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Kumala Putri DS, Sari K, Utami NH, Djaiman SPH. Influence of maternal and neonatal continuum of care on the risk of intergenerational cycle of stunting: a cross-sectional study. BMJ Open 2024; 14:e081774. [PMID: 38643007 PMCID: PMC11033657 DOI: 10.1136/bmjopen-2023-081774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES This study aimed to analyse the influence of the continuum of care during pregnancy and neonatal periods on the risk of intergenerational cycle of stunting. DESIGN This study was a cross-sectional study, with data analysed from the 2018 Basic Health Research in Indonesia. SETTINGS Basic Health Research 2018 was conducted throughout 513 cities/regencies in 34 provinces in Indonesia. The households were selected through two-stage sampling methods. First, census blocks (CB) were selected using probability proportional to size methods in each urban/rural stratum from each city/regency. Ten households were then selected from each CB using systematic sampling methods. All family members of the selected households were measured and interviewed. PARTICIPANTS This study analyses 31 603 children aged 0-24 months. OUTCOMES MEASURES The dependent variable was the risk of the intergenerational cycle of stunting. Mothers who had a height less than 150.1 cm (short stature mothers) and had children (≤ 24 months of age) with length-for-age Z-score less than -2 Standard Deviation (SD) of the WHO Child Growth Standard (stunted children) were defined as at risk of the intergenerational cycle of stunting. RESULTS Mothers with incomplete maternal and neonatal care visits were 30% more likely to be at risk on the intergenerational cycle of stunting (OR (95% CI): 1.3 (1.00 to 1.63)) after adjusting for economic status. CONCLUSION The continuum of maternal and neonatal healthcare visits could potentially break the intergenerational cycle of stunting, especially in populations where stunted mothers are prevalent.
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Affiliation(s)
- Dwi Sisca Kumala Putri
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Kencana Sari
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Nur Handayani Utami
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Sri Poedji Hastoety Djaiman
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
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Brown A, Trimble M, Sokal-Gutierrez K, Fernald L, Madsen K, Turton B. Sugar-Sweetened Beverages, Foods of Low Nutritional Value, and Child Undernutrition in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:169. [PMID: 38397660 PMCID: PMC10887798 DOI: 10.3390/ijerph21020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.
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Affiliation(s)
- Akemi Brown
- University of California San Francisco Joint Medical Program, University of California, Berkeley, CA 94720, USA;
| | - Margaret Trimble
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
| | - Karen Sokal-Gutierrez
- University of California San Francisco Joint Medical Program, University of California, Berkeley, CA 94720, USA;
| | - Lia Fernald
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
| | - Kristine Madsen
- School of Public Health, University of California, Berkeley, CA 94720, USA; (M.T.); (L.F.); (K.M.)
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Sumon IH, Hossain M, Ar Salan S, Kabir MA, Majumder AK. Determinants of coexisting forms of undernutrition among under-five children: Evidence from the Bangladesh demographic and health surveys. Food Sci Nutr 2023; 11:5258-5269. [PMID: 37701232 PMCID: PMC10494611 DOI: 10.1002/fsn3.3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 09/14/2023] Open
Abstract
In many underdeveloped and developing countries, epidemiological and nutritional transitions are leading to an increase in malnutrition, resulting in pediatric diseases and eventually deaths. Therefore, this study intents to determine the important factors of the presence of coexisting forms of malnutrition (CFM), i.e., pediatric undernutrition. This study used the latest Bangladesh Demographic and Health Survey (BDHS)-2017/18 dataset consisting of 7127 under-five children. The logistic regression model has been utilized to gain explicit and in-depth knowledge of the relationship between the presence of pediatric undernutrition with socioeconomic and demographic factors. Findings revealed that about 31%, 22%, and 8% suffered from stunted, underweight, and wasted, respectively. The prevalence of stunted, underweighted, wasted, and CFM among children in the Sylhet division is higher than in any other region. A child of a secondary-level completed mother is 27.6% (OR: 0.724, 95% CI: 0.58-0.90) less likely to suffer from undernutrition than a child of an uneducated mother. The rate of undernutrition of children was less among children of highly educated parents. Age, birth order of the child, twin status, mother's age, body mass index (BMI), working status, parental educational qualification, cooking fuel, toilet facility, region, residence, and wealth index are important for determining the nutritional status of a child. The authors believe that the study findings will be helpful to the policymakers to take proper actions for achieving the sustainable development goal (SDGs) by reducing pediatric undernutrition in Bangladesh by 2030.
