study design. Risk of bias and certainty of evidence were assessed.

RESULTS

Of 20 097 publications, 99 were eligible for inclusion, covering 29 outcomes and 23 interventions (eg, oral contraception, intrauterine devices (IUD)). In 28 instances, at least three studies matched on intervention arms, outcomes and study design. Meta-analysis of RCTs showed that users of hormonal IUDs had significantly higher haemoglobin than oral contraceptive users (four studies; mean difference=1.25 g/dL; 95% CI: 0.38, 2.12; certainty=very low). Users of any hormonal contraceptive had a small reduction in body mass index (BMI) compared with non-contraceptive controls (seven studies; mean difference=-0.28 kg/m2; 95% CI: -0.52 to -0.04; certainty=low); however, most samples were women with polycystic ovarian syndrome. Other relationships were very uncertain and not statistically significant.

CONCLUSION

Evidence is weak suggesting that hormonal IUDs increase haemoglobin compared with oral contraceptives and that any hormonal contraceptive use reduces BMI. Hormonal IUDs likely limit blood loss from menstruation, allowing for higher haemoglobin than oral contraceptives. Mechanisms for lower BMI after hormonal contraceptive use remain unclear. More robust evidence is necessary to guide policy.

PROSPERO REGISTRATION NUMBER

This review was registered prospectively with the International Prospective Register of Systematic Review (PROSPERO ID: CD42023400069).

Geospatial Distribution and Determinants of Undernutrition Among Children Under Five in Oromia Regional State, Ethiopia

Background: Malnutrition is the leading cause of morbidity and mortality among children under five, with significant regional disparities, particularly in Ethiopia, being very high. This study aims to use Geographic Information Systems (GIS) to identify hotspot areas and associated factors for stunting and wasting among children under five in Oromia Regional State, Ethiopia. Methods: A community-based cross-sectional study was conducted. Data were obtained from the 2019 Ethiopian Demographic and Health Survey (EDHS). A total of 653 children under five years old were included in this study. The data were collected using a multistage sampling technique to select the study participants. ArcGis Version 10.7 was used for geospatial analysis. A Bayesian logistic regression model was used to determine the associated factors for undernutrition. A p value < 0.05 was considered statistically significant. Results: Overall, the prevalence of stunting and wasting was 36.29% and 4.9%, respectively. In hotspot analysis, both Guji Zone and East Hararge were at high risk of stunting among children under 5 years. Eastern Guji (Gora Dola) and Eastern Hararge (Goro Muti and Meta) areas were at high risk for wasting children under 5 years old. In the adjusted model, being rural residents, mothers who had attended a secondary/above school, children aged 24-35 and 36-47 months, a preceding birth interval > 48 months, using a protected water source, and wealth index were significantly associated with stunting among children under five years. Similarly, mothers aged 25-35 years, rural residents, married women, preceding birth intervals > 48 months, and having more than three children were significantly associated with wasting among children under 5 years. Conclusion: The prevalence of stunting and wasting among children under 5 years remains high in the study setting. These findings suggest that a multifaceted approach addressing education, water access, socioeconomic conditions, and targeted health interventions for high-risk populations is essential to reducing stunting and wasting among children under 5 years old in Oromia Regional State.

Impact of a Community-based Intervention Program on Nutritional Status of Children Aged Under 5 Years With Undernutrition in Western Rural Nepal

OBJECTIVE

To identify the impact of community-based nutritional intervention among children with undernutrition in Nepal.

DESIGN

Quasi-experimental time series.

SETTING

Three villages in the rural Terai region with a majority marginalized ethnic population.

PARTICIPANTS

Seventy-five children with undernutrition between 6 and 59 months.

INTERVENTIONS

Community-based package included super flour, milk, growth monitoring, nutrition education, and counseling conducted from September, 2016 to March, 2017.

MAIN OUTCOME

Change in nutritional status.

ANALYSIS

We compared differences in pretest and posttest measurements using paired t test and repeated-measures analysis of various identified changes in z-scores. We applied random-effects panel data regression to evaluate the effect of intervention and exposure time.

