Low dietary diversity is a predictor of child stunting in rural Bangladesh

Socioeconomic Patterning of Stunting and Overweight Among Iranian Children Aged 2-5 Years: A National Cross-Sectional Analysis

Background/Objectives: Evidence indicates a high prevalence of stunting and overweight among Iranian children. This study explores their socioeconomic patterning and the mediating role of nutrition adequacy. Methods: The data were derived from the most recent 2017 Demography and Health Survey and the Multiple Indicator Cluster Survey, which were conducted in Iran. Children aged between 2 and 5 years were selected for the study through a two-stage random sampling process (n = 11,147). The probability of stunting and overweight was modeled using logistic regression. Parental education, occupation, and living conditions (areas, rooms, and assets of the household) were explanatory variables, with the diet diversity score (DDS) as a mediator. Analyses were adjusted for age and sex. Results: Children had over 1.7 times higher odds of stunting with a primary-educated father [95% CI: 1.13-2.62] and twice the odds with an illiterate mother [95% CI: 1.30-3.30]. The risk of stunting was almost 1.5 higher in children living in smaller houses [95% CI: 1.12-2.04]. Finally, a significant association was observed between low asset ownership and stunting [OR = 2.01; 95% CI: 1.23-3.27]. The results showed no significant relationship between socioeconomic factors and children's overweight, indicating that overweight was less socially patterned. Higher DDS was associated with lower stunting and higher overweight prevalence but did not mediate the effects of socioeconomic status. Conclusions: Stunting disproportionately affects children from households with a lower socioeconomic background in Iran. Parental education, area, and assets were key factors, highlighting the need for targeted nutrition education programs.

Association of dietary diversity and odds of anemia in children and adolescents: a systematic review and meta-analysis of observational studies

BACKGROUND

Anemia, characterized by a deficiency in red blood cells or hemoglobin, remains a significant public health concern worldwide, particularly among children and adolescents. Inadequate dietary intake, including micronutrient deficiencies, has been associated with anemia. Dietary diversity, characterized by the consumption of a variety of food groups, may contribute to adequate iron intake and a reduced likelihood of anemia. This systematic review and meta-analysis examined the association between dietary diversity and odds of anemia among children and adolescents.

METHODS

A comprehensive search of electronic databases (PubMed, Web of Science, Scopus) was conducted for observational studies (cross-sectional or case-control) published before April 2024 that assessed the association between dietary diversity and anemia among children and adolescents. The odds of Bias in Non-Randomized Studies of Exposures (ROBINS-E) tool was used to assess the quality of included studies, ensuring a standardized and rigorous evaluation process. Subgroup analyses explored potential variations in this association based on age group, geographic location, and type of anemia.

RESULTS

Nineteen studies (18 cross-sectional and 1 case-control) examined the association between dietary diversity and anemia in children under 5 years old. Pooled analysis revealed a significant association between lower dietary diversity and higher odds of anemia among children aged 0 to 5 years (OR = 1.96; 95% CI: 1.57, 2.45; I2 = 83.6%, τ2 = 0.38 P < 0.001). Ten studies examined the relationship in children and adolescents aged 6-18 years, showing a similar pattern (OR = 1.73; 95% CI: 1.27, 2.36; I2 = 87%, τ2 = 0.44; P < 0.001). Subgroup analyses suggested that the association varied across specific geographic regions.

CONCLUSIONS

This meta-analysis indicates a significant association between lower dietary diversity and higher odds of anemia in children and adolescents. These findings underscore the importance of dietary diversity as a potential factor related to anemia prevalence. Future research should focus on standardizing dietary diversity assessment methods and incorporating detailed dietary quality measurements.

Trends and associated factors of animal source foods consumption among children aged 6-23 months in Bangladesh: evidence from four consecutive national surveys

Animal source foods (ASF) are nutrient-dense and essential for the growth and development of children. The Bangladesh Demographic and Health Survey (BDHS) 2022 reported that approximately two-thirds of children aged 6-23 months consumed eggs/flesh foods. However, overall consumption patterns, trends, and factors influencing ASF intake among children in Bangladesh were not well-documented. Therefore, the study aimed to assess the trends and associated factors of ASF consumption among children aged 6-23 months in Bangladesh. A total of 9401 children were extracted from four consecutive BDHS (2011, 2014, 2017/18, and 2022). The Cochran-Armitage test was conducted to assess the trends in ASF consumption, while a two-stage multilevel mixed-effects logistic regression was performed to identify the associated factors. The consumption of ASF significantly increased to 79.1% in 2017/18 from 67% in 2011 but decreased to 73.3% in 2022. ASF consumption was found to be higher among children whose mothers were educated (AOR = 1.60, 95% CI = 1.30-1.98), employed in either agricultural (AOR = 1.27, 95% CI = 1.04-1.54) or non-agricultural (AOR = 1.36, 95% CI = 1.07-1.72) activities, pregnant (AOR = 2.54, 95% CI = 1.66-3.87), had received ANC 1-3 times (AOR = 1.43, 95% CI = 1.20-1.72) or ≥4 times (AOR = 1.59, 95% CI = 1.29-1.95), and was exposed to media (AOR = 1.21, 95% CI = 1.04-1.39). Furthermore, consumption increased with increasing the age of children, and the wealth of their families. However, children who experienced illness were less likely to consume ASF (AOR = 0.76, 95% CI = 0.68-0.86). The recent declines in ASF consumption emphasize the need for targeted interventions to increase ASF consumption among children in Bangladesh.

A community-based study to assess the prevalence and predictors of stunting among under-five children in Sheger City, Oromia, Ethiopia

Background

Stunting is a serious public health issue in Ethiopia. However, due to the scarcity of studies, little is known about the prevalence and predictors of stunting among children under the age of five in urban areas, especially those close to the capital city of the country (Addis Ababa). Thus, the aim of this study was to assess the prevalence of stunting and its predictors among children under the age of five in Lega Tafo Lega Dadi, Sheger City, Oromia, Ethiopia.

Methods

A community-based cross-sectional study was conducted on 566 children under the age of five using a systematic random sampling technique. Data were collected through face-to-face interviews, structured questionnaires, and anthropometric measurements. Afterward, the data were entered into EpiData (version 4.7) and exported to SPSS 26 for analysis. Anthropometric indices were calculated using WHO Anthro software (version 3.2.2). Bivariate and multivariable logistic regression analyses were performed to identify candidate variables and associated factors, respectively. An adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to assess the strength and significance of the association. A p-value of <0.05 was considered statistically significant. The goodness-of-fit for the model was assessed using the Hosmer-Lemeshow test.

