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Anita. Assessment of malnutrition using Z-scores and Composite Index of Anthropometric Failure among street children in Delhi. Nutrition 2024; 125:112487. [PMID: 38905910 DOI: 10.1016/j.nut.2024.112487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Street children are poverty-stricken and have insufficient money to meet their daily nutritional requirements. They do not have a proper place to sleep and defecate. They sleep at traffic signals, in religious places, and on footpaths. This exposes them to pollution, dirt, and other pathogens. OBJECTIVES This study aimed to measure the nutritional status of street children in Delhi using Z-scores and Composite Index of Anthropometric Failure (CIAF). METHODS Anthropometric measurements are direct methods of measuring the nutritional status of humans. Anthropometric indicators such as underweight (weight-for-age), stunting (height-for-age) and BMI/wasting (weight-for-height) are used to measure the nutritional status of street children. Z-scores and CIAF are calculated for street children based on the WHO 2009 reference. RESULTS According to Z-scores, stunting (56%) is the most common anthropometric failure among street children followed by underweight (31%) and wasting (19%). According to the CIAF, 63% of street children are malnourished, where stunting (37%) is the highest single burden of anthropometric failure, followed by wasting (3%) and underweight (1%); children suffering from the double burden of anthropometric failure are 9%, and children suffering from the triple burden of anthropometric failure (i.e., wasting, stunting, and underweight) are 13%. CONCLUSION A high incidence of stunting points to poor quality of food and suggests prolonged nutrition deficiency among street children. The Z-score or conventional measures of anthropometry underestimate the total burden of malnutrition among street children, while CIAF provides an estimation of children with single-burden, double-burden, and triple-burden malnutrition or total burden of malnutrition.
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Affiliation(s)
- Anita
- Guest Faculty, Department of Geography, Government Girls College, Mahuwa, Dausa, Rajasthan, India.
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Sridhar S, Digidiki V, Ratner L, Kunichoff D, Gartland MG. Child Migrants in Family Detention in the US: Addressing Fragmented Care. CHILDREN (BASEL, SWITZERLAND) 2024; 11:944. [PMID: 39201879 PMCID: PMC11352222 DOI: 10.3390/children11080944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/07/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND/OBJECTIVES Migrant children in family detention facilities often experience frequent relocations and prolonged stays in precarious living conditions. This frequent relocation results in fragmentation of necessary medical care, leading to delays and inadequate medical care. We aim to highlight the critical need for comprehensive medical documentation in immigration detention facilities, a fragmented health care system and potential harm to these children without appropriate medical documentation. METHODS We conducted a retrospective review of 165 medical records from children detained at the Karnes County Family Residential Center between June 2018 and October 2020 to evaluate the adequacy of pediatric medical documentation in an Immigration and Customs Enforcement (ICE) family detention facility. Specific areas of interest included acute care, nutrition, immunization, developmental screening, and tuberculosis screening. Simple descriptive statistics were used to analyze the data. RESULTS Only 25% of 418 acute medical care visits included specific diagnoses. There was no documentation regarding follow-up recommendations upon release. 97% of children had a chest X-ray completed for tuberculosis screening, however no follow-up recommendations were documented for those with granulomas. Vaccination histories were inconsistently documented. No nutritional categorizations were completed despite 16% of children being at risk for malnutrition or already malnourished. CONCLUSIONS Our findings revealed significant gaps in documentation, particularly in medical decision-making and clinical reasoning. In a fragmented medical system, inadequate documentation can result in avoidable errors in diagnosis and management. Improving documentation practices is crucial to ensure that all children, regardless of immigration status, receive quality healthcare aligned with national and international standards.
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Affiliation(s)
- Shela Sridhar
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;
| | - Vasileia Digidiki
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA; (V.D.); (D.K.)
| | - Leah Ratner
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;
| | - Dennis Kunichoff
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA; (V.D.); (D.K.)
| | - Matthew G. Gartland
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St. Suite 725, Boston, MA 02114, USA;
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Ijaiya MA, Anjorin S, Uthman OA. Quantifying the increased risk of illness in malnourished children: a global meta-analysis and propensity score matching approach. Glob Health Res Policy 2024; 9:29. [PMID: 39085934 PMCID: PMC11290152 DOI: 10.1186/s41256-024-00371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Childhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity. METHODS We performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort. RESULTS The IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively. CONCLUSIONS Our study revealed a correlation between specific childhood malnutrition subtypes-double-burden malnutrition and wasting-and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition.
