Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors

Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother-child pairs in India: Findings from a nationally representative survey (NFHS-5)

Introduction

Improper consumption of food leads to various forms of malnutrition such as undernutrition, overnutrition and micronutrient deficiency. The coexistence of various malnutrition forms in the same household is a public health concern in developing countries. Very little research has been done on exploring the burden and risk factors associated with double (DBM) and triple burden of malnutrition (TBM).

Methods

Secondary analysis was done using data from India's National Family Health Survey-5 (NFHS-5), 2019-21. Mothers and under-five children were paired at the household level as a unit of analysis. DBM and TBM were interpreted from children's height-for-age, weight-for-height, weight-for-age and anaemia status and mothers' body-mass-index. Stratification and clustering in the sample design were accounted for during the analysis in STATA v14.2. DBM and TBM were summarized as weighted proportions with 95 % confidence interval (CI) and the risk factors associated were reported as adjusted odds ratio (aOR) with 95%CI using mixed effects logistic regression.

Results

We included 167,380 mother-child pairs for analysis. In India, the prevalence of DBM was 7.7 % (95 % CI: 7.5-7.9 %) and TBM was 5.1 % (5.0-5.3 %) at the household level among mother-child dyads. Mothers' age, age at first birth, educational levels, current breastfeeding habits, mode of delivery, child's age, gender, twin birth, birth weight, geographical region, residence, caste and religion, and wealth index were associated with both DBM and TBM.

Conclusion

Both DBM and TBM are public health concerns in India. Thus, scaling-up of health intervention, effective implementation of nutritional programmes and life-course approach are needed to control malnutrition.

Double burden of malnutrition among women and children in Zimbabwe: a pooled logistic regression and Oaxaca-Blinder decomposition analysis

Background

The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure.

Methods

This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015.

Results

The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women.

Conclusion

The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population.

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: A Comprehensive National Nutrition Survey

BACKGROUND

Limited information on the co-prevalence of undernutrition, micronutrient deficiencies, overnutrition, and abnormal levels of noncommunicable disease biomarkers at the same time in children and adolescents in India hinders efforts to comprehensively address their health.

OBJECTIVES

This study aimed to examine the prevalence and correlates of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among children and adolescents (5-19 y) to inform policies and programs.

METHODS

A total of 17,599 children (5-9 y) and 16,184 adolescents (10-19 y) with available biomarker data from the Comprehensive National Nutrition Survey were included. Malnutrition was defined based on either undernutrition based on anthropometry, overnutrition/abnormal metabolic markers, and anemia/micronutrient deficiency. DBM was defined as the coexistence of any 2 forms of malnutrition. DBM+ was defined as the coexistence of undernutrition and/or micronutrient deficiency along with overnutrition. TBM was defined as having the coexistence of all 3 forms of malnutrition. The prevalence of DBM, DBM+, and TBM was estimated accounting for probabilistic selection. We used mixed-effect binomial regression to determine correlates of DBM/TBM in children and adolescents separately.

RESULTS

The prevalence of DBM, DBM+, and TBM was 50.8%, 37.2%, and 14.4%, respectively, in children and 53.4%, 36.1%, and 12.7%, respectively, in adolescents. The prevalence of DBM+ was significantly higher in children girls than that in boys. In children, being in a disadvantaged caste group, having a lower wealth index, having inadequate diet diversity, having no maternal schooling, and having a recent history of acute illness were associated with DBM. In adolescents, being in a disadvantaged caste group, maternal occupation, and lower paternal age were correlated with DBM. A similar set of variables was associated with TBM in both age groups.

CONCLUSIONS

The prevalence of DBM and TBM is substantial in children and adolescents in India and varies across states. Socioeconomic factors and acute illness were the main correlates for DBM and TBM.

Nutritional status and dietary intake among Nigerian adolescent: a systematic review

INTRODUCTION

The prevailing nutritional conditions and the triple challenge of malnutrition faced by adolescents have adverse consequences for both the present and future generations' health and nutrition. Summarizing the available research on the nutritional status and dietary habits of adolescents in Nigeria is crucial.

OBJECTIVE

This study aims to systematically evaluate available literature on the nutritional status of adolescent aged 10 to 19years in Nigeria.