RESULTS

The mean z-scores of weight-for-age (underweight) and weight-for-height (wasting) continued to increase until 6 months of intervention, except for the height-for-age (stunting). On average, every month of the nutritional intervention led to an improvement in weight-for-age z-scores by 0.49 units (coefficient, 0.49 [95% coefficient intervals (CI), 0.47-0.50]), weight-for-height z-scores by 0.41 units (coefficient, 0.41 [95% CI, 0.38-0.44]) and height-for-age z-scores by 0.31 units (coefficient, 0.31 [95% CI, 0.29-0.33]) after adjusting the sociodemographic and health-related variables.

CONCLUSIONS AND IMPLICATIONS

Community-based nutrition interventions that use local resources effectively reduce undernutrition. Similar interventions can be promoted in low-resource settings.

Exploring methods for assessing stakeholder perspectives in Scaling-Up Nutrition (SUN) countries: a scoping review

OBJECTIVES

The scaling-up nutrition (SUN) initiative, which was launched in 2010 to eradicate malnutrition in all its forms by 2030, collaborates with a diverse range of stakeholders, such as governments, non-governmental organisations (NGOs), donors, businesses and academia. Given the widespread adoption of this multisectoral approach, it is crucial to explore methods for evaluating the perspectives of multiple stakeholders in child undernutrition topics.

DESIGN

This scoping review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

DATA SOURCES

Six peer-reviewed databases, including PubMed, Web of Science, Cochrane, Embase, CINAHL and PROQUEST ASSIA, were systematically searched.

ELIGIBILITY CRITERIA

Original English studies published between 1 January 2010 and 1 June 2023, focusing on undernutrition in SUN countries.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Rayyan.

RESULTS

Out of the 4533 articles, 19 met the inclusion criteria for the review, and 5 more were added through manual searches. These studies were conducted in 14 SUN countries, with 62% using mixed methods and the remaining using qualitative methods. Six methods were used to gather stakeholder perspectives, including in-depth interviews, focus group discussions, Net-Map, organisational network analysis and Q methodology. Most studies focused on government, development partners and NGOs, while only two studies involved the business network.

CONCLUSIONS

Our study indicates that study on stakeholder perspectives in SUN countries focuses mainly on those showing progress in malnutrition/undernutrition reduction. Future research should explore countries with less progress to improve partnership frameworks. The SUN movement should establish a standard method for evaluating stakeholder perspectives, considering both outcomes and processes.

TRIAL REGISTRATION NUMBER

The final protocol was registered prospectively with the Open Science Framework in July 2023 (https://osf.io/te7cb).

The global burden of high BMI among adolescents between 1990 and 2021

BACKGROUND

Adolescent high body mass index (BMI) is a growing global health problem. This study analyzes global, regional, and national prevalence and trends of high BMI among adolescents (aged 10-19 years) from 1990 to 2021, investigates disparities by sex, country, and socio-demographic index (SDI), and projects prevalence to 2030.

METHODS

This study analyzed Global Burden of Disease (GBD) study 2021 data. Prevalence and trends of high BMI among adolescents were stratified by sex, SDI, and region. Estimated annual percentage change (EAPC), joinpoint regression, and Bayesian age-period-cohort (BAPC) analysis were used to quantify trends and project prevalence to 2030.

RESULTS

Global adolescent high BMI prevalence has increased from 8.36% (1990) to 17.64% (2021), with females having a slightly higher prevalence than males. Marked disparities are observed across SDI levels; high SDI countries have the highest prevalence, but middle SDI countries are experiencing the fastest increases. Substantial geographic variations are also evident, with particularly rapid increases in some regions, such as the Pacific Island nations, and slower growth or declines in others, such as parts of East Asia. The BAPC model projects a continued rise in global high BMI prevalence up to 2030, with considerable variation across individual countries.

CONCLUSIONS

The global rise of high BMI among adolescents, coupled with projections of continued increases, presents a pressing public health concern. The observed disparities across SDI levels and geographic regions necessitate tailored interventions to address this growing epidemic effectively.

