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Salas-Ortiz A, Jones AM. Inequality of opportunity in the double burden of malnutrition in Mexico. HEALTH ECONOMICS 2024; 33:2342-2380. [PMID: 38944848 DOI: 10.1002/hec.4870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
This paper proposes a pseudo-birth-cohort approach to deal with a lack of longitudinal data to measure health inequities over time. Using Roemer's framework for inequality of opportunity, this study measures ex-ante and ex-post inequalities in malnutrition, a concept that spans both sides of the nutrition continuum. The total contribution of observed circumstances and the direct contribution of observed efforts to the variation of malnutrition are disentangled for people born between 1983 and 1988 in Mexico. Results indicate that inequality of opportunity has been persistent across this 30-year lifespan for that cohort. Some evidence suggests that a lack of opportunities has been transmitted from parents to children and that people's circumstances account for most of the explained variation in the double burden of malnutrition. However, stratifying the analysis by sex shows that efforts account for more of the explained variation of inequality of opportunity for women in their middle adulthood than for men in most of the outcomes analyzed.
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Affiliation(s)
| | - Andrew M Jones
- Department of Economics and Related Studies, University of York, York, UK
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Alam F, Ali MK, Patel SA, Iqbal R. Concordance of weight status between mothers and children: a secondary analysis of the Pakistan Demographic and health survey VII. BMC Public Health 2024; 24:2244. [PMID: 39160501 PMCID: PMC11331857 DOI: 10.1186/s12889-024-19598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/26/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Familial concordance of weight status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. There is a dearth of published data for concordance of weight status within Pakistani households. METHODS We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data from 2017-18. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child's weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years and 2 to 5 years). RESULTS In all children under-five and in children 2 to 5 years, maternal BMI was positively associated with child's WHZ. For all children under-five, children of normal weight, overweight, and obese women had WHZ scores that were 0.21 [95% CI (confidence interval): 0.04, 0.37], 0.43 [95% CI: 0.25, 0.62], and 0.51 [95% CI: 0.30, 0.71] units higher than children of underweight women, respectively. For children ages 2 to 5, children of normal weight, overweight, and obese women had WHZ scores that were 0.26 [95% CI: 0.08, 0.44), 0.50 [95% CI: 0.30, 0.71), and 0.61 [95% CI: 0.37, 0.84] units higher than children of underweight women, respectively. There was no association between maternal BMI and child WHZ for children under-two. CONCLUSIONS The findings indicate that the weight status of mother's is positively associated with that of their children, particularly after age 2. These associations further strengthen the call for research regarding interventions and policies aimed at healthy weight promotion among mothers and their children collectively, rather than focusing on individuals in isolation.
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Affiliation(s)
- Faiz Alam
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
- Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Sindh, Pakistan.
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Shahid M, Xie Y, Bashir S, Noureen N, Song J, Malik NI, Tang K. Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan. CHILDREN (BASEL, SWITZERLAND) 2024; 11:872. [PMID: 39062321 PMCID: PMC11276128 DOI: 10.3390/children11070872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. METHODS Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. RESULTS Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. CONCLUSIONS In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.
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Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China; (M.S.); (Y.X.)
| | - Yuantao Xie
- School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China; (M.S.); (Y.X.)
| | - Shamshad Bashir
- Department of Psychology, Lahore Garrison University, Lahore 54000, Pakistan;
| | - Nazia Noureen
- Department of Psychology, Foundation University Rawalpindi Campus, Rawalpindi 44000, Pakistan;
| | - Jiayi Song
- Tsinghua Shenzhen International School, Tsinghua University, Beijing 100084, China
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan;
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
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Tchuente BRT, Nguedjo MW, Ngoumen DJN, De Wandji GCF, Tene Mouafo H, Tambe BA, Medoua GN, Ndomo Tsamo V. Prevalence and associated factors of coexisting forms of malnutrition in children under 5 years age in a rural area of Cameroon. PLoS One 2024; 19:e0303611. [PMID: 38857288 PMCID: PMC11164324 DOI: 10.1371/journal.pone.0303611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/28/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Malnutrition of children under 5 years of age is persistent in Cameroon principally in rural areas. Moreover, there is limited knowledge of coexisting forms of malnutrition (CFM) among children of this age. Therefore, the aim of this study was to assess the prevalence of CFM in a cohort of children under 5 years and to identify the associated factors. METHODS A cross-sectional study was conducted in the Health Districts of the locality of Dschang in the West region of Cameroon between June 2021 to November 2021. Data were collected from 200 under-five children of both sexes and an interviewer-administered questionnaire was administered to consented children's mothers/guardians. Malnutrition in children was assessed by WHO growth standards (weight-for-height, weight-for-age, height-for-age and body mass index-for-age). The different CFM were defined by the presence of two autonomous forms of malnutrition in the same child. Logistic regression analyses were done to identify factors associated to different coexisting forms of malnutrition. RESULTS The results obtained showed prevalences of 4.20% for the coexistence of underweight with wasting, 7.8% for the coexistence of underweight with stunting and 14.8% for the coexistence of stunting with overweight. Lower maternal age (15-24 years old; OR = 0.09; p = 0.05) and lower education level (primary education, OR = 23.33; p = 0.00) were associated with the coexistence of underweight with wasting. Marital status (single mother, OR = 0.28; p = 0.00) was associated to the coexistence of stunting with overweight/obesity. CONCLUSION The findings of this study provide evidence on the coexistence of different forms of malnutrition among children below five years of age in rural area of Cameroon. These finding would guide future research, policies, and programs on the management of malnutrition in rural areas of Cameroon.
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Affiliation(s)
- Boris Ronald Tonou Tchuente
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | | | | | - Hippolyte Tene Mouafo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Betrand Ayuk Tambe
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Gabriel Nama Medoua
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Vigny Ndomo Tsamo
- Nkong-Ni Subdivisionnnal Medical Center, Menoua Division, West Region of Cameroon, Dschang, Cameroon
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Sumon IH, Hossain M, Ar Salan S, Kabir MA, Majumder AK. Determinants of coexisting forms of undernutrition among under-five children: Evidence from the Bangladesh demographic and health surveys. Food Sci Nutr 2023; 11:5258-5269. [PMID: 37701232 PMCID: PMC10494611 DOI: 10.1002/fsn3.3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 09/14/2023] Open
Abstract
In many underdeveloped and developing countries, epidemiological and nutritional transitions are leading to an increase in malnutrition, resulting in pediatric diseases and eventually deaths. Therefore, this study intents to determine the important factors of the presence of coexisting forms of malnutrition (CFM), i.e., pediatric undernutrition. This study used the latest Bangladesh Demographic and Health Survey (BDHS)-2017/18 dataset consisting of 7127 under-five children. The logistic regression model has been utilized to gain explicit and in-depth knowledge of the relationship between the presence of pediatric undernutrition with socioeconomic and demographic factors. Findings revealed that about 31%, 22%, and 8% suffered from stunted, underweight, and wasted, respectively. The prevalence of stunted, underweighted, wasted, and CFM among children in the Sylhet division is higher than in any other region. A child of a secondary-level completed mother is 27.6% (OR: 0.724, 95% CI: 0.58-0.90) less likely to suffer from undernutrition than a child of an uneducated mother. The rate of undernutrition of children was less among children of highly educated parents. Age, birth order of the child, twin status, mother's age, body mass index (BMI), working status, parental educational qualification, cooking fuel, toilet facility, region, residence, and wealth index are important for determining the nutritional status of a child. The authors believe that the study findings will be helpful to the policymakers to take proper actions for achieving the sustainable development goal (SDGs) by reducing pediatric undernutrition in Bangladesh by 2030.
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Affiliation(s)
| | - Moyazzem Hossain
- Department of StatisticsJahangirnagar UniversitySavar, DhakaBangladesh
| | - Sifat Ar Salan
- Department of StatisticsJahangirnagar UniversitySavar, DhakaBangladesh
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Zemene MA, Anley DT, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Tesfa NA, Kebede YS, Bantie B, Feleke SF, Dejenie TA, Bayeh WA, Dessie AM. Concurrent stunting and overweight or obesity among under-five children in sub-Saharan Africa: a multilevel analysis. Arch Public Health 2023; 81:119. [PMID: 37391826 DOI: 10.1186/s13690-023-01138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Globally, the co-occurrence of stunting and overweight or obesity (CSO) in the same individual is becoming an emerging layer of malnutrition and there is a paucity of information in low- and middle-income countries, particularly in sub-Saharan Africa. Hence, this study aimed to determine the pooled prevalence and determinants of concurrent stunting and overweight or obesity among under-five children in SSA. METHODS Secondary data analysis was conducted from a recent nationally representative Demographic and Health Survey dataset of 35 SSA countries. A total weighted sample of 210,565 under-five children was included in the study. A multivariable multilevel mixed effect model was employed to identify the determinant of the prevalence of under-5 CSO. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of the clustering effect. A p-value of p < 0.05 was used to declare statistical significance. RESULT The pooled prevalence of concurrent stunting and overweight/obesity among under-five children was 1.82% (95% CI: 1.76, 1.87) in SSA. Across the SSA regions, the highest prevalence of CSO was reported in Southern Africa (2.64%, 95% CI: 2.17, 3.17) followed by the Central Africa region (2.21%, 95% CI: 2.06, 2.37). Under five children aged 12-23 months (AOR = 0.45, 95% CI: 0.34, 0.59), 24-35 months (AOR = 0.41, 95% CI: 0.32, 0.52), 36-59 months (AOR = 055, 95% CI: 0.43, 0.70), ever had no vaccination (AOR = 1.25, 95% CI: 1.09, 1.54), under-five children born from 25 to 34 years mother (AOR = 0.75, 95% CI: 0.61, 0.91), under-five children born from overweight/obese mothers (AOR = 1.63, 95% CI: 1.14, 2.34), and under-five children living in West Africa (AOR = 0.77, 95% CI: 0.61, 0.96) were significant determinants for under-five CSO. CONCLUSION Concurrent stunting and overweight or obesity is becoming an emerging layer of malnutrition. Under five children born in the SSA region had almost a 2% overall risk of developing CSO. Age of the children, vaccination status, maternal age, maternal obesity, and region of SSA were significantly associated with under-five CSO. Therefore, nutrition policies and programs should base on the identified factors and promote a quality and nutritious diet to limit the risk of developing CSO in early life.
