The dietary diversity and stunting prevalence in minority children under 3 years old: a cross-sectional study in forty-two counties of Western China

Low serum lipase levels in mothers of children with stunted growth indicate the possibility of low calcium absorption during pregnancy: A cross-sectional study in North Sumatra, Indonesia

Stunting is caused by various factors, including low nutritional intake in the first two years of life. This study aimed to investigate the differences in sociodemographic factors and mineral, vitamin, and enzyme parameters in mothers associated with the occurrence of stunting in children. We conducted a cross-sectional study from September to November 2020 on North Sumatra Island, Indonesia. The data collected included sociodemographic characteristics, pregnancy history, birth history, food intake, and laboratory examinations, including measurements of calcium, iron, zinc, vitamin D, pancreatic amylase, and serum lipase levels. This study included 50 healthy mothers aged 18-50 years old with children aged 2 to 60 months. There was a significant difference in serum calcium levels between the groups of mothers of children with normal and stunted growth (p = 0.03, mean difference±standard error (SE) = 0.23±0.12, 95% CI: 0.19-0.45). All of the study subjects were categorized as vitamin D deficient. The mean lipase level in the group of mothers of children with stunted growth was significantly lower than that in the group of mothers of children with normal growth (p = 0.02, mean difference±SE = 4.34±1.83, 95% CI: 0.62-8.06). The conclusion was that serum lipase levels were significantly lower in mothers of children with stunted growth compared to mothers of children with normal growth. Serum lipase levels this low are likely to indicate that a mother is unable to meet her child's calcium needs during pregnancy, increasing the child's risk of stunted growth.

Height and body mass index trajectories from 1975 to 2015 and prevalence of stunting, underweight and obesity in 2016 among children in Chinese cities: findings from five rounds of a national survey

BACKGROUND

A more comprehensive assessment of growth and nutrition in children is required in China due to rapid socioeconomic processes. We aimed to investigate height and body mass index (BMI) trajectories from 1975 to 2015 and the prevalence of stunting and obesity in 2016 among children in Chinese cities.

METHODS

A total of 904,263 children from birth to 6.9 years were collected from a series of nationally representative surveys in China. Height and BMI trajectories and prevalence of stunting, underweight, overweight and obesity were assessed.

RESULTS

The average height level of Chinese urban children under 7 years presented a positive secular trend from 1975 to 2015; however, a slowing tendency occurred in 2005‒2015. An apparent increase was observed at the 5th, 50th and 95th percentiles of BMI in urban children aged 3 years and older, with a more prominent increase at the 95th percentile. The total prevalence of stunting and underweight under 7 years was 1.4% and 2.0%, respectively. The total prevalence of overweight and obesity under 7 years was 12.6% and 4.3%, respectively, with 12.7% and 4.9% for boys, 12.6% and 3.6% for girls, 12.1% and 4.0% in urban areas and 13.1% and 4.5% in suburban rural areas.

CONCLUSIONS

The average height level of Chinese urban children has reached World Health Organization child growth standards since 2005 and presented a slowing tendency in secular trend in 2005‒2015. More attention and efforts and public health interventions should be urgently made to combat overweight and obesity among preschool children. Video Abstract.

Social determinants of child malnutrition outcomes: Evidence from CHNS in China

China is committed to reduce child malnutrition outcomes (CMO) rates to less than 5 % by 2030 in order to meet the Sustainable Development Goal (SDG). Yet, this is still an enormous challenge for China, particularly in disadvantaged areas, due to regional and urban-rural disparities. Using China Health and Nutrition Survey (CHNS) data from 1991 to 2015 and fixed-effect models, this study investigates the social determinants of stunting (n = 4012) measured by height-for-age z score (HAZ) and wasting (n = 4229) measured by weight-for-height z score (WHZ) in children under the age of five. According to the empirical findings, the significant social determinants of child stunting encompassed whether the child is insured (p < 0.01), maternal education level (primary school (p < 0.01) low middle school (p < 0.01); vocational school (p < 0.01)), maternal employment status (p < 0.05), mother's average working days (p < 0.05), average household per capita income (p < 0.01), household asset index (p < 0.01), urbanization index living in a community (medium (p < 0.05); higher (p < 0.01); highest (p < 0.01)) and living regions (west (p < 0.01); northeast (p < 0.05)). Children's maternal employment status (p < 0.05), mother's average working days (p < 0.05), living areas (p < 0.05) and living regions (central (p < 0.01); west (p < 0.01); north-east (p < 0.05)) are the significant factors impacting child wasting. Furthermore, the interaction impact between maternal employment and have one additional working day per week is positive. To attain SDGs, the Chinese government should priorities lowering stunting and wasting among 5-year-olds in the western region, particularly in impoverished regions. Also, it is possible to develop tailored policies for the growth and development of children under the age of five by addressing pertinent socio-economic factors.

Infant and young child feeding indicators are positively associated with length and family care indicators in the children of the Women First trial participants

This research describes the proportion of children in four low- and middle-income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z-scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud-Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04-0.22) and MMF (β = 0.10; 95% CI = 0.03-0.17) were positively associated with length-for-age z-score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02-1.07), MMF (PR = 1.02; 95% CI = 1.01-1.04), MAD (PR = 1.05; 95% CI = 1.02-1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices.

The influence of dietary diversity on anthropometric status among young children ages 12 and 24 months in Wuhan, China

The relative research on investigating the association between dietary diversity scores and anthropometric status among young children is few and inconsistent. Since understanding this association is quite essential to give more detailed advice about diet to ensure young children's healthy growth, we sought to determine the association between dietary diversity levels and anthropometric status among young children under 24 months. The study included 1408 mother-child pairs from the Tongji Maternal and Child Health Cohort, whose children range in age from 12 to 24 months. Multivariable logistic regressions were used to examine the effect of dietary diversity on children's anthropometric failure and obesity. All obese children aged 12 and 24 months had low-medium diverse diets in their first year of life. Risks of anthropometric failure for 12-month young children consumed low-medium diverse diets in their first year and 24-month young children consumed low-medium diverse diets in their second year are, respectively, 1.27 (odds ratio [OR], 95% confidence interval [CI] = [1.06-1.53]) and 1.19 (OR, 95% CI = [1.02-1.40]) times of those who consumed high diverse diets in corresponding year. The risk of anthropometric failure for 24-month-old children who consumed low-medium diverse diets during their first year of life is 4.70 (OR, 95% CI = [1.62-19.91]) times that of young children who consumed highly diverse diets during their first year of life. Introducing more diverse diets to young children under 24 months of age may be an effective strategy to prevent anthropometric failure and obesity in young children in later life.