Impact of early-life food deprivation on health-related quality of life among older people in China: evidence from CHARLS

OBJECTIVES

This study aims to explore the impact of early-life food deprivation on health-related quality of life (HRQoL) among older people, providing a scientific basis for developing public health strategies to improve the quality of life for older people.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants aged ≥60 years. The study included 7,192 eligible participants, categorized based on their self-reported early-life food deprivation experiences. HRQoL was measured using a newly developed scale based on variables from the Short Form-36 (SF-36) scale and CHARLS questionnaires. Inverse probability of treatment weighting (IPTW) was used to control for baseline differences. Weighted linear regression models were employed to analyze the impact of early-life food deprivation levels on HRQoL.

RESULTS

Findings indicate that older people who experienced early-life food deprivation exhibit a lower HRQoL (β = -1.83; 95% CI: -2.59, -1.07). This effect is particularly pronounced in older people with extreme early-life food deprivation (β = -3.50; 95% CI: -4.53, -2.47). Specifically, they exhibited lower scores in physical functioning, bodily pain, general health, role emotional, vitality, and mental health.

CONCLUSIONS

Early-life food deprivation has a lasting negative effect on the HRQoL among older people. The results highlight the importance of early identification and improvement in cases of early-life food deprivation, alongside the implementation of targeted interventions. These measures can help improve the HRQoL of older adults affected by early-life food deprivation.

Associations between national plant-based vs animal-based protein supplies and age-specific mortality in human populations

Transitions to sustainable food systems require shifts in food production and availability, particularly the replacement of animal-based protein with plant-based protein. To explore how this transition may relate to demographic patterns, we undertake an ecological analysis of global associations between age-specific mortality, total national macronutrient distributions, and protein substitution. Our dataset includes per capita daily food supply and demographic data for 101 countries from 1961-2018. After adjusting for time, population size, and economic factors, we find associations between low total protein supplies and higher mortality rates across all age groups. Early-life survivorship improves with higher animal-based protein and fat supplies, while later-life survival improves with increased plant-based protein and lower fat supplies. Here, we show that the optimal balance of protein and fat in national food supplies, which correlates with minimal mortality, varies with age, suggesting that reductions in dietary protein, especially from animal sources, may need to be managed with age-specific redistributions to balance health and environmental benefits.

Determinants of child malnutrition and morbidity in Ethiopia: a structural equation modeling approach

Background

Childhood malnutrition and morbidity remain significant public health challenges in Ethiopia, highlighting the need to assess the risk factors contributing to these issues for effective prevention and control strategies. Thus, this study aims to investigate the underlying risk factors by employing a structural equation model to analyze malnutrition as a mediator in the relationship between selected factors and morbidity.

Methods

The study utilized data from the 2016 Ethiopia Demographic and Health Survey and a sample of 8,560 under-five children were considered. The structural equation model was used to examine the association between child malnutrition, morbidity, and potential risk factors. The structural equation model makes it possible to analyze malnutrition as a mediator of the association between selected risk factors and morbidity.

Results

Out of the 8,560 sampled children, 12.80% were wasted, 34.75% were stunted, 23.91% were underweight, 13.9% had fever, 11.2% had diarrhea, and 59.7% had anemia. Birth interval, wealth index household, place of delivery, size of child at birth, number of children, and socioeconomic condition had a significant direct effect on childhood malnutrition and morbidity. The time to get water, toilet facility, and child is a twin variables had direct effects on childhood malnutrition and had no significant direct effects on childhood morbidity. Time to get water, birth interval, toilet facility, wealth index of household, child is a twin, place of delivery, size of child, and number of children exhibited an indirect effect on morbidity through malnutrition.

Conclusions

The study revealed that there was a high prevalence of malnutrition and morbidity among under-five children in Ethiopia. Time to get water in min, place of delivery, size of child, and number of children showed a significant indirect and total effect on morbidity through malnutrition and socioeconomic conditions showed a significant total effect on morbidity via malnutrition. Implementing and extending programs such as community-based nutrition interventions for early childhood is critical, as early malnutrition showed long-term effects on growth and immunity, particularly in the regions of Affar, Dire Dawa, Gambela, Harari, Amhara, and Somali.