Results

The prevalence of stunting was 18.9% (95% CI: 16, 22%) among under-five children in our study setting. Children whose mothers were daily laborers (AOR: 10.3), whose mothers' education level was primary school (AOR: 4.3), whose fathers were daily laborers (AOR: 4), who were born into families with an average birth interval of ≤24 months (AOR: 7.9), who were from families with a size ≥5 (AOR: 7.3), who had a history of diarrhea (AOR: 6.3), who had meals ≤3 times per day (AOR: 13.9), who were underweight (AOR: 2.8), who were breastfed for less than 2 years (AOR: 5.6), who had low dietary diversity (AOR: 6.3), and who experienced food insecurity (AOR: 3.6) were identified as the predictors of stunting in under-five children.

Conclusion

Approximately one-fifth of the under-five children were stunted in the study setting. Family occupational and educational status, average birth interval, family size, a history of diarrhea, meal frequency per day, underweight status, duration of breastfeeding, inadequate dietary diversity, and household food insecurity were all associated with stunting among the under-five children in the study setting.

Malnutrition among under-5 children and its determinants in the southwestern coastal region of Bangladesh: A community-based study

OBJECTIVE

The study examines the prevalence of stunting, the most common form of malnutrition and its determinants among children under-5 in the southwestern coastal region of Bangladesh.

DESIGN

Cross-sectional survey.

SETTINGS

Two coastal villages of the Bagerhat and Khulna districts of Bangladesh.

PARTICIPANTS

Participants were selected using the simple random sampling technique with the following criteria: mothers who had at least one under-5 child and resided in the study area for not less than three consecutive years.

OUTCOME MEASURES

To assess the nutritional status particularly, stunting (height for age) in children under-5, a standardised anthropometric measurement tool, such as a height-measuring vertical scale, was used and categorised into severely stunted, moderately stunted and normal height.

RESULTS

The study found that 57.5% of children were severely and 29% were moderately stunted. Findings revealed that mothers' age, prior experience of under-5 mortality, mothers' working status and age of the children were significant determinants of stunting prevalence among children under-5. Moreover, children of mothers aged 21-30 years (AOR = 2.190; 95% CI: 1.039 to 4.613; p = 0.039) and children of mothers without prior experience of under-5 mortality (AOR = 4.426; 95% CI: 1.461 to 13.405; p = 0.009) were more possibly to be severely and moderately stunted, respectively. Additionally, children of non-working mothers were more likely to be moderately (AOR = 4.037; 95% CI: 1.382 to 11.792; p = 0.011) and severely stunted (AOR = 2.538; 95% CI: 1.033 to 6.238; p = 0.042). Moreover, children aged ≤24 months (AOR = 0.151; 95% CI: 0.034 to 0.661; p = 0.012) and 25-36 months (AOR = 0.195; 95% CI: 0.046 to 0.829; p = 0.027) were less possibly to be moderately stunted.

CONCLUSION

The study recommends training young mothers on effective child-rearing practices, creating income opportunities for women in rural Bangladesh, implementing local awareness programmes about appropriate growth standards for children and expanding facility-based healthcare centres in rural areas for better access to quality healthcare.

Henry C, A. Zello G. A Nutrition Education Intervention Positively Affects the Diet-Health-Related Practices and Nutritional Status of Mothers and Children in a Pulse-Growing Community in Halaba, South Ethiopia

OBJECTIVE

We conducted a six-month nutrition education intervention focused on the consumption of pulses and other foods to assess the effect on knowledge, attitude and practice (KAP) as well as the nutritional status of children and mothers from two pulse-growing communities in Halaba, south Ethiopia.

METHODS

About 200 mother-child pairs in each of two purposively selected communities participated in this intervention study. A six-month nutrition education programme, involving interactive monthly community meetings and home visits, was offered to one of the two communities and the other served as a control/comparison. This study incorporated the use of Health Belief Model constructs to assess the KAP/perceptions of mothers surrounding pulse and other food consumptions, as well as nutrition-related issues before and after the intervention. Objective measures included dietary diversity scores (DDSs), one-day weighed dietary intakes and nutritional status measures based on anthropometric information. Demographics and socioeconomic information were also collected at baseline and endline.

RESULTS

Significant improvements (p < 0.05) were found in the intervention group on the KAP and perceptions of pulse nutrition benefits among mothers, DDSs and pulse and animal source food consumption indexes for mothers and children and the mean body-mass-index-for-age Z-score and wasting among children.

CONCLUSIONS

Community-based nutrition education interventions involving monthly interactive community meetings and home visits in pulse-growing communities from a resource-poor country like Ethiopia can be effective in improving mothers' knowledge of pulse nutrition and consumption frequency, leading to improvements in the DDSs of children and mothers while decreasing child underweight and wasting.

Maternal socio-economic status determines animal source food consumption of children aged 6-23 months in East African countries: a multilevel mixed-effects generalized linear model

Background

Nutrient deficiencies in Africa persist due to limited access to animal-source foods, causing a higher undernutrition prevalence, with 30.7% stunted children under five, which is higher than the global average of 22.0%. In African regions, there needs to be more information on access, consumption, and factors influencing children's animal-source food consumption. Therefore, we comprehensively analyse data from the Demographic and Health Surveys (DHS) to determine factors associated with children's (aged 6-23 months) consumption of animal-source foods (ASFs) in East African countries, which is crucial for policy and program development.

Methods

We utilized cross-sectional pooled DHS data from nine East African countries reported from 2015 to 2021. The sample size consisted of 18,686 weighted children aged 6-23 months who were included. The DHS data were collected from women (15-49 years old) from households in each enumeration area of each country. We calculated the pooled proportion of consumption of foods of animal origin using multi-level logistic regression analysis to determine factors of ASFs, and the strength of the association was measured by an adjusted odds ratio (AOR) with a 95% CI and a p-value < 0.05, which was declared as significant.

Result

The study found that 51.07% (95% CI: 50.26-51.88%) of infants and young children in East Africa consume ASFs, with variation across countries, of which 28.26% (95% CI: 26.31-30.29%) was the lowest in Burundi and 55.81% (95% CI: 53.39-58.21%) was the highest ASF consumption in Zimbabwe. The amount of ASF consumed grows with children's age and varies greatly between countries. In addition, children in the wealthiest quintile and with the highest educational attainment consume more ASFs. However, those who lived in rural areas consumed fewer ASFs.

Conclusion

The consumption of ASFs increased with the age of children, maternal education, and household wealth index. The government and non-government sectors should implement public health interventions targeting rural residents and poor households to increase access to and consumption of ASFs for children aged 6-23 months in East Africa.

Household food insecurity, dietary diversity with undernutrition among children younger than five years in Indian subcontinent-a narrative review

The emerging predictors of childhood undernutrition include household food insecurity (HFI) and inadequate diet diversity (DD). Geographical, socio-cultural, economic, and demographic factors contribute to HFI. Earlier, HFI was often considered an outcome of hunger and poverty leading to undernutrition. The increasing availability of data related to childhood DD and its direct association with undernutrition indicates that DD could mediate the relationship between HFI and undernutrition. This narrative review examined the association of HFI and/or DD with undernutrition in children younger than 5 years in the Indian subcontinent; and the current programmes and policies. The current evidence showed a possible association between HFI and DD either independently or together with childhood undernutrition. Until now, nutrition-specific interventions to address moderate and severe forms of undernutrition were focused, with a limited attention on nutrition-sensitive approaches to improve HFI and DD. Interventions which improve HFI and DD may be included in the existing programmes and would help address the undernutrition in children younger than 5 years.