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Affiliation(s)
| | - Moyazzem Hossain
- Department of StatisticsJahangirnagar UniversitySavar, DhakaBangladesh
| | - Sifat Ar Salan
- Department of StatisticsJahangirnagar UniversitySavar, DhakaBangladesh
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de Vries Mecheva M, Rieger M, Sparrow R, Prafiantini E, Agustina R. Behavioural and environmental risk factors associated with primary schoolchildren's overweight and obesity in urban Indonesia. Public Health Nutr 2023; 26:1562-1575. [PMID: 37138496 PMCID: PMC10410387 DOI: 10.1017/s1368980023000897] [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: 04/11/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To aid the design of nutrition interventions in low- and middle-income countries undergoing a nutrition transition, this study examined behavioural and environmental risk factors associated with childhood overweight and obesity in urban Indonesia. DESIGN Body height and weight of children were measured to determine BMI-for-age Z-scores and childhood overweight and obesity status. A self-administered parental survey measured socio-economic background, children's diet, physical activity, screen time and parental practices. Logistic and quantile regression models were used to assess the association between risk factors and the BMI-for-age Z-score distribution. SETTING Public primary schools in Central Jakarta, sampled at random. PARTICIPANTS Children (n 1674) aged 6-13 years from 18 public primary schools. RESULTS Among the children, 31·0 % were overweight or obese. The prevalence of obesity was higher in boys (21·0 %) than in girls (12·0 %). Male sex and height (aOR = 1·67; 95 % CI 1·30, 2·14 and aOR = 1·16; 95 % CI 1·14, 1·18, respectively) increased the odds of being overweight or obese, while the odds reduced with every year of age (aOR = 0·43; 95 % CI 0·37, 0·50). Maternal education was positively associated with children's BMI at the median of the Z-score distribution (P = 0·026). Dietary and physical activity risk scores were not associated with children's BMI at any quantile. The obesogenic home food environment score was significantly and positively associated with the BMI-for-age Z-score at the 75th and 90th percentiles (P = 0·022 and 0·023, respectively). CONCLUSIONS This study illustrated the demographic, behavioural and environmental risk factors for overweight and obesity among primary schoolchildren in a middle-income country. To foster healthy behaviours in primary schoolchildren, parents need to ensure a positive home food environment. Future sex-responsive interventions should involve both parents and children, promote healthy diets and physical activity and improve food environments in homes and schools.
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Affiliation(s)
- Margarita de Vries Mecheva
- The International Institute of Social Studies of Erasmus University Rotterdam, 2518 AXThe Hague, the Netherlands
| | - Matthias Rieger
- The International Institute of Social Studies of Erasmus University Rotterdam, 2518 AXThe Hague, the Netherlands
| | - Robert Sparrow
- The International Institute of Social Studies of Erasmus University Rotterdam, 2518 AXThe Hague, the Netherlands
- Development Economics Group, Wageningen University, Wageningen, the Netherlands
| | - Erfi Prafiantini
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia – Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia – Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Handayani NS, Huriyati E, Hasanbasri M. Association of Maternal Education With Nutritional Outcomes of Poor Children With Stunting in Indonesia. Asia Pac J Public Health 2023; 35:373-380. [PMID: 37415330 DOI: 10.1177/10105395231185980] [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] [Indexed: 07/08/2023]
Abstract
The consequences of poverty and food insecurity can indirectly contribute to obesity. Long-term effect of stunting children may be the risk factor for overweight and obesity in the poor in Indonesia. The role of parental education is also associated with overweight and obesity in children. This study aimed to observe the risk of stunted children becoming overweight and obese based on maternal education among poor people in Indonesia. This study involved three cohorts design. Cohort 1 is a 14-year cohort, and two 7-year cohorts for cohorts 2 and 3. We used secondary longitudinal data from Indonesian Family Life Survey (IFLS) 3 (2000), IFLS 4 (2007), and IFLS 5 (2014). After stratification by high maternal education and economic status of the family, there is an increased risk of stunting children becoming overweight and obese, with a risk ratio of 2 in cohort 1 and 1.69 in cohort 2. These results showed that stunted children with high-education mothers and lived in the low-income families have a 1.69 to 2 times higher risk of becoming overweight and obese. Thus, the importance of primary education and health education for women to increase children's health in the future.