METHODOLOGY

A systematic search using PRISMA guideline was conducted. Three electronic databases were searched i.e., PubMed, Web of Science and Scopus using specific terms and keywords for online articles published between 2013 and 2023. After applying specified inclusion and exclusion criteria, 51 articles were selected for data extraction, synthesis and quality assessment.

RESULTS

Of the 51 included studies, 78.4% were conducted in the Southern Nigeria, 11.8% in the Northern Nigeria and 9.8% included both regions. The prevalence of overweight ranged between 0.8 and 31% and obesity ranged between 0.1 and 14%. The prevalence of thinness, stunting and underweight ranged between 3 and 31%, 0.4 to 41.6%, 0.3 to 73.3% respectively. The review also identified an inadequate intake of essential nutrients including iron, zinc, calcium, vitamin A, C, D, niacin, thiamin, riboflavin, cobalamin, and folate, with vitamin A deficiency prevalence ranges from 44 to 96%. The dietary patterns were characterized by a high consumption of cereals grains and starchy foods, low animal proteins, fast-food with soft drinks, and limited consumption of fruits and vegetables along with meal skipping.

CONCLUSION

These findings portray a complex picture of the nutritional challenges faced by this demographic group, highlighting both undernutrition and overnutrition, poor eating behaviour and micronutrient deficiency as significant concerns. The review revealed regional disparities in research representation, with a concentration of studies in Southern Nigeria. This highlights the importance of directing research efforts toward the northern regions, where the prevalence of nutritional issues is equally severe, but less studied.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023481095.

Food Acquirability: An Unexplored Component of Food Security?

The key elements, or pillars, of food security are stated as food availability, food access, food utilization, and stability. These food security pillars are often linked to food security interventions at the national, community or household level. However, if the urban 'household' is the unit of interest for any food security intervention, this research asks if a more holistic element, or pillar, is needed. The aim of this research has been to explore the socio-economic aspects of food security/insecurity that we have termed as a result of the research "food acquirability". Through the use of structured questionnaires (n = 120), and analysis of the data derived from local market and supermarket settings in the city of Awka, Nigeria, the concept of food acquirability has emerged and been conceptualized and critiqued. The contribution of this paper is to frame the concept of acquirability with regard to food security in Nigeria in order to develop a better understanding of the factors that impact household urban food security/insecurity and how they can be effectively mitigated. Factors of acquirability that emerged were culture, time poverty, resource availability and cooking skills, and household food preference and meal choice.

Spatial distribution and associated factors of co-occurrence of overweight/obesity and Anemia among women in the reproductive age in sub-Saharan Africa: A multilevel analysis, DHS 2016-2021

BACKGROUND

Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age.

METHODS

Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15-49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15-49 years.

RESULTS

The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9-14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran's I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia.

CONCLUSION AND RECOMMENDATIONS

The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.

Nutrition knowledge and health vulnerability of mothers of pre-school children in north-central, Nigeria

OBJECTIVE

This study explores the contribution of nutrition knowledge to the health status of pre-school children's mothers in Niger State, North-Central, Nigeria.

DESIGN

The study is a descriptive cross-sectional design using a quantitative data collection method.

SETTING/PARTICIPANTS

A multi-stage sampling technique was used to recruit 450 mothers of pre-school children across Niger state, Nigeria. Chi-square and linear regression were used to test the level of statistical significance (at p < 0.05). Socioeconomic and demographic information, anthropometric indices and nutrition knowledge were obtained using semi-structured questionnaires. Feeding patterns were also assessed using a qualitative 7-day dietary recall.

RESULT

The results showed that the majority (63.8%) of the mothers were within 26-35 years, and more than half (51.6%) of the mothers lacked knowledge of a "balanced diet". Fruits, vegetables, and dairy products were the least consumed food group among the mothers (7.1% and 9.1%, respectively). Place of residence, occupation, and method of waste disposal were significantly associated with maternal minimum dietary diversity adequacy (p<0.05). Over half (57.6%) of the mothers were within the normal BMI range, and the mean waist/hip ratio was 0.82± 0.08. Social media/online was the most (36.4%) explored source of nutrition information among the mothers. This study shows no significant association between nutrition knowledge and adequacy of minimum dietary diversity among the mothers of preschool children (p = 0.09, χ2 = 13.682).

CONCLUSION

Dietary diversity among mothers was associated with the socioeconomic status and BMI of the mothers, which were strong determinants of meal quality and health outcomes in Nigeria and other developing countries experiencing food insecurity.

