Predictors of wasting among children under-five years in largely food insecure area of north Wollo, Ethiopia: a cross-sectional study

Prevalence and socio-economic determinants of growth and developmental delays among Iranian children aged under five years: A cross sectional study

BACKGROUND

The main cause of growth and development delays remains unknown, but it can occur as an interaction between genetic, environmental, and socio-economic factors.

OBJECTIVE

The aim of the study was to investigate the prevalence and social determinants of growth and developmental delays among children aged under five years in Qazvin, Iran.

METHODS

A cross-sectional study was conducted between January 2019 to December 2020 with participation of 1800 mothers with children aged 4-60 months who were referred to comprehensive health centers in Qazvin city, Iran. Structural and intermediate social determinants of health were assessed including: parents and children socio-demographic characteristics, families' living and economic status, parents' behavioral factors, household food security, mother's general health, and perceived social support. Children's growth was assessed based on their anthropometric assessment and their development was assessed using their age-specific Ages and Stages Questionnaire. Data were analyzed using univariable and multivariable logistic regression models using SPSS software version 24 and Stata version 14.

RESULTS

The prevalence of developmental problems in each domain were 4.28% for personal and social delay, 5.72% for gross motor delay, 6.5% for communication delay, 6.72% for fine motor delay, and 8% for problem-solving delay. The prevalence of weight growth delays was 13.56% and height growth delays was 4.66%. Communication, gross motor, and problem-solving delays were higher among children whose fathers' smoked cigarettes. Fine motor delays were lower among mothers with education status of high school diploma and university degree vs. the under diploma group. Personal and social delay was significantly higher among families with fair economic status and lower among children when their fathers were employed (vs. unemployed). Weight and height growth delays were higher among mothers who had experienced pregnancy complications and household food insecure families, respectively.

CONCLUSION

There are different predictors of growth and developmental delay problems among Iranian children aged under five years including fathers' smoking, families' economic status, and household food insecurity as well as history of mothers' pregnancy complications. The present study's findings can be used to screen for at-risk of growth and developmental delays among children and could help in designing and implementation of timely interventions.

Assessment of Malnutrition among Children Presenting in a Nutrition Center in Gimbichu, Ethiopia

Nowadays, Ethiopia has several problems affecting children below 5 years of age, resulting in low life expectancies. Our group carried out a study to calculate the presence of malnutrition as wasting, stunting underweight, and BMI-for-age in children presenting in a nutrition center in a rural Ethiopian village in the Oromia region according to WHO guidelines. Our results demonstrated that they had moderate chronic malnutrition or stunting from 1 to 2 years of age, affecting their life, their parents, their community/household, and their country. In our viewpoint, the solution for this situation will require a global focus on several levels, including individual, family, community, and country, the last being with the help of new health policies focused on short-, medium-, and long-term strategies with multi- and interdisciplinary approaches.

Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models

BACKGROUND

Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems.

OBJECTIVE

This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments.

METHODS

We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model's assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method.

RESULTS

In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (-40.40, 95% CI -40.41 to -40.32), home delivery (-35.51, 95% CI -35.55 to -35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (-12.65, 95% CI -12.69 to -12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92).

CONCLUSIONS

According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services.

Prevalence and determinants of wasting among under-5 Egyptian children: Application of quantile regression

Wasting is one of the symptoms of malnutrition that has been connected to the deaths of malnourished children. This study was intended to explain the effect of socio-demographic and economic factors on under-5 wasting by evaluating their conditional effect across the distribution of weight-for-height Z (WHZ) scores using the quantile regression (QR) model. The weighted sample which included 13,680 children under 5 years was taken from the countrywide Egyptian DHS 2014 survey. The results depicted that about 2% of Egyptian children were severely wasted, with the prevalence of wasting being around 8%. It was discovered that across the WHZ distribution, the child's features, maternal characteristics, father's education, and social factors had significant but varied contributions in explaining the wasting status of under-5 children. It was revealed that female children had a significant weight advantage, notably 0.21 standard deviation (SD) higher weight at the 95th quantile over their male counterparts. The WHZ score was also found to be significantly positively associated with both age and household's wealth status at the lower and upper tails of the WHZ distribution, respectively. Moreover, in comparison with children whose mothers were underweight, those whose mothers were normal or overweight had higher WHZ scores, with a 1.45 SD increase in WHZ scores at the 95th quantile for mothers who were normal weights. Furthermore, the children who were breastfed, whose mothers received antenatal care (ANC) services, and/or who had educated parents had an advantage in terms of WHZ scores than their counterparts. In addition, the children with higher birth order and/or who resided in urban areas had weight disadvantages compared to their counterparts. Therefore, in order to improve children's nutritional status and achieve the Sustainable Development Goals (SDGs) by 2030, the government and public-private owner organizations must work together at the community level focusing on vulnerable groups.

Stunting and Associated Factors Among 6-23 Months Age Children in Ethiopia: Application of Generalized Linear Latent and Mixed Modeling

Low height/length-for-age (stunting) is a public health problem in Ethiopia. Efforts that have been made to evaluate factors affecting national and international strategies related to the problem are very limited and poorly achieved. The present study aimed to evaluate low length/height-for-age (stunting) and its associated factors among children 6 to 23 months of age in Ethiopia. We used cross-sectional data collected for 2019 EMDHS. We cleaned, processed, and analyzed in Stata v.15. Socio-demographic, socio-economic parameters, and nutritional (wasting, diet frequency, breast milk, and animal milk) factors were used in the analysis. We fitted Generalized Linear Latent and Mixed Model (GLLAMM) to examine the associations. We analyzed the data of 2,037 children aged 6-23 months and found stunting of 933.07(45.80%). Some factors such as home delivery [coef. = -4.58, 95% CI:-7.81,-1.34] and household size of ≥6 [coef. = -5.53, 95% CI:-10.36,-7.10] were positively associated. No current breastfeeding [coef. = 10.70, 95% CI: 2.16, 19.23] and still breastfeed [coef. = 10.68, 95% CI: 2.62, 18.74] were negatively associated with stunting. Stunting among 6-23 months aged children in Ethiopia is very high above all the national, regional, and international targets. Feeding practice, socio-economic, and psychosocial-support for mothers need revised commitment for pragmatic solution.