Systematic Literature Review of the Nutrient Status, Intake, and Diet Quality of Chinese Children across Different Age Groups

There is a lack of comprehensive reports on nutrient deficiencies and dietary intake among various age groups of children in China. The objective of this review is to provide an overview of the nutrient status, intake, and diet adequacy of Chinese children (0-18 years old). PubMed and Scopus were searched for literature published between January 2010 and July 2022. A systematic review approach with a quality assessment was performed to analyze 2986 identified articles in English and Chinese. Eighty-three articles were included in the analysis. In younger children, anemia and iron and Vitamin A deficiencies remain severe public health problems, despite high Vitamin A and adequate iron intake. In older children, a high prevalence of selenium; Vitamin A and D deficiencies; and inadequate intakes of Vitamins A, D, B, C, selenium, and calcium were reported. Intakes of dairy, soybeans, fruits, and vegetables were below recommended levels. High intakes of iodine, total and saturated fat, and sodium and low dietary diversity scores were also reported. As nutritional concerns vary with age and region, future nutrition interventions should be tailored accordingly.

Household Dietary Diversity among the Ethnic Minority Groups in the Mekong Delta: Evidence for the Development of Public Health and Nutrition Policy in Vietnam

Poor household dietary diversity has been linked to malnutrition in individuals, households, and cumulatively in populations. High rates of malnutrition among Khmer ethnic children aged five years and younger have been reported in Tri Ton district, Vietnam. This paper aims to further investigate household dietary diversity and associated factors among Khmer ethnic minority populations in Vietnam. A cross sectional study was conducted from October 2018 to April 2019 in Tri Ton District, An Giang Province. By employing a multistage sampling technique, a total of 402 (99.8% response rate) participants were interviewed to measure household dietary diversity using a structured and validated questionnaire developed by FAO. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with household dietary diversity. The results showed that the prevalence of low, medium and high dietary diversity scores were 21.4%, 70.4% and 8.2%, respectively. Male-headed households, literacy level, household income, exposure to mass media on nutrition and health information, and frequency of eating were positively associated with household dietary diversity (p < 0.05). However, owning a vegetable and rice farm was not statistically related to households’ dietary diversification. The paper concludes that the magnitude of household diversified dietary intakes was essentially low to medium in participants’ households. These findings have provided evidence to inform the development of the National Nutrition Strategy—2021−2030 in Vietnam, to be revised in 2045. This national strategy proposes appropriate interventions, programs and policies to improve socioeconomic status in ethnic groups and in mountainous areas to enhance populations’ health and well-being including controlling childhood malnutrition. In order to improve population health and wellbeing in Tri Ton District, further actions to address effective dietary practices including strengthening nutrition and health communication about the need to improve household dietary diversity to high levels are recommended.

Patterns of Socioeconomic Inequities in SDGs Relating to Children's Well-Being in Thailand and Policy Implications

Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children's wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women's health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people.

Cash transfers and nutrition education to improve dietary diversity among children aged 6-23 months in Grand Gedeh County, Liberia: a cluster-randomized trial

OBJECTIVES

To evaluate the efficacy of a cash transfer and nutrition education program on dietary diversity among children in Liberia. We hypothesized that a multi-pronged intervention would result in improved dietary diversity among children.

METHODS

We conducted a three-armed, cluster-randomized study in 42 communities (12 children per community) in Grand Gedeh County, Liberia, over a 12-month period. We randomly assigned communities to control (n = 14 communities), those that received both bimonthly cash transfers and a structured nutrition education program (n = 14 communities) and those that received bimonthly cash transfers alone (n = 14 communities). Community health assistants conducted bimonthly assessments in participants' homes. The primary outcome was the proportion of children aged 6-23 months who met minimum dietary diversity score (i.e., ≥4 food groups consumed per day). Secondary outcomes included meal frequency and healthcare utilization for illnesses (NCT04101487).

RESULTS

There were 599 children enrolled; 533 (88.9%) were retained through the trial period. The proportion of children who consumed ≥4 food groups per day did not differ among the three arms. However, children randomized to receive cash transfers had higher dietary diversity scores than the control group. Children in communities that received cash transfers alone and with nutrition education consumed significantly more meals per day and were less likely to have visits to clinics or hospitals for illnesses than children in control communities.

CONCLUSION

Bimonthly, unconditional cash transfers and nutrition education were associated with higher dietary diversity scores, greater meal frequency, and fewer healthcare visits for illnesses among children aged 6-23 months.

Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program)

The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children.

Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo.

Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes.

This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.

Low Fruit and Vegetable Consumption Associated with Linear Growth Faltering among Children in Urban Bangladesh

The objective of this study was to examine the association between dietary diversity and child growth among children 6 to 23 months of age in urban slums of Bangladesh. This prospective cohort study enrolled 192 participants 6 to 23 months of age in Dhaka, Bangladesh. A total of 170 children with follow-up anthropometric data were included in the analysis. To collect dietary intake information for children 6 to 23 months of age, consumption of five or more of the following eight minimum dietary diversity food groups was recorded using 24-hour dietary recall at enrollment provided by the child's caregiver: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A-rich fruits and vegetables; and 8) other fruits and vegetables. Height and weight were measured at baseline and at a 12-month follow-up. Fifty-five percent of children (106 of 192) consumed five or more of the eight minimum dietary diversity food groups during their first visit to assess dietary intake. Eighty-two percent of children (157 of 192) had a report of consuming an animal source of food (e.g., eggs, diary, flesh foods) in the past 24 hours, 85% (164 of 192) consumed any source of protein (e.g., eggs, diary, flesh foods, nuts, and legumes), and 65% of children (125 of 192) were reported to consume any fruits and vegetables. Child consumption of fruits and vegetables was associated positively with change in length-for-age z-scores from baseline to the 12-month follow-up (coefficient, 0.86; 95% CI, 0.03-1.68). Inadequate fruit and vegetable consumption was associated with linear growth faltering among the young children residing in urban Dhaka, Bangladesh. These findings demonstrate the need for effective interventions to increase fruit and vegetable consumption in this susceptible pediatric population.