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Affiliation(s)
- Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Wolaita Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Alebachew Bayeh
- Department of Maternal and neonatal health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Alam F, Ali MK, Patel SA, Iqbal R. Concordance of weight status between mothers and children: A secondary analysis of the Pakistan Demographic and Health Survey VII. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.04.23289509. [PMID: 37205423 PMCID: PMC10187450 DOI: 10.1101/2023.05.04.23289509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Familial concordance of nutritional status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. Little published data exist for concordance of nutritional status within Pakistani households. We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child's weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years and 2 to 5 years). In all children under-five and in children 2 to 5 years, maternal BMI was positively associated with child's WHZ, while there was no association between maternal BMI and child WHZ for children under-two. The findings indicate that the weight status of mother's is positively associated with that of their children. These associations have implications for interventions aimed at healthy weights of families.
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Affiliation(s)
- Faiz Alam
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, United States of America
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, United States of America
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
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Sahiledengle B, Mwanri L, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Kene C, Seyoum K, Gomora D, Woldeyohannes D, Agho KE. The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors. BMC Pediatr 2023; 23:218. [PMID: 37147654 PMCID: PMC10163774 DOI: 10.1186/s12887-023-04037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia. METHODS Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO. RESULTS The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)]. CONCLUSION The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Centre for Public Health Research, Equity and Human Flourishing, Torrens University, Adelaide Campus, Adelaide, SA, 5000, Australia
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Modjadji P, Masilela LN, Cele L, Mathibe M, Mphekgwana PM. Evidence of Concurrent Stunting and Obesity among Children under 2 Years from Socio-Economically Disadvantaged Backgrounds in the Era of the Integrated Nutrition Programme in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12501. [PMID: 36231797 PMCID: PMC9564645 DOI: 10.3390/ijerph191912501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
In view of persistent stunting and increasing rates of obesity coexisting among children in the era of the Integrated Nutrition Programme, a cross-sectional study was conducted to determined concurrent stunting and obesity (CSO) and related factors using a random sample of child-mother pairs (n = 400) in Mbombela, South Africa. Sociodemographic data was collected using a validated questionnaire, and stunting (≥2SD) and obesity (>3SD) were assessed through respective length-for-age (LAZ) and body mass index (BAZ) z-scores. Using SPSS 26.0, the mean age of children was 8 (4; 11) months, and poor sociodemographic status was observed, in terms of maternal singlehood (73%), no education or attaining primary education only (21%), being unemployed (79%), living in households with a monthly income below R10,000 (≈$617), and poor sanitation (84%). The z-test for a single proportion showed a significant difference between the prevalence of CSO (41%) and non-CSO (69%). Testing for the two hypotheses using the Chi-square test showed no significant difference of CSO between boys (40%) and girls (41%), while CSO was significantly different and high among children aged 6-11 months (55%), compared to those aged 0-5 months (35%) and ≥12 months (30%). Further analysis using hierarchical logistic regression showed significant associations of CSO with employment (AOR = 0.34; 95%CI: 0.14-0.78), maternal education status (AOR = 0.39; 95%CI: 0.14-1.09) and water access (AOR = 2.47; 95%CI: 1.32; 4.63). Evidence-based and multilevel intervention programs aiming to prevent CSO and addressing stunting, while improving weight status in children with social disadvantages, are necessary.
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Affiliation(s)
- Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Lucy Nomsa Masilela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Lindiwe Cele
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Mmampedi Mathibe
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Peter Modupi Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
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Serván-Mori E, Ramírez-Baca MI, Fuentes-Rivera E, García-Martínez A, Quezada-Sánchez AD, Del Carmen Hernández-Chávez M, Olvera-Flores F, Pineda-Pérez D, Zelocuatecatl-Aguilar A, Orozco-Núñez E, Schnaas L. Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy. Acta Psychol (Amst) 2022; 230:103743. [PMID: 36130413 DOI: 10.1016/j.actpsy.2022.103743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development. METHODS We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge. RESULTS The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs. CONCLUSION Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Martín I Ramírez-Baca
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Evelyn Fuentes-Rivera
- Center for Demographic, Urban and Environmental Studies, College of Mexico A.C., Mexico City, Mexico
| | - Angélica García-Martínez
- Lucy Family Institute for Data and Society, University of Notre Dame, Notre Dame, IN, United States of America
| | - Amado D Quezada-Sánchez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | | | - Emanuel Orozco-Núñez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico
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Thompson AL, Jahnke JR, Teran E, Bentley ME. Pathways linking maternal mental health and child health in a dual burden context: Evidence from Galapagos, Ecuador. Soc Sci Med 2022; 305:115043. [PMID: 35660699 DOI: 10.1016/j.socscimed.2022.115043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Research in low-and-middle income countries links maternal depression to child undernutrition; conversely, maternal depression is a risk factor for child overweight in higher income settings. Less is known about impacts of maternal mental health in dual burden contexts or the environmental and behavioral pathways linking maternal mental health to child health outcomes. Consequently, we examine the association between maternal mental health and the dual burden of undernutrition/infectious disease and overweight/obesity in children and test whether pathogenic, dietary and caregiving exposures mediate this association. Data come from 113 mothers and their 204 children, aged 2 weeks to 15 years, participating in the Healthy Families Study in Galapagos, Ecuador from July 2018 to May 2019, with mental health, anthropometry, diet and household environmental measures. Path analyses were used to test for direct and indirect effects of maternal distress on the likelihood of children experiencing the dual burden. We found that maternal distress is directly associated with a greater risk of having a child in the household with the dual burden with significant indirect paths through the emotional climate of the household and child diet quality. Maternal distress also moderated the impact of exposure to pathogens and diet quality. Our results highlight the need to understand how maternal distress may shape care practices in environments that present challenges for mothers in acquiring adequate resources and support needed to promote healthy child growth.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Johanna R Jahnke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador; Galapagos Science Center, San Cristobal, Ecuador
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Sebsbie A, Minda A, Ahmed S. Co-existence of overweight/obesity and stunting: it's prevalence and associated factors among under - five children in Addis Ababa, Ethiopia. BMC Pediatr 2022; 22:377. [PMID: 35764944 PMCID: PMC9241306 DOI: 10.1186/s12887-022-03445-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Double burden of malnutrition is a global problem posing a serious public health challenge especially in low- and middle-income countries including Ethiopia, where a high prevalence of under-nutrition continues to exist and overweight is increasing at an alarming rate. Although both under-nutrition and over-nutrition are investigated extensively in Ethiopia, evidence about the double burden of malnutrition especially at the individual level is very limited. Objective To assess the prevalence of the co-existence of overweight/obesity and stunting and associated factors among under-five children in Addis Ababa, Ethiopia at an individual level. Methods Institution-based cross-sectional study was conducted from May to June 2021 among 422 mothers to child pairs in Addis Ababa. Twenty-nine (30%) of the health centers in Addis Ababa were selected to take part in the study using a simple random sampling technique. The total sample size was allocated proportionally to each of the selected health centers based on their performances within 6 months prior to the study. A systematic random sampling method was used to select the study participants. An interviewer-administered structured questionnaire was used to collect data. Descriptive statistics and a hierarchical logistic regression model were used to characterize the study population and to identify factors that are associated with the outcome variable respectively. Odds ratio along with 95% CI were estimated to measure the strength of the association. The level of statistical significance was declared at a p-value less than 0.05. Results The prevalence of the co-existence of overweight/obesity and stunting was 5.1% with 95% CI (2.9–7.1%). The hierarchical logistic regression analysis revealed that child age (6–23 months) [(AOR = 2.86, 95% CI: (1.02–8.04)], maternal education status (non-educated) [(AOR = 4.98, 95% CI: (1.33–18.66)], maternal age during birth (≥ 28 years) [(AOR = 0.22, 95% CI: (0.06–0.79)] and childbirth order (3+) [(AOR = 6.38, 95% CI: (1.03–39.7)] were significantly associated with the co-existence of overweight /obesity and stunting. Conclusion and recommendations: The study revealed that the prevalence of the co-existence of overweight/obesity and stunting is low in Ethiopia. However, local and national nutrition policies and programs should be tailored and implemented to simultaneously address both under-nutrition and over-nutrition. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03445-5.