Exploring disparities in malnutrition among under-five children in Nigeria and potential solutions: a scoping review

Introduction

Triple burden of malnutrition in children remains a significant public health issue. This scoping review aims to assess the information on undernutrition, micronutrient deficiencies and the quality of complementary feeding in various regions in Nigeria.

Methods

A literature search was conducted using PubMed and Google Scholar databases from January 1, 2018 to January 31, 2023 to include studies focusing on 0 to 5 years old children in Nigeria, reporting data on nutritional status, nutrient deficiencies, and published in English.

Results

73 out of 1,545 articles were included. Stunting remained alarmingly high ranging from 7.2% (Osun, South West) to 61% (Kaduna, North Central), while wasting varied from 1% (Ibadan, South West) to 29% (FCT Abuja, Central) and underweight from 5.9% (Osun, South West) to 42.6% (Kano, North West) respectively. The overall prevalence of anemia and vitamin A deficiency ranged between 55.2 to 75.1 % and 5.3 to 67.6%, respectively. Low rates of achieving minimum dietary diversity and minimum meal frequency were reported across different states depicting the suboptimal quality of complementary feeding. The prevalence of overweight/obesity ranged from 1.5% (Rivers, South South) to 25.9% (Benue, North Central).

Conclusion

Multiple early childhood malnutrition issues exist with a wide disparity across states in Nigeria, particularly in the Northern region. Targeted nutrition interventions must be implemented to improve the situation.

Mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa

BACKGROUND

Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa.

METHODS

Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother-child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child's undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI).

RESULTS

Higher likelihood of OWOBM-SUWC was found among women aged 45-49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC.

CONCLUSION

Combination of child, maternal, and contextual factors could explain mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.

Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa

OBJECTIVE

Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA.

SETTING

Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed.

DESIGN

A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition.

METHODS

Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15-49 years) and children under five years in the household.

RESULTS

More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition.

CONCLUSION

These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.

Mainstreaming traditional fruits, vegetables and pulses for nutrition, income, and sustainability in sub-Saharan Africa: the case for Kenya and Ethiopia

This study documented existing knowledge on traditional fruits, vegetables and pulses in Kenya and Ethiopia. The aim was to identify neglected and underutilized species with high potential for food security, for their economic value and contribution to sustainable agriculture, based on a literature review and confirmation of existing data by local experts. In order of priority, the top 5 fruit species in Kenya are Tamarindus indica L., Adansonia digitata L., Sclerocarya birrea (A.Rich.) Hochst, Balanites aegyptiaca (L.) Delile, and Ziziphus mauritiana Lam., for vegetables are Amaranthus spp., Vigna unguiculata (L.) Walp., Solanum spp., and Cleome gynandra L. Top fruits in Ethiopia are Balanites aegyptiaca (L.) Delile, Ziziphus spina-christi (L.) Desf., Cordeauxia edulis Hemsl., Cordia africana Lam., and Mimusops kummel A. DC., for vegetables are Brassica carinata A. Braun, Cucurbita pepo L., and Amaranthus spp. In both countries, priority pulse species (no ranking) are Phaseolus lunatus L., Sphenostylis stenocarpa (A.Rich.) Harms, Mucuna pruriens (L.) DC., Lablab purpureus (L.) Sweet, and Cajanus cajan (L.) Millsp. Generally, these priority species are good sources of key nutrients known for their inadequate dietary intakes in sub-Saharan Africa, represent a safety net for household income, and contribute positively to ecosystem resilience in existing agricultural systems. Complete, accurate and reliable nutrient composition data are needed to raise consumer awareness about their nutritional and health benefits. Since women play a central role in traditional food systems, their empowerment, and hence resilience, increase the positive impact they can have on the households' dietary diversity. In particular, introducing small-scale processing techniques and marketing strategies could enhance their supply and consumption.

Prevalence and factors associated with the coexistence of overweight/obesity and anaemia among women of reproductive age in Guinea

OBJECTIVE

To determine the prevalence and associated factors of the coexistence of overweight or obesity (OWOB) and anaemia among non-pregnant Guinean women aged 15-49 years.

DESIGN

The analysis was performed using data from the 2018 Guinean Demographic and Health Survey. Multivariate logistic regression was used to identify factors associated with the coexistence of OWOB and anaemia (OWOB + anaemia) among non-pregnant Guinean women.

