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Asebe HA, Asmare ZA, Mare KU, Kase BF, Tebeje TM, Asgedom YS, Shibeshi AH, Lombebo AA, Sabo KG, Fente BM, Bezie MM, Seifu BL. The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis. Front Nutr 2024; 11:1336864. [PMID: 38903623 PMCID: PMC11187342 DOI: 10.3389/fnut.2024.1336864] [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: 11/11/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.
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Affiliation(s)
- Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanose Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Afewerk Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meklit Melaku Bezie
- Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia
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Ewune HA, Abebe RK, Sisay D, Tesfa GA. Prevalence of wasting and associated factors among children aged 2-5 years, southern Ethiopia: a community-based cross-sectional study. BMC Nutr 2022; 8:160. [PMID: 36585708 PMCID: PMC9805277 DOI: 10.1186/s40795-022-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Wasting (acute malnutrition) is the most serious form of malnutrition for children in the near term. Malnutrition has a variety of causes, all of which are interconnected and hierarchically related. The purpose of this study was to assess the prevalence of wasting and its associated determinants among children under the age of five in the Wonago district, Gedeo zone, southern Ethiopia. METHODS Community based cross-sectional study was conducted from October 1 to 30, 2021 using a systematic random sampling technique. Data were entered using Epidata manager and STATA v.20 software was used for analysis. Descriptive statistics were reported to describe the study population. To identify associated factors of wasting, bivariate and multivariate logistic regression analysis were fitted. Variables having p-value < 0.05 were declared statistically significant predictors of wasting. RESULTS A total of 390 respondents participated with a response rate of 92.6%. The prevalence of wasting among children aged 2-5 years in Wonago district was 36.4% (95% CI: 31.76-41.32). Moderate household food insecurity (AOR = 0.35, 95%CI: 0.14-0.83), history of recurrent illness (AOR = 0.15, 95%CI: 0.26-0.84), and duration of breastfeeding greater than 2 years (AOR = 0.15, 95%CI: 0.26-0.84) were significantly associated with wasting. CONCLUSION Almost one-third of the children were wasted. Household food insecurity, breastfeeding, and recurrent illness were significantly associated with wasting among children aged 24-59 months. It is recommended that interventions be designed with food security, disease prevention, and breastfeeding awareness in mind and put the spotlight on food and nutrition policy to insure children's nutritional status.
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Affiliation(s)
- Helen Ali Ewune
- grid.472268.d0000 0004 1762 2666Human nutrition department, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Reta Kassa Abebe
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Getanew Aschalew Tesfa
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
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Factors Related to Underweight Prevalence among 33,776 Children Below 60 Months Old Living in Northern Geopolitical Zones, Nigeria (2008–2018). Nutrients 2022; 14:nu14102042. [PMID: 35631183 PMCID: PMC9142964 DOI: 10.3390/nu14102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/30/2022] [Accepted: 05/10/2022] [Indexed: 02/05/2023] Open
Abstract
The prevalence of underweight among children below 60 months old in Nigeria remains a significant public health challenge, especially in northern geopolitical zones (NGZ), ranging from 15% to 35%. This study investigates time-based trends in underweight prevalence and its related characteristics among NGZ children below 60 months old. Extracted NGZ representative dataset of 33,776 live births from the Nigeria Demographic and Health Survey between 2008 and 2018 was used to assess the characteristics related to underweight prevalence in children aged 0–23, 24–59, and 0–59 months using multilevel logistics regression. Findings showed that 11,313 NGZ children below 60 months old were underweight, and 24–59-month-old children recorded the highest prevalence (34.8%; 95% confidence interval: 33.5–36.2). Four factors were consistently significantly related to underweight prevalence in children across the three age groups: poor or average-income households, maternal height, children who had diarrhoea episodes, and children living in the northeast or northwest. Intervention initiatives that include poverty alleviation through cash transfer, timely health checks of offspring of short mothers, and adequate clean water and sanitation infrastructure to reduce the incidence of diarrhoea can substantially reduce underweight prevalence among children in NGZ in Nigeria.
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Moshi CC, Sebastian PJ, Mushumbusi DG, Azizi KA, Meghji WP, Kitunda ME, Kasankala LM. Determinants of underweight among children aged 0-23 months in Tanzania. Food Sci Nutr 2022; 10:1167-1174. [PMID: 35432972 PMCID: PMC9007294 DOI: 10.1002/fsn3.2748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Underweight is the most dependable growth indicator for overall child growth. Tanzania has the highest rate of underweight children in East Africa, with 1.27 million children under the age of five suffering from the condition. This study aimed to determine factors that influence underweight in Tanzanian children aged 0–23 months. We used data from the Tanzania Demographic and Health Survey (TDHS) 2015–2016 to conduct secondary analysis on a sample of 4,327 children aged 0–23 months. Descriptive and inferential statistics such as frequency, chi‐square, binary, and multivariate logistic regression were performed using the Statistical Package of Social Science (SPSS version 25). Statistical significance was defined as a p‐value of less than 0.05. Multivariate analysis found risk factors for underweight children were as follows: child's gender, age, birth weight, mothers' BMI, level of education, and type of toilet facility used by the households. Females had a significantly lower risk of being underweight (AOR = 0.62, 95% CI = 0.48–0.81, p < .05) compared with male children. The odds of being underweight increase with low birth weight (AOR = 2.92, 95% CI = 1.92–4.43, p < .05), low mother's BMI (AOR = 2.48, 95% CI = 1.34–4.58, p < .05), and low educational level (AOR = 1.78, 95% CI = 1.23–2.58, p < .05). Nutrition interventions such as growth monitoring, nutrition counseling, and nutrition education for parents/caregivers are critical to ensuring proper weight gain for all children under 2 years of age.