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Affiliation(s)
- Alem Sebsbie
- Department of Public Health Kotebemetropolitan University, Deberbirhan, Ethiopia
| | - Abebe Minda
- Department of Public Health Deberbirhan University, Deberbirhan, Ethiopia
| | - Sindew Ahmed
- Department of Nursing Kotebemetropolitan University, Deberbirhan, Ethiopia.
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13
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Khaliq A, Wraith D, Nambiar S, Miller Y. A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children. BMC Public Health 2022; 22:879. [PMID: 35505427 PMCID: PMC9063291 DOI: 10.1186/s12889-022-13098-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children. METHODS A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies. RESULTS The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive. CONCLUSION Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| | - Smita Nambiar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, 4059, Australia
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
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Khaliq A, Wraith D, Miller Y, Nambiar-Mann S. Prevalence, Trends, and Socioeconomic Determinants of Coexisting Forms of Malnutrition Amongst Children under Five Years of Age in Pakistan. Nutrients 2021; 13:4566. [PMID: 34960118 PMCID: PMC8707290 DOI: 10.3390/nu13124566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
In Pakistan, malnutrition is a chronic issue. Concerns regarding coexisting forms of malnutrition (CFM) in an individual child are emerging, as children suffering from CFM have a 4 to 12-fold higher risk of death compared with healthy children. This study assessed the prevalence, trends, and socioeconomic determinants of various types of CFM using Pakistan Demographic and Health Survey (PDHS) datasets. Data from children aged 0-5 years old, with complete height and weight information, and valid anthropometry, from all regions of Pakistan (except residents of Azad Jammu Kashmir (AJK) and Federally Administered Tribal Areas (FATA), and non-de jure residents), were included. The prevalence of CFM was 30.6% in 2012-2013 and 21.5% in 2017-2018 PDHS. Both PDHSs reported a significantly higher prevalence of CFM in Sindh and Baluchistan compared with other regions of Pakistan. Improved socioeconomic status significantly reduced the odds of various types of CFM, except the coexistence of underweight with wasting. The high prevalence of CFM in Pakistan can be averted by multisectoral collaboration and by integrating nutrition-sensitive and nutrition-specific interventions.
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Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane 4059, Australia; (D.W.); (Y.M.)
| | - Smita Nambiar-Mann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane 4059, Australia;
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15
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AlZoubi KM, Alshammari GM, AL-Khalifah AS, Mohammed MA, Aljuhani HE, Yahya MA. Nutritional Status and Associated Risk Factors of Syrian Children's Residents in the Kingdom of Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1053. [PMID: 34828766 PMCID: PMC8624700 DOI: 10.3390/children8111053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/04/2022]
Abstract
This study aimed to evaluate the nutritional status and associated risk factors of Syrian children living in Saudi Arabia. In this study, 55 boys and 55 girls ranging in age from 6 to 12 years were selected. Socioeconomic data of families were collected using a structured questionnaire. The participants' anthropometric measurements were calculated. The 24-h recall method was applied to calculate the daily food intake. Dietary nutrients' average daily intake of both boys and girls was significantly (p ≤ 0.01) lower than that of the dietary reference intake (DRI) with few exceptions. The sedentary lifestyles of both boys and girls had a negative impact on their food choices, and as a result, a large number of them were underweight and suffered from malnutrition and stunting. Spearman correlation coefficients revealed that most of the children's dependent variables were risk factors and strongly and negatively associated with their nutritional status proxies. The study concluded that both boys and girls had unbalanced nutritional status with high percentages of malnutrition and stunting because most dependent factors were adversely related to the independent ones.
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Affiliation(s)
| | - Ghedeir M. Alshammari
- Department of Food Science and Nutrition, College of Food and Agricultural Science, King Saud University, P.O. Box 2460, Riyadh 11451, Saudi Arabia; (K.M.A.); (A.S.A.-K.); (M.A.M.); (H.E.A.); (M.A.Y.)
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Double burden of malnutrition and its association with infant and young child feeding practices among children under-five in Thailand. Public Health Nutr 2021; 24:3058-3065. [PMID: 33054885 PMCID: PMC9884786 DOI: 10.1017/s1368980020003304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined the prevalence of stunting-overweight and socio-demographic determinants among children under-five years of age, as well as associations with infant and young child feeding (IYCF) among children aged 6-23 months. DESIGN Secondary data analysis based on the Thailand Multiple Indicator Cluster Survey 2015-2016. SETTING Cross-national study. PARTICIPANTS Nationally representative sample of children under-five years of age (n 12 313). RESULTS The prevalence of wasting, stunting, overweight and stunting-overweight was 5·3, 10·5, 10·1 and 1·6 %, respectively. In multivariate analyses, children under 6 months, children from low and middle wealth tertiles, and children living in rural areas were prone to being wasted. Male children, low wealth tertile and a non-Thai speaking household head were positively and children aged 48-59 months and a one-child household were inversely associated with stunting. Children from a low wealth tertile were less likely to be overweight, while older age, male children and children from a one-child household were more likely to be overweight. Stunting-overweight was associated with children aged 24-47 months, male children, mothers having secondary education, a one-child household, a non-Thai speaking household head and an urban area. In terms of IYCF indicators, despite no association with stunting and stunted-overweight children, current breast-feeding and inadequate meal frequency were associated with being wasting, while current breast-feeding and dietary diversity were inversely associated with being overweight. CONCLUSIONS This study revealed the double burden of malnutrition at the individual and population levels among Thai children under-five, which calls for concrete integrated interventions to tackle all forms of malnutrition.
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Household structure and concurrent stunting and overweight among young children in Indonesia. Public Health Nutr 2021; 24:2629-2639. [PMID: 33843538 DOI: 10.1017/s1368980021001385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the association of household type and household composition with concurrent stunting and overweight in young children from urban and rural Indonesia. DESIGN This study is a secondary data analysis using a nationally representative cross-sectional survey. Household structure was analysed as household type, household size, number of working adults, number of dependent adults and children, and household head's gender. We defined 'concurrent stunting and overweight' as height-for-age Z-score <-2 and weight-for-height Z-score >+2 based on WHO growth standards. Multivariable logistic regression to test the aforementioned association was performed separately for urban and rural areas. SETTING Data were from Indonesia Basic Heath Research 2013. PARTICIPANTS Children aged 2-5 years (n 45 050). RESULTS The prevalence of concurrent stunting and overweight children was 5·6 %. In rural areas, this prevalence differed significantly by household types and the highest prevalence was among children in nuclear two-parent households (6·8 %). In rural areas, children in extended households had lower odds of concurrent stunting and overweight than those from nuclear households (OR = 0·73, 95 % CI 0·59, 0·92). In urban areas, household size and number of working adults were significantly associated with the decreased odds of concurrent stunting and overweight in children. CONCLUSIONS Household structure was associated with children's concurrent stunting and overweight in urban and rural regions of Indonesia. The patterns of the association might differ between urban and rural regions, but no significant interaction term was found.
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Concurrence of stunting and overweight/obesity among children: Evidence from Ethiopia. PLoS One 2021; 16:e0245456. [PMID: 33449970 PMCID: PMC7810347 DOI: 10.1371/journal.pone.0245456] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 01/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background Nutrition transition in many low- and middle-income countries (LMICs) has led to shift in childhood nutritional outcomes from a predominance of undernutrition to a double burden of under- and overnutrition. Yet, policies that address undernutrition often times do not include overnutrition nor do policies on overweight, obesity reflect the challenges of undernutrition. It is therefore crucial to assess the prevalence and determinants of concurrence stunting and overweight/obesity to better inform nutrition programs in Ethiopia and beyond. Methods We analyzed anthropometric, sociodemographic and dietary data of children under five years of age from 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 8,714 children were included in the current study. Concurrence of stunting and overweight/obesity (CSO) prevalence was estimated by basic, underlying and immediate factors. To identify factors associated with CSO, we conducted hierarchical logistic regression analyses. Results The overall prevalence of CSO was 1.99% (95% CI, 1.57–2.53). The odds of CSO was significantly higher in children in agrarian region compared to their counter parts in the pastoralist region (AOR = 1.51). Other significant factors included; not having improved toilet facility (AOR = 1.94), being younger than 12 months (AOR = 4.22), not having history of infection (AOR = 1.83) and not having taken deworming tablet within the previous six months (AOR = 1.49). Conclusion Our study provided evidence on the co-existence of stunting and overweight/obesity among infants and young children in Ethiopia. Therefore, identifying children at risk of growth flattering and excess weight gain provides nutrition policies and programs in Ethiopia and beyond with an opportunity of earlier interventions through improving sanitation, dietary quality by targeting children under five years of age and those living in Agrarian regions of Ethiopia.
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Félix-Beltrán L, Macinko J, Kuhn R. Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers. Public Health Nutr 2021; 24:106-116. [PMID: 32867877 PMCID: PMC10049080 DOI: 10.1017/s136898002000292x 10.1017/s136898002000292x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.