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Affiliation(s)
- Nur Septia Handayani
- Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Emy Huriyati
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mubasysyir Hasanbasri
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Zemene MA, Anley DT, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Tesfa NA, Kebede YS, Bantie B, Feleke SF, Dejenie TA, Bayeh WA, Dessie AM. Concurrent stunting and overweight or obesity among under-five children in sub-Saharan Africa: a multilevel analysis. Arch Public Health 2023; 81:119. [PMID: 37391826 DOI: 10.1186/s13690-023-01138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Globally, the co-occurrence of stunting and overweight or obesity (CSO) in the same individual is becoming an emerging layer of malnutrition and there is a paucity of information in low- and middle-income countries, particularly in sub-Saharan Africa. Hence, this study aimed to determine the pooled prevalence and determinants of concurrent stunting and overweight or obesity among under-five children in SSA. METHODS Secondary data analysis was conducted from a recent nationally representative Demographic and Health Survey dataset of 35 SSA countries. A total weighted sample of 210,565 under-five children was included in the study. A multivariable multilevel mixed effect model was employed to identify the determinant of the prevalence of under-5 CSO. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of the clustering effect. A p-value of p < 0.05 was used to declare statistical significance. RESULT The pooled prevalence of concurrent stunting and overweight/obesity among under-five children was 1.82% (95% CI: 1.76, 1.87) in SSA. Across the SSA regions, the highest prevalence of CSO was reported in Southern Africa (2.64%, 95% CI: 2.17, 3.17) followed by the Central Africa region (2.21%, 95% CI: 2.06, 2.37). Under five children aged 12-23 months (AOR = 0.45, 95% CI: 0.34, 0.59), 24-35 months (AOR = 0.41, 95% CI: 0.32, 0.52), 36-59 months (AOR = 055, 95% CI: 0.43, 0.70), ever had no vaccination (AOR = 1.25, 95% CI: 1.09, 1.54), under-five children born from 25 to 34 years mother (AOR = 0.75, 95% CI: 0.61, 0.91), under-five children born from overweight/obese mothers (AOR = 1.63, 95% CI: 1.14, 2.34), and under-five children living in West Africa (AOR = 0.77, 95% CI: 0.61, 0.96) were significant determinants for under-five CSO. CONCLUSION Concurrent stunting and overweight or obesity is becoming an emerging layer of malnutrition. Under five children born in the SSA region had almost a 2% overall risk of developing CSO. Age of the children, vaccination status, maternal age, maternal obesity, and region of SSA were significantly associated with under-five CSO. Therefore, nutrition policies and programs should base on the identified factors and promote a quality and nutritious diet to limit the risk of developing CSO in early life.
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Affiliation(s)
- Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Wolaita Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Alebachew Bayeh
- Department of Maternal and neonatal health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Sahiledengle B, Mwanri L, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Kene C, Seyoum K, Gomora D, Woldeyohannes D, Agho KE. The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors. BMC Pediatr 2023; 23:218. [PMID: 37147654 PMCID: PMC10163774 DOI: 10.1186/s12887-023-04037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia. METHODS Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO. RESULTS The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)]. CONCLUSION The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Centre for Public Health Research, Equity and Human Flourishing, Torrens University, Adelaide Campus, Adelaide, SA, 5000, Australia
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Sebsbie A, Minda A, Ahmed S. Co-existence of overweight/obesity and stunting: it's prevalence and associated factors among under - five children in Addis Ababa, Ethiopia. BMC Pediatr 2022; 22:377. [PMID: 35764944 PMCID: PMC9241306 DOI: 10.1186/s12887-022-03445-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Double burden of malnutrition is a global problem posing a serious public health challenge especially in low- and middle-income countries including Ethiopia, where a high prevalence of under-nutrition continues to exist and overweight is increasing at an alarming rate. Although both under-nutrition and over-nutrition are investigated extensively in Ethiopia, evidence about the double burden of malnutrition especially at the individual level is very limited. Objective To assess the prevalence of the co-existence of overweight/obesity and stunting and associated factors among under-five children in Addis Ababa, Ethiopia at an individual level. Methods Institution-based cross-sectional study was conducted from May to June 2021 among 422 mothers to child pairs in Addis Ababa. Twenty-nine (30%) of the health centers in Addis Ababa were selected to take part in the study using a simple random sampling technique. The total sample size was allocated proportionally to each of the selected health centers based on their performances within 6 months prior to the study. A systematic random sampling method was used to select the study participants. An interviewer-administered structured questionnaire was used to collect data. Descriptive statistics and a hierarchical logistic regression model were used to characterize the study population and to identify factors that are associated with the outcome variable respectively. Odds ratio along with 95% CI were estimated to measure the strength of the association. The level of statistical significance was declared at a p-value less than 0.05. Results The prevalence of the co-existence of overweight/obesity and stunting was 5.1% with 95% CI (2.9–7.1%). The hierarchical logistic regression analysis revealed that child age (6–23 months) [(AOR = 2.86, 95% CI: (1.02–8.04)], maternal education status (non-educated) [(AOR = 4.98, 95% CI: (1.33–18.66)], maternal age during birth (≥ 28 years) [(AOR = 0.22, 95% CI: (0.06–0.79)] and childbirth order (3+) [(AOR = 6.38, 95% CI: (1.03–39.7)] were significantly associated with the co-existence of overweight /obesity and stunting. Conclusion and recommendations: The study revealed that the prevalence of the co-existence of overweight/obesity and stunting is low in Ethiopia. However, local and national nutrition policies and programs should be tailored and implemented to simultaneously address both under-nutrition and over-nutrition. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03445-5.