Stunting and associated factors among 6-23 month old children in drought vulnerable kebeles of Demba Gofa district, southern Ethiopia

BACKGROUND

Stunting is impaired linear growth of children: they experience stunting in the first 1000 days after conception and is an indication of chronic malnutrition. Children under the age of two are regarded as the most vulnerable to malnutrition due to their rapid growth and greater exposure to infectious disease.

OBJECTIVE

To assess the magnitude and associated factors of stunting among 6 to 23-month-old children in drought-vulnerable kebeles of the Demba Gofa district, southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from February to March 2021. Systematic random sampling was used to select pairs of mothers/caregivers with children aged 6 to 23 months. A semistructured questionnaire and anthropometric measurement were used to collect the data. The data were checked coded and entered into Epi-data version 3.1 and exported to SPSS for Windows version 20.0 for analysis. Simple and multivariable linear regressions were conducted. The level of significance was declared at 95% CI and p-value < 0.05.

RESULTS

The magnitude of stunting in the study area was 79(21.82%). Household dietary diversity [β = 0.217, 95% CI, 0.093-0.342], early initiation of complementary feeding [β = 0.444, 95% CI, 0.344-0.543], frequency of breastfeeding within 24 h [β = 0.217, 95% CI, 0.179-0.263] and child eating animal source food [β = 0.351, 95% CI, 0.196-0.506] were positively significant predictors of child height/length-for-age (HAZ).

CONCLUSION

The extent of stunting in the study area is relatively lower than that in regional and national reports, but one out of five children were still stunted. Therefore, health education on infant and young child feeding practices should be provided to mothers to reduce the problem.

Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China

Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.

Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review

OBJECTIVE

This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years.

DESIGN

This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

SETTING AND PARTICIPANTS

PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles.

MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS

Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight.

CONCLUSIONS AND IMPLICATIONS

The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.

The Effect of Risk Accumulation on Childhood Stunting: A Matched Case-Control Study in China

BACKGROUND

Childhood stunting is still a public health issue in developing countries. However, the traditional risk factors in underdeveloped areas are not suitable for developed areas. Moreover, childhood stunting is influenced by several aspects, including genetic factors, perinatal conditions, maternal conditions, and feeding practices, but researchers have not yet clearly determined which aspect of risk accumulation exerts the strongest effect on stunting. A matched case-control study was performed to assess the effect of different aspects of risk accumulation on childhood stunting.

METHODS

In total, 173 non-stunted children aged under 7 years were matched in our study from June 2015 to August 2015. The children's heights and weights were measured, and a self-administered questionnaire was used to collect information from the children and their parents. The risk factors were assigned to the following five aspects: genetic factors, family socioeconomic status, perinatal conditions, maternal conditions, and feeding practices. The risk accumulation (cumulative risk score) in each aspect was defined as the total number of risk factors that occurred in a certain aspect. A conditional logistic regression model was used to assess the effect of risk accumulation in different aspects on stunting, and a decision-tree model was used to predict the children's stunting based on the cumulative risk scores.

RESULTS

Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices was significant in the conditional logistic regression model (P < 0.05). Perinatal conditions showed the strongest association with stunting in both the regression analysis and the decision-tree model. The risk of stunting increased by 1.199 times if the cumulative risk score for perinatal conditions increased by one, and the probability of stunting was 75.8% if the cumulative risk score for perinatal conditions was ≥1.

CONCLUSION

Risk accumulation in perinatal conditions, genetic factors, maternal conditions, and feeding practices substantially increased the probability of stunting in childhood. Perinatal conditions were the main aspect associated with stunting. Prevention and intervention measures should be adopted to avoid risk accumulation in stunting.

Double burden of malnutrition in ethnic minority school-aged children living in mountainous areas of Vietnam and its association with nutritional behavior

BACKGROUND/OBJECTIVES

Although children of ethnic minority groups are experiencing a transition from a predominance of undernutrition to overnutrition, there is little evidence of a dual-malnutrition burden. Therefore, this study examined the double burden of malnutrition among school-aged ethnic minority children living in mountainous areas and its association with their diets.

SUBJECTS/METHODS

A cross-sectional study was conducted from September 2019 to March 2020 in 3 mountainous areas of Northern Vietnam among 1,556 ethnic minority school-aged children. The prevalence of under-nutrition (stunting and thinness) and over-nutrition (overweight and obesity) were measured using the WHO 2006 child growth standards (height-for-age and BMI-for-age Z-score). Nutritional practices were evaluated by the frequency of food consumption based on a 4-level scale.

RESULTS

The percentage of children with stunting and thinness were 14.0% and 5.4%, respectively, while the figure for overweight/obesity was 9.4%. The factors positively associated with stunting were living in a family with more than 2 children or being Muong/other ethnicities compared to the Tay ethnicity. Children who consumed fish/shrimps/crabs or milk weekly/daily were less likely to be undernourished compared to those who never consumed these foods. By contrast, children who never consumed foods rich in vitamin A precursors and vitamin A and fruit or consumed daily snacks/junk food were more likely to be overweight/obese.

CONCLUSIONS

Undernutrition remains a common issue among school-aged children and adolescents of ethnic minority groups, while over-nutrition exists simultaneously. Public health nutrition programs promoting adequate diets and positive lifestyle changes related to nutrition are essential to tackle the double burden of malnutrition among ethnic minority children.

Stunting among kindergarten children in China in the context of COVID-19: A cross-sectional study

BACKGROUND

The impact of COVID-19 has most likely increased the prevalence of stunting. The study aimed to determine the prevalence of stunting among kindergarten children in the context of coronavirus disease 2019 (COVID-19) in Longgang District, Shenzhen, China, and its risk factors.