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Affiliation(s)
- Lucía Félix-Beltrán
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
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Al-Taiar A, Alqaoud N, Sharaf Alddin R, Alanezi F, Subhakaran M, Dumadag A, Albatineh AN. Stunting and Combined Overweight with Stunting among Schoolchildren in Kuwait: Trends over a 13-Year Period. Med Princ Pract 2021; 30:515-521. [PMID: 34348312 PMCID: PMC8739943 DOI: 10.1159/000518533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the sex- and age-specific trends of stunting and combined overweight with stunting among schoolchildren over a 13-year period in Kuwait. SUBJECTS AND METHODS The Kuwait Nutrition Surveillance System objectively measured the height of 172,573 schoolchildren (5-19 years) over a 13-year period (2007-2019). Data on gender and date of birth were extracted from school records. Stunting was defined as height 2 standard deviations (SD) below the World Health Organization growth reference median. Logistic regression models were used to examine the trends of stunting over the study period while stratifying by gender. RESULTS In males, the prevalence of stunting increased from 2.46% in 2007 to 4.18% in 2019 (p for trend <0.001). In females, the prevalence of stunting fluctuated but remained around 3.80% in both 2007 and 2019. The odds of stunting significantly increased in the period 2017-2019 compared to the period 2007-2010 among males, adjusted odds ratio (AOR) 1.04 (95% confidence interval [CI]: 1.14-1.76); p = 0.009, but not females, AOR 0.89 (95% CI: 0.73-1.07); p = 0.176. Although not statistically significant, there was a tendency for the odds of combined overweight with stunting to increase in males, AOR 1.65 (95% CI: 0.90-3.04); p = 0.087, but not females, AOR 1.13 (95% CI: 0.88-1.45); p = 0.248. CONCLUSION Although the prevalence of stunting and combined stunting with overweight is low, there is an emerging upward trend in schoolboys that warrants further investigation and monitoring. This highlights the need for gender-specific interventions to reduce nutritional abnormalities in high-income countries in the Middle East countries like Kuwait.
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Affiliation(s)
- Abdullah Al-Taiar
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
- *Abdullah Al-Taiar,
| | - Nawal Alqaoud
- Food and Nutrition Administration, Ministry of Health, Kuwait City, Kuwait
| | - Reem Sharaf Alddin
- HealthCare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Faheema Alanezi
- Food and Nutrition Administration, Ministry of Health, Kuwait City, Kuwait
| | - Monica Subhakaran
- Food and Nutrition Administration, Ministry of Health, Kuwait City, Kuwait
| | - Anne Dumadag
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Ahmed N. Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Hawkes C, Fox E, Downs SM, Fanzo J, Neve K. Child-centered food systems: Reorienting food systems towards healthy diets for children. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers. Public Health Nutr 2020; 24:106-116. [PMID: 32867877 PMCID: PMC10049080 DOI: 10.1017/s136898002000292x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.
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Eshete T, Kumera G, Bazezew Y, Marie T, Alemu S, Shiferaw K. The coexistence of maternal overweight or obesity and child stunting in low-income country: Further data analysis of the 2016 Ethiopia demographic health survey (EDHS). SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa. Eur J Clin Nutr 2020; 75:189-197. [PMID: 32801307 PMCID: PMC7817521 DOI: 10.1038/s41430-020-00716-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/19/2020] [Accepted: 08/04/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa). SUBJECTS/METHODS For 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9-16 years) were collected. Stunting at 2 years (height-for-age z-score < -2), 5-18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models. RESULTS Stunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM. CONCLUSIONS Being stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.
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The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries. Public Health Nutr 2020; 24:2944-2951. [PMID: 32633230 PMCID: PMC7613087 DOI: 10.1017/s1368980020001226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. Design We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. Setting Nationally representative surveys from ninety-three LMIC. Participants A total of 825 633 children were studied. Results DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. Conclusions The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Mbogori T, Kimmel K, Zhang M, Kandiah J, Wang Y. Nutrition transition and double burden of malnutrition in Africa: A case study of four selected countries with different social economic development. AIMS Public Health 2020; 7:425-439. [PMID: 32968668 PMCID: PMC7505783 DOI: 10.3934/publichealth.2020035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background Disease and lifestyle patterns have been changing rapidly especially in Africa due to transformation in economic development and urbanization. Research on the magnitude and consequences of these transformations in Africa is limited. This study investigates the shifts in nutritional status in children and adults in four selected low-, middle- and high-income countries in Africa, identifies factors associated with the shifts, and provides recommendations for future studies. Methods Malawi, Kenya, Ghana, and South Africa were selected based on their Gross Domestic Product (GDP). Nationally representative data were obtained from the 2017 Global Nutrition Report, Demographic Health Surveys (DHSs), and the World Health Organization (WHO) database. Prevalence of underweight, overweight, and obesity were assessed and compared across the countries, gender, residence, and over time. Results: South Africa had the highest GDP and largest prevalence of overweight and obesity rates in children < 5 years old and adults > 18 (13.3% and 51.9%, respectively). Malawi, with the lowest GDP, had the highest stunting rate (37.0%). In all 4 countries, but most notably in South Africa, trends indicated that the increasing prevalence of overweight and obesity was much greater than the declining rate of underweight. Malawi, Kenya, and Ghana had a slight decline in overweight prevalence in children under 5 years. Conclusions Nutritional shifts are occurring in Africa and seem to be heavily influenced by economic development. The double-burden of malnutrition presents prioritization challenges for policymakers. Attention needs to be shifted towards prevention of obesity, at least in the higher income countries in Africa.
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Affiliation(s)
- Teresia Mbogori
- Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA
| | - Kilee Kimmel
- Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA
| | - Mengxi Zhang
- Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA
| | - Jay Kandiah
- Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA
| | - Youfa Wang
- Department of Nutrition and Health Sciences, Ball State University, 2000 W University Avenue, Muncie, Indiana 47306, USA.,Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, Ball State University, 2000 W University Avenue, Muncie Indiana 47306, USA
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Binagwaho A, Rukundo A, Powers S, Donahoe KB, Agbonyitor M, Ngabo F, Karema C, Scott KW, Smith Fawzi MC. Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications. BMC Public Health 2020; 20:83. [PMID: 31959142 PMCID: PMC6971879 DOI: 10.1186/s12889-020-8164-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda. Methods Data for this study come from the 2000 to 2015 Rwanda’s Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting. Results The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight. Conclusions Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.
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Affiliation(s)
- Agnes Binagwaho
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda. .,Harvard Medical School, Boston, MA, USA. .,Dartmouth Geisel School of Medicine, Hanover, NH, USA.
| | | | - Samuel Powers
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda.,University of Virginia, Charlottesville, VA, USA
| | - Kateri B Donahoe
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda
| | | | - Fidel Ngabo
- School of Public Health, Universite libre de Bruxelles, Brussels, Belgium
| | - Corine Karema
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda
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Thompson AL, Nicholas KM, Watson E, Terán E, Bentley ME. Water, food, and the dual burden of disease in Galápagos, Ecuador. Am J Hum Biol 2020; 32:e23344. [PMID: 31642150 PMCID: PMC7114884 DOI: 10.1002/ajhb.23344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Rapid development in low- and middle-income countries (LMIC) has led to changes in diet that have outpaced water and sanitation improvements, contributing to a dual burden of overweight and noncommunicable disease risk factors (OWT/NCD) and undernutrition and infectious disease symptoms (UND/ID) within individuals and households. Yet, little work has examined the joint impact of water and food exposures on the development of the dual burden. METHODS We use data from Ecuador's nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT-ECU) to test whether water access and quality and diet quality and security are associated with OWT/NCD and UND/ID among 1119 children and 1582 adults in Galápagos. Adjusted multinomial and logistic models were used to test the separate and joint associations between water and food exposures and the dual burden and its components at the individual and household levels. RESULTS The prevalence of the dual burden of OWT/NCD and UND/ID was 16% in children, 33% in adults, and 90% in households. Diet quality was associated with a higher risk of dual burden in individuals and households. Mild food insecurity was positively associated with the risk of dual burden at the household level. No water variable separately predicted the dual burden. Joint exposure to poor water access and food insecurity was associated with greater odds of dual burden in households. CONCLUSION Our results suggest that unhealthy diets and poor water quality contribute to the dual burden at the individual and household levels. Addressing both food and water limitations is important in LMIC.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Khristopher M Nicholas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elijah Watson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad de San Francisco Quito, Quito, Ecuador
- Galapagos Science Center, San Cristobal, Ecuador
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Ghattas H, Acharya Y, Jamaluddine Z, Assi M, El Asmar K, Jones AD. Child-level double burden of malnutrition in the MENA and LAC regions: Prevalence and social determinants. MATERNAL AND CHILD NUTRITION 2019; 16:e12923. [PMID: 31828957 PMCID: PMC7083402 DOI: 10.1111/mcn.12923] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Although the prevalence of obesity has rapidly increased in the low‐ and middle‐income countries of the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public‐health challenge. We examined region‐specific sociodemographic determinants of this double burden of malnutrition, specifically, the co‐occurrence of child stunting and overweight, using Demographic and Health Survey and Multiple Indicator Cluster Survey data (2003–2016) from 11 countries in the MENA (n = 118,585) and 13 countries in the LAC (n = 77,824) regions. We used multiple logistic regressions to model region‐specific associations of maternal education and household wealth with child nutritional outcomes (6–59 months). The prevalence of stunting, overweight, and their co‐occurrence was 24%, 10%, and 4.3% in children in the MENA region, respectively, and 19%, 5%, and 0.5% in children in the LAC region, respectively. In both regions, higher maternal education and household wealth were significantly associated with lower odds of stunting and higher odds of overweight. As compared with the poorest wealth quintiles, decreased odds of co‐occurring stunting and overweight were observed among children from the second, third, and fourth wealth quintiles in the LAC region. In the MENA region, this association was only statistically significant for the second wealth quintile. In both regions, double burden was not statistically significantly associated with maternal education. The social patterning of co‐occurring stunting and overweight in children varied across the two regions, indicating potential differences in the underlying aetiology of the double burden across regions and stages of the nutrition transition.