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Affiliation(s)
- Mukhtar A Ijaiya
- Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT, Nigeria.
| | - Seun Anjorin
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Zonta ML, Servián A, Virgolini B, Garraza M, Minardi G, Navone GT. Malnutrition and intestinal parasitosis: Current prevalences and risk factors among schoolchildren in Misiones (Argentina). Am J Hum Biol 2024:e24140. [PMID: 39034672 DOI: 10.1002/ajhb.24140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES To assess the current prevalences of nutritional status and intestinal parasites, and their potential association with socio-environmental conditions among schoolchildren in Aristóbulo del Valle, Misiones. METHODS We measured body weight and height in 444 schoolchildren aged 3-14 years and evaluated their nutritional status following WHO criteria. We examined fecal samples and anal swabs from 234 schoolchildren and collected socio-environmental data through questionnaires. RESULTS The prevalence of undernutrition was 4.5% and excess of weight was 24.1%. The prevalence of stunting and of being overweight reached 2.3% and 12.4%, respectively. About 42% of the schoolchildren were infected with at least one of the 12 species identified. The most prevalent species were Blastocystis sp., Enterobius vermicularis, and Giardia lamblia. Entamoeba dispar was recorded for the first time in the locality. The multiple correspondence analysis identified peri-urban, urban, and rural groups. Underweight, stunting and obesity were highest in the peri-urban group, while overweight, wasting and parasitism rates were highest in the rural group. The urban group showed the lowest parasitic prevalences. Bed-sharing, mother's education, and animal husbandry were associated with parasitic infections. CONCLUSIONS The study highlights a decrease in undernutrition but a rise in overweight and obesity, indicating an ongoing nutritional transition. The association between socio-environmental risk factors and parasitic infections underscore the need for comprehensive interventions addressing both nutritional and socio-environmental conditions to improve the population's life quality.
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Affiliation(s)
- María Lorena Zonta
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asoc. CIC), Buenos Aires, La Plata, Argentina
| | - Andrea Servián
- Instituto Nacional de Parasitología (INP) "Dr. Mario Fatala Chaben", Paseo Colón 568 (1063), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Buenos Aires, Argentina
| | - Belén Virgolini
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asoc. CIC), Buenos Aires, La Plata, Argentina
| | - Mariela Garraza
- Laboratorio de Investigaciones en Ontogenia y Adaptación (LINOA)-Facultad de Ciencias Naturales y Museo (FCNyM), Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Graciela Minardi
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asoc. CIC), Buenos Aires, La Plata, Argentina
| | - Graciela T Navone
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asoc. CIC), Buenos Aires, La Plata, Argentina
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Ow MYL, Tran NT, Berde Y, Nguyen TS, Tran VK, Jablonka MJ, Baggs GE, Huynh DTT. Oral nutritional supplementation with dietary counseling improves linear catch-up growth and health outcomes in children with or at risk of undernutrition: a randomized controlled trial. Front Nutr 2024; 11:1341963. [PMID: 39050140 PMCID: PMC11266289 DOI: 10.3389/fnut.2024.1341963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Childhood undernutrition is associated with increased morbidity, mortality and a high socio-economic burden. Methods Supporting Pediatric GRowth and Health OUTcomes (SPROUT) is a randomized, controlled trial evaluating the effects of an oral nutritional supplement (ONS) with dietary counseling (DC; n = 164) compared to a DC-only group who continued consuming their habitual milk (n = 166; NCT05239208). Children aged 24-60 months who were at risk or with undernutrition, as defined by weight-for-age [WAZ] < -1 and height-for-age [HAZ] < -1 according to the WHO Growth Standards, and who also met the criterion of weight-for-height [WHZ] < 0, were enrolled in Vietnam. Results ONS + DC had a larger WAZ increase at day 120 (primary endpoint) vs. DC (least squares mean, LSM (SE): 0.30 (0.02) vs. 0.13 (0.02); p < 0.001), and larger improvements in all weight, BMI and weight-for-height indices at day 30 and 120 (all p < 0.01). Height gain was larger in ONS + DC in all indices, including height-for-age difference [HAD; cm: 0.56 (0.07) vs. 0.10 (0.07); p < 0.001], at day 120. ONS + DC had larger arm muscle but not arm fat indices, higher parent-rated appetite, physical activity and energy levels, longer night sleep, fewer and shorter awakenings, and better sleep quality than DC. Conclusion Adding ONS to DC, compared to DC-alone, improves growth in weight and height, linear catch-up growth, and health outcomes in children with or at risk of undernutrition.