An Egg Intervention Improves Ponderal But Not Linear Growth Among Infants 6-12 mo of Age in Rural Bangladesh

BACKGROUND

Animal source foods are rich in multiple nutrients. Regular egg consumption may improve infant growth in low- and middle-income countries.

OBJECTIVES

To assess the impact of daily egg consumption on linear growth among 6-12-mo olds in rural Bangladesh.

METHODS

We conducted a 2 × 4 factorial cluster-randomized controlled trial allocating clusters (n = 566) to treatment for enteric pathogens or placebo and a daily egg, protein supplement, isocaloric supplement, or control. All arms received nutrition education. Here, we compare the effect of the egg intervention versus control on linear growth, a prespecified aim of the trial. Infants were enrolled at 3 mo. We measured length and weight at 6 and 12 mo and visited households weekly to distribute eggs and monitor compliance. We used linear regression models to compare 12-mo mean length, weight, and z-scores for length-for-age (LAZ), weight-for-length, and weight-for-age (WAZ), and log-binomial or robust Poisson regression to compare prevalence of stunting, wasting, and underweight between arms. We used generalized estimating equations to account for clustering and adjusted models for baseline measures of outcomes.

RESULTS

We enrolled 3051 infants (n = 283 clusters) across arms, with complete 6 and 12 mo anthropometry data from 1228 infants (n = 142 clusters) in the egg arm and 1109 infants (n = 141 clusters) in the control. At baseline, 18.5%, 6.0%, and 16.4% were stunted, wasted, and underweight, respectively. The intervention did not have a statistically significant effect on mean LAZ (β: 0.05, 95% confidence interval [CI]: -0.01, 0.10) or stunting prevalence (β: 0.98, 95% CI: 0.89, 1.13) at 12 mo. Mean weight (β: 0.07 kg, 95% CI: 0.02, 0.11) and WAZ (β: 0.06, 95% CI: 0.02, 0.11) were significantly higher in the egg compared with control arms.

CONCLUSIONS

Provision of a daily egg for 6 mo to infants in rural Bangladesh improved ponderal but not linear growth.

TRIAL REGISTRATION NUMBER

NCT03683667, https://clinicaltrials.gov/ct2/show/NCT03683667.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6-23 months in India

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study

OBJECTIVE

We aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers.

METHODS

We selected 614 preschoolers (2-6 years) who had one day of 24-h dietary recall data from the 2013-2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants' outpatient and emergency medical service utilization were obtained for 2013-2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases.

RESULTS

After adjustment for confounding factors, children aged 2-3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69-0.83) and 16% (95% CI 0.77-0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4-6 years in the T2 group exhibited 15% (95% CI 0.80-0.91) and 11% (95% CI 0.82-0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group.

CONCLUSIONS

TCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh

OBJECTIVES

Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association.

METHODS

This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y.

RESULTS

In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53-2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure-child undernutrition association.

CONCLUSIONS

Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

The interlink between chrono-nutrition and stunting: current insights and future perspectives

Stunting is the one factor that is responsible for the irretrievable damage to children's mental and physical health. Stunting imitates chronic undernutrition throughout the most extreme critical stages of growth and development of a child in their early life, and due to that stunted child does not completely develop and are too short for their age. Stunting is mainly linked with brain underdevelopment, along with lifelong damaging consequences, comprising weakened mental and learning capacity, deprived performance in school during childhood, and enhanced risks of nutrition linked to chronic long-lasting ailments, such as diabetes, hypertension, diabesity, and obesity in the future. In this review, the authors mainly summarize the latest studies related to chronic nutrition and how it is related to stunting. Optimal nutrition, particularly during pregnancy and the first 24 months of a child's life, is crucial in preventing stunting. Circadian rhythms play a significant role in maternal and fetal health, affecting outcomes such as premature birth and stunting. Maintaining a balanced diet, avoiding late-night carbohydrate-heavy meals during pregnancy, and promoting breastfeeding align with the body's biological clock, which can benefit newborns in various ways. Providing dedicated spaces for breastfeeding in public places is important to support infant health.

Parental migration and children's dietary diversity at home: Evidence from rural China

There is a growing literature documenting the link between parental migration and children's health. However, few studies have explained the underlying mechanism of this observed relationship. This paper examines the effect of parental migration on children's health through dietary diversity, using survey data collected in a less developed prefecture in South Central China in 2018. To overcome the potential endogeneity of parental migration, we instrument parental migration with the proportion of households with migrated labor force at the village level, and find that parental migration reduces children's dietary diversity at home. Moreover, we provide suggestive evidence that the reduction in dietary diversity may attribute to significant negative separation effects whereas minimal positive income effects in migrant-sending households. This study highlights the negative effects of labor migration on the next generation's nutrition. In those developing countries with a high prevalence of labor migration, policies that facilitate access to dietary diversity of those left-behind children are warranted.

Factors associated with food consumption and dietary diversity among infants aged 6-18 months in Ashanti Region, Ghana

BACKGROUND

Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants.

METHODS

In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity.

RESULTS

About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge.

CONCLUSIONS

Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants.

Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study

Introduction

A stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021.

Methods

From 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals.

Results

A total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3-43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6-47.5) than among unemployed mothers (36.7%) (95% CI: 32.0-41.7). Maternal age [AOR = 2.8, 95% CI: 1.26-6.34] and wealth status [AOR = 0.32, 95% CI: 0.18-0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95-17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12-3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06-0.26] were associated with stunting of preschool children among employed mothers.

Conclusion

Stunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers.

The determinants of growth failure in children under five in 25 low- and middle-income countries

BACKGROUND

Past studies have identified determinants of growth failure (GF) such as socio-economic, nutritional, parenting, and inequality factors. However, few studies investigate the numerous causes of GF across multiple countries. By analysing the data of children under five in 25 low and middle-income countries, this study aims to examine the correlations of determinants with GF to identify the strongest modifiable risk factors.

METHODS

Cross-sectional study design was used, and data were collected across 25 LMICs by the United Nations Children's Fund in 2019. Regions and households were randomly selected in participating LMICs. The four outcome measures were stunting, wasting, underweight and low body mass index (BMI).

RESULTS

Multilevel analysis was performed to identify the impact of country, suburb, and household levels on the variance of outcome variables. GF measures were significantly correlated with low gross domestic product (GDP) per capita (odds ratio (OR) = 2.482), rural areas (OR = 1.223), lack of health insurance (OR = 1.474), low maternal education (OR = 2.260), lack of plain water (OR = 1.402), poor maternal physical caregiving ability (OR = 1.112), low carbohydrate consumption (OR = 1.470), and continued breastfeeding in children >12 months old (OR = 0.802).