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Affiliation(s)
- Hala Ghattas
- Faculty of Health SciencesAmerican University of Beirut, Beirut, Lebanon
| | - Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, Pennsylvania
| | - Zeina Jamaluddine
- Faculty of Health SciencesAmerican University of Beirut, Beirut, Lebanon
| | - Moubadda Assi
- Faculty of Health SciencesAmerican University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Faculty of Health SciencesAmerican University of Beirut, Beirut, Lebanon
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Little BB, Malina RM, Pena-Reyes ME, Chavez GB. Thinness, overweight, and obesity in indigenous school children and youth in Mexico. Ann Hum Biol 2019; 46:448-459. [PMID: 31661341 DOI: 10.1080/03014460.2019.1674378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The prevalence of overweight (OWT) and obesity (OB), defined by the body mass index (BMI, kg/m2) among children and youth has increased worldwide in the last 30-40 years.Aim: To evaluate the weight status, defined by the BMI, of indigenous school children and youth resident in different regions of MexicoSubjects and methods: Students 6-18 years (31,448 boys, 27,306 girls) were enrolled in bilingual schools for indigenous children and youth in Mexico in 2012. Height and weight were measured; the BMI was calculated. The BMI of each student was classified relative to International Obesity Task Force (IOTF) age- and sex-specific criteria as thin (three grades), normal, overweight (OWT) or obese (OB). The sample was divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Age- and sex-specific prevalence, 95% confidence intervals, and Chi-square tests were calculated.Results: Prevalence of OWT + OB was highest in the South-Gulf, South-Pacific and South-Southeast regions and lowest in the North and Central regions, while thinness was most prevalent in the North and Central regions.Conclusion: Prevalence of severe and moderate thinness was relatively low, while the combined prevalence of OWT + OB was generally more prevalent in indigenous boys than girls. However, the prevalence of thinness, OWT + OB among indigenous children and youth was lower than in the general population of children and youth in Mexico.
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Affiliation(s)
- Bert B Little
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.,Department of Anthropology, University of Louisville, Louisville, KY, USA
| | - Robert M Malina
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.,Department of Anthropology, University of Louisville, Louisville, KY, USA.,Department of Kinesiology and Health Education, University of Texas at Austin, Bay City, TX, USA
| | - Maria Eugenia Pena-Reyes
- Escuela Nacional de Antropología e Historia, Instituto Nacional de Antropología e Historia, Mexico City, Mexico
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Extended composite index of anthropometric failure in Argentinean preschool and school children. Public Health Nutr 2019; 22:3327-3335. [PMID: 31640824 DOI: 10.1017/s1368980019002027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces. DESIGN ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. SETTING Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina). PARTICIPANTS 10 879 children of both sexes aged between 3 and 13·99. RESULTS ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight. CONCLUSIONS The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.
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Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka. PLoS One 2019; 14:e0224222. [PMID: 31639148 PMCID: PMC6805006 DOI: 10.1371/journal.pone.0224222] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5–10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child’s body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08–5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16–0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.
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Anik AI, Rahman MM, Rahman MM, Tareque MI, Khan MN, Alam MM. Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar. PLoS One 2019; 14:e0221274. [PMID: 31419251 PMCID: PMC6697370 DOI: 10.1371/journal.pone.0221274] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The coexistence of overweight mother and stunted child at the same household is a type of Double Burden of Malnutrition at Household Level (DBMHL). This particular public health concern is now emerging at an alarming rate among most of the South Asian and its neighboring lower-and-middle income countries which are going through nutritional transition. This study has examined the prevalence rate and the risk factors of DBMHL along with the socio-economic inequality in DBMHL among Bangladesh, Nepal, Pakistan, and Myanmar. METHODS Latest Demographic and Health Survey datasets were used in this study. To identify the significant association of DBMHL with socio-demographic characteristics, a multivariate technique named as logistic regression model, and for measuring socio-economic inequalities in DBMHL prevalence, relative index of inequality (RII) and slope index of inequality (SII) were used. RESULTS The prevalence rates of DBMHL were 4.10% (urban: 5.57%, rural: 3.51%), 1.54% (urban: 1.63%, rural: 1.42%), 3.93% (urban: 5.62%, rural: 3.20%), and 5.54% (urban: 6.16%, rural: 5.33%) respectively in Bangladesh, Nepal, Pakistan, and Myanmar. The risk ratios (RR) obtained from RII for Bangladesh, Nepal, Pakistan and Myanmar were 1.25, 1.25, 1.14, and 1.09, respectively, and β coefficient from SII were 0.01, 0.004, 0.005, and 0.006 unit respectively. In addition to not breastfeeding [Bangladesh (AOR: 1.55; 95% CI: 1.11-2.15), Myanmar (AOR: 1.74; 95% CI: 1.02-2.95)], respondent's older age (in Bangladesh, Nepal, and Myanmar), child's older age (in Pakistan and Myanmar), and middle and rich groups of wealth-index (in Bangladesh and Pakistan) were strong risk factors for DBMHL. On the other hand, female child [Nepal (AOR: 0.50; 95% CI: 0.26-0.95), Pakistan (AOR: 0.58; 95% CI: 0.41-0.84)], higher education [in Pakistan], respondent not participated in decision making [in Bangladesh and Nepal] and media access [Nepal (AOR: 0.44; 95% CI: 0.20-0.98)] had negative association with DBMHL. CONCLUSION The DBMHL persists in all selected countries, with a higher prevalence in urban areas than in rural areas. In order to control the higher prevalence of DBMHL in urban areas, respective countries need urgent implementation of multisectoral actions through effective policies and empowering local communities.
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Affiliation(s)
- Asibul Islam Anik
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Ismail Tareque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - M. Mahmudul Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Cauich-Viñas P, Azcorra H, Rodríguez L, Banik SD, Varela-Silva MI, Dickinson F. Body Mass Index in Mother and Child Dyads and its Association With Household Size and Parents' Education in 2 Urban Settings of Yucatan, Mexico. Food Nutr Bull 2019; 40:383-392. [PMID: 31195833 DOI: 10.1177/0379572119842990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overweight/obesity (OW/OB) coexists in mother-child dyads. However, a dearth of evidence on the factors associated with this phenomenon calls for research. OBJECTIVE To analyze the association of sociodemographic factors with OW/OB in a sample of 260 Maya mother-child dyads from Yucatan, Mexico. METHODS During 2011 to 2014, we measured height and weight in children and their mothers and calculated their body mass index (BMI). The OW/OB cutoff points were defined, for mothers, as having a BMI >25 kg/m2 and, for children, as having a BMI-for-age >2 standard deviation of the World Health Organization references. Mother-child dyads were grouped according to their BMI status: (1) normal weight mother and child, (2) normal weight mother and OW/OB child, (3) OW/OB mother and normal weight child, and (4) OW/OB mother and child. A multinomial logistic regression model was used to analyze the interrelationships among BMI status in mother-child dyads, household size, and parental education. RESULTS Overweight/obesity coexisted in 40% of dyads. Compared to normal weight dyads (1), each unit increase in household size and in years of maternal education decreased the risks of the coexistence of OW/OB in mother-child dyads (odds ratio [OR] = 0.72, 95% confidence interval [CI] 0.55-0.94, P = .015; OR = 0.70, 95% CI 0.52-0.94, P = .019, respectively). Conversely, each year increase in paternal education increased the risk for OW/OB in dyads (OR = 1.47, 95% CI 1.08-1.99, P = .015). CONCLUSIONS Results suggest that household size and parental education contribute to shape BMI-based nutritional status in this sample of mother-child dyads.
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Affiliation(s)
| | - Hugo Azcorra
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mérida, Yucatán, México
| | - Luis Rodríguez
- Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Sudip Datta Banik
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mérida, Yucatán, México
| | | | - Federico Dickinson
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mérida, Yucatán, México
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Turnbull B, Gordon SF, Martínez-Andrade GO, González-Unzaga M. Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic. Health Psychol Open 2019; 6:2055102919849406. [PMID: 31205736 PMCID: PMC6537260 DOI: 10.1177/2055102919849406] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mexico has the highest prevalence globally for children who are overweight. We
conducted a qualitative study to understand childhood obesity in Mexico and the
complex factors at play. Data were collected at three elementary schools in a
low socio-economic area in Mexico City. Semi-structured interviews were
conducted with 60 children, 24 parents and 28 teachers. The children interviewed
were between the ages of 8 and 12 years old. Interview texts were analysed using
NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how
children’s choices around nutrition and physical activity were constrained by
their environment and discursive constructions.
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Affiliation(s)
| | - Sarah Frances Gordon
- Universidad Iberoamericana, Mexico
- Sarah Frances Gordon, Universidad
Iberoamericana, 01219 México City, Mexico.