SETTING

Guinea.

PARTICIPANTS

A total of 4783 non-pregnant women aged 15-49 years with valid data on the nutritional status (BMI and Hb level) were included in the analysis.

RESULTS

The prevalence of coexistence of OWOB and anaemia among non-pregnant women was 11·16 % (95% CI: 10·05, 12·37). The following variables were associated with OWOB + anaemia in multivariate models (adjusted OR (AOR) 95% CI): higher wealth index (AOR = 4·69; 95% CI: 2·62, 8·39), middle wealth index (AOR = 1·96; 95% CI: 1·31, 2·93), four or more antenatal visits (AOR = 1·62; CI: 1·16, 2·28), having four or more children (AOR = 2·47; 95% CI: 1·37, 4·43) and the rural areas (AOR = 0·59; 95% CI: 0·37, 0·95).

CONCLUSION

The current study's findings reveal that OWOB + anaemia concerned one-tenth of non-pregnant women. Associated factors were household wealth index, multiparity, antenatal visits and rural areas. Thus, there is a need to design specific interventions to prevent the double burden of malnutrition among women of reproductive age. Interventions should include promoting physical exercise, family planning, healthy eating and raising awareness of behavioural change.

A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys

BACKGROUND

Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia.

METHODS

We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics.

RESULTS

Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds.

CONCLUSION

TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.

Pollinator-dependent crops significantly contribute to diets and reduce household nutrient deficiencies in sub-Saharan Africa

Recent literature highlights the potential of animal pollinator-dependent (PD) crops in enhancing food and nutrition security, although there is a lack of detailed household-level estimates. In this study, we investigate the nutrient composition, productivity, and contribution of PD and pollinator-independent (PI) crops to household nutrition in four sub-Saharan African (SSA) countries. We also evaluate the impact of reallocating resources from PI crops to PD crops on nutrient deficiencies, utilizing nationally representative panel data from three waves and over 30,000 household-year observations. Our findings reveal that PD crops exhibit higher micronutrient content per unit, albeit with lower macronutrient content compared to PI crops. PI crops have higher yield of calories per hectare while PD crops have higher vitamin A yield per hectare. However, protein and iron yield for PD and PI crops varies across countries. PI crops predominantly contribute to macronutrients and iron, while PD crops significantly contribute to vitamin A production. Our econometric results demonstrate that increasing the cultivation of PD crops relative to PI crops reduces the prevalence of nutrient deficiencies and increases crop income without compromising macronutrients production. This suggests that greater investment in PD crop production can be an integral approach to achieving nutrition security in SSA.

Exploring the double burden of malnutrition at the household level in the Philippines: Analysis of National Nutrition Survey data

BACKGROUND

In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking.

METHODS

Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM.

RESULTS

The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age.

CONCLUSIONS

The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.

Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and determinants of the triple burden of malnutrition among mother-child pairs in low-income and middle-income countries.

DESIGN

Cross-sectional study.

SETTING

Low-income and middle-income countries.

PARTICIPANTS

Women and children.

PRIMARY OUTCOME

Triple burden of malnutrition (overweight/obese mother with undernourished and anaemic under 5 years child).

METHODS

Data for this study were drawn from recent 22 low-income and middle-income countries Demographic and Health Surveys. A total weighted sample of 116 795 mother-child pairs was included in the study. STATA V.14.2 was used to clean, code and analyse the data. Multilevel logistic regression was employed to identify factors associated with the problem. Adjusted OR (AOR) with 95% CI and a p<0.05 was reported to indicate statistical association. Model fitness and comparison were done using intraclass correlation coefficient, median OR, proportional change in variance and deviance.

RESULT

The pooled prevalence of the triple burden of malnutrition among mother-child pairs was 11.39%. It showed statistically significant positive associations with mothers aged ≥35 years (AOR 2.25, 95% CI 2.08 to 2.44), family size >10 (AOR 1.17, 95% CI 1.08 to 1.26), delivery by caesarean section (AOR 1.93, 95% CI 1.83 to 2.03), the richest household (AOR 1.72, 95% CI 1.56 to 1.88), grand multiparous (AOR 1.62, 95% CI 1.46 to 1.81), age of child 36-47 months (AOR 1.77, 95% CI 1.64 to 1.90), at a p<0.05. Whereas breast feeding (AOR 0.94, 95% CI 0.89 to 0.99), married mothers (AOR 0.87, 95% CI 0.78 to 0.96), female children (AOR 0.88, 95% CI 0.84 to 0.92), improved toilet (AOR 0.23, 95% CI 0.17 to 0.29), improved source of drinking water (AOR 0.28, 95% CI 0.21 to 0.35), rural residents (AOR 0.66, 95% CI 0.62 to 0.69) had a contrasting relationship with the triple burden of malnutrition.