Association of Escherichia coli pathotypes with fecal markers of enteropathy and nutritional status among underweight adults in Bangladesh

Introduction

Environmental enteric dysfunction (EED), a subclinical intestinal disorder, is characterized by chronic fecal-oral exposure to entero-pathogens and could be diagnosed by measuring non-invasive biomarkers. Escherichia coli is the one of the key bacterial enteric pathogens that drives EED, but there is a lack of information on the E. coli pathotypes in relation to the biomarkers of EED in malnourished adults. Here, we intended to measure the possible association of these pathotypes with EED biomarkers and nutritional status of adults residing in a slum in Bangladesh.

Method

Fecal samples were collected from 524 malnourished adults (BMI ≤18.5 kg/m2) living in a slum-setting in Dhaka from March 2016 to September 2019 and analyzed by TaqMan Array Card assays to evaluate the presence of E. coli pathotypes and other entero-pathogens. The multivariable linear regression model was used to assess the association.

Results

In these malnourished adults, the most prevalent pathotype of E. coli was EAEC (61.7%) and the least prevalent was STEC (6.7%). The prevalence of atypical EPEC, ETEC and Shigella/EIEC were 52%, 48.9% and 45.1% respectively. The infection with atypical EPEC had significant positive association with levels of Myeloperoxidase (b = 0.38; 95% CI = 0.11, 0.65; p-value = 0.006). Similarly, a significantly higher concentration of alpha-1-antitrypsin (b = 0.13; 95% CI = 0.03, 0.22; p-value = 0.011) was found in the STEC-infected adults. However, no notable association was found between the E. coli pathotypes and nutritional status of these adult participants. Moreover, Plesiomonas infected adults were more likely to be infected with EAEC (p-value = 0.017), ETEC (p-value <0.001) and STEC (pvalue = 0.002). Significant coinfection was also detected among the pathotypes and other entero-pathogens such as Giardia, Ascaris, Campylobacter, Salmonella, Enterocytozoon bieneusi, and Adenovirus.

Discussion

The study results imply that there is an influence of particular E. coli pathotypes (EPEC and STEC) on intestinal inflammation and gut permeability of the malnourished Bangladeshi adults, but no association with nutritional status is found. Potential pathogenicity of the E. coli pathotypes is also observed when co-infection with other pathogens exists in these adults.

Perceptions of Underlying Factors and Consequences of Childhood Malnutrition and Care-Seeking Behaviour for Children Under 5 Years With Acute Malnutrition: A Qualitative Study in Rural Bangladesh

Acute Malnutrition affects 45 million children under five globally, with Bangladesh contributing more than 1.7 million cases. While community-based management of acute malnutrition (CMAM) guidelines in Bangladesh exist, they primarily emphasise nutritional counselling and face challenges in coverage and implementations. It is important to understand barriers to CMAM uptake and implementation. This study aims to explore the perceptions of acute malnutrition's underlying factors and consequences among parents, healthcare providers, and policymakers, alongside parents' care-seeking behaviours for under-five children with acute malnutrition. Conducted in areas with and without CMAM programs, the research follows a phenomenological design with thematic analysis of focus group discussions (FGDs) and key informant interviews (KIIs). Thirty FGDs with parents, 28 KIIs with healthcare providers, and 16 KIIs with policymakers were conducted. Identified causes of acute malnutrition included infections, diseases, lack of awareness about nutritious foods, supernatural beliefs, poverty, and inadequate care and feeding practices. Consequences included stunted growth, impaired mental development, and increased illness risk. Although parents acknowledged the urgency of treating acute malnutrition, they sought care at healthcare facilities regardless of illness. Factors influencing care-seeking behaviour were inability in problem prioritisation, transportation cost and availability, healthcare access, wage loss, and out-of-pocket expenses. Despite awareness of acute malnutrition's underlying factors and consequences, parental care-seeking remains limited. The study recommends integrating acute malnutrition guidelines with communicable disease programs, implementing targeted social and behavioural change programs, addressing superstitions, fostering collaboration with traditional healers strengthening social safety nets, and empowering women in healthcare decision-making.

Dietary practices of adolescents during COVID-19 and the perceived effect of the pandemic on nutrition-related behaviours

BACKGROUND

Though there are suggestions on how COVID 19 has affected nutrition-related practices and the nutritional status of people, few studies have evaluated this among adolescents. This study aimed to assess the perceived effect of the pandemic on nutrition-related practices of adolescents.