METHODS

A cross-sectional study was conducted to identify children from 11 sub districts of 481 kindergartens in the Longgang District of Shenzhen City from May to July 2021. In the context of COVID-19, an online survey was conducted to gather demographic information, height, birth information, and lifestyle. The prevalence of stunting was calculated, and the risk factors were analyzed using binary logistic regression with three stepwise models.

RESULTS

A total of 118,404 subjects were included from May to July 2021, with a response and questionnaire effective rates of 85.75% and 95.03%, respectively. The prevalence of stunting and severe stunting were 3.3% and 0.8%, respectively. Model 3 showed that risk factors for stunting were male sex [odds ratio (OR) = 1.07], low birth weight (OR = 2.02), insufficient sleep time (OR = 1.08), less food intake than their peers (OR = 1.66), slower eating than their peers (OR = 1.16), accompanied by grandparents alone or non-lineal relatives (reference: parents accompanying) (OR = 1.23, 1.51), and children induced to eat (OR = 1.17). Protective factors included only-child status (OR = 0.66), reported high activity (OR = 0.37, 0.26, 0.23), parents with high education levels (father: OR = 0.87, 0.69; mother: OR = 0.69, 0.58), high monthly income per capita of the family (OR = 0.88, 0.74, 0.68), and allowing children to make food choices (OR = 0.82).

CONCLUSION

The stunting rate of children in kindergartens in Longgang District is 3.3%, close to the level of developed countries but higher than the average level of developed cities in China. The relatively high stunting rate in children under 3 years old in 2021 may be associated with the influence of COVID-19. Appropriate policies should be formulated for individuals and families with children to help children establish good living habits and reduce stunting.

Prevalence of Complementary Feeding Indicators and Associated Factors Among 6- to 23-Month Breastfed Infants and Young Children in Poor Rural Areas of China

This study aimed to estimate the status of complementary feeding (CF) and its associated factors among 6-23-month breastfed infants and young children (IYC). We used secondary data from the China Nutrition Improvement Project on Children in Poor Areas in 2018. The status of CF was provided by parents of IYC through 24-h dietary recall. The study included 13,972 6-23-month-old breastfed IYC comprising 24.7% 6-8-month, 28.5% 9-11-month, 31.4% 12-17-month, and 18-23-month IYC. The highest percentage of IYC introduced to cereal foods was 84.8%. Nearly, 83.6% of 6-8-month infants were introduced to solid or semi-solid food. The prevalence of meeting requirements of non-dairy animal source food and minimum acceptable diet (MAD) was 75.3 and 35.1% of 6-23-month IYC, respectively, and was significantly higher in older than younger IYC (p < 0.001). Age of IYC, education level of parents, paternal employment, and nutrition knowledge of parents were positively associated factors for the prevalence of meeting requirements of MAD, and diarrhea at 2 weeks and maternal employment were negatively associated with MAD. Totally, the prevalence of meeting the requirements of MAD was relatively lower in breastfed IYC. The government should scale up appropriate CF with consideration of food availability.

Prevalence of Malnutrition and Associated Factors of Stunting among 6-23-Month-Old Infants in Central Rural China in 2019

This study aimed to evaluate the prevalence of malnutrition and to investigate the associated factors of stunting among 6-23-month-old infants in poor rural areas of central China. The China Nutrition Improvement Project on Children in Poor Areas was conducted in 56 national-level poor counties of seven provinces in 2019. We performed a multivariate binary logistic regression analysis to determine the associated factors of stunting. This cross-sectional study included 17,193 infants. The overall prevalence of stunting was the highest (3.9%), followed by overweight (3.0%), underweight (2.1%), wasting (2.0%), and obesity (0.5%). Girls [OR = 0.55, 95% CI (0.46, 0.65)], infants meeting requirements of minimum diversity diet [OR = 0.81, 95% CI (0.67, 0.98)], and mothers with middle-school or high-school education and above decreased the prevalence of stunting. Infants with diarrhea in two weeks [OR = 1.26,95% CI (0.98, 1.62)] were at higher odds of stunting. The malnutrition status in the study areas was improved, and vulnerable infants were found to need additional and earlier monitoring to detect and fundamentally prevent undernutrition.

Factors associated with child malnutrition in mountainous ethnic minority communities in Lao PDR

Background

Although in many low- and middle-income countries undernutrition is steadily decreasing, nutritional challenges persist in remote communities, such as those in mountainous areas of Lao PDR. Isolated, with limited access to food and to health care and other public services, local diets are low in both quantity and diversity. Data needed to guide policy and planning are lacking.

Objectives

The study aimed to identify the extent of malnutrition and associated factors among children aged 12–47 months in remote mountainous communities in Lao PDR.

Methods

A cross-sectional survey was conducted in Nong district, Savannakhet province, covering 173 households, involving heads of households, mothers and their children aged 12–47 months.

Results

The prevalence of undernutrition was very high among the 173 children studied: 72.8% were stunted, 50.3% underweight and 10.4% wasted. Key factors showing significant positive associations with nutritional status were assets (mobile phone or electric rice mill), collection of non-timber forest products, and household dietary diversity. Negative associations were found with experience of malaria and consuming high amounts of white roots and tubers. Immediate causes of malnutrition were prevalent; half the children had insufficient consumption of all micro- and macronutrients. Diseases were highly prevalent; 30% had recently experienced fever. The households in these villages were quite homogeneous. All scored high on causes of malnutrition; 90% of households experienced food insecurity, nearly all lived below the poverty line, and almost two-thirds of household heads and nearly all mothers had had no education.

Conclusion

This study identified multiple factors influencing child malnutrition, including low household food diversity, food insecurity, and poor feeding practices among ethnic minority people living in a difficult environment with limited resources. Child undernutrition in these poor communities is complex. Interventions are needed in different sectors, including agricultural production, knowledge on feeding and health services.

Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia

OBJECTIVE

To investigate the relation of child dietary diversity and household food insecurity along with other socio-demographic with child anthropometric indices in north-central Ethiopia, an area with a high level of food insecurity and inadequate diet quality.