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Affiliation(s)
- Mandy Y. L. Ow
- Abbott Nutrition R&D Asia Pacific-Center, Abbott Laboratories, Singapore, Singapore
| | - Nga Thuy Tran
- Department of Micronutrients, National Institute of Nutrition, Hanoi, Vietnam
| | - Yatin Berde
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd., Mumbai, India
| | - Tu Song Nguyen
- Department of General Planning, National Institute of Nutrition, Hanoi, Vietnam
| | - Van Khanh Tran
- Department of Micronutrients, National Institute of Nutrition, Hanoi, Vietnam
| | | | | | - Dieu T. T. Huynh
- Abbott Nutrition R&D Asia Pacific-Center, Abbott Laboratories, Singapore, Singapore
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Abel L, Casanova JL. Human determinants of age-dependent patterns of death from infection. Immunity 2024; 57:1457-1465. [PMID: 38986441 PMCID: PMC11345826 DOI: 10.1016/j.immuni.2024.05.020] [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: 02/05/2024] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024]
Abstract
Regardless of microbial virulence (i.e., the global infection-fatality ratio), age generally drives the prevalence of death from infection in unvaccinated humans. Four mortality patterns are recognized: the common U- and L-shaped curves of endemic infections and the unique W- and J-shaped curves of pandemic infections. We suggest that these patterns result from different sets of human genetic and immunological determinants. In this model, it is the interplay between (1) monogenic genotypes affecting immunity to primary infection that preferentially manifest early in life and related genotypes or their phenocopies, including auto-antibodies, which manifest later in life and (2) the occurrence and persistence of adaptive, acquired immunity to primary or cross-reactive infections, which shapes the age-dependent pattern of human deaths from infection.
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Affiliation(s)
- Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Necker Hospital for Sick Children, Paris, France; Paris Cité University, Imagine Institute, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA.
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Inserm U1163, Necker Hospital for Sick Children, Paris, France; Paris Cité University, Imagine Institute, Paris, France; St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA; Department of Pediatrics, Necker Hospital for Sick Children, Paris, France; Howard Hughes Medical Institute, New York, NY, USA.
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7
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Spoto G, Accetta AS, Grella M, Di Modica I, Nicotera AG, Di Rosa G. Respiratory Comorbidities and Complications of Cerebral Palsy. Dev Neurorehabil 2024; 27:194-203. [PMID: 38992903 DOI: 10.1080/17518423.2024.2374959] [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: 08/16/2023] [Revised: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers.
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Sahu SK, Pradhan DD, Gudu RK, Tripathy SK, Jena P. Prevalence of Acute Bacterial Infections and Their Antibiotic Sensitivity Pattern in Children With Severe Acute Malnutrition From a Tertiary Care Hospital of Odisha. Cureus 2024; 16:e65280. [PMID: 39184695 PMCID: PMC11343070 DOI: 10.7759/cureus.65280] [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] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background and objective Malnutrition remains a significant cause of childhood morbidity and mortality worldwide. Severe acute malnutrition (SAM) profoundly affects immune development, physiological functions, and metabolic processes, increasing susceptibility to infections. This study aimed to investigate the prevalence of acute bacterial infections and their antibiotic sensitivity patterns among SAM children admitted to a tertiary care hospital. Methodology This prospective observational study was conducted at the pediatric department of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, from November 2020 to October 2023. The study included 95 children aged 6-59 months meeting WHO criteria for SAM. Participants underwent comprehensive demographic assessments, clinical evaluations, and relevant laboratory tests, including blood and urine cultures with sensitivity testing. Results The study found that 82.1% of children had weight-for-height below -3 standard deviations, and 84.21% had mid-upper arm circumference below 115 mm, confirming SAM diagnosis. The most prevalent infections were acute gastroenteritis (47.3%), respiratory tract infections (46.3%), bacteremia (27.4%), and urinary tract infections (26.3%). Positive urine cultures were observed in 25 cases (26.3%), predominantly among females (68%). Escherichia coli (40%) and Klebsiella pneumoniae (24%) were the most common organisms isolated from urine, with high sensitivity to gentamicin (76%) and meropenem (72%). Blood cultures were positive in 26 cases (27.36%), with Staphylococcus aureus (30.76%) and Klebsiella pneumoniae (23%) being predominant. Blood isolates showed significant sensitivity to vancomycin (73%), meropenem (69.2%), and linezolid (65.3%). Conclusion Acute gastroenteritis, respiratory tract infections, bacteremia, and urinary tract infections are prevalent among SAM children. Staphylococcus aureus was frequently isolated from blood cultures, while Escherichia coli were predominant in urine cultures. High sensitivity of urinary isolates to gentamicin and meropenem, and of blood isolates to vancomycin, meropenem, and linezolid, highlights effective antibiotic choices. These findings emphasize the importance of tailored antimicrobial therapy based on local sensitivity patterns to improve clinical outcomes in SAM children.