METHODS

The study was conducted among adolescents (n = 290) in three Metropolitan, Municipal, and District Assemblies (MMDAs) in Accra using a cross-sectional design. Participants provided information on dietary habits, and diet-related messages received during the pandemic. Food consumption during the peak periods of COVID-19 and afterwards was assessed using a 7-day food frequency tool. Food consumption scores (FCS) were generated based on the guidelines of the World Food Programme. The dietary practices of the participants at the two time periods (during and after pandemic) were compared using Pearson's Chi Square tests.

RESULTS

While meal frequency remained similar during and after the peak of the COVID-19 pandemic among the participants, meal skipping and dependence on ready-to-use foods were significantly lower during the peak of the COVID pandemic. Though significantly higher proportions of the participants consumed legumes/nuts/seeds and sugar-sweetened beverages (SSB) at the peak of the pandemic compared to afterwards, overall food consumption was similar at the two time points (acceptable diet: 100% vs. 99.3%). More than a third of the study participants indicated that COVID-19 had negatively affected their food quantity, exercise, and overall physical activity level. Additionally, 41% indicated that their screen time increased at the same time.

CONCLUSION

Our study found that food consumption among adolescents in Accra did not vary much with respect to the COVID-19 pandemic. However, the observed high intake of SSBs coupled with reduced physical activity levels call for concerted efforts from various stakeholders to address these habits to avoid an even faster increasing rate of obesity.

Lessons learned from operationalizing the integration of nutrition-specific and nutrition-sensitive interventions in rural Ethiopia

BACKGROUND

Undernutrition reduction requires coordinated efforts across sectors to address its causes. A multisectoral approach is important in diagnosing the problem and identifying solutions that would be implemented across different sectors. The study aimed to explore the experience of health and agriculture extension workers in integrating nutrition-specific and nutrition-sensitive interventions provided to households with children under two years of age at community level.

METHODS

A qualitative study was conducted in agrarian areas of Ethiopia following the completion of a multi-sectoral program that integrated health and agriculture interventions, in 2021. The program's goal was to reduce stunting and improve the dietary diversity of young children. In total, 28 key informant interviews were conducted with health- and agriculture-extension workers and mothers. A framework analysis approach was applied to manage and analyze data using NVivo version 12 software.

RESULTS

The study showed that joint health and agriculture interventions improved community knowledge on childcare and agricultural practices. The practice of farm gardening and cooking demonstrations were improved after the implementation of the program. Because of service integration, extension workers perceived an improved father's role in supporting mothers in childcaring and feeding nutritious diets to children and decreased severe cases of undernutrition. Integration of health and agriculture sectors for nutrition intervention was challenged by the high workload on extension workers, poor supervision and leadership commitment, lack of appropriate agricultural inputs, and absence of clarity on sector-specific roles. In some areas nutrition services are not owned by the health and agriculture sectors, and it was overlooked.

CONCLUSION

Integrating community-level platforms were key entry points to address undernutrition and promote key agriculture and health interventions. The joint implementation of health and agriculture services were effective in the reduction of wasting and improved the role of family members in supporting mothers. However, Integration of sectors were facing challenges in creating shared vision to improve nutrition status of children and women, distributing workload and equal commitment among sectors.

Flood exposure and childhood malnutrition in India using composite index of anthropometric failure (CIAF)

The flood exposure in India exacerbates childhood malnutrition, particularly in the vulnerable regions of India. Presently, India is facing a dual burden of natural disasters and malnutrition, especially in the vulnerable regions that are exposed to floods. Many studies have been focused on micro-level or regional-level analyses. The present study is uniquely examining the association between flood exposure and malnutrition at a national scale. The study investigated the impacts of flood exposure on childhood malnutrition, using the Composite Index of Anthropometric Failure (CIAF) to assess stunting, wasting, and underweight among children under five years age group. The present study is based on the analyses of data from the National Family Health Survey (NFHS-5, 2019-2021) and Central Water Commission (CWC) reports. The data were analyzed across flood-affected regions in India and categorized by the frequency of flood events (i.e., non-flooded; 1-2 times flooded; and three times flooded events). The analysis reveals a significant increase in malnutrition rates with higher flood exposure in regions experiencing three flood events, 38 percent of children were stunted, 20 percent were wasted, and 35.7 percent were underweight as compared to non-flooded areas. Factors such as low birth weight, maternal education, sanitation facilities, and household infrastructure intensified malnutrition outcomes. The major findings of the study suggested that repeated flooding events aggravate food insecurity and increase vulnerability to child malnutrition. This study not only highlights the compounded effects of flood exposure and socio-economic disparities on CIAF malnutrition but also offers policy-relevant insights. The results of the study highlight the urgent need for targeted interventions, including developing disaster-resilient infrastructure, educational programs for mothers, and enhanced access to sanitation and healthcare in flood-affected regions in India.