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Minh Do L, Lissner L, Ascher H. Overweight, stunting, and concurrent overweight and stunting observed over 3 years in Vietnamese children. Glob Health Action 2019; 11:1517932. [PMID: 30253704 PMCID: PMC6161605 DOI: 10.1080/16549716.2018.1517932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Malnutrition, both stunting and overweight/obesity, present a public health concern in many countries in the world. Objective: This study aims to examine: (1) longitudinal changes in prevalence of overweight, stunting, and concurrent overweight and stunting among preschool children during 3 years and (2) secular changes in these prevalences of a specific age group of children aged 5.5–6.5 year over a period of 3 years. Methods: A cohort of 2,602 children initially aged 3–6 years old, 1,311 in an urban area and 1,291 in a rural area, was followed for 3 years. Of them, children aged 5.5–6.5 years old were identified to be included in three repeated cross-sectional surveys. The World Health Organization standard was used to classify children with overweight or stunting. Results: Findings from the cohort study indicate that between 2013 and 2016, the estimated prevalence of overweight including obesity (OWOB) increased with age, particularly in the urban setting (14.2%–29.9% in boys and 9.0%–21.6% in girls). The estimated prevalence of stunting decreased from 8.2% to 3.4% in boys and 9.5% to 3.5% in girls with a considerably greater decrease among rural children. There was a similar pattern of an age-related decrease of concurrent OWOB and stunting from 2.4% in 2013 to 1.4% in 2016 in boys and from 2.9% to 1.3% in girls with significant decreases in rural children. Secular trends in the group of children 5.5 to 6.5 show the same pattern as the longitudinal results: decreasing prevalence of stunting as well as concurrent OWOB and stunting. OWOB prevalence increased significantly in urban girls and rural boys. Conclusions: The pattern of increasing overweight, decreasing stunting and concurrent overweight and stunting both with increasing age and over chronological time is observed among Vietnamese preschool children.
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Affiliation(s)
- Loan Minh Do
- a Outpatient Department , National Children's Hospital , Hanoi , Vietnam
| | - Lauren Lissner
- b Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine , Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Henry Ascher
- b Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine , Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,c Research Department , Angered Hospital , Gothenburg , Sweden
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Chávez-Zárate A, Maguiña JL, Quichiz-Lara AD, Zapata-Fajardo PE, Mayta-Tristán P. Relationship between stunting in children 6 to 36 months of age and maternal employment status in Peru: A sub-analysis of the Peruvian Demographic and Health Survey. PLoS One 2019; 14:e0212164. [PMID: 30943197 PMCID: PMC6447236 DOI: 10.1371/journal.pone.0212164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/29/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru. Methods A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers. Results The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers. Conclusion No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children.
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Affiliation(s)
- Airin Chávez-Zárate
- Escuela de Nutrición y Dietética, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
- * E-mail: (AC); (PM)
| | - Jorge L. Maguiña
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima Perú
| | | | | | - Percy Mayta-Tristán
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima Perú
- * E-mail: (AC); (PM)
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Weegels PL. The Future of Bread in View of its Contribution to Nutrient Intake as a Starchy Staple Food. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2019; 74:1-9. [PMID: 30637605 DOI: 10.1007/s11130-019-0713-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The growing, ageing, more urbanized and more sedentary global population urges for increased, more nutritious and more secure food supply. To combat undernutrition, adequate nutrient intake is required. Staple foods, especially starch based ones, like (pseudo)cereals, roots and tubers, are by definition contributing for a very large extent to our nutrient intake. It is important therefore that the contribution of ready to consume staple foods to the recommended intakes of nutrients are compared. This can be done in a transparent and simple way by calculating the nutrient contribution of ready to eat staple foods to the recommended daily allowances (RDA) or daily reference intakes (DRI). By using online nutrition tables from the USA and Europe, and DRI by USA and RDA by European food authorities, the potential nutrient contributions of staple foods were calculated. It can be concluded that consumption of ready to eat staple foods from the bread category and lentils overall contribute most to the recommended nutrient intakes. In view of its convenience, bread, especially whole grain bread is the staple food of choice to combat the future food supply challenges ahead.
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Affiliation(s)
- Peter L Weegels
- European Bakery Innovation Centre, Rietgorsweg 1-3, 3356 LJ, Papendrecht, The Netherlands.
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Deaconu A, Mercille G, Batal M. The Agroecological Farmer's Pathways from Agriculture to Nutrition: A Practice-Based Case from Ecuador's Highlands. Ecol Food Nutr 2019; 58:142-165. [PMID: 30691294 DOI: 10.1080/03670244.2019.1570179] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Agroecology is increasingly recognized as a sustainable production strategy that is appropriate for the rural poor. Meanwhile, agricultural initiatives have received much attention for their role in improving farmer nutrition, and three key pathways between agriculture and nutrition include consumption of own production, income and women's empowerment. In this study based in Ecuador's Imbabura province, we used qualitative methods to explore the practices of agroecological farmers with respect to these three key pathways. Results demonstrate the heterogeneity of lived experiences through which agroecology increases agricultural diversity and builds social and human capital to improve nutrition. We further identify barter as an under-explored means to nutrition outcomes, and we discuss the role of the complex rationales that mediate farmers' performance on agriculture-for-nutrition pathways. Finally, our results illustrate agroecology's potential to spread nutrition-promoting practices through endogenous farmers' networks.
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Affiliation(s)
- Ana Deaconu
- a Research Group on Nutrition Transition and Development (TRANSNUT), Nutrition Department, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Geneviève Mercille
- a Research Group on Nutrition Transition and Development (TRANSNUT), Nutrition Department, Faculty of Medicine , Université de Montréal , Montreal , Canada
| | - Malek Batal
- a Research Group on Nutrition Transition and Development (TRANSNUT), Nutrition Department, Faculty of Medicine , Université de Montréal , Montreal , Canada.,b Université de Montréal Public Health Research Institute (IRSPUM) , Montreal , Canada
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Associations of stunting at 2 years with body composition and blood pressure at 8 years of age: longitudinal cohort analysis from lowland Nepal. Eur J Clin Nutr 2018; 73:302-310. [PMID: 30154534 PMCID: PMC6368558 DOI: 10.1038/s41430-018-0291-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Stunting remains a very common form of child malnutrition worldwide, particularly in South Asian populations. There is poor understanding of how it develops and how it is associated with subsequent phenotype. SUBJECTS/METHODS We used data from a longitudinal cohort of children (n = 841) in lowland Nepal to investigate associations of stunting at 2 years with maternal traits and early growth patterns, and with body size and composition, kidney dimensions by ultrasound, lung function by spirometry and blood pressure (BP) at 8 years. RESULTS Compared to non-stunted children, children stunted at 2 years came from poorer families and had shorter, lighter mothers. They tended to have higher birth order, were born smaller, and remained shorter, lighter and thinner at 8 years. They had lower leg length, lean and fat masses, smaller kidneys, and reduced lung function (all p < 0.0001). These differences persisted with smaller magnitude after adjusting for current height, maternal height and education, family assets and birth order. Stunting was not associated with BP. DISCUSSION Stunting developed on an inter-generational timescale in this population and its risk increased with birth order. At 8 years, children stunted at 2 years had deficits in tissue masses and some aspects of physical function that were only partially attributable to their persisting short height and maternal phenotype. This suggests that the early stunting is associated with greater deficits in long-term outcomes than would be expected from the persistent short stature alone.
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Caleyachetty R, Thomas GN, Kengne AP, Echouffo-Tcheugui JB, Schilsky S, Khodabocus J, Uauy R. The double burden of malnutrition among adolescents: analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries. Am J Clin Nutr 2018; 108:414-424. [PMID: 29947727 DOI: 10.1093/ajcn/nqy105] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Adults and young children in countries experiencing the nutrition transition are known to be affected simultaneously by undernutrition and overnutrition. Adolescence is a critical period for growth and development. Yet, it is unknown to what extent this double burden of malnutrition affects adolescents in low- and middle-income countries (LMICs) and the macrolevel contextual factors associated with the double burden of malnutrition. Objective The aim was to quantify the magnitude of the double burden of malnutrition among adolescents and to examine the potential sources of heterogeneity in prevalence estimates across LMICs. Design We used individual-participant data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys conducted in 57 LMICs between 2003 and 2013, comprising 129,276 adolescents aged 12-15 y. Pooled estimates of stunting, thinness, or both; overweight or obesity; and concurrent stunting and overweight or obesity were calculated overall, by regions, and stratified by sex, with random-effects meta-analysis. Guided by UNICEF's conceptual framework for child malnutrition, we used ecological linear regression models to examine the association between macrolevel contextual factors (internal conflict, lack of democracy, gross domestic product, food insecurity, urbanization, and survey year) and stunting, thinness, and overweight and obesity prevalence, respectively. Results The prevalence of stunting was 10.2% (95% CI: 8.3%, 12.2%) and of thinness was 5.5% (95% CI: 4.3%, 6.9%). The prevalence of overweight or obesity was 21.4% (95% CI: 18.6%, 24.2%). Between 38.4% and 58.7% of the variance in adolescent malnutrition was explained by macrolevel contextual factors. The prevalence of concurrent stunting and overweight or obesity was 2.0% (95% CI: 1.7%, 2.5%). Conclusions The double burden of malnutrition among adolescents in LMICs is common. Context-sensitive implementation and scale-up of interventions and policies for the double burden of malnutrition are needed to achieve the Sustainable Development Goal to end malnutrition in all of its forms by 2030. This trial was registered at clinicaltrials.gov as NCT03346473.