CONCLUSIONS

By identifying key GF risk factors, this study may provide valuable insights for policymaking and interventions. This may allow the prioritisation of resources within countries for preventative measures to be developed.

Is women's household decision-making autonomy associated with their higher dietary diversity in Bangladesh? Evidence from nationally representative survey

In Bangladesh, a low-quality repetitive diet characterized by starchy staple foods is typical, leading to disorders associated with micronutrient deficiencies, particularly among mothers and their children. The purpose of the study was to validate the link between women's decision-making autonomy and higher dietary diversity score. Participants were ever married women aged 15-49 years old with comprehensive dietary information (n = 17,842), selected from the Bangladesh Demographic and Health Survey, 2014. The dietary diversity score (DDS) was obtained from a 24-h recall of dietary intake from nine food groups, categorized into lower DDS (DDS ≤ 4) and higher DDS (DDS ≥ 5). Descriptive analysis, bivariate and multivariate logistic regression were conducted using STATA version 15. Almost all women consumed starchy foods, flesh (83.86%), and fruits (67.30%). Using logistic regression, the odds of achieving dietary diversity score were higher among women who participated in household purchases (OR 2.40; 95% CI: 1.52-3.83; p = 0.022). Women who had higher and secondary education were 2.72 (95% CI: 1.49-3.02; p = 0.025) and 1.31 (95% CI: 0.58-2.18; p = 0.029) times more likely to achieve higher DDS than women having no education, as well as women in the richest quintile (OR 6.49; 95% CI: 4.12-8.5; p = 0.037) compared to women in the lowest quintile. This study highlighted the association of several socioeconomic conditions of ever married women and their dietary diversity score in Bangladesh. Therefore, promoting the women's education status, improving the socioeconomic conditions, and prioritizing their decisions are recommended for the attainment of higher dietary diversity score.

Agricultural diversification and intra-household dietary diversity: Panel data analysis of farm households in Bangladesh

This paper investigates the associations between agricultural diversification and dietary diversity among men, women and children of farm households in Bangladesh. Using three waves of nationally representative Bangladesh Integrated Household Survey (BIHS- 2011-12, 2015 and 2018) data and a panel data model, the study found that agricultural production diversification can emphasize the dietary diversification across the life cycle of farm household members. The balanced panel data reveals that agricultural production diversification has a statistically significant and positive impact on dietary diversity of individual members (men, women and children) of farm households. Moreover, other important factors that impact on agricultural diversification and improve dietary diversity like women's education and employment, commercialization of farm households, access to non-farm income sources, and access to information facilities also have a strong association in improving dietary status, food and nutritional security as well. Although there is currently limited diversity in the diets of adult men, women and children of rural farm households, the situation can be improved over time with proper and consistent support. The findings suggest policy interventions should target not only agricultural diversification but also improve women's education and on and off farm employment opportunities and facilitate better access to information for rural households. These recommendations can support improved dietary diversity for all household members under different settings.

Determinants of meeting the minimum acceptable diet among children aged 6 to 23 months in Bangladesh: Evidence from a national representative cross-sectional study

Background

Minimum acceptable diet (MAD) is a core indicator of infant and child feeding practices (IYCF). Meeting the MAD is essential to enhance the nutritional status of children aged 6-23 months.

Objective

To identify the determinants of meeting the MAD among children aged 6-23 months in Bangladesh.

Methods

The study was based on a secondary dataset of the 2017-2018 Bangladesh Demographic and Health Survey (BDHS 2017-18). Complete (weighted) data from 2,426 children aged 6-23 months were analyzed.

Results

The overall percentage of meeting the MAD was 34.70%, whereas, in terms of urban and rural, it was 39.56% and 32.96%, respectively. Age of the children 9-11 months [Adjusted odds ratio (AOR) = 3.54; 95% CI: 2.33-5.4], 12-17 months [AOR = 6.72; 95% CI: 4.63-9.77], and 18-23 months [AOR = 7.12; 95% CI: 1.72-5.98], the maternal primary [AOR = 1.75; 95% CI: 1.07-2.86], secondary [AOR = 2.3; 95% CI: 1.36-3.89], and higher education [AOR = 3.21; 95% CI: 1.72-5.98], currently working mothers [AOR = 1.45; 95% CI: 1.13-1.79], mothers' access to mass media [AOR = 1.29; 95% CI: 1-1.66], and at least four antenatal care (ANC) from medically skilled providers [AOR = 1.74; 95% CI: 1.39,2.18] were independent determinants of meeting the MAD.

Conclusions

Many children are still far behind in meeting the MAD. Nutritional interventions like improved nutrition recipes, nutrition education and homemade food supplementation, nutritional counseling by home visits, community mobilization, health forums, antenatal and postnatal sessions, and media campaigns on IYCF are needed to meet MAD practice.

Income-Nutrition Gradient and Intrahousehold Allocation in Rural Pakistan

OBJECTIVE

To estimate the relationship between household income and child health outcomes for male and female children, aged 0-5 years, in rural Pakistan.

METHOD

The study uses 2014 round of Pakistan Rural Household Panel Survey (PRHPS) and regression analyses to estimate the relationship between household income and child health outcomes for male and female children in rural Pakistan.

RESULTS AND POLICY IMPLICATIONS

We find that increase in income is associated with an increase in child weight-for-age and weight-for-height z-scores, and reduction in the likelihood of a child being underweight or wasted. However, our results suggest that these gains associated with an increase in income are greater for male children as compared to female children. These differences in income-nutrition gradient can be explained by the gender-differences in consumption of health inputs (e.g., food intake, vaccinations, and nutritional supplements) associated with an increase in income. Our results indicate the need for policy instruments that can encourage an equitable resource allocation within households.

Trends in and predictors of animal source food consumption among 6-23 months age children in Tigrai, Northern Ethiopia: evidence from three consecutive ethiopian demographic and health surveys, EDHS 2005-2016

BACKGROUND

Despite numerous interventions, child undernutrition continues as a problem of global concern. Although consumption of animal source foods has shown positive associations with child undernutrition, no much evidence exists on its trends and predictors among children in Tigrai.

OBJECTIVES

This study aimed to investigate the trends in and predictors of consumption of animal source foods among children 6-23 months of age in Tigrai.

METHODOLOGY

This study used complex data of 756 children extracted from three consecutive Ethiopian Demographic and Health Surveys. Data were analyzed using STATA 14.0 by accounting for sampling weight and cluster and strata variables. Multivariable logistic regression was used to determine the independent predictors of animal source foods consumption. Odds ratio and 95% confidence interval were used to measure strength of association at a statistical significance of p < 0.05.