DESIGN

A community-based cross-sectional study was used.

SETTINGS

The study was conducted in Dessie and Combolcha towns of north-central Ethiopia from April to May 2018.

PARTICIPANTS

Randomly selected 512 mother-child pairs with child's age range of 6-59 months.

RESULTS

The mean (± SD) scores of weight-for-height/length, height/length-for-age, weight-for-age, and BMI-for-age Z-scores were 1.35 (± 2.03), - 1.89 (± 1.79), 0.05 (± 1.54), and 1.39 (± 2.06), respectively. From all anthropometric indicators, stunting and overweight/obesity remained the severe public issues hitting 43% and 42% of the children, respectively. In the model, mothers' age and education and child's age, sex, and dietary diversity were significantly related with child height-for-age Z-score while place of residence, sex of household head, child's age, and dietary diversity score were the predictors of child BMI-for-age Z-score in the urban contexts of the study area. Nevertheless, food insecurity was not related to any of the child anthropometric indices.

CONCLUSION

The double burden of malnutrition epidemics (stunting and obesity) coexisted as severe public health concerns in urban settings. Anthropometric statuses of children were affected by multidimensional factors and seek strong integration and immediate intervention of multiple sectors.

Does Dietary Diversity Reduce the Risk of Obesity? Empirical Evidence from Rural School Children in China

Childhood and adolescence overweight and obesity have implications for both health consequences and economic burden. Although it has been an emerging public health problem for primary school children in rural China and the importance of the diet-health link has been stressed for many years, rigorous analysis of the dietary diversity and obesity among children is rare. To clarify this issue, this study provides a better understanding of the functional linkage between dietary diversity and obesity by analyzing data from nearly 8500 rural primary students (aged from 10 to 13 years old) covering three provinces in China. Our estimation results show that there is a significantly negative correlation between dietary diversity and the probability of being overweight among primary students. In particular, for subgroups with higher dietary diversity, the negative correlation between dietary diversity and the incidence of overweight or obesity is stronger, and the absolute value of the coefficient is greater. The results also suggest that the increase in the consumption frequency of all dietary categories can significantly lead to a lower proportion of overweight. Thus, we conclude that higher dietary diversity can help to lower the risk of overweight and obesity among primary school children, presumably through increasing the daily frequency of food intakes and developing a more diverse dietary pattern.

Relationships between dietary diversity and early childhood developmental outcomes in rural China

The period from birth to 2years of age is highly sensitive with respect to the relationship between nutrition and neurodevelopment, but data regarding the association between dietary diversity and early childhood neurodevelopment are limited. We sought to examine the association of two feeding indicators-minimum dietary diversity (MDD) and minimum meal frequency (MMF)-with the neurodevelopment of children aged 6-23 months, using data from a cross-sectional survey conducted in six rural counties in China. Data on 1,534 children were analysed using logistic regression to explore the associations between dietary diversity and early neurodevelopment, with adjustments for the age, sex and prematurity of the child; the age, sex and educational level of the caregiver; and family size, income and simulative care practices and resources. We found that 32.4% of children had suspected developmental delays based on the Chinese version of the Ages and Stages Questionnaires Version 3, whereas 77.0% and 39.2% failed to meet the MDD and MMF, respectively. Meeting the MDD was associated with a 39% lower risk of developmental delays (AOR = 0.61, 95% CI [0.43, 0.86]). There was a significant association between MDD and reduced likelihood of developmental delays in gross motor, fine motor, problem-solving and personal social subscales, whereas MMF was only associated with a lower risk of developmental delays in the gross motor subscale (AOR = 0.63, 95% CI [0.42, 0.94]). We observed an inverse dose-response relationship between the number of food groups consumed and the risk of developmental delays (P < .001).

Diet Quality among Women with Previous Gestational Diabetes Mellitus in Rural Areas of Hunan Province

Diet quality is critical for postpartum type 2 diabetes mellitus (T2DM) progression among women with a history of gestational diabetes mellitus (GDM). The Chinese Healthy Eating Index (CHEI) is a dietary index developed according to the latest Chinese Dietary Guidelines (CDG-2016). Our study aimed to assess the diet quality of women with previous GDM in rural areas of Hunan Province by applying the CHEI. Women with previous GDM in two counties of Hunan were enrolled. Their food intake data, which were used to calculate their CHEI scores, were collected by a 24-h dietary recall. The association of CHEI with sociodemographic and anthropometric variables was evaluated via linear regression models. 404 women were included in the final analysis. The mean score of the total CHEI was 54.9 (SD 7.9). The components of whole grains and mixed beans, seeds and nuts, tubers, dairy, and poultry scored extremely low. Ethnic minority groups and women younger than 30 years had lower CHEI scores. Our study observed an unsatisfactory diet quality among women with previous GDM in rural areas of Hunan Province. Future dietary education focusing on the CDG is needed to improve their diet quality and help in T2DM prevention among this population, especially young and ethnic minority women.

Breastfeeding Practices and Overweight/Obesity Among Children Under 5 Years of Age: A Multistage Random Sampling Survey in Central and Western China

OBJECTIVES

To describe the prevalence of overweight and obesity among children under 5 years old, assess the indicators of breastfeeding practices, and explore the associations between breastfeeding practices and early childhood overweight/obesity.

METHODS

The survey was conducted in 20 counties in central and western China in 2016. All children under 5 years old were physically measured for anthropometric data and their breastfeeding practices were obtained through a face-to-face questionnaire interview. We performed logistic regressions to assess the associations of different breastfeeding practices with overweight/obesity.

RESULTS

The prevalence of overweight and obesity among children under 5 years old were 8.7% and 2.6%, respectively. Overall, 93.6% of children were breastfed, while only 20.7% had exclusive breastfeeding under 6 months of age and about half of the children under 5 years old were weaned at 12 months. Compared with children with a duration of breastfeeding ≥ 12 months, children who have been breastfed for < 6 months were significantly associated with a 97% increased risk of overweight/obesity (OR 1.97, 95% CI 1.34-2.88, P = 0.001).

