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Ahmed KY, Ogbo FA, Tegegne TK, Dalton H, Arora A, Ross AG. Interventions to improve the nutritional status of children under 5 years in Ethiopia: a systematic review. Public Health Nutr 2023; 26:3147-3161. [PMID: 37905557 PMCID: PMC10755407 DOI: 10.1017/s1368980023002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To conduct a systematic review of experimental or quasi-experimental studies that aimed to improve the nutritional status of children under 5 years of age in Ethiopia. DESIGN Embase, MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, and Academic Search Database were used to locate peer-reviewed studies, and Google Scholar and Open Dissertation were used to locate grey literatures. All searches were conducted between 2000 and November 2022. SETTING Ethiopia. PARTICIPANTS Pregnant women and mothers with children aged 0-59 months. RESULTS Ten cluster randomised controlled trials (RCT), six quasi-experimental studies and two individual RCT were included. Out of the identified eighteen studies, three studies targeted pregnant mothers. Our findings showed that almost two-thirds of published interventions had no impact on childhood stunting and wasting, and more than half had no impact on underweight. Some behaviour change communication (BCC) interventions, food vouchers, micronutrient supplementation and quality protein maize improved stunting. Similarly, BCC and fish oil supplementation showed promise in reducing wasting, while BCC and the provision of quality protein maize reduced underweight. Additionally, water, sanitation and hygiene (WaSH) interventions provided to pregnant mothers and children under 2 years of age were shown to significantly reduce childhood stunting. CONCLUSION Future childhood nutritional interventions in Ethiopia should consider adopting an integrated approach that combines the positive effects of interdependent systems such as BCC, food supplemental programmes (e.g. boosting protein and micronutrients), health interventions (e.g. strengthening maternal and childcare), WaSH and financial initiatives (e.g. monetary support and income schemes).
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Affiliation(s)
- Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, SA Health, Government of South Australia, Berri, SA, Australia
| | - Teketo Kassaw Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Hazel Dalton
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Orange, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
- Health Equity Laboratory, Campbelltown, NSW, Australia
| | - Allen G Ross
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
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Patterson GT, Osorio EY, Peniche A, Dann SM, Cordova E, Preidis GA, Suh JH, Ito I, Saldarriaga OA, Loeffelholz M, Ajami NJ, Travi BL, Melby PC. Pathologic Inflammation in Malnutrition Is Driven by Proinflammatory Intestinal Microbiota, Large Intestine Barrier Dysfunction, and Translocation of Bacterial Lipopolysaccharide. Front Immunol 2022; 13:846155. [PMID: 35720380 PMCID: PMC9204284 DOI: 10.3389/fimmu.2022.846155] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Acute malnutrition, or wasting, is implicated in over half of all deaths in children under five and increases risk of infectious disease. Studies in humans and preclinical models have demonstrated that malnutrition is linked to an immature intestinal microbiota characterized by increased prevalence of Enterobacteriaceae. Observational studies in children with moderate acute malnutrition (MAM) have also observed heightened systemic inflammation and increased circulating bacterial lipopolysaccharides (LPS; endotoxin). However, the mechanisms that underpin the systemic inflammatory state and endotoxemia, and their pathophysiological consequences, remain uncertain. Understanding these pathophysiological mechanisms is necessary to design targeted treatments that will improve the unacceptable rate of failure or relapse that plague current approaches. Here we use a mouse model of MAM to investigate the mechanisms that promote inflammation in the malnourished host. We found that mice with MAM exhibited increased systemic inflammation at baseline, increased translocation of bacteria and bacterial LPS, and an exaggerated response to inflammatory stimuli. An exaggerated response to bacterial LPS was associated with increased acute weight loss. Remarkably, intestinal inflammation and barrier dysfunction was found in the cecum and colon. The cecum showed a dysbiotic microbiota with expansion of Gammaproteobacteria and some Firmicutes, and contraction of Bacteroidetes. These changes were paralleled by an increase in fecal LPS bioactivity. The inflammatory phenotype and weight loss was modulated by oral administration of non-absorbable antibiotics that altered the proportion of cecal Gammaproteobacteria. We propose that the heightened inflammation of acute malnutrition is the result of changes in the intestinal microbiota, intestinal barrier dysfunction in the cecum and colon, and increased systemic exposure to LPS.
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Affiliation(s)
- Grace T Patterson
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.,Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Elvia Y Osorio
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Alex Peniche
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Sara M Dann
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.,Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States.,Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States
| | - Erika Cordova
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Geoffrey A Preidis
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Ji Ho Suh
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Ichiaki Ito
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Omar A Saldarriaga
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Michael Loeffelholz
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Nadim J Ajami
- The Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Bruno L Travi
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.,Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States
| | - Peter C Melby
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.,Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States.,Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX, United States
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Conway K, Akseer N, Subedi RK, Brar S, Bhattarai B, Dhungana RR, Islam M, Mainali A, Pradhan N, Tasic H, Thakur DN, Wigle J, Maskey M, Bhutta ZA. Drivers of stunting reduction in Nepal: a country case study. Am J Clin Nutr 2020; 112:844S-859S. [PMID: 32889522 PMCID: PMC7487432 DOI: 10.1093/ajcn/nqaa218] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic child malnutrition represents a serious global health concern. Over the last several decades, Nepal has seen a significant decline in linear growth stunting - a physical manifestation of chronic malnutrition - despite only modest economic growth and significant political instability. OBJECTIVE This study aimed to conduct an in-depth assessment of the determinants of stunting reduction in Nepal from 1996 to 2016, with specific attention paid to national-, community-, household-, and individual-level factors, as well as relevant nutrition-specific and -sensitive initiatives rolled out within the country. METHODS Using a mixed-methods approach, 4 types of inquiry were employed: 1) a systematic review of published peer-reviewed and gray literature; 2) retrospective quantitative data analyses using Demographic and Health Surveys from 1996 to 2016; 3) a review of key nutrition-specific and -sensitive policies and programs; and 4) retrospective qualitative data collection and analyses. RESULTS Mean height-for-age z-scores (HAZ) improved by 0.94 SDs from 1996 to 2016. Subnational variation and socioeconomic inequalities in stunting outcomes persisted, with the latter widening over time. Decomposition analysis for children aged under 5 y explained 90.9% of the predicted change in HAZ, with key factors including parental education (24.7%), maternal nutrition (19.3%), reduced open defecation (12.3%), maternal and newborn health care (11.5%), and economic improvement (9.0%). Key initiatives focused on decentralizing the health system and mobilizing community health workers to increase accessibility; long-standing nationwide provision of basic health interventions; targeted efforts to improve maternal and child health; and the prioritization of nutrition-sensitive initiatives by both government and donors. National and community stakeholders and mothers at village level highlighted a mixture of poverty reduction, access to health services, improved education, and increased access to water, sanitation, and hygiene as drivers of stunting reduction. CONCLUSIONS Improvements in both nutrition-specific and nutrition-sensitive sectors have been critical to Nepal's stunting decline, particularly in the areas of poverty reduction, health, education, and sanitation.
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Affiliation(s)
- Kaitlin Conway
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Samanpreet Brar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | | | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Jannah Wigle
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Russell F, Azzopardi P. WASH: a basic human right and essential intervention for child health and development. LANCET GLOBAL HEALTH 2020; 7:e417. [PMID: 30879506 DOI: 10.1016/s2214-109x(19)30078-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/29/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Fiona Russell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, VIC 3052, Australia.
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, VIC 3052, Australia; Maternal and Child Health Program, Burnet Institute, Melbourne, VIC, Australia; Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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