CONCLUSION

About 1 out of 10 households suffer from the triple burden of malnutrition in low-income and middle-income countries. This study revealed that several maternal, child, household and community-level factors have a significant impact on the triple burden of malnutrition among mother-child pairs.

Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania

Background

Inadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development.

Objectives

To assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania.

Methods

Early feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6-18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level.

Results

The MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations.

Conclusions

Poor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.

The 'Nigerian Diet' and Its Evolution: Review of the Existing Literature and Household Survey Data

Natural and social science studies have commonly referenced a 'typical' or 'habitual' Nigerian diet, without defining what such a diet entails. Our study, based on a systematic review of the existing literature and an analysis of household-level survey data, describes the general outline of a common Nigerian diet and how it varies based on spatial, demographic, and socio-economic characteristics. We further try to establish whether Nigeria has embarked on a dietary transition common in most modern economies, marked by a greater consumption of processed foods, fats, and sugar at the expense of traditional whole cereals and pulses. We conclude that while a traditional Nigerian diet is still relatively healthy from an international perspective, it has indeed been transitioning, with an increasing inclusion of high-energy, high-fat, and high-sugar processed foods and a related growing incidence of overweight, obesity, and diet-related non-communicable diseases.

Food knowledge level among Tanzanian women of childbearing age: developing a score for the food knowledge questionnaire

Food knowledge (FK) is one of the factors that contribute to malnutrition conditions in developing countries, together with food safety, food security and food access. FK is defined as ‘the competence to understand healthy nutrition concepts’; it impacts individuals’ life due to its relationship with food behaviour and eating habits. Therefore, acting on FK can represent a starting point for improving the health status of vulnerable populations. The authors present a total score of an FK questionnaire (FKQ) and its relation to the socio-demographic characteristics of a specific target population: Tanzanian women of childbearing age. The results of the manuscript complement evidence of construct validity of the FKQ by providing an algorithm to compute a total score as a measure of FK. The strength of this tool, and its score, lies in the fact that the questionnaire has been validated and is easy to administer.

Genome-wide association studies of grain yield and quality traits under optimum and low-nitrogen stress in tropical maize (Zea mays L.)

KEY MESSAGE

Genome-wide association study (GWAS) demonstrated that multiple genomic regions influence grain quality traits under nitrogen-starved soils. Using genomic prediction, genetic gains can be improved through selection for grain quality traits. Soils in sub-Saharan Africa are nitrogen deficient due to low fertilizer use and inadequate soil fertility management practices. This has resulted in a significant yield gap for the major staple crop maize, which is undermining nutritional security and livelihood sustainability across the region. Dissecting the genetic basis of grain protein, starch and oil content under nitrogen-starved soils can increase our understanding of the governing genetic systems and improve the efficacy of future breeding schemes. An association mapping panel of 410 inbred lines and four bi-parental populations were evaluated in field trials in Kenya and South Africa under optimum and low nitrogen conditions and genotyped with 259,798 SNP markers. Genetic correlations demonstrated that these populations may be utilized to select higher performing lines under low nitrogen stress. Furthermore, genotypic, environmental and GxE variations in nitrogen-starved soils were found to be significant for oil content. Broad sense heritabilities ranged from moderate (0.18) to high (0.86). Under low nitrogen stress, GWAS identified 42 SNPs linked to grain quality traits. These significant SNPs were associated with 51 putative candidate genes. Linkage mapping identified multiple QTLs for the grain quality traits. Under low nitrogen conditions, average prediction accuracies across the studied genotypes were higher for oil content (0.78) and lower for grain yield (0.08). Our findings indicate that grain quality traits are polygenic and that using genomic selection in maize breeding can improve genetic gain. Furthermore, the identified genomic regions and SNP markers can be utilized for selection to improve maize grain quality traits.