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Affiliation(s)
- Rishi Caleyachetty
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - G N Thomas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa.,The George Institute for Global Health, Sydney, Australia
| | | | - Samantha Schilsky
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Juneida Khodabocus
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, United Kingdom
| | - Ricardo Uauy
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile.,Division of Pediatrics, School of Medicine, Catholic University of Chile, Santiago, Chile.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Maternal and familial correlates of anthropometric typologies in the nutrition transition of Colombia, 2000-2010. Public Health Nutr 2018; 21:2584-2594. [PMID: 29852886 DOI: 10.1017/s1368980018001337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to assess the maternal and family determinants of four anthropometric typologies at the household level in Colombia for the years 2000, 2005 and 2010. DESIGN We classified children 2) to assess stunting and overweight/obesity, respectively; mothers were categorized according to BMI to assess underweight (<18·5 kg/m2) and overweight/obesity (≥25·0 kg/m2). At the household level, we established four final anthropometric typologies: normal, underweight, overweight and dual-burden households. Separate polytomous logistic regression models for each of the surveyed years were developed to examine several maternal and familial determinants of the different anthropometric typologies. SETTING National and sub-regional (urban and rural) representative samples from Colombia, South America. SUBJECTS Drawing on data from three waves of Colombia's Demographic and Health Survey/Encuesta Nacional de Salud (DHS/ENDS), we examined individual and household information from mothers (18-49 years) and their children (birth-5 years). RESULTS Higher parity was associated with an increased likelihood of overweight and dual burden. Higher levels of maternal education were correlated with lower prevalence of overweight, underweight and dual burden of malnutrition in all data collection waves. In 2010, participation in nutrition programmes for children <5 years, being an indigenous household, food purchase decisions by the mother and food security classification were also associated with the four anthropometric typologies. CONCLUSIONS Results suggest that maternal and family correlates of certain anthropometric typologies at the household level may be used to better frame policies aimed at improving social conditions and nutrition outcomes.
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Dietary patterns and nutritional status of HIV-infected children and adolescents in El Salvador: A cross-sectional study. PLoS One 2018; 13:e0196380. [PMID: 29763418 PMCID: PMC5953455 DOI: 10.1371/journal.pone.0196380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/12/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The present study aimed to assess the nutritional status, the dietary patterns and its associated factors in the HIV-infected population of children and adolescents on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID). Methods A cross-sectional survey was carried out between December 2010 and December 2011. Socio-demographic and clinical characteristics were collected from 307 children and adolescents aged 2–18 years and receiving antiretroviral therapy. Nutritional status was assessed by height-for-age, weight-for-height and body mass index-for-age. Dietary data was collected through a 24 hour recall, and through a weekly food frequency questionnaire. Dietary patterns were identified by principal component analysis. Bivariate and multivariable statistical methods were used to assess the factors associated with “high adherence” to the “healthy diet” pattern. Results More than a third of the study group (33.2%) were stunted, 3.3% were identified as being wasted, and 10% were overweight or obese. Their diets were predominantly based on a high consumption of cereals, beans, eggs and processed foods and a low consumption of fruits, vegetables and dairy products. Three dietary patterns were identified: “healthy diet”, “high fat/sugar diet” and “low diversity diet”. Being female (OR: 1.63; 95%CI: 0.97–2.75), younger (OR: 2.37; 95%CI: 1.28–4.36) and institutionalized (OR: 14.5; 95%CI: 5.35–39.50) increased the odds to adhere to the “healthy diet” pattern. Conclusion Our findings reveal a high prevalence of stunting and overweight in HIV-infected children in El Salvador. Institutionalized children were more likely to adhere to a healthy dietary pattern whereas children in poverty were more likely to have less varied and healthy diets. These results highlight the need to assess the dietary patterns of HIV-infected children and adolescents in order to guide public policies to design healthy life style interventions for this population at risk.
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Examining the relationship between socioeconomic status and the double burden of maternal over and child under-nutrition in Bangladesh. Eur J Clin Nutr 2018; 73:531-540. [PMID: 29691487 DOI: 10.1038/s41430-018-0162-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/14/2018] [Accepted: 03/16/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES There is little research on the association between socioeconomic status (SES) and the familial co-existence of maternal over and child under-nutrition (MOCU). Most of these studies conducted in the Latin American countries. Therefore, we intended to further this important area of query by exploring the relationship between SES and the dual burden of MOCU in Bangladesh. SUBJECTS/METHODS We used data from the 2014 Bangladesh Demographic Health Survey (BDHS). The analyses were based on the responses of 5687 mother-child pairs. We focused standard of living (hereafter referred to as wealth) as a measure of SES. We determined MOCU if there were an undernourished child and an overweight mother in the same household. RESULTS Maternal overweight and MOCU prevalence is higher among the wealthier segment whereas prevalence of child under-nutrition is higher among the poorest segment of the households. The relative risk of a household having MOCU increased by the factors of 2.84 (confidence interval (CI) = 1.58-5.12) among households with richest bands of wealth compared to the poorest category. Household from the medium (Relative risk ratio (RRR) = 1.87, 95% CI = 1.07-3.28) and richer SES groups (RRR = 2.56, 95% CI = 1.39-4.69) had increased chance for MOCU as compared to the household from poorest SES group. CONCLUSIONS As opposed to findings from other Latin American countries, the prevalence of MOCU in Bangladesh is higher in the wealthiest households. Findings of our study therefore suggest that overweight prevention programs in wealthier households of Bangladesh need to think out the possibility that their focus households may also include underweight persons.
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Jones AD, Hoey L, Blesh J, Janda K, Llanque R, Aguilar AM. Peri-Urban, but Not Urban, Residence in Bolivia Is Associated with Higher Odds of Co-Occurrence of Overweight and Anemia among Young Children, and of Households with an Overweight Woman and Stunted Child. J Nutr 2018; 148:632-642. [PMID: 29659966 DOI: 10.1093/jn/nxy017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background Urban populations have grown globally alongside emerging simultaneous burdens of undernutrition and obesity. Yet, how heterogeneous urban environments are associated with this nutritional double burden is poorly understood. Objective We aimed to determine: 1) the prevalence of the nutritional double burden and its components in urban, peri-urban, and rural areas of Bolivia; and 2) the association of residence in these areas with the nutritional double burden and its components. Design We surveyed 3946 randomly selected households from 2 metropolitan regions of Bolivia. Census data and remotely sensed imagery were used to define urban, peri-urban, and rural districts along a transect in each region. We defined 5 nutritional double burdens: concurrent overweight and anemia among women of reproductive age (15-49 y), and children (6-59 mo), respectively; concurrent overweight and stunting among children; and households with an overweight woman and, respectively, an anemic or stunted child. Capillary hemoglobin concentrations were measured to assess anemia (women: hemoglobin <120 g/L; children: hemoglobin <110 g/L), and overweight and stunting were calculated from height, weight, and age data. Results In multiple logistic regression models, peri-urban, but not urban residence, was associated with higher odds of concurrent overweight and anemia among children (OR: 1.8; 95% CI; 1.0, 3.2) and of households with an overweight woman and stunted child (1.8; 1.2, 2.7). Examining the components of the double burden, peri-urban women and children, respectively, had higher odds of overweight than rural residents [women (1.5; 1.2, 1.8); children (1.5; 1.0, 2.4)], and children from peri-urban regions had higher odds of stunting (1.5; 1.1, 2.2). Conclusions Peri-urban, but not urban, residence in Bolivia is associated with a higher risk of the nutritional double burden than rural areas. Understanding how heterogeneous urban environments influence nutrition outcomes could inform integrated policies that simultaneously address both undernutrition and obesity.
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Affiliation(s)
- Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lesli Hoey
- College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI
| | - Jennifer Blesh
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI
| | - Kathryn Janda
- University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX
| | | | - Ana María Aguilar
- Instituto de Investigación en Salud y Desarrollo, Universidad Mayor de San Andres, La Paz, Bolivia
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A. Balalian A, Simonyan H, Hekimian K, Deckelbaum RJ, Sargsyan A. Prevalence and determinants of stunting in a conflict-ridden border region in Armenia - a cross-sectional study. BMC Nutr 2017; 3:85. [PMID: 32153861 PMCID: PMC7050870 DOI: 10.1186/s40795-017-0204-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0- to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years. METHODS We conducted a cross-sectional study including 594 children aged 6-month- 6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children's stool and conducted a survey with children's caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25-72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6-24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers' height, the overall duration of breastfeeding, birthweight, child's history of diarrhea and mean socio-economic score. RESULTS The prevalence of stunting was significantly higher among the 6-24 months old children (13.3%) compared to the children aged 25-72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6-24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother's height significantly decreased the odds of stunting among the children 25-72- months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups. CONCLUSIONS The study results highlight the significance of mother's height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region.