CONCLUSIONS FOR PRACTICE

The present study showed that overweight and obesity among children under 5 years old in central and western China remained an important childhood health concern. The rates of most indicators of breastfeeding practices were low, which needed more public attention. Moreover, we found that a shorter duration of breastfeeding was associated with an increased risk of overweight/obesity among children in central and western China.

Relationship between moderate to late preterm, diet types and developmental delay in less-developed rural China

Aim: To measure the development of moderate to late preterm children by Ages and Stages Questionnaires (ASQ) and explore the relationship between moderate to late preterm, diet types and development delay in less-developed rural China.Methods: Data were collected from a cross-sectional community-based survey, which recruited 1748 children aged 1-59 months in eight counties of China. Caregivers of these children completed the Chinese version of ASQ-3 (ASQ-C) while physical examination and questionnaires on socio-demographic characteristics were conducted. Multivariate logistic regressions were used to analyze the association between moderate to late preterm and suspected developmental delay, as well as the association between diet types and suspected developmental delay. Consumption of certain food types was compared between moderate to late preterm and full-term children.Results: The prevalence of suspected overall developmental delay was 31.3% in the moderate to the late preterm group, compared with 21.6% in the full-term group. Moderate to late preterm birth was not associated with total suspected developmental delay and developmental delay in all the domains of ASQ, except for fine motor (OR = 2.43 95% C.I.: 1.04-5.56). The intake of vegetables and fruits had a protective influence on developmental delay in fine motor function, and moderate to late preterm children had lower relative consumption of fruits and vegetables than full-term children.Conclusion: Moderate to late preterm children in rural China showed an increased likelihood of developmental delay in fine motor function. Future interventions to improve the intake of vegetables and fruits in moderate to late preterm children are recommended.

Childhood malnutrition within the indigenous Wayuú children of northern Colombia

Malnutrition contributes to nearly half of all preventable deaths in children under the age of five. While the burden of disease is heaviest in Sub-Saharan Africa, South, and Southeast Asia, malnutrition in Latin America remains high, especially within indigenous communities. This study evaluates the prevalence of malnutrition and its relationship with access to healthcare resources within 172 indigenous Wayuú communities in La Guajira, Colombia. Healthcare workers administered a health questionnaire and collected anthropometric measurements on all children 6 months to 5 years of age within the Wayuú households. These data were utilised to calculate the prevalence of acute malnutrition, stunting, and underweight. Of all surveyed Wayuú children, 22.9% and 18.3% met criteria for moderate and severe malnutrition, 33.4% and 28.1% met criteria for moderate and severe stunting, and 28.1% and 16.6% were moderately and severely underweight. Across all categories, malnourished children were older, less likely to have had a medical professional present at birth, less likely to have received medical care after birth, and more likely to have been born in a non-medical, community setting. The prevalence of malnutrition is much higher than national levels in Colombia. This population requires urgent assistance to address their disproportionately high rates of malnutrition.

Factors associated with dietary diversity and length-for-age z-score in rural Ethiopian children aged 6-23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation

Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length-for-age z-score (LAZ) in children 6-23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May-June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio-economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership. LAZ was positively associated with age, socio-economic status, maternal education, fruit and vegetable production, and land ownership.

Strengthening the maternal and child health system in remote and low-income areas through multilevel governmental collaboration: a case study from Nujiang Prefecture in China

OBJECTIVE

The aim of the study was to assess the effects of the maternal and child health (MCH) system strengthening through multilevel governmental collaboration in Nujiang Prefecture, China.

STUDY DESIGN

A case study design was applied.

METHODS

Guided by the logical framework of the Nujiang MCH Comprehensive Intervention Project, national, provincial, and prefecture government sectors jointly implemented comprehensive health system strengthening (HSS) interventions in Nujiang Prefecture. In this case study, we conducted the end point surveys (November 2015 and January 2016) with 33 local MCH facilities. We also interviewed 35 MCH providers, government officials, leaders of MCH facilities, and project specialists. The thematic framework method was used to analyze the interview data, and descriptive analysis was performed to analyze the survey data.

RESULTS

The three levels of governmental collaboration contributed to increased government investment in the local MCH system and ensured the successful implementation of the project. Participatory training methods and appropriate HSS interventions tailored to the local context were crucial to improve MCH providers' knowledge and skills, with the proportion of qualified MCH providers increasing from 70% in 2011 to 96% in 2015. Owing to this increase in knowledge and the increase in needed equipment, more MCH hospitals could provide inpatient obstetric services, and more town health clinics were capable of providing basic MCH services. The development of a reimbursement policy tailored to the local context promoted in-hospital delivery. At the conclusion of the project, percentages of antenatal care, in-hospital delivery, and newborn screening increased by 20.71%, 18.12%, and 278.62%, respectively. Growth monitoring coverage for children younger than three years remained stable at around 90%. However, the MCH system was negatively impacted by the workforce shortage. Those shortages were caused by a lack of positive recruitment and retention and incentive policies.

CONCLUSIONS

Implementation of comprehensive HSS interventions through multilevel governmental collaboration improves the MCH system in remote and low-income areas.

Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

Risk factors for undernutrition among children 0-59 months of age in Myanmar

The prevalence of childhood stunting in Myanmar is one of the highest among the countries of Southeast Asia. Cross-sectional data from the Myanmar Demographic Health Survey 2015-2016 were used to examine risk factors for stunting, wasting, and underweight among children aged 0-59 months. The prevalence of stunting, wasting, and underweight was 29.0%, 7.3%, and 19.2%, respectively. Accounting for sampling design and weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height <145 cm, home delivery, child's small birth size recalled by mother, and older age (ref: 0-5 months) predicted both stunting and underweight. Larger than average birth size was protective for all stunting, wasting, and underweight. Maternal body mass index <18.5 kg m-2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in nonagricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin A supplementation in the previous 6 months were risk factors for wasting only. Regional variation was also seen, with a higher odds of stunting in the West-South Region, North-East States, and West States, compared with the Central Regions. In Myanmar, socio-economic and demographic factors, poor maternal nutritional status, and living in certain geographical locations are affecting children's undernutrition. It is recommended that interventions for growth faltering focus on the first 1,000 days of life; optimum maternal nutrition be ensured during and before pregnancy and at adolescence; societal support be provided for mothers in poverty or engaged in nonagriculture; and region-specific undernutrition pathways be understood.