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Affiliation(s)
- Alem Sebsbie
- Department of Public Health Kotebemetropolitan University, Deberbirhan, Ethiopia
| | - Abebe Minda
- Department of Public Health Deberbirhan University, Deberbirhan, Ethiopia
| | - Sindew Ahmed
- Department of Nursing Kotebemetropolitan University, Deberbirhan, Ethiopia.
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Steyn NP, Nel JH. Prevalence and Determinants of the Double Burden of Malnutrition with a Focus on Concurrent Stunting and Overweight/Obesity in Children and Adolescents. Curr Nutr Rep 2022; 11:437-456. [PMID: 35715686 DOI: 10.1007/s13668-022-00417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF THE REVIEW To determine the prevalence and determinants of concurrent stunting and overweight/obesity (CSO) in the same child or adolescent. RECENT FINDINGS After searching PubMed and the Web of Science, 26 articles comprised the prevalence and/or determinants of concurrent stunting and overweight/obesity. Most of the articles were published from 2018 onwards. There is great variation in the prevalence of concurrent stunting and overweight/obesity across the globe. For children under five years the prevalence of CSO is higher among children under two years compared with those 2-<5 years. The main determinants of this condition appear to be associated with gender, age, and urban versus rural ones. Income varied greatly between studies. However, a few additional variables were mentioned including having a mother with a short stature, time of weaning, having an improved toilet facility, being dewormed in the past few months, and the level of education of the mother.
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Affiliation(s)
- Nelia P Steyn
- Department of Human Biology, University of Cape Town, Anzio Road, Observatory, South Africa.
| | - Johanna H Nel
- Department of Logistics, University of Stellenbosch, Stellenbosch, South Africa
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Khaliq A, Wraith D, Nambiar S, Miller Y. A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children. BMC Public Health 2022; 22:879. [PMID: 35505427 PMCID: PMC9063291 DOI: 10.1186/s12889-022-13098-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children. METHODS A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies. RESULTS The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive. CONCLUSION Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| | - Smita Nambiar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, 4059, Australia
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
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Indra J, Khoirunurrofik K. Understanding the role of village fund and administrative capacity in stunting reduction: Empirical evidence from Indonesia. PLoS One 2022; 17:e0262743. [PMID: 35089957 PMCID: PMC8797224 DOI: 10.1371/journal.pone.0262743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
The Indonesian government launched various programs to handle stunting cases, including village funds. This paper examined the effects of village fund programs and village apparatuses’ capacities to combat stunting based on aggregate data at the district level in Indonesia. Using descriptive data analysis and fixed effect panel regression, we observed that village fund programs could significantly reduce Indonesia’s stunting prevalence, especially outside Java. It also revealed that the increasing education of regional leaders does not necessarily positively impact leaders’ skills in handling stunting. At the same time, the number of village officials has a statistically significant influence on reducing stunting prevalence. It advised that the village budget fund can support national priorities in tackling the prevalence of stunting. Furthermore, it is essential to build the capacity of the village head for increasing awareness of health activities, especially early prevention of stunting, in addition to an adequate number of officials.
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Affiliation(s)
- Jul Indra
- Graduate Programme in Economics, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
| | - Khoirunurrofik Khoirunurrofik
- Graduate Programme in Economics, Faculty of Economics and Business, University of Indonesia, Depok, Indonesia
- Research Cluster on Energy Modeling and Regional Economic Analysis (RCEMREA), Faculty of Economics and Business, Universitas Indonesia, Depok, Indonesia
- * E-mail:
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Khaliq A, Wraith D, Miller Y, Nambiar-Mann S. Prevalence, Trends, and Socioeconomic Determinants of Coexisting Forms of Malnutrition Amongst Children under Five Years of Age in Pakistan. Nutrients 2021; 13:4566. [PMID: 34960118 PMCID: PMC8707290 DOI: 10.3390/nu13124566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
In Pakistan, malnutrition is a chronic issue. Concerns regarding coexisting forms of malnutrition (CFM) in an individual child are emerging, as children suffering from CFM have a 4 to 12-fold higher risk of death compared with healthy children. This study assessed the prevalence, trends, and socioeconomic determinants of various types of CFM using Pakistan Demographic and Health Survey (PDHS) datasets. Data from children aged 0-5 years old, with complete height and weight information, and valid anthropometry, from all regions of Pakistan (except residents of Azad Jammu Kashmir (AJK) and Federally Administered Tribal Areas (FATA), and non-de jure residents), were included. The prevalence of CFM was 30.6% in 2012-2013 and 21.5% in 2017-2018 PDHS. Both PDHSs reported a significantly higher prevalence of CFM in Sindh and Baluchistan compared with other regions of Pakistan. Improved socioeconomic status significantly reduced the odds of various types of CFM, except the coexistence of underweight with wasting. The high prevalence of CFM in Pakistan can be averted by multisectoral collaboration and by integrating nutrition-sensitive and nutrition-specific interventions.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Smita Nambiar-Mann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia;