RESULTS

Although statistically not significant (p-trend = 0.28), animal source foods consumption increased from 31.3% to 2005 through 35.9% in 2011 to 41.5% in 2016. For every month increase in the age of a child, a 9% increment in the odds of animal source food consumption was observed. Muslim children showed 3.1 times higher odds of animal source food consumption than Orthodox Christians. The likelihood of animal source foods consumption were 33% lower among children born to mothers who didn't attend formal education as compared to their counterparts. A unit increase in the number of household assets and number of livestock led to a 20% and 2% increase in the odds of animal source foods consumption, respectively.

CONCLUSION

Animal source foods consumption showed a statistically non-significant increase over the three consecutive Ethiopian Demographic and Health Surveys. This study found out that consumption of animal source foods might be increased through pro-maternal education policies, programs with household asset increasing schemes, and pro-livestock projects. Our study also highlighted the need for considering religion as one important player when planning or undertaking ASF programs.

An Egg Intervention Improves Dietary Intakes but Does Not Fill Intake Gaps for Multiple Micronutrients among Infants in Rural Bangladesh

BACKGROUND

Eggs are nutrient-rich. Strengthening evidence of the impact of egg consumption on dietary quality can inform complementary feeding guidance.

OBJECTIVES

We aimed to assess the effect of an egg intervention on dietary intakes among infants aged 6-12 mo in rural Bangladesh.

METHODS

We conducted a cluster-randomized controlled trial allocating clusters (n = 566) to enteric pathogen control or placebo treatment, with daily provision of a protein-rich meal, isocaloric meal, egg, or control. Nutrition education was provided to all arms. Our focus here is on the egg and control arms. Infants were enrolled at 3 mo. From 6 mo, we visited households weekly to distribute eggs and measure compliance. A semistructured feeding questionnaire assessed 24-h intake at 6, 9, and 12 mo. Assessments were repeated in ∼10% of subjects 2-29 d later. Using NCI SAS macros, we estimated usual intake distributions for energy, protein, fat, and 18 micronutrients and the proportion meeting intake recommendations. We compared the outcomes between the arms using clustered bootstrapping.

RESULTS

Data were available from 757 infants (137 clusters) and 943 infants (141 clusters) in the egg and control arms, respectively. In the egg arm compared with the control arm, the mean usual intakes were higher for energy (610 compared with 602 kcal/d, 9 mo; 669 compared with 658 kcal/d, 12 mo), crude protein (2.2 compared with 1.7 g/(kg·d), 9 mo; 2.4 compared with 1.9 g/(kg·d), 12 mo), available protein (2.0 compared with 1.6 g/(kg·d), 9 mo; 2.1 compared with 1.8 g/(kg·d), 12 mo), and for 13 and 14 micronutrients at 9 and 12 mo, respectively. The proportion meeting intake recommendations for most micronutrients was higher in the egg arm but remained <50% for 15 and 13 micronutrients at 9 and 12 mo, respectively.

CONCLUSIONS

Daily egg consumption improved dietary intakes among Bangladeshi infants, but was insufficient to meet multiple micronutrient intake recommendations, demonstrating the need to be coupled with other strategies.

Determinants of Stunting Children Under Five of Age During the COVID-19 in the Working Area of the Liwuto-Primary Public Health Center, Baubau City-Indonesia: A Community-Based Unmatched Case–Control Study

BACKGROUND: In Indonesia, the stunting prevalence has reached 24.4% in 2021. AIM: The study aims to examine the determinants of stunting among children under five of age during the COVID-19 pandemic in the working area of the Liwuto-Primary Public Health Center, Baubau city. METHODS: A community-based unmatched case–control study was conducted from January 10, to March 10, 2022, on a sample of 94, cases (n = 21), and controls (n = 73) of children aged 0–59 months with their respective mothers. Data were collected using a face-to-face interviewer-administered questionnaire and physical measurements standard. The data were analyzed using SPSS version 17. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with stunting. Adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) and p < 0.05 was used to declare the significance. RESULTS: There are 22% of the stunting become in children under 5 years. Stunting children under 5 years was associated with maternal age (AOR = 5.71, 95%, CI: 1.91–17.03). While family income (AOR = 1.78, 95%, CI: 0.17–18.86), exclusive breastfeeding (AOR = 3.95, 95%, CI: 0.14–112.72), complementary feeding (AOR = 1.24, 95%, CI: 0.18–8.55), formal education (AOR = 0.74, 95%, CI: 0.36–1.53), and occupation (AOR = 2.98, 95%, CI: 0.24–36.55) were not associated with the stunting. CONCLUSION: Young mother under 30 years old was an important risk factor on the incidence of stunting in children under 5 years during the COVID-19 pandemic.

Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia

In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The dominant factors that caused stunting in this study were the children’s age of 24−35 months (OR = 2.08, 95% CI: 1.12−3.86), mothers with low education (OR = 1.57, 95% CI: 1.18−2.08), and children living in rural areas (OR = 1.39, 95% CI: 1.01−1.91). The highest prevalence of stunting was in the group of children aged 12−23 months (45.2%). To prevent child stunting, the government must intervene for mothers with low education and those living in rural areas. Intervention includes intensive socialization about improving nutritional status during pregnancy and practicing complementary feeding and breastfeeding habits until the child is 24 months old.

A comprehensive intervention package improves the linear growth of children under 2-years-old in rural Bangladesh: a community-based cluster randomized controlled trial

Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother-infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.

Socio-economic inequalities in minimum dietary diversity among Bangladeshi children aged 6-23 months: a decomposition analysis

This study aimed to measure the socio-economic inequalities in having minimum dietary diversity (MDD) among Bangladeshi children aged 6-23 months as well as to determine the factors that potentially contribute to the inequity. The Bangladesh Demographic and Health Survey (BDHS) 2017-2018 data were used in this study. A sample of 2405 (weighted) children aged 6-23 months was included. The overall weighted prevalence of MDD was 37.47%. The concentration index (CIX) value for inequalities in MDD due to wealth status was positive and the concentration curve lay below the line of equality (CIX: 0.1211, p < 0.001), where 49.47% inequality was contributed by wealth status, 25.06% contributed by the education level of mother, and 20.41% contributed by the number of ante-natal care (ANC) visits. Similarly, the CIX value due to the education level of mothers was also positive and the concentration curve lay below the line of equality (CIX: 0.1341, p < 0.001), where 52.68% inequality was contributed by the education level of mother, 18.07% contributed by wealth status, and 14.69% contributed by the number of ANC visits. MDD was higher among higher socioeconomic status (SES) groups. Appropriate intervention design should prioritize minimizing socioeconomic inequities in MDD, especially targeting the contributing factors of these inequities.