Spatial and demographic disparities in short stature among school children aged 7-18 years: a nation-wide survey in China, 2014

OBJECTIVES

To identify spatial disparities and demographic characteristics of short stature, we analysed the prevalence of short stature collected in a nationwide health survey.

SETTINGS

Data were obtained from the 2014 Chinese National Survey on Students Constitution and Health (a cross-sectional study of China). Participants came from 30 provinces, autonomous regions, and municipalities (except Tibet, Hong Kong, Macao, and Taiwan).

PARTICIPANTS

There were 213 795 Han school children between 7 and 18 years old enrolled in our study. All participants were sampled by stratified cluster.

PRIMARY AND SECONDARY OUTCOME MEASURES

Short stature; Chinese and WHO age-specific and gender-specific height growth references were used for short stature assessment.

RESULTS

The age-standardised and age-gender-standardised prevalence of short stature nationwide was 3.70% and 2.69% according to Chinese and WHO growth references, respectively. The short stature prevalence differed significantly among age groups, urban and rural areas, and regions with different socioeconomic development levels (all p<0.0001). The prevalence was 2.23% in urban versus 5.12% in rural areas (p<0.001). The prevalence was 2.60% in developed, 3.72% in intermediately developed, and 4.69% in underdeveloped regions (p<0.0001). These values were all according to China's growth reference, but similar patterns were observed on prevalence based on the WHO reference. The spatial distribution of prevalence of short stature presented a clustered pattern. Moran's I value was 0.474 (p<0.001) and 0.478 (p<0.001) according to the Chinese and WHO growth references, respectively. The southwest part of China showed a higher prevalence of short stature, whereas lower prevalence of short stature was observed mainly in the northeast part of China.

CONCLUSIONS

There is an appreciably high prevalence of short stature in rural, underdeveloped areas of China. There are high prevalence spatial clusters of short stature in southwestern China. This provides corroborating evidence for a tailored strategy on short stature prevention and reduction in special areas.

Quality of care and suspected developmental delay among children aged 1-59 months: a cross-sectional study in 8 counties of rural China

BACKGROUND

The data about quality of care of more than 70 countries were available from UNICEF but little was known about China. We examined the status about quality of care and explored its associations with developmental outcomes in Chinese children.

METHODS

A cross-sectional study with probability proportional to size sampling method was conducted in 8 counties of rural China. A total 1927 children were assessed on development status using Ages and Stages Questionnaires-Chinese (ASQ-C) based on Chinese normative data. Nutritional status was derived from the anthropometric method following WHO guidelines. Caregivers were interviewed through household questionnaires from UNICEF's 5th Multiple Indicator Cluster Survey to understand the quality of care, including the status of availability of children's books, availability of playthings, support for learning, fathers' support for learning and inadequate care. Moreover, quality of care was explored to be categorized into three levels (poor, medium and good) for overall assessment. Multivariable logistic regression model was applied to estimate the odds ratios and 95% confidence intervals between quality of care and suspected developmental delay (SDD) after adjustment for potential confounding variables.

RESULTS

The proportions of availability of children's books, playthings, support for learning, fathers' support for learning and inadequate care were 36.8, 91.3, 83.1, 16.4 and 4.9%, respectively. When compared to available data of more than 70 countries and areas, the quality of care in rural China was in the middle to upper level. After adjustment for potential confounding variables, multivariable analysis showed that SDD in overall ASQ remained negatively associated with availability of children's books (odds ratio [OR] and 95% confidence interval [CI]: 1.64 [1.27-2.12]), playthings (OR and 95% CI: 2.23 [1.52-3.27]) and support for learning (OR and 95% CI: 1.81 [1.06-3.10]). When compared with children under good quality of care, children under medium and poor quality of care had higher prevalence of SDD in overall ASQ (OR and 95% CI: 1.59 [1.21-2.07]; 3.05 [1.96-4.74]).

CONCLUSIONS

Quality of care in rural China still had scope for improvement. Better quality of care had negative associations with SDD.

Perbedaan Tingkat Keragaman Pangan Balita dan Tingkat Pendidikan Orang Tua di Rumah Tangga Kawasan Rumah Pangan Lestari (KRPL) Dan Non KRPL