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Double burden of malnutrition and its association with infant and young child feeding practices among children under-five in Thailand. Public Health Nutr 2021; 24:3058-3065. [PMID: 33054885 PMCID: PMC9884786 DOI: 10.1017/s1368980020003304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined the prevalence of stunting-overweight and socio-demographic determinants among children under-five years of age, as well as associations with infant and young child feeding (IYCF) among children aged 6-23 months. DESIGN Secondary data analysis based on the Thailand Multiple Indicator Cluster Survey 2015-2016. SETTING Cross-national study. PARTICIPANTS Nationally representative sample of children under-five years of age (n 12 313). RESULTS The prevalence of wasting, stunting, overweight and stunting-overweight was 5·3, 10·5, 10·1 and 1·6 %, respectively. In multivariate analyses, children under 6 months, children from low and middle wealth tertiles, and children living in rural areas were prone to being wasted. Male children, low wealth tertile and a non-Thai speaking household head were positively and children aged 48-59 months and a one-child household were inversely associated with stunting. Children from a low wealth tertile were less likely to be overweight, while older age, male children and children from a one-child household were more likely to be overweight. Stunting-overweight was associated with children aged 24-47 months, male children, mothers having secondary education, a one-child household, a non-Thai speaking household head and an urban area. In terms of IYCF indicators, despite no association with stunting and stunted-overweight children, current breast-feeding and inadequate meal frequency were associated with being wasting, while current breast-feeding and dietary diversity were inversely associated with being overweight. CONCLUSIONS This study revealed the double burden of malnutrition at the individual and population levels among Thai children under-five, which calls for concrete integrated interventions to tackle all forms of malnutrition.
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Household structure and concurrent stunting and overweight among young children in Indonesia. Public Health Nutr 2021; 24:2629-2639. [PMID: 33843538 DOI: 10.1017/s1368980021001385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the association of household type and household composition with concurrent stunting and overweight in young children from urban and rural Indonesia. DESIGN This study is a secondary data analysis using a nationally representative cross-sectional survey. Household structure was analysed as household type, household size, number of working adults, number of dependent adults and children, and household head's gender. We defined 'concurrent stunting and overweight' as height-for-age Z-score <-2 and weight-for-height Z-score >+2 based on WHO growth standards. Multivariable logistic regression to test the aforementioned association was performed separately for urban and rural areas. SETTING Data were from Indonesia Basic Heath Research 2013. PARTICIPANTS Children aged 2-5 years (n 45 050). RESULTS The prevalence of concurrent stunting and overweight children was 5·6 %. In rural areas, this prevalence differed significantly by household types and the highest prevalence was among children in nuclear two-parent households (6·8 %). In rural areas, children in extended households had lower odds of concurrent stunting and overweight than those from nuclear households (OR = 0·73, 95 % CI 0·59, 0·92). In urban areas, household size and number of working adults were significantly associated with the decreased odds of concurrent stunting and overweight in children. CONCLUSIONS Household structure was associated with children's concurrent stunting and overweight in urban and rural regions of Indonesia. The patterns of the association might differ between urban and rural regions, but no significant interaction term was found.
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Socio-economic status and the double burden of malnutrition in Cambodia between 2000 and 2014: overweight mothers and stunted children. Public Health Nutr 2021; 24:1806-1817. [PMID: 33632364 PMCID: PMC8094435 DOI: 10.1017/s1368980021000689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time. DESIGN We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon. PARTICIPANTS We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers. SETTING Nationally representative household survey across all regions. RESULTS SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. CONCLUSIONS Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.
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Vaezghasemi M, Öhman A, Ng N, Hakimi M, Eriksson M. Concerned and Conscious, but DefenselessThe intersection of gender and generation in child malnutrition in Indonesia: a qualitative grounded theory study. Glob Health Action 2020; 13:1744214. [PMID: 32370625 PMCID: PMC7241482 DOI: 10.1080/16549716.2020.1744214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Several studies in Indonesia have shown the protective effect of women-headed households on the double burden of malnutrition (coexistence of undernutrition and overnutrition in a household). Many other studies have presented a positive impact on children’s health and conditions when women are educated, have higher social capital and have control of income and its intra-household allocation. However, how women’s status affects the nutritional status of a household and, in particular, of children still remains understudied. Objective: In this study, our aim was to explore the role of gender relations and contextual factors for overnutrition and undernutrition among children within a household. Method: We conducted a qualitative study in two provinces of Indonesia: Central Java (urban and rural) and Jakarta (central and suburban) among 123 community members (59 men and 64 women). We utilised principles of constructivist grounded theory in conducting this study, and focus group discussions were chosen as a tool to collect data. Results: Three categories were constructed, capturing the significance of: (i) the man is dominant within the family (gendered power relations), (ii) the environment that makes the unhealthy choice the easy choice (the emerging obesogenic environment) and (iii) parents’ being concerned but unable to control their children’s eating habits (intersection of gender and generational relations) in child malnutrition. Conclusion: Community health and nutrition programmes should help both women and men within the context of households to acknowledge and respect women’s status. More importantly, these programmes should involve men when it comes to children’s nutritional habits and consider them as an important factor in the realisation of gender equality and empowerment. Furthermore, it is increasingly important to recognise the implication of the availability and accessibility of junk food among children.