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Affiliation(s)
| | - Deepti D Pradhan
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Rama K Gudu
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Suresh K Tripathy
- Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Pravati Jena
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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van den Brink D, Mponda K, Thompson D, van Hees C, Ngong'a F, Segula E, Mbale E, Boele van Hensbroek M, Bandsma RHJ, Walson JL, Brals D, Berkely J, Voskuijl W. Dermatological changes in a prospective cohort of acutely ill, hospitalised Malawian children, stratified according to nutritional status. BMJ Paediatr Open 2024; 8:e002289. [PMID: 38851219 PMCID: PMC11163641 DOI: 10.1136/bmjpo-2023-002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
RATIONALE Since the first documentation of skin changes in malnutrition in the early 18th century, various hair and skin changes have been reported in severely malnourished children globally. We aimed to describe the frequency and types of skin conditions in children admitted with acute illness to Queen Elizabeth Central Hospital, Blantyre, Malawi across a spectrum of nutritional status and validate an existing skin assessment tool. METHODS Children between 1 week and 23 months of age with acute illness were enrolled and stratified by anthropometry. Standardised photographs were taken, and three dermatologists assessed skin changes and scored each child according to the SCORDoK tool. RESULTS Among 103 children, median age of 12 months, 31 (30%) had severe wasting, 11 (11%) kwashiorkor (nutritional oedema), 20 (19%) had moderate wasting, 41 (40%) had no nutritional wasting and 18 (17%) a positive HIV antibody test. Six (5.8%) of the included patients died. 51 (50%) of children presented with at least one skin change. Pigmentary changes were the most common, observed in 35 (34%), with hair loss and bullae, erosions and desquamation the second most prevalent skin condition. Common diagnoses were congenital dermal melanocytosis, diaper dermatitis, eczema and postinflammatory hyperpigmentation. Severe skin changes like flaky paint dermatosis were rarely identified. Inter-rater variability calculations showed only fair agreement (overall Fleiss' kappa 0.25) while intrarater variability had a fair-moderate agreement (Cohen's kappa score of 0.47-0.58). DISCUSSION Skin changes in hospitalised children with an acute illness and stratified according to nutritional status were not as prevalent as historically reported. Dermatological assessment by means of the SKORDoK tool using photographs is less reliable than expected.
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Affiliation(s)
- Deborah van den Brink
- Amsterdam Centre for Global Child Health & Emma Children's Hospital, Pediatrics, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - Kelvin Mponda
- Department of Dermatology, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Debbie Thompson
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Colette van Hees
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fletchter Ngong'a
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Emma Segula
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | - Michael Boele van Hensbroek
- Amsterdam Centre for Global Child Health & Emma Children's Hospital, Pediatrics, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
| | - Robert H J Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Childhood Acute Illness Network, Nairobi, Kenya
| | - Judd L Walson
- Childhood Acute Illness Network, Nairobi, Kenya
- Departments of Global Health, Epidemiology, Infectious Disease, University of Washington, Seattle, Washington, USA
| | - Daniella Brals
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - James Berkely
- Childhood Acute Illness Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropcial Medicine & Global Health, Oxford University, Oxford, UK
| | - Wieger Voskuijl
- Amsterdam Centre for Global Child Health & Emma Children's Hospital, Pediatrics, Amsterdam UMC, Locatie AMC, Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
- Childhood Acute Illness Network, Nairobi, Kenya
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Kiosia A, Dagbasi A, Berkley JA, Wilding JPH, Prendergast AJ, Li JV, Swann J, Mathers JC, Kerac M, Morrison D, Drake L, Briend A, Maitland K, Frost G. The double burden of malnutrition in individuals: Identifying key challenges and re-thinking research focus. NUTR BULL 2024; 49:132-145. [PMID: 38576109 DOI: 10.1111/nbu.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
The 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low- and middle-income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet-related non-communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context-specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re-evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio-economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions.