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Affiliation(s)
- Cypriana Cyprian Moshi
- Department of Food Science and Nutrition Tanzania Food and Nutrition Center Dar es Salaam Tanzania
| | - Penina Joseph Sebastian
- Department of Food Science and Nutrition Tanzania Food and Nutrition Center Dar es Salaam Tanzania
| | | | - Kaunara Ally Azizi
- Department of Food Science and Nutrition Tanzania Food and Nutrition Center Dar es Salaam Tanzania
| | - Wessy Pirbhai Meghji
- Department of Food Science and Nutrition Tanzania Food and Nutrition Center Dar es Salaam Tanzania
| | - Malimi Emmanuel Kitunda
- Department of Food Science and Nutrition Tanzania Food and Nutrition Center Dar es Salaam Tanzania
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Smith-Greenaway E. Does Parents' Union Instability Disrupt Intergenerational Advantage? An Analysis of Sub-Saharan Africa. Demography 2020; 57:445-473. [PMID: 32034724 DOI: 10.1007/s13524-019-00854-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The long arm of childhood, with its wide-ranging influence on individuals' life chances, highlights the importance of understanding the determinants of health in early life. Research has established that parents' education is a major determinant of childhood health, but children across the globe increasingly experience their parents' divorce and subsequent remarriage, raising questions of whether union instability alters these intergenerational processes. Does divorce and remarriage interfere with parents' education benefiting their young children's health? I explore this question in sub-Saharan Africa, a world region where parents' education plays a major role in protecting children against severe health risks, and where young children commonly experience parental divorce and remarriage. Moreover, sub-Saharan Africa features distinct family lineage systems, affording an opportunity to explore this question in both majority matrilineal and patrilineal contexts. Analyses of Demographic and Health Survey data on 271,292 children in 30 sub-Saharan African countries offer no evidence that the high levels of union instability in the region will weaken the health benefits of parents' education for future generations. Following divorce, children benefit from their biological parents' education to the same degree as children with married parents-a finding that is consistent across lineage contexts. Moreover, stepfathers' education corresponds with pronounced health benefits for their coresident stepchildren, particularly in patrilineal regions where these children benefit less dramatically from their mothers' education. Together, the study results offer a renewed sense of the importance of parents'-including stepfathers'-education for early childhood health across diverse family structures.
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Affiliation(s)
- Emily Smith-Greenaway
- Department of Sociology, University of Southern California, 851 Downey Way, Los Angeles, CA, 90089-1059, USA.
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Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E863. [PMID: 28788108 PMCID: PMC5580567 DOI: 10.3390/ijerph14080863] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/24/2023]
Abstract
Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.
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Affiliation(s)
- Blessing J Akombi
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - John J Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nidhi Wali
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
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Akombi BJ, Agho KE, Merom D, Hall JJ, Renzaho AM. Multilevel Analysis of Factors Associated with Wasting and Underweight among Children Under-Five Years in Nigeria. Nutrients 2017; 9:E44. [PMID: 28075336 PMCID: PMC5295088 DOI: 10.3390/nu9010044] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/29/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022] Open
Abstract
Wasting and underweight reflect poor nutrition, which in children leads to retarded growth. The aim of this study is to determine the factors associated with wasting and underweight among children aged 0-59 months in Nigeria. A sample of 24,529 children aged 0-59 months from the 2013 Nigeria Demographic and Health Survey (NDHS) was used. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify significant factors associated with wasting/severe wasting and underweight/severe underweight. The prevalence of wasting was 18% (95% Confidence Interval (CI): 17.1, 19.7) and severe wasting 9% (95% CI: 7.9, 9.8). The prevalence of underweight was 29% (95% CI: 27.1, 30.5) and severe underweight 12% (95% CI: 10.6, 12.9). Multivariable analysis revealed that the most consistent factors associated with wasting/severe wasting and underweight/severe underweight are: geopolitical zone (North East, North West and North Central), perceived birth size (small and average), sex of child (male), place/mode of delivery (home delivery and non-caesarean) and a contraction of fever in the two weeks prior to the survey. In order to meet the WHO's global nutrition target for 2025, interventions aimed at improving maternal health and access to health care services for children especially in the northern geopolitical zones of Nigeria are urgently needed.
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Affiliation(s)
- Blessing J Akombi
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith NSW 2571, Australia.
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith NSW 2571, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith NSW 2571, Australia.
| | - John J Hall
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan NSW 2308, Australia.
| | - Andre M Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia.
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