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Affiliation(s)
- Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Ann Öhman
- Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Mohammad Hakimi
- Centre for Health and Nutrition Research Laboratory, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.,Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Malin Eriksson
- Department of Social Work, Umeå University, Umeå, Sweden
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The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries. Public Health Nutr 2020; 24:2944-2951. [PMID: 32633230 PMCID: PMC7613087 DOI: 10.1017/s1368980020001226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. Design We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. Setting Nationally representative surveys from ninety-three LMIC. Participants A total of 825 633 children were studied. Results DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. Conclusions The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Javid N, Pu C. Maternal stature, maternal education and child growth in Pakistan: a cross-sectional study. AIMS Public Health 2020; 7:380-392. [PMID: 32617364 PMCID: PMC7327405 DOI: 10.3934/publichealth.2020032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
Pakistan has a significantly higher prevalence of stunted children under five years old compared with other countries with a similar income level. Given maternal education is a modifiable factor, we analyzed whether education has a larger marginal effect on improving children's growth for shorter stature mothers. Pakistan Demographic and Health Survey of 2012–13 was analyzed, with a total of 3,883 of children under five years of age (belonged to 2,327 mothers). The results showed that the overall prevalence of stunting, underweight, wasting, and overweight in our sample was 45%, 26.2%, 9.9%, and 9.5%, respectively. Short stature mothers have a higher number of malnourished children as compared to taller mothers. Compared to tall stature mothers, short stature mothers at all education levels have a higher number of stunted and underweight children. Maternal education has a significant positive effect on children's growth. However, we did not find significant differences in the marginal effect of maternal education among mothers with different statures. Policies providing specialized care to children born to short stature mothers are crucial, along with emphasizing mothers' education. Moreover, a poverty elevation program is necessary as a significant fraction of childhood malnutrition is attributed to the wealth index.
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Affiliation(s)
- Nazli Javid
- Institute of Public Health, National Yang-Ming University, Taiwan
| | - Christy Pu
- Institute of Public Health, National Yang-Ming University, Taiwan
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Schipper L, van Heijningen S, Karapetsas G, van der Beek EM, van Dijk G. Individual housing of male C57BL/6J mice after weaning impairs growth and predisposes for obesity. PLoS One 2020; 15:e0225488. [PMID: 32453751 PMCID: PMC7250426 DOI: 10.1371/journal.pone.0225488] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/23/2020] [Indexed: 01/08/2023] Open
Abstract
For (metabolic) research models using mice, singly housing is widely used for practical purposes to study e.g. energy balance regulation and derangements herein. Mouse (social) housing practices could however influence study results by modulating (metabolic) health outcomes. To study the effects of the social housing condition, we assessed parameters for energy balance regulation and proneness to (diet induced) obesity in male C57Bl/6J mice that were housed individually or socially (in pairs) directly after weaning, both at standard ambient temperature of 21°C. During adolescence, individually housed mice had reduced growth rate, while energy intake and energy expenditure were increased compared to socially housed counterparts. At 6 weeks of age, these mice had reduced lean body mass, but significantly higher white adipose tissue mass compared to socially housed mice, and higher UCP-1 mRNA expression in brown adipose tissue. During adulthood, body weight gain of individually housed animals exceeded that of socially housed mice, with elevations in both energy intake and expenditure. At 18 weeks of age, individually housed mice showed higher adiposity and higher mRNA expression of UCP-1 in inguinal white but not in brown adipose tissue. Exposure to an obesogenic diet starting at 6 weeks of age further amplified body weight gain and adipose tissue deposition and caused strong suppression of inguinal white adipose tissue mRNA UCP-1 expression. This study shows that post-weaning individual housing of male mice impairs adolescent growth and results in higher susceptibility to obesity in adulthood with putative roles for thermoregulation and/or affectiveness.