Intra-Household Decision-Making and their Effects on Women Dietary Diversity: Evidence from Ethiopia

This paper attempts to analyze the status of women in household decision-making processes and their effects on dietary diversity in Ethiopia. The results indicate that men and women do not have equal decision-making authority within a household when it comes, particularly to decisions on food crop production, proportion of produced crop consumed at home and to be sold out in the market, and income generating activities. The results show variations in minimum dietary diversity for women across regions in Ethiopia. Therefore, more emphasis needed to empower women to improve their benefit from agricultural production and other income generating activities in Ethiopia.

Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Gender-common and gender-specific determinants of child dietary diversity in eight Asia Pacific countries

Background

Optimal child feeding practices contribute to reducing child undernutrition in low- and middle-income countries. Minimum dietary diversity (MDD) is a key indicator of complementary feeding quality for children aged 6-23 months. We aimed to examine the gender-common and gender-specific factors associated with the failure to meet MDD in eight Asia Pacific countries.

Methods

The study used data of children aged 6-23 months from the Demographic and Health Surveys (DHS) conducted in Afghanistan (n = 8410), Bangladesh (n = 2371), Nepal (n = 1478), Pakistan (n = 3490), Cambodia (n = 2182), Indonesia (n = 5133), Myanmar (n = 1379), and Timor-Leste (n = 2115). A total of 41 household, maternal, and child-level variables were examined for association with MDD using univariate and multivariable logistic regressions. All analyses accounted for the survey design and sampling weights.

Results

Being aged 6-11 months, not receiving Vitamin A supplementation, low maternal education, belonging to a low wealth quintile, and having two or more young children in the household were factors related to the failure to meet MDD among both male and female children. Mothers’ not watching TV or not being exposed to media at least once a week, delivery at home, young age, and engagement to non-agricultural work were only significant risk factors among female children. Non-professional delivery assistance, unsafe disposal of children’s stool, tolerant attitudes towards domestic violence, and rural residence were significant factors only among male children.

Conclusions

It is possible that male and female children in the region may consume food in various ways, because the factors for meeting MDD are not the same for different genders of children. It is advised to enhance dietary diversity in child nutrition programmes through gender-specific activities.

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.

Minimum acceptable diet and associated factors among children aged 6-23 months during fasting days of orthodox Christian mothers in Gondar city, North West Ethiopia

Background

Nutritional improvement through appropriate feeding practices is critical for young children's healthy growth and development. Even if children are exempted from fasting, their diets are influenced by the widespread fasting practices of their Orthodox Christian mothers. However, scientific evidence on a minimum acceptable diet (MAD) among children aged 6–23 months during the fasting period was limited. Therefore, this study aimed to assess the minimum acceptable diet and associated factors among children aged 6–23 months during the fasting period among Orthodox Christian mothers in Gondar city, Northwest Ethiopia.

Method

A community-based cross-sectional study was conducted during the fasting season (Lent) from March 8, 20,121 to April 8, 2021. A total of 738 Orthodox Christian mothers with their children were selected by multistage sampling. A structured questionnaire was used to collect data among mothers to assess children’s MAD status. The degree of association between independent and dependent variables was assessed by using an odds ratio with a 95% confidence interval. Those variables with a p-value of less than 0.05 in the multivariable analysis were considered as a significant factor for MAD among children aged 6–23 months. Data were presented using texts, tables and figures.

Results

The overall prevalence of MAD among children aged 6–23 months was 19.4% (95% CI: 16.40%-22.20). Having household wealth index of rich and middle (AOR = 4.39, 95% CI: 2.26,8.50) and (AOR = 3.25, 95% CI: 1.69,6.22), respectively, children aged from 12–17 months (AOR = 2.66, 95% CI: 1.43,4.92) and 18–23 months (AOR = 5.39, 95% CI: 2.93,9.95) respectively, Children who lived with a family member who consumed any time without keeping the fasting time(AOR = 1.79, 95% CI: 1.13,2.83) and mothers of young children who were married (AOR = 4.13, 95% CI: 1.29,13.23) have significant association with MAD.

Conclusion

The practice of minimum acceptable diet was inadequate. Age of child, wealth status, marital status, and presence of family member who fed without keeping fasting time were significantly associated factors for MAD among children aged 6–23 months. Advocacy for appropriate feeding practice and meeting the MAD for children aged 6–23 months during the fasting period should also be strengthened targeting the unmarried women and those with poor households and giving awareness for mothers in collaboration with the respective religious leaders is highly recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00558-z.

Exploring the Factors Associated with Dietary Diversity of Children Aged 6-59 Months in Some Rural and Slum Areas of Bangladesh amid the COVID-19 Pandemic: A Mixed-Effect Regression Analysis

Background

Dietary diversity (DD) is a key component of diet quality, and malnutrition due to poor diet quality leads to child morbidity and mortality. However, in Bangladesh, there is a lack of information on childhood DD (for children aged 6-59 mo) amid the coronavirus disease 2019 (COVID-19) pandemic.

Objectives

The purpose of this study was to assess the minimum DD and its associated factors among children aged 6-59 mo during the COVID-19 pandemic in Bangladesh.

Methods

A cross-sectional study was carried out in 6 districts of Bangladesh. A total of 1190 respondents were included using cluster random sampling. The Individual Dietary Diversity Score (IDDS) for children was used to assess the children's DD. Factors associated with DD of children were identified using a multilevel binary logistics regression model.

Results

About 70% of the children aged 6-59 mo had minimum DD during the COVID-19 pandemic in Bangladesh. Children who belonged to slum areas [adjusted odds ratio (AOR): 0.45; 95% CI: 0.24, 0.83], family income 12,000-15,000 Bangladeshi taka (BDT) (AOR: 1.79; 95% CI: 1.06, 3.05) and >15,000 BDT (AOR: 2.59; 95% CI: 1.47, 4.57), mothers aged 26-30 y (AOR: 0.35; 95% CI: 0.20, 0.62) and >30 y (AOR: 0.43; 95% CI: 0.22, 0.85), respondents who had 2 children <5 y old (AOR: 0.43; 95% CI: 0.28, 0.66), and children aged 12-23 mo (AOR: 1.89; 95% CI: 1.14, 3.20) were significantly associated with DD among children aged 6-59 mo.

Conclusions

The findings of this study highlight the need for food and nutrition-related intervention, particularly targeting mothers of younger age and with >2 children <5 y old, mothers from slum regions, and fathers who were unemployed, to improve children's DD practices.

Association between Diet Quality and Health Outcomes among Children in Rural Areas of Northwest China

This study aims to examine the relationship between diet quality and health outcomes among children in rural remote areas of China. We draw on a cross-sectional dataset of 1216 children from two counties in the Gansu Province in Northwest China. Child health outcomes were assessed with both anthropometric measurements and reports by primary caregivers of the children. Child diet quality was assessed with the diet quality score (DQS) using information from a food frequency questionnaire (FFQ). Our data show the prevalence of stunting and underweight among sample children were 12% and 11%, respectively; 27% of children were reported by their caregivers as unhealthy, and 60% of children had at least one of the seventeen selected non-communicable diseases (NCDs) over the past 14 days. Overall, 780 (72%) children have at least one of the four above-mentioned health problems. Results from logistic regression models show that a higher DQS was significantly associated with a lower likelihood of being stunted and a higher likelihood of being reported healthy after adjusting for confounders. These findings imply that improving child diet quality might be an option when designing interventions to improve child health.

Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon

BACKGROUND

Adequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities.

METHODS

Using two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6-24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis.

RESULTS

Among breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees' children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p <  0.05). Among refugees, education and spouse's employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months.

CONCLUSION

Breastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.

Food Security and Stunting Incidences in the Coastal Areas of Indonesia

BACKGROUND: Food insecurity is a condition determined by limited or uncertain access to nutritious food for active, healthy, disproportionate people or community of people who are not prepared to anticipate. Stunting in coastal areas such as Indonesia is still severe at 30.8%, higher than the global data at 22.2%. Stunting in sub-Saharan Africa is 34.5%, Ethiopia is 52.4%, and Congo is 40%. The World Health Organization has determined that nutritional problems in a country should be <20% since it leads to impaired growth, development, and degenerative diseases in later adulthood. AIM: This study aimed to identify the risk factors of the determinant of food security and stunting in the Indonesian Coastal regions. METHODS: This review was conducted by collecting literature from various publications or articles in English and Indonesian, using the online database of PubMed, ScienceDirect, ProQuest, and manual searching using Google Scholar in reputable journals since the 2000s regarding factors related to or influencing factors can determine food security and the occurrence of stunting in the Indonesian Coastal regions. RESULTS: Several studies pointed out that one of the causes of stunting in children is the lack of good nutrition for an extended period and often not realized by the parents until their children reach over 2 years old and look stunted. Based on the results of the literature review, it shows that the risk factors for stunting in coastal areas of Indonesia include birth length at risk of 16.43 times, low maternal education at risk of 3.27 times, children living in villages at risk of 2.45 times, LBW at risk 4.5 times, no ANC at risk of 3.4 times, no immunization at risk of 6.38 times, and not exclusively breastfeed at risk of 4.0 times. CONCLUSION: The results of this synthesis that consistently become risk factors for stunting in children in coastal areas are family socio-economic status (family income), mother’s education, low birth weight, premature birth, non-exclusive breastfeeding, length of birth, and macronutrient and micronutrient deficiencies. Those are given the complex risk factors for stunting.

Magnitude and determinants of animal source food consumption among children aged 6-23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey

Background

Undernutrition puts children in a physical and cognitive disadvantage. Animal source foods (ASFs) are important components of nutritious diets and play a significant role in increasing dietary diversity and minimizing the risk of undernutrition among children. Ethiopia still suffers from child undernutrition and there’s no adequate information regarding consumption of ASFs. The objective of this study was to determine the magnitude and determinanats of ASF consumption among children 6–23 months of age.

Methodology

A total weighted sample of 2861 children drawn from the 2016 Ethiopian demographic and health survey was analyzed using “SVY” command of STATA 14.0. Multivariable logistic regression was used to determine the independent determinants of ASF consumption. The strength of the association was measured by odds ratio and 95% confidence interval and p-value < 0.05 was considered statistically significant.

Results

Nearly half (46.5%) of the children reported consuming any type of ASF. Religion, child age, number of household assets, number of livestock owned by a household, and ownership of land usable for agriculture were significant determinants of the outcome variable. The odds of ASF consumption were six times, twice, and 70% lower in orthodox children compared to other (catholic, traditional, or others), muslim, and protestant children, respectively. Household ownership of assets and livestock led to an increase in consumption of ASF by 19 and 2%, respectively. Children aged 18–23 months were more likely to consume ASF as compared to the younger age group (6–8 months old children). In the contrary, children from households that own land usable for agriculture were 33% less likely to consume ASFs as compared to those from households that do not own.

Conclusions

In Ethiopia, only nearly half of children aged 6–23 months consume any type of ASF. The findings of this study imply that ASF consumption can be increased through integrated actions that involve community and religious leaders and programs focused on empowering households’ capability of owning other socioeconomic entities including assets and livestock. This study also may contribute to the growing body of research works on the importance of ASF provision in preventing child undernutrition.

Can Anganwadi services strengthening improve the association between maternal and child dietary diversity? Evidence from Project Spotlight implemented in tribal dominated Gadchiroli and Chandrapur districts of Maharashtra, India

Dietary intake is a fundamental determinant of maternal and child nutrition. This paper presents evidence on whether maternal and child dietary diversity can be improved with systemic improvements focused on strengthening training, capacity building, and behavior change communication among frontline workers to encourage improved nutritional practices among mothers and children in the intervention area. The evidence is derived from Project Spotlight intervention that was jointly implemented by Department of Women and Child Development, Government of Maharashtra and Tata Trusts in tribal dominated Gadchiroli and Chandrapur districts in Maharashtra. Based on a pre-post comparison of baseline (2019) and endline (2021) household survey data it is confirmed that there is a significant association between maternal and child dietary diversity in the study area. Notably, dietary diversity in mother-child dyads is marked with a higher consumption of fruits and vegetables as well as eggs and flesh foods. Econometric analysis further reveals that the association between maternal and child dietary diversity has improved after the systems strengthening interventions. The paper concludes that local interventions such as Project Spotlight for strengthening counselling services and coverage by frontline workers and enhancing knowledge and awareness on maternal and child dietary diversity among communities are important for improving maternal and child nutrition.

The role of food preferences in determining diet quality for Tanzanian consumers

Consumer preferences can be leveraged to magnify the impacts of agricultural investments and interventions on diets for all consumers in an economy, not just farmers. Using nationally representative panel data from Tanzania, we estimate demand for 19 food groups using an Exact Affine Stone Index censored demand system, which is flexible, utility-theoretic, controls for unobserved heterogeneity, and accounts for bias arising from endogenous prices. We find strong links between growth in household expenditures and improved diet quality. Also, staple grain prices are important determinants of nutrient intake. For poor consumers, e.g., protein and iron intake are more sensitive to maize price changes than to changing prices of other foods that contain more protein and iron. We use simulations to show that cash transfers and price vouchers targeting staple grains, pulses & nuts, and starchy staples could be effective in shrinking gaps between recommended and actual dietary intake for poor consumers.

How COVID-19 pandemic is affecting achieved food security in Bangladesh: A perspective with required policy interventions

The COVID-19, also known as a coronavirus, is currently wreaking havoc on livelihood, food security, and nutrition security around the world. In developing countries like Bangladesh the situation is far worse. The purpose of this perspective is to highlight the current state and changes of food security in Bangladesh in the context of COVID-19. During the COVID-19 period, the income of a certain set of people fell, which may have contributed to the growth in the poverty rate. It also had an impact on the agro-food systems, supply-value chain, and market levels as a result of the lockdown, movement and social gathering restrictions. The COVID-19 pandemic has an impact on the total food consumption status of the entire country, affecting all segments of the population. To obtain a greater understanding, our analysis identifies current gaps and the pandemic's potential impact from previously published works and reports.