Simple solutions for complex problems? What is missing in agriculture for nutrition interventions

Within the nutritionism paradigm, in this article we critically review the marketization and medicalization logics which aim to address the pressing issue of malnutrition in low- and middle-income countries. Drawing from political economy and food system transformation discourses, we are using the popular intervention types of nutrition-sensitive value chains (marketization logic) and biofortification exemplified through orange-fleshed sweet potato (medicalization logic) to assess their outcomes and underlying logics. We demonstrate that there is insufficient evidence of the positive impact of these interventions on nutritional outcomes, and that their underlying theories of change and impact logics do not deal with the inherent complexity of nutritional challenges. We show that nutrition-sensitive value chain approaches are unable to leverage or enhance the functioning of value chains to improve nutritional outcomes, especially in light of the disproportionate power of some food companies. We further demonstrate that orange-fleshed sweet potato interventions and biofortification more broadly adopt a narrow approach to malnutrition, disregarding the interactions between food components and broader value chain and food system dynamics. We argue that both intervention types focus solely on increasing the intake of specific nutrients without incorporating their embeddedness in the wider food systems and the relevant political-economic and social relations that influence the production and consumption of food. We conclude that the systemic nature of malnutrition requires to be understood and addressed as part of the food system transformation challenge in order to move towards solving it. To do so, new evaluation frameworks along with new approaches to solutions are necessary that support multiple and diverse development pathways, which are able to acknowledge the social, political-economic, and environmental factors and drivers of malnutrition and poverty.

Sex of household head and other household determinants of childhood anaemia among households in Ghana: regression analysis of the 2019 Malaria Indicator Survey

BACKGROUND

Childhood anaemia is still a major public health concern. Although the prevalence of anaemia among children under age five is reducing in Ghana, the severity level is still worsening. This study sought to examine and compare household factors affecting the anaemia status of children under age five living in male- and female-headed households in Ghana.

METHODS

The study used a weighted sample of 5,799 household heads from the 2019 Ghana Malaria Indicator Survey (GMIS). A binary logistic regression analysis was used to examine the effect of sex of household heads and other household factors on the anaemia status of children under the age of five in male- and female-headed households in Ghana. All analyses were conducted at the 95% confidence level.

RESULTS

The results showed that a higher proportion (83.0%) of children under age five are not anaemic in households in Ghana. However, the probability of a child being anaemic is higher in male-headed households (aOR = 1.28; C.I:1.08-1.51), in the poorest (aOR = 2.41; CI: 1.59-3.65), poorer (aOR = 2.04; C.I:1.41-2.94) and middle (aOR = 1.78; C.I:1.29-2.46) household wealth category. Higher likelihood of anaemia was found among children in households that used charcoal (aOR = 1.51; C.I:1.15-1.99) and fuelwood (aOR = 1.44; C.I:1.02-2.02) for cooking. Similarly, there is a high probability of childhood anaemia in households with 5-10 members (aOR = 4.49; C.I: 3.78-5.34), 11 or more members (aOR = 7.21; C.I: 4.60-11.31) and household residing in northern part of Ghana (aOR = 1.40; C.I:1.07-1.83). The lower odds of being anaemic were recorded among children whose household heads were aged 40 years and older, household using other cooking fuels (aOR = 0.49; C.I: 0.21-0.78) and household with no bednets (aOR = 0.57; C.I: 0.44-0.74).

CONCLUSIONS

The GMIS data suggest that anaemia and its severity are higher among children living in MHH than among those living in FHH. The results indicate that poverty, a higher number of household members, relatively younger male household heads and the type of cooking fuel used were factors accounting for the differences in childhood anaemia in MHH and FHH. Equal attention should be given to MHH and FHH in terms of programmes and interventions aimed towards preventing and reducing childhood anaemia in Ghana.