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Affiliation(s)
- Lidewij Schipper
- Danone Nutricia Research, Utrecht, The Netherlands
- GELIFES, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Steffen van Heijningen
- GELIFES, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Giorgio Karapetsas
- GELIFES, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Eline M. van der Beek
- Danone Nutricia Research, Utrecht, The Netherlands
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gertjan van Dijk
- GELIFES, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
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Febriana WR, Nurhaeni N. Is There Any Relationship between Feeding Practices for Children Under Two Years of Age (6-23 Months) and Stunting? Compr Child Adolesc Nurs 2019; 42:65-72. [PMID: 31192725 DOI: 10.1080/24694193.2019.1577927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of the paper is to examine the relationship between infant and young child feeding practices (aged 6-23 months) and stunting in East Jakarta. A cross-sectional study design is conducted with three main instruments: maternal and child characteristics, feeding practices, and health behaviors. Sampling is done by simple random sampling technique with a total of 143 respondent mothers in East Jakarta. The results of the analysis show no significant relation between infant and young child feeding practices and stunting (p = 0.147), and its relation with maternal and child characteristics, such as maternal age, maternal employment status, maternal educational level, low birthweight less than 2,500 g, sanitation and health behaviors, and household income (p > 0.05). Further longitudinal studies are required to identify risk factors associated with stunting among children.
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Affiliation(s)
| | - Nani Nurhaeni
- a Faculty of Nursing , Universitas Indonesia , Depok , Indonesia
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Minh Do L, Lissner L, Ascher H. Overweight, stunting, and concurrent overweight and stunting observed over 3 years in Vietnamese children. Glob Health Action 2019; 11:1517932. [PMID: 30253704 PMCID: PMC6161605 DOI: 10.1080/16549716.2018.1517932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Malnutrition, both stunting and overweight/obesity, present a public health concern in many countries in the world. Objective: This study aims to examine: (1) longitudinal changes in prevalence of overweight, stunting, and concurrent overweight and stunting among preschool children during 3 years and (2) secular changes in these prevalences of a specific age group of children aged 5.5–6.5 year over a period of 3 years. Methods: A cohort of 2,602 children initially aged 3–6 years old, 1,311 in an urban area and 1,291 in a rural area, was followed for 3 years. Of them, children aged 5.5–6.5 years old were identified to be included in three repeated cross-sectional surveys. The World Health Organization standard was used to classify children with overweight or stunting. Results: Findings from the cohort study indicate that between 2013 and 2016, the estimated prevalence of overweight including obesity (OWOB) increased with age, particularly in the urban setting (14.2%–29.9% in boys and 9.0%–21.6% in girls). The estimated prevalence of stunting decreased from 8.2% to 3.4% in boys and 9.5% to 3.5% in girls with a considerably greater decrease among rural children. There was a similar pattern of an age-related decrease of concurrent OWOB and stunting from 2.4% in 2013 to 1.4% in 2016 in boys and from 2.9% to 1.3% in girls with significant decreases in rural children. Secular trends in the group of children 5.5 to 6.5 show the same pattern as the longitudinal results: decreasing prevalence of stunting as well as concurrent OWOB and stunting. OWOB prevalence increased significantly in urban girls and rural boys. Conclusions: The pattern of increasing overweight, decreasing stunting and concurrent overweight and stunting both with increasing age and over chronological time is observed among Vietnamese preschool children.
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Affiliation(s)
- Loan Minh Do
- a Outpatient Department , National Children's Hospital , Hanoi , Vietnam
| | - Lauren Lissner
- b Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine , Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Henry Ascher
- b Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine , Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,c Research Department , Angered Hospital , Gothenburg , Sweden
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Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. MATERNAL AND CHILD NUTRITION 2018; 14:e12617. [PMID: 29770565 PMCID: PMC6175423 DOI: 10.1111/mcn.12617] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/03/2018] [Accepted: 03/15/2018] [Indexed: 12/26/2022]
Abstract
Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio-economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors-particularly, poor access to health care and living in rural areas-have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.
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Affiliation(s)
- Ty Beal
- Department of Environmental Science and Policy, Program in International and Community Nutrition, University of California, Davis, Davis, California, USA
| | | | - Aang Sutrisna
- Consultant for Global Alliance for Improved Nutrition (GAIN), Jakarta, Indonesia
| | - Doddy Izwardy
- Direktorat Gizi Masyarakat-Kementerian Kesehatan RI, Jakarta, Indonesia
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Vonaesch P, Tondeur L, Breurec S, Bata P, Nguyen LBL, Frank T, Farra A, Rafaï C, Giles-Vernick T, Gody JC, Gouandjika-Vasilache I, Sansonetti P, Vray M. Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA). PLoS One 2017; 12:e0182363. [PMID: 28796794 PMCID: PMC5552116 DOI: 10.1371/journal.pone.0182363] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022] Open
Abstract
Stunting remains a major public health concern worldwide. Although its global prevalence is slowly decreasing, the actual number of affected children is still rising in Sub-Saharan Africa. In the Central African Republic (CAR), about one third of all children below the age of five are stunted. Stunting is correlated with many long-term consequences, including poor cognitive development and a higher rate of morbidity and mortality, making stunting a major contributor to poverty. In CAR, little is known about the factors that contribute to stunting. This study aimed at analysing, in a cross-sectional study, the main factors associated with stunting in a group of 414 children recruited between December 2011 and November 2013, aged five years or less and living in Bangui. For all children, demographic, socio-economic and anthropometric data were recorded and asymptomatic enteropathogen carriage was assessed in stool samples using classical microbiological assays. The study group had a mean age of 14.2±10 months. Fifty-eight percent (292/414) were boys, and 36 percent (148/414) exhibited stunted growth. Of the stunted children, 51% (75/148) showed a moderate delay in linear growth for their age group [height-for-age z-score (HAZ) between -2 and -3 SD] while 49% (73/148) presented a severe delay (HAZ < -3). Factors significantly associated with stunting included gender (aOR: 1.67; 95% CI: 1.07; 2.62 for boys compared to girls) and age (aOR of 3.98 (95% CI: 2.45; 6.46) for toddlers and aOR 4.42 (95% CI: 2.36; 8.28) for children compared to infants). Most importantly, we identified being overweight [weight-for-height z-score (WHZ) > 2 SD; aOR: 3.21; 95% CI: 1.50; 6.90 of overweight compared to normal weight] as also being significantly associated with stunting. This is the first study showing that even in the poorest countries of the world there is an association of stunting with being overweight.