Maternal dietary patterns as predictors of neonatal body composition in Ethiopia: the IABC birth cohort study

BACKGROUND

Malnutrition during pregnancy is associated with adverse birth outcomes, but the importance of maternal diet during pregnancy for neonatal body composition remains inconclusive. This study investigated the role of maternal diet during pregnancy for neonatal body composition in the Ethiopian iABC birth cohort.

METHODS

The data stemmed from the first visit at birth comprising 644 mother-child pairs. Shortly after delivery, the diet of the last week of pregnancy was assessed by a non-quantitative and non-validated 18-items food frequency questionnaire. Multiple imputation was used to handle missing data. Twin births and implausible values were excluded from analysis (n = 92). The Dietary Diversity Score (0-9 points) was constructed and exploratory dietary patterns were derived via principal component analysis. Neonatal fat mass and fat-free mass were assessed by air-displacement plethysmography. The associations of maternal Dietary Diversity Score and exploratory dietary patterns with gestational age, neonatal anthropometric measures and body composition were investigated using multiple-adjusted linear regression analysis.

RESULTS

In this cohort (n = 552), mean ± standard deviation (SD) mother's age was 24.1 ± 4.6 years and the median maternal Dietary Diversity Score was 6 (interquartile range = 5-7). An 'Animal-source food pattern' and a 'Vegetarian food pattern' were identified. The mean ± SD birth weight was 3096 ± 363 g and gestational age was 39.0 ± 1.0 weeks. Maternal adherence to the Animal-source food pattern, but not Vegetarian food pattern, was related to birth weight [79.5 g (95% confidence interval (CI): -14.6, 173.6)]. In the adjusted model, adherence to the Animal-source food pattern was associated with higher neonatal fat-free mass [53.1 g (95% CI: -20.3, 126.6)], while neonates of women with high compared to low adherence to Dietary Diversity Score and Vegetarian food pattern had higher fat mass [19.4 g (95% CI: -7.4, 46.2) and 33.5 g (95% CI: 2.8, 64.1), respectively].

CONCLUSIONS

In this Ethiopian population, maternal diet during pregnancy was associated with neonatal body composition. The analysis of body composition adds important detail to the evaluation of maternal dietary habits for the newborn constitution.

Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.

Double burden of malnutrition among under-five children in Eastern and Southern African countries

There is limited evidence on the burden and drivers of the co-occurrence of overweight/obesity and undernutrition at the individual level in low- and middle-income countries. This gap hinders the design of double-duty actions (DDAs) that can effectively address all forms of malnutrition. This multi-country study aimed to determine the magnitude of double burden of malnutrition (DBM) among under five children and identify household and individual level determinants in Eastern and Southern Africa (ESA) countries. We pooled data of 79,394 children aged 6-59 months, collected from Demographic and Health Surveys (DHS) conducted in 12 ESA countries between 2013 and 2016. We identified confounders a priori. A random effect logistic regression was performed to identify factors associated with the co-occurrence of Stunting and Overweight (StOw), Overweight and Anemia (OwA), and Stunting Overweight and Anemia (StOwA). The study revealed that the burden of co-occurrence of StOwA, StOw, and OwA among under-five children were 5.38%; 95% confidence interval (CI) (5.00-5.79), 4.04 (95% CI: 3.86-4.23), and 5.72% (95% CI: 5.40-6.04), respectively. South Africa had the highest burden of co-occurrence of StOwA (15.58%) and OwA (22.30%), while Namibia and Burundi had the lowest StOwA (2.19%) and OwA (2.78%), respectively. Male children were more likely than female children to experience co-occurrence of StOwA [adjusted odds ratio (AOR) (95% CI): 1.96 (1.49-2.57)], OwA [AOR = 1.51: (95% CI) (1.22, 1.86)], and StOw [AOR = 1.59: (95% CI) (1.36, 1.87)]. Children from the poorest and poorer households had higher odds of co-occurrence of StOwA, OwA, and StOw compared to those from the richest households. Compared to children born to mothers with normal body mass index, those born to mothers with overweight/obese had 60% and 39% higher risk, whereas those born to mothers who were underweight had 49% and 36% lower risk of StOw and OwA, respectively. The DBM among children poses a significant public health and economic problem in ESA countries. The DDAs approach should be strengthened in the ESA region to address all forms of malnutrition.