Increasing pulse agrobiodiversity to improve food security and sustainable agriculture in Sub-Saharan Africa

Long-life cycle pulses have significant food security potential, however, there is little evidence to explain why they are not more widely produced and consumed in sub-Saharan Africa (SSA). This study aimed at exploring existing knowledge to inform on future research priorities in mainstreaming superior species. As staple food along with cereals, pulses are an important source of nutrients whose intake is often inadequate in SSA, however, pulse consumption remain inadequate in SSA. Depending on the crop's life cycle, pulses have multiple functions that can support food systems and ecosystem resilience. Compared to short-life cycle pulses, long-life cycle pulses rank higher in multipurpose role. However, prior research has focused primarily on short-life cycle pulses due to rapid grain production. Long-life cycle pulses remain underutilized and neglected despite showing steady but modest yield increases and adaptation to environments, suggesting that they are better positioned to respond to the diverse needs of smallholder farmers in SSA. In the context of climate change, rain-fed agriculture, depleted agricultural soils, and lack of subsidized fertilizers, there is need to transform existing food systems toward sustainable food production and improved resilience. Increasing pulse agrobiodiversity by integrating long-life cycle pulses in existing farming systems could not only contribute in alleviating malnutrition, but also poverty and inequalities. In addition, representative and accurate data are needed based on the correct use of accepted scientific names for all data across the food system. This is a prerequisite for assessing pulse consumption adequacy and quantifying production and consumption trends.

Anthropometrics, Hemoglobin Status and Dietary Micronutrient Intake among Tanzanian and Mozambican Pigeon Pea Farmers

Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.

Intra‐household double burden of overweight/obesity and anaemia: Evidence from 49 low‐and middle‐income countries

Globally, overweight/obesity is rising rapidly while anaemia persists. Nevertheless, evidence on their coexistence at the household level remains limited. Using data from the Demographic and Health Surveys, we quantified the magnitude, distribution and inequalities (i.e., estimates by wealth, education level and residence) in the intra‐household double burden (DBM) of overweight/obesity and anaemia among mothers and their children living in 49 low‐ and middle‐income countries (LMICs). The pooled prevalence of total intra‐household DBM was 17.2% (95% confidence interval [CI]: 15.6, 18.8); 16.2% (95% CI: 14.6, 17.9) for mothers with overweight/obesity and children with anaemia; and 2.8% (95% CI: 2.5, 3.1) for mothers with anaemia and children with overweight/obesity. South Africa had the highest prevalence of total DBM at the household level, affecting almost one in three households. Households with mothers with overweight/obesity and children with anaemia followed an inverse social gradient, with higher estimates found in the richest quintile, highest maternal education level and in urban areas; although with some variation across regions. The opposite was observed for mothers with anaemia and children with overweight/obesity. The largest inequality gaps were found for mothers with overweight/obesity and children with anaemia in Togo by household wealth (29.3%‐points; p < 0.001), in Ghana by maternal education level (28.0%‐points; p = 0.001) and in Niger by area of residence (25.2%‐points; p < 0.001). Although double‐duty actions might help accelerate action towards reducing malnutrition in all its forms, a comprehensive assessment of the causes of anaemia is first warranted to design effective country‐specific programmes.

Using anthropometric and anaemia data from 49 low‐ and middle‐income countries, we found an overall pooled prevalence of total intra‐household double burden of malnutrition of 17.2%, with South Africa bearing the highest burden.

The prevalence of mothers with overweight/obesity and children with anaemia ranged from 3.1% (Ethiopia) to 42.2% (South Africa), and was higher in the richest quintile, highest maternal education level and in urban areas.

Mothers with anaemia and children with overweight/obesity was low (<9.0% in all countries).

Food systems and rural wellbeing: challenges and opportunities

The future wellbeing of billions of rural people is interconnected with transforming food systems for equity, nutrition, environmental sustainability, and resilience. This article tackles three blind spots in the understanding of rural poverty and vulnerability: the narrow focus on extreme poverty and hunger that hides a much wider set of inequalities and vulnerabilities, insufficient recognition of the diversity of rural households, and an inadequate appreciation of the impact of rapid structural changes in markets, the physical environment, and the political economic context. A better understanding of these areas is necessary for imagining a new policy landscape that can align progress on rural poverty alleviation with a wider transformation of food systems. The article provides a framework for assessing the dynamics of rural wellbeing and food systems change. It looks at the viability of small-scale farming and the diversification of livelihood options needed to overcome rural poverty and inequality. The analysis suggests that the future prosperity of rural areas will depend on policy reforms to address market failures in the food system, which currently work against equity, good nutrition and sustainability. Investments will also be needed to enable rural economies to capture greater value from the food system, particularly in the midstream of food distribution, processing and services. The likely future scale and nature of rural poverty and inequality is such that improved social protection and humanitarian relief schemes that support those in crisis or being left behind will still be essential.