Public Health-Based Policy on Stunting Prevention in Pati Regency, Central Java, Indonesia

BACKGROUND: In Indonesia, the Law on Long-Term Development Goals and the implementing regulations, namely the Health Law and the Food Law and their implementing regulations have stipulated nutritional adequacy for all ages including toddlers to prevent stunting. However, stunting still occurs, including in Pati Regency, Central Java Province. AIM: This research aims to know and evaluate the stunting program from the Pati Regency, Province of Central Java, Indonesia and to found the solution. METHODS: This is empirical (non-doctrinal) legal research which aims to analyze the public health-based local government policy in tackling the stunting problem in Pati Regency. RESULTS: The results of the study indicate that there are eight stages of convergence actions from the public health-based local government policies to accelerate stunting prevention in the Pati Regency. However, the stunting prevention policy as a form of legal protection for children has not succeeded in reducing the stunting prevalence rate in this regency. CONCLUSION: The conclusion of this research is beneficial to become an input for the Pati Regency Government, Central Java Provincial Government in formulating and evaluating stunting prevention policies in their areas.

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

OBJECTIVE

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

DESIGN

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

SETTING AND PARTICIPANTS

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

MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

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.

Dietary diversity and associated factors among children (6-23 months) in Gedeo zone, Ethiopia: cross - sectional study

INTRODUCTION

Different foods and food groups are good sources for various macro- and micronutrients. Diversified diet play an important role in both physical and mental growth and development of children. However, meeting minimum standards of dietary diversity for children is a challenge in many developing countries including Ethiopia.

OBJECTIVE

To assess dietary diversity and associated factors among children (6-23 months) in Gedieo Zone, Ethiopia.

METHOD

Community based cross-sectional study was carried out at Gedieo Zone, Ethiopia, from January to March 15, 2019. Multi-stage sampling technique was used to get a total of 665 children with the age of between 6 and 23 months from their kebeles. Data was collected by using face-to-face interview with structured questionnaire. Data was entered into Epidata version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. Variables having p < 0.25 at bivariate analysis were fitted to multivariable analysis. Multivariable logistic regression model was used at 95% confidence interval and with P-Value < 0.05. Bivariate.

RESULT

A total of 665 children were participated with response rate of 96.2%. Only 199(29.9%) of children were met the minimum requirements for dietary diversity. Age of children [AOR 4.237(1.743-10.295))], Educational status [AOR 2.864(1.156-7.094)], Number of families [AOR 2.865(1.776-4.619))] and household wealth index [AOR4.390(2.300-8.380)] were significantly associated with Dietary Diversity of children.

CONCLUSION

Only, one out of four children aged of 6-23 months attained the minimum dietary diversity score. Children from low socioeconomic status and mothers with no formal educational attainment need special attention to improve the practice of appropriate feeding of children.

Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review

BACKGROUND

The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting.

METHODS

This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020.

RESULTS

Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity.

CONCLUSIONS

This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

Analyzing the Drivers of Household Dietary Diversity: Evidence from Burkina Faso

BACKGROUND

The diets of millions of poor individuals lack adequate amount of essential nutrients.

OBJECTIVE

To examine the determinants of household dietary diversity in Burkina Faso and assess whether the choice of a diversity metric matters.

METHODS

Using survey data from 2014, we construct 3 metrics-Household Dietary Diversity Score (HDDS), Berry Index (BI), and Healthy Food Diversity Index (HFDI). Unlike the oft-used HDDS, the BI captures the quantity distribution of food items while the HFDI captures all 3 aspects of a healthy diet-count, quantity distribution, and health value. We fit linear (for BI and HFDI) and Poisson (for HDDS) models controlling for several socioeconomic and climatic covariates.

RESULTS

Some parameter estimates are sensitive to the diversity metric with fewer significant covariates observed in the HFDI model. Overall, diets are more diverse for households in urban areas, with female or better educated heads, with higher asset-based wealth and with more diverse on-farm production, while remoteness reduces dietary diversity. Higher precipitation seems to reduce diversity, potentially driven by the spatial heterogeneity in precipitation and on-farm production diversity.

CONCLUSIONS

The sensitivity of estimates to the metric used underscores potentially more complex interactions that determine the quantity distribution of food items consumed. Policies that enhance on-farm production diversity, market access, and women's empowerment may help improve dietary diversity and subsequent nutritional benefits. Efforts should be made to compile health value data that are relevant to developing countries facing nutrition transition.

The Prevalence of Stunting and Associated Factors among Children Under Five years of age in Southern Ethiopia: Community Based Cross-Sectional Study

Background

According to the Ethiopian Mini Demographic Health survey (EMDHS) of 2019, about 37% of children under five years of age are stunted. Data are scarce on stunting in the study area.

Objective

This study was aimed to assess the prevalence and factors associated with stunting in among children under five years of age in southern Ethiopia.

Method

A community-based cross-sectional study was conducted among 660 randomly selected under five child-mother pairs. The study was conducted from December 1 to 30, 2018 using a structured pretested questionnaire and anthropometric measurement tools. A simple random sampling technique was used to select study participants. Data were entered into EpiData version 3.1 and analyzed by Statistical Package for the Social Sciences (SPSS) version 20 and Emergency Nutrition Assessment (ENA) for Standardizing Monitoring and Assessment of Relief and Transition (SMART) 2011 software. Variables with P-value < 0.25 during the bivariate were entered into multivariable logistic regression analysis and significant association with stunting was declared at P-value < 0.05 with 95% CI.

Result

Prevalence of stunting among children under five years of age was 37.7%. Factors: family size less than five [AOR = 0.59; 95% CI (0.37, 0.97)], age less than 11 months [AOR = 0.17; 95% CI (0.08, 0.4)] and rich wealth status [AOR = 0.46; 95% CI (0.27, 0.79)] had a protective effect, while source of drinking water like river water [AOR = 5.11; 95% CI (1.6, 16.4)], presence of two or more under five children in the household [AOR = 1.72; 95% CI (1.07, 2.77)], undiversified diet [AOR = 1.82; (1.17, 2.83)] and household food insecurity [AOR = 1.83; 95% CI (1.13, 2.96)] increased the risk of stunting.

Conclusion and recommendation

The prevalence of stunting was high. Child age, family size, number of children under five years of age in the household, wealth status, source of drinking water, undiversified diet, and household food insecurity were associated with stunting. Thus, efforts should be made to improve nutritional status through strengthening of nutrition education, promotion of different family planning methods to limit the family size, involvment in different income generating activities to improve wealth status, securing of household food, use of improved sources of water, and nutrition education to diversify child diet. Further longitudinal study is recommended for researchers.