Mitigating the Impact of Intergenerational Risk Factors on Stunting: Insights From Seven of the Most Food Insecure Districts in South Africa

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

Caregiver Feeding Behaviours and Child Dietary Diversity and Growth in Rural Bangladesh

This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to reflect low and high use. Stunting (length-for-age Z-score < -2), wasting (weight-for-length Z-score < -2) and underweight (weight-for-age Z-score < -2) were defined using international growth reference standards. Associations between feeding behaviours, dietary diversity score (DDS, food groups consumed; range 0-7) and anthropometric indicators were examined using multivariable linear or logistic regression models, adjusting for study design, confounders and intervention arm. Mean (SD) age of children in the study was 24.1 (0.3) months. Mean (SD) DDS was 3.7 (1.4), with 55% of children meeting minimum dietary diversity (MDD, DDS ≥ 4). Stunting, wasting and underweight were 40%, 19% and 42%, respectively. Use of high responsive/involved feeding behaviours (reported in 71% of mothers) was associated with higher DDS (0.09, 95% confidence interval [CI]: 0.001, 0.17) and higher odds of achieving MDD (OR: 1.17; 95% CI: 1.02, 1.33) but not with anthropometric outcomes. Use of high forceful feeding behaviours (reported in 34% of mothers) was associated with lower DDS (-0.12, 95% CI: -0.21 to 0.04), lower odds of achieving MDD (OR: 0.82, 95% CI: 0.72, 0.93), and higher odds of underweight (OR: 1.38, 95% CI: 1.22, 1.56) and wasting (OR: 1.55, 95% CI: 1.33, 1.81). In Bangladesh, responsive/involved feeding was associated with higher child dietary diversity whereas forceful feeding was associated with lower dietary diversity and undernutrition. Future research is needed to understand causality and test the effect of responsive feeding interventions on the promotion of child growth.

Effect of counselling about complementary food flour soaking on nutritional and health status of children 6-23 months, a quasi-experimental study

BACKGROUND

Strategies for achieving improved nutrition in young children in developing countries where plant-based complementary foods are the main source of nutrients can address the challenge of meeting nutritional needs from these foods.

OBJECTIVES

This study aimed to assess the effect of counseling about complementary food flour soaking on nutritional and health status of children 6-23 months.

METHODS

A total of 726 mother-child pairs (intervention n = 363 and control n = 363) were enrolled in this study. Participants in the intervention district received personalized nutritional counseling for six months. Interviewer-administered questionnaires and anthropometric measurements were used to collect data. The data were analyzed using SPSS. The difference in difference regression analysis and the Poisson regression analyses were used to estimate the effect of the interventions on anthropometric Z-score and incidence of disease episodes, respectively. Mean differences and Incidence Rate Ratio were computed as a measure of intervention effects.

RESULT

The results showed that the intervention improved the Weight-for-Age Z score of children by 0.30 (β = 0.30, 95 % CI: 0.15-0.45) and Weight-for-length Z score by 0.47 (β = 0.47, 95 % CI: 0.25-0.69). However, the intervention did not improve Length-for-age and health status.

CONCLUSION

The findings imply the need for strengthening social behavior change communication to improve the complementary feeding practices of mothers in the study area. The trial was registered on ClinicalTrials.gov with a registration number NCT05254717.