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Affiliation(s)
- Arin A. Balalian
- Fund for Armenian Relief of America, #22 Khorenatsi Street, Yerevan, Armenia
- Department of Epidemiology, Columbia University, Mailman School of Public Health, Room #1616, 722 W 168th Street, New York, NY 10032 USA
| | - Hambardzum Simonyan
- Fund for Armenian Relief of America, #22 Khorenatsi Street, Yerevan, Armenia
| | - Kim Hekimian
- Institute of Human Nutrition, Columbia University, 630 W. 168th Street, New York, NY 10032 USA
| | - Richard J. Deckelbaum
- Institute of Human Nutrition, Columbia University, 630 W. 168th Street, New York, NY 10032 USA
| | - Aelita Sargsyan
- Fund for Armenian Relief of America, #22 Khorenatsi Street, Yerevan, Armenia
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Vonaesch P, Tondeur L, Breurec S, Bata P, Nguyen LBL, Frank T, Farra A, Rafaï C, Giles-Vernick T, Gody JC, Gouandjika-Vasilache I, Sansonetti P, Vray M. Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA). PLoS One 2017; 12:e0182363. [PMID: 28796794 PMCID: PMC5552116 DOI: 10.1371/journal.pone.0182363] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022] Open
Abstract
Stunting remains a major public health concern worldwide. Although its global prevalence is slowly decreasing, the actual number of affected children is still rising in Sub-Saharan Africa. In the Central African Republic (CAR), about one third of all children below the age of five are stunted. Stunting is correlated with many long-term consequences, including poor cognitive development and a higher rate of morbidity and mortality, making stunting a major contributor to poverty. In CAR, little is known about the factors that contribute to stunting. This study aimed at analysing, in a cross-sectional study, the main factors associated with stunting in a group of 414 children recruited between December 2011 and November 2013, aged five years or less and living in Bangui. For all children, demographic, socio-economic and anthropometric data were recorded and asymptomatic enteropathogen carriage was assessed in stool samples using classical microbiological assays. The study group had a mean age of 14.2±10 months. Fifty-eight percent (292/414) were boys, and 36 percent (148/414) exhibited stunted growth. Of the stunted children, 51% (75/148) showed a moderate delay in linear growth for their age group [height-for-age z-score (HAZ) between -2 and -3 SD] while 49% (73/148) presented a severe delay (HAZ < -3). Factors significantly associated with stunting included gender (aOR: 1.67; 95% CI: 1.07; 2.62 for boys compared to girls) and age (aOR of 3.98 (95% CI: 2.45; 6.46) for toddlers and aOR 4.42 (95% CI: 2.36; 8.28) for children compared to infants). Most importantly, we identified being overweight [weight-for-height z-score (WHZ) > 2 SD; aOR: 3.21; 95% CI: 1.50; 6.90 of overweight compared to normal weight] as also being significantly associated with stunting. This is the first study showing that even in the poorest countries of the world there is an association of stunting with being overweight.
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Affiliation(s)
- Pascale Vonaesch
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | - Laura Tondeur
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | - Sébastien Breurec
- Laboratoire de Microbiologie Clinique et Environnementale, Centre Hospitalo-Universitaire, Pointe-à-Pitre/Les Abymes, Guadeloupe, France
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
- Université des Antilles, Faculté de Médecine, Pointe-aà-Pitre, Guadeloupe, France
| | - Petula Bata
- Complexe Pédiatrique de Bangui, Bangui, République Centrafricaine
| | - Liem Binh Luong Nguyen
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Thierry Frank
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Alain Farra
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Clotaire Rafaï
- Laboratoire de Bactériologie médicale, Institut Pasteur de Bangui, Bangui, République Centrafricaine
| | - Tamara Giles-Vernick
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
| | | | | | - Philippe Sansonetti
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
| | - Muriel Vray
- Unité d'épidémiologie et d'expertise des maladies émergentes, Institut Pasteur, Paris, France
- Unité d’épidémiologie des maladies infectieuses, Institut Pasteur de Dakar, Dakar, Sénégal
- * E-mail:
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Bates K, Gjonça A, Leone T. Double burden or double counting of child malnutrition? The methodological and theoretical implications of stuntingoverweight in low and middle income countries. J Epidemiol Community Health 2017; 71:779-785. [PMID: 28566281 PMCID: PMC5537509 DOI: 10.1136/jech-2017-209008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing concern at research and policy levels about the double burden of child malnutrition (DBCM)-with stunting and overweight found across different groups of children. Despite some case studies suggesting that stunting and overweight can occur concurrently in children, here known as 'stuntingoverweight', and major drives to reduce all forms of malnutrition in low and middle income countries (LMICs), stuntingoverweight is continually overlooked. This research evidences the prevalence of stuntingoverweight across LMICs, exploring the theoretical and methodological implications of failing to acknowledge this form of malnutrition. METHODS Prevalence estimates of stuntingoverweight are constructed from 79 LMICs with nationally representative anthropometric survey data. Stunting and overweight estimates are amended to exclude stuntedoverweight children. These estimates are compared with those published in the Joint Child Malnutrition Estimates (JMEs)-evidencing overestimation and double counting of stuntedoverweight children. RESULTS Children can be concurrently stunted and overweight. Stuntedoverweight children are found in all LMICs, from 0.3% to 11.7% of under-fives and are included in both stunting and overweight rates. Analysed together, this leads to double counting of stuntedoverweight children. This artificial inflation of stunting and overweight rates can give a false impression of a DBCM, obscuring the true diversity of malnutrition present. Over 10 million children are stuntedoverweight in the world. CONCLUSIONS Stuntingoverweight is a newly recognised, understudied phenomenon. Affected children are included in both stunting and overweight prevalence estimates, introducing unobserved heterogeneity to both individual-level and population-level research and double counting to population-level research. Overlooking stuntedoverweight children has great implications for methodology, theory, policies, programmes and the health of affected children.
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Affiliation(s)
- Katie Bates
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Arjan Gjonça
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Tiziana Leone
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Atsu BK, Guure C, Laar AK. Determinants of overweight with concurrent stunting among Ghanaian children. BMC Pediatr 2017; 17:177. [PMID: 28750614 PMCID: PMC5531099 DOI: 10.1186/s12887-017-0928-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition (undernutrition and overnutrition) is a major public health problem in Ghana –affecting growth and development of individuals and the nation. Stunting and overweight are of particular interest, as recent national surveys show a rising trend of overnutrition and stubbornly high burden of stunting among Ghanaian children. There are currently no data on the simultaneous occurrence of overweight and stunting within individuals in Ghana. This paper presents the burden, the individual-level, and contextual determinants of overweight with concurrent stunting among Ghanaian children. Methods This study analyzed data set of the fourth round of the Ghana Multiple Indicator Cluster Survey (MICS4). Bivariate analyses were used to describe selected characteristics of survey respondents and their children. Hierarchical modelling approach facilitated identification of significant distal, intermediate and proximal factors/determinants of concurrent stunting and overweight. Both crude and adjusted prevalence ratios via a multivariable Poison regression model with their corresponding 95% Confidence Intervals (CI) are reported. Variables with p ≤ 0.25 at the bivariate level were included in the multivariable analysis. An alpha value of 5% was used to indicate significance. Results Of 7550 cases (children) analyzed, the prevalence of stunting was 27.5%; underweight was 17.3%; and wasting was 7.7%. The prevalence of overweight and concurrent overweight and stunting were respectively 2.4% and 1.2%. Children who belonged to the fourth wealth quintile, were more likely to be overweight and concurrently stunted as against children belonging to the poorest quintile (aPR = 1.010; 95% CI, 1.003–1.017). Compared to religious (Christians/Muslim/Traditionalist) household heads, children whose household heads did not belong to any religion had 2 times the rates of the Overweight with concurrent stunting (PR = 2.024; 95% CI, 1.016–4.034). Children with mothers aged 20–34 and 35–49 had an increased though insignificant prevalence ratio of association (aPR = 1.001; 95% CI, 0.994–1.005) and (aPR = 1.001; 95% CI, 0.998–1.012) respectively. Conclusion This analysis determined the prevalence of concurrent stunting and overweight among Ghanaian children to be 1.2%. Four contextual variables (breastfeeding status, religion, geographic region, and wealth index quintile) were associated with overweight with concurrent stunting. We conclude that, only contextual factors are predictive of DBM among children under five living in Ghana.
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Affiliation(s)
- Benedicta K Atsu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Chris Guure
- Department of Biostastics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Amos K Laar
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
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Swigart TM, Bonvecchio A, Théodore FL, Zamudio-Haas S, Villanueva-Borbolla MA, Thrasher JF. Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies. PLoS One 2017; 12:e0180185. [PMID: 28671954 PMCID: PMC5495390 DOI: 10.1371/journal.pone.0180185] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 06/12/2017] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior. OBJECTIVE Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico. METHODS We performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321). RESULTS Women reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older. CONCLUSIONS Future strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers.
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Affiliation(s)
- Tessa M. Swigart
- Nutrition and Health Research Center, National Institute of Public Health. Cuervanaca, Morelos, Mexico
| | - Anabelle Bonvecchio
- Nutrition and Health Research Center, National Institute of Public Health. Cuervanaca, Morelos, Mexico
- * E-mail:
| | - Florence L. Théodore
- Nutrition and Health Research Center, National Institute of Public Health. Cuervanaca, Morelos, Mexico
| | - Sophia Zamudio-Haas
- Center for AIDS Prevention Studies, University of California, San Francisco. California, United States of America
| | | | - James F. Thrasher
- Nutrition and Health Research Center, National Institute of Public Health. Cuervanaca, Morelos, Mexico
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
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