Background: Sustainable Reserve Food Garden Area (KRPL) is program that to increase family dietary diversity, such as children. Children’s dietary diversity can affect to nutritional adequacy and can impact to growth process. The factor that can affect successful of KRPL program is parents’ education level.Objectives: The purpose of this study was to identify the difference between children’s dietary diversity level, household income level, and parents’ education level in sustainable reserve food garden area (KRPL) and non KRPL household in Kamal sub-district, Bangkalan district, Madura.  Method: This was an observational study with case control comparative study design was conducted among 25 children in KRPL area and 25 children in non KRPL area with mother or other family member as respondents. Simple random sampling method was used to select the samples. Children and parents’ characteristic were asked to answer structured questionnaire. Children dietary diversity level was asked by Individual Dietary Diversity Score (IDDS) instrument. The data was analyzed with Mann Whitney statistic test. Result: Children that involved in this study, either in KRPL or non KRPL area, was less than the same 35 months old (52%). Children from KRPL area was mostly girls (64%), while children from non KPRL area was mostly boys (56%). Children dietary diversity condition in KRPL area was low (52%), while children dietary diversity level in non KRPL area was sufficient (64%). Children who lived in KRPL area not always have diverse intake. The result showed that there was no difference between children dietary diversity level in KRPL and non KRPL area (p=0.259). Household income level on KRPL area was higher (68%) if compared to household on non KRPL area (44%). Parents’ education level in KRPL area was classified high (father=88%, mother=88%), while that parents’ education level in non KRPL area classified low (father=88%, mother=100%) (p=0.000). Parents in KRPL area have higher education level compare to parents in non KPRL area. Conclusion: Children dietary diversity in KRPL area are not different with non KRPL area. Children who lived in KRPL area not always have diverse intake. There is difference between household’s income level and parents’ education level. Household in KRPL area have higher income and parents in KRPL area have higher education level compare to households and parents in non KPRL area. ABSTRAKLatar Belakang: Kawasan Rumah Pangan Lestari (KRPL) merupakan program yang bertujuan untuk memperbaiki dan meningkatkan keragaman pangan keluarga, salah satunya balita. Keragaman pangan pada balita dapat berpengaruh pada kecukupan kebutuhan gizi dan berdampak pada proses pertumbuhannya. Salah satu faktor yang dapat mempengaruhi keberhasilan program KPRL adalah tingkat pendidikan orang tua.Tujuan: Tujuan dari penelitian ini adalah untuk mengidentifikasi perbedaan tingkat keragaman pangan balita dan tingkat pendapatan keluarga, dan tingkat pendidikan orang tua di rumah tangga Kawasan Rumah Pangan Lestari (KRPL) dan non KRPL Kecamatan Kamal, Kabupaten Bangkalan, Madura.Metode: Penelitian observasional dengan rancang bangun penelitian potong lintang komparatif dilakukan pada subjek penelitian yang terdiri dari 25 balita di wilayah KRPL dan 25 balita di wilayah non KRPL dengan ibu atau anggota keluarga lainnya sebagai responden. Metode simple random sampling digunakan untuk memilih sampel. Karakteristik balita dan orang tua ditanyakan melalui kuesioner. Tingkat keragaman pangan balita ditanyakan melalui instrumen Individual Dietary Diversity Score (IDDS) Data dianalisis menggunakan uji statistik Mann Whitney.Hasil: Balita yang terlibat dalam penelitian ini, baik di area KPRL maupun non KPRL, sebagian besar berusia kurang dari sama dengan 35 bulan (52%). Balita yang berasal dari wilayah KRPL sebagian besar perempuan (64%), sedangkan dari wilayah non KPRL sebagian besar laki-laki (56%). Kondisi tingkat keragaman pangan balita di wilayah KRPL tergolong rendah (52%), sedangkan tingkat keragaman pangan balita di wilayah non KRPL tergolong cukup (64%). Balita yang tinggal di rumah tangga KRPL tidak selalu mengonsumsi makanan yang beragam. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan tingkat keragaman pangan balita di wilayah KRPL dan non KPRL (p=0,259). Tingkat pendapatan keluarga balita di wilayah KRPL lebih tinggi (68%) apabila dibandingkan dengan wilayah non KPRL (44%). Tingkat pendidikan orang tua di wilayah KRPL tergolong tinggi (ayah=88%, ibu=88%), sedangkan tingkat pendidikan orang tua di wilayah non KRPL tergolong rendah (ayah=88%, ibu=100%) (p=0,000).Kesimpulan: Tingkat keragaman pangan balita di area KRPL tidak berbeda dengan balita di area non KPRL. Terdapat perbedaan tingkat pendapatan keluarga dan tingkat pendidikan orang tua balita. Keluarga di wilayah KRPL memiliki tingkat pendapatan yang lebih tinggi dan orang tua di area KRPL memiliki tingkat pendidikan lebih tinggi apabila dibandingkan dengan rumah tangga dan orang tua di wilayah non KPRL.

Double burden of malnutrition among children under 5 in poor areas of China

OBJECTIVE

The aim of this study was to investigate the nutritional status and its risk factors among children under 5 years, with special focus on the coexistence of under and over nutrition in population level.

METHODS

We enrolled 6,570 children under 5 years among 26 counties in poor areas of China. Prevalences of malnutrition (stunting, underweight, wasting, overweight) were calculated. Overweight was evaluated using two indicators-weight for height Z score (WHZ) and body mass index for age Z score (BAZ), and results were compared.

RESULTS

The total prevalence of malnutrition was 19.2%. The prevalence of stunting and overweight were as high as 8.4% and 8.8%, respectively. The BAZ-estimated prevalence of overweight was 9.9%, which was higher than the WHZ-estimated prevalence (p<0.001). Children older than 12 months age, within a minority group, with a caregiver of illiteracy/primary education level were significantly associated with stunting in multilevel regression models (p<0.05). Children younger than 24 months age and boys were significantly associated with overweight (p<0.05).

CONCLUSIONS

Stunting and overweight were coexisted in surveyed areas. In conclusion, BAZ tended to overestimate the overweight prevalence compared with WHZ. While with the raising problem of childhood overweight, stunting should still be on the agenda for the poor areas in China. To improve children's nutritional status in poor areas of China, caregivers with children at high risk of malnutrition should be guided for healthy feeding practices.

Improved timely birth dose coverage of hepatitis B vaccine narrows the socio-economic inequality in western China in 2011-2016

OBJECTIVE

To compare timely birth dose (TBD) coverage of hepatitis B vaccine and socio-economic inequality distribution of TBD coverage between 2011 and 2016 in rural areas of western China.

METHODS

In western China, using multi-stage probability proportion to size sampling, 2633 and 1929 children aged 0-35 months with an immunization card were selected from 14 rural counties in 2011 and 2016, respectively. Socio-economic characteristics were obtained from face-to-face questionnaire survey and copies of vaccination certificates. We performed multivariate logistic regression models to identify the determinants of TBD coverage of hepatitis B vaccine. We grouped TBD coverage by wealth quintiles, calculated inequality using the difference base on coverage in richest (quintile 5) and poorest (quintile 1) household wealth quintiles.

FINDINGS

From 2011 to 2016, the overall TBD coverage of hepatitis B vaccine among children aged 0-35 months in rural areas of western China increased from 52.8% (95% confidence interval, CI: 42.4-62.8) to 80.2% (95% CI: 69.5-87.8). The absolute difference in TBD coverage between richest and poorest quintiles was 20.6 (95%CI: 9.4-31.8) and 15.8 (95%CI: 1.4-30.2) in 2011 and 2016, respectively.

CONCLUSION

The socioeconomic inequality in TBD coverage decreased over the study period, but such inequality still existed in 2016. To improve inequality in TBD, the government should pay more attention to the disadvantaged groups, especially the children who were delivered at home, or whose caregivers were ethnic minority or who have a lower level of education.