Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: a multi-country analysis

Predictors of Stunting and Pathway Analysis for Linear Growth among Children Aged Two to Three Years after a Trial of Small-Quantity Lipid-Based Nutrient Supplements and Home-Installed Growth Charts in Three Districts in Zambia

BACKGROUND

Globally, 148 million children aged <5 y are stunted, with risk factors varying by context. Our "Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia" (ZamCharts) trial observed persistently high rates of stunting in all treatment groups after 18-mo of intervention with monthly distributions of small-quantity lipid-based nutrient supplements (SQ-LNS) and/or installation of a wall-mounted growth chart in children's homes.

OBJECTIVES

We sought to identify determinants of stunting and height-for-age z-score in children aged 27-36 mo who participated in the ZamCharts endline survey (n = 1911).

METHODS

Multilevel, log-binomial models were used to estimate univariable and multivariable prevalence ratios for predictors of stunting. Multilevel models were also used to predict height-for-age z-score (HAZ) with and without baseline HAZ (assessed at ages 211 mo). We also conducted a path analysis using covariance analysis of linear structural equations to assess underlying and modifiable risk factors for impaired linear growth.

RESULTS

Significant predictors of stunting in the multivariable model included low asset ownership, being male, using biomass as cooking fuel, lower maternal height, a mother with ≤ primary education, lower baseline HAZ, and not being randomly assigned to SQ-LNS. Significant predictors of a lower mean HAZ in the full multivariable models included all the same risk factors that predicted stunting but also living in an urban area, having ≥1 child aged <5 y in the household, and diarrhea in the previous 2 wk. The multivariable model explained 48% of variability in endline HAZ; the strongest predictor was baseline HAZ, which explained 29% of endline HAZ variability in the univariable model.

CONCLUSIONS

Preventing stunting in Zambia will require investments in early life (pre- and postnatal) determinants of growth trajectory as well as improving complementary feeding practices and addressing risk factors for infectious diseases; SQ-LNS can also improve linear growth and reduce stunting.

Analysing the drivers of stunting reduction in twelve sub-saharan African countries using the RIF decomposition approach

BACKGROUND

This study examines how significant is the changes in child stunting in Sub-Saharan African countries (SSA). Then, it investigates factors that contributed to the reduction in child stunting in those countries. For each country, we distinguish the contribution of compositional effects and structural effect.

METHODS

This paper uses data from Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2000 and 2020. The z-test to compare two independent proportions was used to assess changes in child stunting and explanatory variables over the period. Recentred influence function (RIF) decomposition method was used to decompose changes in stunting over the year in each country, and to determine the contribution of each variable to the changes.

RESULTS

The prevalence of child stunting declines significantly in 11 countries over the year. The decline varies from 6.8% in Cameroun to 19% in Mali. The average year of education of the child's mother and father, and the proportion of households with access to an improved drinking water source have contributed to the reduction in child stunting. This result was found in all the countries. Improvements in living standards, child vaccination, antenatal care attendance, delivery to health care centres, maternal education, improved drinking water sources, and improved sanitation make the largest contribution to the composition component, hence reducing child stunting.

CONCLUSIONS

This study sheds light on what has contributed to the achieved improvement in child nutritional status and suggests how to possibly accelerate the reduction in undernutrition in countries that lag.

Sustainable aquatic food systems: Multisectoral analysis of determinants of child nutrition in coastal Kenya

Marine foods produced by small-scale fishers can make vital contributions to sustainable, healthy food systems with multisectoral considerations of public health nutrition, gender equity, economics, and marine ecology. This pilot study aimed to map the multidimensional determinants of fish food security and young child nutrition in four coastal communities of Kenya with a view toward designing a large intervention trial. We compared anthropometric and dietary diversity indicators of children under 5 years in fishing vs. non-fishing households. Mixed methods included household surveys, 24-h recalls for dietary intake, and anthropometric measures of children. Child dietary diversity score (CDDS) and height-for-age Z (HAZ) were primary outcomes tested in ordinary least square regression modeling. Stunting was widely prevalent (20.2%), as were morbidities for acute diarrhea (29.0%) and fever (46.5%), with no statistically significant differences in fishing compared to non-fishing households. High proportions of children showed nutrient intake inadequacies for vitamins A, C, and E, iron and zinc; &lt;50% met requirements for all nutrients except protein, which was derived primarily from plant-based foods. Regression modeling showed children living in fishing households were associated with lower CDDS. Maternal education, maternal body mass index (BMI), and household livelihood diversity were positively associated with both CDDS and HAZ, while child morbidities and north coast (of Mombasa) residence showed negative associations. Our findings highlight nutritional vulnerabilities within a coastal food system of Kenya and the need to involve multiple sectors—education, environment, health, finance, communications, and governance and policy—in deriving solutions.

Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review

Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa.

Basic determinants of child linear growth outcomes in sub-Saharan Africa: a cross-sectional survey analysis of positive deviants in poor households

Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0–59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child’s height-for-age Z-scores (HAZ), categorised into HAZ > − 2 standard deviations (SD) (not stunted) and HAZ < − 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive effect on better linear growth, while in Nigeria, healthy maternal body mass index (kg/m²) had a positive effect on child's linear growth. The putative socio-demographic determinants investigated in our study can promote the linear growth of children living in poor households. Interventions aimed at fostering linear growth among children living in poverty should focus on enhancing these factors.

Does maternal empowerment improve dietary diversity of children? Evidence from Pakistan demographic and health survey 2017-18

The role of maternal empowerment (ME) to improve child nutrition in patriarchal societies of developing countries remains ambiguous. This study provides empirical evidence about the impact of ME and some other factors selected under United Nations International Children's Emergency Fund theoretical framework, on dietary diversity of children (under 5 years age) in Pakistan. Partial proportional odds model is estimated to obtain varying estimates of the parameters by using data of Pakistan Demographic and Health Survey 2017-18. Significant positive role of empowered mothers to improve child dietary diversity (CDD) is explored (OR = 1.135; Confidence Interval [CI] = 1.001-1.288). Moreover, positive association of maternal higher education on CDD (OR = 1.329; 95% CI = 1.085-1.628) supports the productive and allocative efficiency hypotheses of health economics. Maternal agricultural employment, paternal education, and paternal employment were not significantly associated with CDD. This requires further exploration. Positive association of household socioeconomic status with CDD (OR = 1.768; 95% CI = 1.314-2.380) and significance of some demographic variables call for social welfare programs. Positive association of mother's age and CDD demands for amendment in Child Marriage Restraint Act. The observed adverse association of family size with CDD induces effective family planning to control high birth rate in Pakistan. It may be concluded that ME and creation of awareness about nutrition security through maternal education are the important factors to overcome child malnutrition in Pakistan. Since, socioeconomic and cultural environment in South Asian countries is homogeneous, the analysis in this study might be relevant to the South Asian region. Moreover, the study provides evidence informing the debate on the role of ME to improve child nutrition in patriarchal societies.

Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya: A Latent Class Analysis

Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women’s dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.

Improvement of Dietary Diversity and Attitude toward Recommended Feeding through Novel Community Based Nutritional Education Program in Coastal Kenya-An Intervention Study

Community-based nutritional intervention to improve the practice of dietary diversity and child nutrition by community health workers (CHWs) involving Nyumba Kumi as small neighborhood units (SNUs) in communities has not yet been explored. This study was conducted in two villages in rural Kenya between 2018 and 2019. In total, 662 participants (control vs. intervention: n = 339 vs. n = 323) were recruited. The intervention group received education on maternal and child nutrition and follow-up consultations. The custom-tailored educational guidelines were made based on Infant and Young Child Feeding and the mother and child health booklet. The educational effects on household caregivers’ feeding practice attitude and child nutritional status were analyzed using multiple linear regression. After the intervention, a total of 368 household caregivers (187 vs. 181) and 180 children (113 vs. 67) were analyzed separately. Between the groups, no significant difference was found in their background characteristics. This study successfully improved the dietary diversity score (β = 0.54; p < 0.01) and attitude score (β = 0.29; p < 0.01). The results revealed that the interventions using CHWs and SNUs were useful to improve dietary diversity and caregivers’ attitudes toward recommended feeding. This research has the potential to be successfully applied in other regions where child undernutrition remains.

Spatial heterogeneity and factors influencing stunting and severe stunting among under-5 children in Ethiopia: spatial and multilevel analysis

Stunting remains a major public health concern in Ethiopia. Government needs to reshape and redesign new interventions to reduce stunting among under-five children. Hence, this study identified the problem according to location and risk factor. This study is a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey. A total of 9588 children aged 0-59 months were included in the study. The spatial and multilevel logistic regression analyses were used to explore spatial heterogeneity and identify individual- and household-level factors associated with stunting and severe stunting. Spatial heterogeneity of stunting and severe stunting was seen across the study setting. Male children (AOR = 1.51, CI 1.16, 1.96); multiple births (AOR = 27.6, CI 10.73, 71.18); older children (AOR = 1.04, CI 1.01, 1.05) and anemic children (AOR = 3.21, CI 2.3, 4.49) were severely stunted at individual-level factors. Children from educated and malnourished mothers (respectively, AOR = 0.18, CI 0.05, 0.71; AOR = 5.35, CI 3.45, 8.32), and from less wealthier mothers (AOR = 5.95, CI 2.58, 13.69) were severely stunted at household-level factors. Giving priority to the hotspot areas of stunting and older and anemic children, multiple births, and maternal undernutrition is important to reduce stunting. Studies are recommended to fill the gaps of this study.

Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana

BACKGROUND

Under-five malnutrition is a major public health issue contributing to mortality and morbidity, especially in developing countries like Ghana where the rates remain unacceptably high. Identification of critical risk factors of under-five malnutrition using appropriate and advanced statistical methods can help formulate appropriate health programmes and policies aimed at achieving the United Nations SDG Goal 2 target 2. This study attempts to develop a simultaneous quantile regression, an in-depth statistical model to identify critical risk factors of under-five severe chronic malnutrition (severe stunting).

METHODS

Based on the nationally representative data from the 2014 Ghana Demographic and Health Survey, height-for-age z-score (HAZ) was estimated. Multivariable simultaneous quantile regression modelling was employed to identify critical risk factors for severe stunting based on HAZ (a measure of chronic malnutrition in populations). Quantiles of HAZ with focus on severe stunting were modelled and the impact of the risk factors determined. Significant test of the difference between slopes at different selected quantiles of severe stunting and other quantiles were performed. A quantile regression plots of slopes were developed to visually examine the impact of the risk factors across these quantiles.

RESULTS

Data on a total of 2716 children were analysed out of which 144 (5.3%) were severely stunted. The models identified child level factors such as type of birth, sex, age, place of delivery and size at birth as significant risk factors of under-five severe stunting. Maternal and household level factors identified as significant predictors of under-five severe stunting were maternal age and education, maternal national health insurance status, household wealth status, and number of children under-five in households. Highly significant differences exist in the slopes between 0.1 and 0.9 quantiles. The quantile regression plots for the selected quantiles from 0.1 to 0.9 showed substantial differences in the impact of the covariates across the quantiles of HAZ considered.

CONCLUSION

Critical risk factors that can aid formulation of child nutrition and health policies and interventions that will improve child nutritional outcomes and survival were identified. Modelling under-five severe stunting using multivariable simultaneous quantile regression models could be beneficial to addressing the under-five severe stunting.

Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data

Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance.

Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data

This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects.

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.

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.

Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa

OBJECTIVE

To investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries.

DESIGN

Secondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m²), normal weight (18.50-24.99 kg/m²), overweight (25.0-29.9 kg/m²) and obesity (≥30.0 kg/m²).

SETTINGS

Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).

SUBJECTS

Women aged 15-49 years (n=64698).

RESULTS

Compared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight.

CONCLUSIONS

Our analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates.

Energy and nutrient production in Ethiopia, 2011-2015: Implications to supporting healthy diets and food systems

Agricultural sector plays a key role towards achieving healthier diets that are deemed critical for improving health and nutritional outcomes. To what extent the current food supply systems support healthy diets remains unknown. Using annual and nationally representative data on crop and livestock production in Ethiopia, we assess the national agricultural sector from a nutrition lens and its role in supporting healthy diets in the country. We do so by converting the agricultural production into energy and nutrients for the period of 2011–2015. These data show that the national food production has increased dramatically over the 5-year period to supply more than 3,000 calories per capita in 2015. Moreover, nutrient production gaps have substantially decreased (2011–15), but deficits in energy (5%), vitamin C (16%), and calcium (9%) production remained in 2015. However, this production growth–coming primarily from the cereal sector and at the expense of other food groups–led to a decrease in production diversity as reflected by a drop in the Shannon index between 2011 and 2015. Together these findings imply that the production increases in Ethiopia would need to be sustained to feed the rapidly growing population but more emphasis should be given to diversification to support healthy and nutritionally diversified diets.

Quantile regression analysis of modifiable and non-modifiable drivers' of blood pressure among urban and rural women in Ghana

High blood pressure is an increasingly problematic public health concern in many developing countries due to the associated cardiovascular and renal complications. This study set out to investigate the drivers of blood pressure among urban and rural women using the 2014 Ghana Demographic and Health Survey data. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were the outcomes of interest. Our findings showed that body mass index (BMI) had a significant positive effect on DBP and SBP in both urban and rural settings, with the largest effect occurring among women in the 75^th quantile. Arm circumference also had a positive effect on DBP and SBP across all quantiles in both settings. Age had an increasing positive effect along the entire conditional DBP and SBP distribution in both settings. Women who were pregnant had lower DBP and SBP relative to those who were not pregnant in both settings. These results highlight the important drivers of DBP and SBP, and the differential effects of these drivers on blood pressure (BP) among women in urban and rural settings. To increase their effectiveness, interventions to address high BP should take into account these differential effects.

Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster-randomized trial

Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community-based, open cluster-randomized trial, 511 mother/children dyads aged 6-8 months were enrolled to an intervention (n = 263) or control (n = 248) group. The primary outcome was change in length-for-age z-score at age 20-24 months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length-for-age z-score at 20-24 months between the 2 study groups: 0.10, 95% CI [-0.17, 0.36], p = .49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III, the mean difference being 15.6, 95% CI [10.9, 20.2], p = .0001; 9.9, 95% CI [6.4, 13.2], p = .0001; and 14.6, 95% CI [10.9, 18.2], p = .0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p = .001; 5.9, 95% CI [1.2, 10.3], p = .01; 4.2, 95% CI [1.7, 6.7], p = .001; 8.9, 95% CI [5.3, 12.3], p = .0001; and 4.4, 95% CI [0.0, 8.8], p = .05, for communication, gross motor, fine motor, problem solving, and personal-social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at ClinicalTrials.gov as NCT02098031.

Dietary diversity and anthropometric status and failure among infants and young children in Sri Lanka

OBJECTIVES

We investigate the association between child dietary diversity and anthropometric status and failure in Sri Lanka while accounting for other child and household factors by employing multivariable logistic and linear regression analyses.

METHODS

Using a nationally representative survey of children ages 6 mo to 59 mo, child dietary diversity was based on the 24-h recall of a child's food intake across seven food groups. The minimum dietary diversity was a score of four or above. Anthropometric status (i.e., height for age (HAZ), weight for age, and weight for height z-scores) and failure (i.e., stunting, wasting, and underweight) were calculated.

RESULTS

The prevalence of stunting, wasting, and underweight was 15%, 21%, and 26%, respectively. The prevalence of inadequate dietary diversity was 9%. Child dietary diversity was positively associated with HAZ (b = 0.02; standard error = 0.01; P = 0.04) but not with any indicator of anthropometric failure. However, low birth weight, wealth, and location were strong risk factors for anthropometric status and failure. Analyses stratified by child age indicated that dietary diversity was positively associated with anthropometric status for children ages 24 mo to 59 mo (HAZ: b = 0.03; standard error = 0.01; P = 0.02). Mixed associations were found for children ages 6 mo to 12 mo and there were no associations for children ages 12 mo to 24 mo.

CONCLUSIONS

Child dietary diversity predicted anthropometric status among children ages ≥24 mo. Interventions to address both proximal and distal risk factors for anthropometric status may be necessary in Sri Lanka to reduce anthropometric failure among infants and young children.

Temporal changes and determinants of childhood nutritional status in Kenya and Zambia

BACKGROUND

The prevalence of undernutrition is decreasing in many parts of the developing world, but challenges remain in many countries. The objective of this study was to determine factors influencing childhood nutrition status in Kenya and Zambia. The objective of this study is to determine factors associated with temporal changes in childhood nutritional status in two countries in sub-Saharan Africa.

METHODS

Data from national demographic and health surveys from the World Bank for Kenya (1998-2009) and Zambia (1996-2014) were used to select the youngest child of each household with complete data for all variables studied. Multiple linear regression analyses were used for data from 2902 and 11,335 children from Kenya and Zambia, respectively, in each year to determine the relationship between social and economic factors and measures of nutritional status, including wasting, stunting, and overweight.

RESULTS

There was a decreased prevalence of stunting (35% in Kenya and 40% in Zambia), while the prevalence of wasting was unchanged (6-8% in both countries). From 1998 to 2009, there was a protective effect against stunting for wealthier families and households with electricity, for both countries. Finally, better educated mothers were less likely to have stunted children and girls were less likely to be stunted than boys.

CONCLUSIONS

Based on the data analyzed, there was a higher risk of stunting in both Kenya and Zambia, for those with lower literacy, less education, no electricity, living in rural areas, no formal toilet, no car ownership, and those with an overall lower wealth index. Improving the education of mothers was also a significant determinant in improving the nutritional status of children in Kenya and Zambia. More broad-based efforts to reduce the prevalence of undernutrition need to focus on reducing the prevalence of undernutrition without promoting excess weight gain. Future economic advances need to consider integrated approaches to improving economic standings of households without increasing the risk for overnutrition.