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Affiliation(s)
- Pascale Vonaesch
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | - Laura Tondeur
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | - Sébastien Breurec
- Laboratoire de Microbiologie Clinique et Environnementale, Centre Hospitalo-Universitaire, Pointe-à-Pitre/Les Abymes, Guadeloupe, France
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
- Université des Antilles, Faculté de Médecine, Pointe-aà-Pitre, Guadeloupe, France
| | - Petula Bata
- Complexe Pédiatrique de Bangui, Bangui, République Centrafricaine
| | - Liem Binh Luong Nguyen
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Thierry Frank
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Alain Farra
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Clotaire Rafaï
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Tamara Giles-Vernick
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | | | | | - Philippe Sansonetti
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
| | - Muriel Vray
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
- Unité d’épidémiologie des maladies infectieuses, Institut Pasteur de Dakar, Dakar, Sénégal
- * E-mail:
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24
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Hoffman DJ, Campos-Ponce M, Taddei CR, Doak CM. Microbiome, growth retardation and metabolism: are they related? Ann Hum Biol 2017; 44:201-207. [PMID: 27927018 DOI: 10.1080/03014460.2016.1267261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Despite an improvement in food security and the delivery of nutritional supplements to children living in impoverished parts of the world, poor growth is still highly prevalent. Given that the microbiome is related to both nutrient absorption, as well as overweight/obesity, it may play a central role in limiting or modifying normal growth processes while contributing to chronic disease risks. OBJECTIVE The objective of this paper is to describe normal growth processes, the role of the microbiome in supporting or disrupting normal growth processes, and its potential impact on long-term health. METHODS A literature search of relevant human and laboratory research on growth, microbiome and the relationship between poor growth and chronic diseases was conducted. This review focuses on potential mechanisms that implicate the microbiome as a mediator of poor growth and later metabolic outcomes. In this relationship, attention was given to the potential for gastrointestinal infections to disrupt the microbiome. RESULTS Based on the studies reviewed, it is clear that exposure to infections disturbs both intestinal functioning as well as normal growth and changes in the microbiome may influence micronutrient availability and metabolic processes. CONCLUSIONS The microbiome may play a significant role in limiting human growth, but little is known about changes in the microbiome during periods of undernutrition. Thus, it is of great scientific and public health importance to improve the understanding of how the microbiome changes during nutrient deprivation. To best address the issue of the double burden and poor growth in low-income countries, research is warranted to advance the knowledge of the long-term role of the microbiome in the health of children exposed to undernutrition.
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Affiliation(s)
- Daniel J Hoffman
- a Department of Nutritional Sciences and the New Jersey Institute for Food, Nutrition, and Health , Rutgers, the State University of New Jersey , New Brunswick , NJ , USA
| | - Maiza Campos-Ponce
- b Department of Health Sciences , VU University , Amsterdam , The Netherlands
| | - Carla R Taddei
- c Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences , University of São Paulo , São Paulo, SP , Brazil.,d School of Arts, Science and Humanities , University of São Paulo , São Paulo, SP , Brazil
| | - Colleen M Doak
- b Department of Health Sciences , VU University , Amsterdam , The Netherlands
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25
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Rachmi CN, Agho KE, Li M, Baur LA. Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence? Int J Public Health 2016; 62:153-162. [PMID: 27704160 DOI: 10.1007/s00038-016-0905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence. METHODS A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9 years. Stunting (HAZ < -2), thinness (BMIZ < -2), and overweight/obesity (BMIZ > +1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents. RESULTS 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P < 0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure. CONCLUSIONS We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.
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Affiliation(s)
- Cut Novianti Rachmi
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead (University of Sydney Clinical School), Sydney, Australia.
| | | | - Mu Li
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Louise Alison Baur
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead (University of Sydney Clinical School), Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
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