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Affiliation(s)
- Agklinta Kiosia
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Health Data Research Global, HDR UK, London, UK
| | - Aygul Dagbasi
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James A Berkley
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jia V Li
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jon Swann
- School of Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle upon Tyne, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Douglas Morrison
- Scottish Universities Environmental Research Centre, East Kilbride, UK
| | - Lesley Drake
- Partnership for Child Development, School of Public Health, Imperial College London, London, UK
| | - Andre Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Kathryn Maitland
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Gary Frost
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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Fazid S, Haq ZU, Gillani BH, Khan AJ, Khan MN, Khan A, Garzon C, Habib I, Tanimoune M, Ihtesham Y, Heald AH. Effectiveness of locally produced ready-to-use supplementary foods on the prevention of stunting in children aged 6-23 months: a community-based trial from Pakistan. Br J Nutr 2024; 131:1189-1195. [PMID: 38012887 PMCID: PMC10918516 DOI: 10.1017/s0007114523002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
Undernutrition is a major public health problem in developing countries. Around 40·2 % of children are stunted in Pakistan. This longitudinal study aimed to assess the effectiveness of locally produced ready-to-use supplementary foods in the prevention of stunting by detecting change in of children in intervention v. control arm against the 2006 WHO growth reference. A community-based non-randomised cluster-controlled trial was conducted from January 2018 to December 2020 in the district of Kurram, Khyber Pakhtunkhwa, Pakistan. A total of 80 clusters (each cluster comprising ≈ 250-300 households) were defined in the catchment population of twelve health facilities. Children aged 6-18 months were recruited n 1680. The intervention included a daily ration of 50 g - locally produced ready-to-use-supplementary food (Wawa-Mum). The main outcome of this study was a change in length for age z-score (LAZ) v. WHO growth standards. Comparison between the interventions was by t test and ANOVA. Cox proportional hazard models were used to assess the association between stunting occurrence and the utilisation of locally produced supplement. Out of the total 1680, fifty-one out of the total 1680, 51·1 out of the total 1680 and 51·1 % (n 859) were male. Mean age 13·9 months (sd + 859) were male. Mean age 13·9 months (sd + -4·4). At baseline, 36·9 % (n 618) were stunted. In the intervention group, mean LAZ score significantly increased from -1·13(2·2 sd) at baseline to -0·93(1·8 sd) at 6-month follow-up (P value 0·01) compared with the control group. The incidence rate of stunting in the intervention arm was 1·3 v. 3·4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (Hazard Ratio (HR) 1·7, 95 % CI 1·46, 2·05, P value < 0·001) v. the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below 2 years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan.
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Affiliation(s)
- Sheraz Fazid
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zia Ul Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Abdul Jalil Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Muhammad Naseem Khan
- Department of Popualtion Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Aslam Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | | | | | | | | | - Adrian H. Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
- The School of Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Saeedi FA, Hegazi MA, Alsaedi H, Alganmi AH, Mokhtar JA, Metwalli EM, Hamadallah H, Siam GS, Alaqla A, Alsharabi A, Alotaibi SA. Multidrug-Resistant Bacterial Infections in Pediatric Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Western Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2024; 11:444. [PMID: 38671661 PMCID: PMC11049043 DOI: 10.3390/children11040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Multidrug-resistant bacterial infections (MDRIs) constitute a major global threat due to increased patient morbidity/mortality and hospital stay/healthcare costs. A few studies from KSA, including our locality, addressed antimicrobial resistance in pediatric patients. This study was performed to recognize the incidence and clinical/microbiologic features of MDRIs in hospitalized pediatric patients. A retrospective cross-sectional study included pediatric patients < 18 years, admitted to King Abdulaziz University Hospital, between October 2021 and November 2022, with confirmed positive cultures of bacteria isolated from blood/body fluids. Patients' medical files provided the required data. MDR organisms (MDROs) were identified in 12.8% of the total cultures. The incidence of MDRIs was relatively high, as it was detected in 42% of patients and in 54.3% of positive bacterial cultures especially among critically ill patients admitted to the NICU and PICU. Pneumonia/ventilator-associated pneumonia was the main type of infection in 37.8% of patients with MDROs. Klebsiella pneumoniae was the most common significantly isolated MDRO in 39.5% of MDR cultures. Interestingly, a low weight for (no need for their as terminology weight for age is standard and well-known) was the only significant risk factor associated with MDROs (p = 0.02). Mortality was significantly higher (p = 0.001) in patients with MDROs (32.4%) than in patients without MDROs (3.9%). Patients who died including 85.7% of patients with MDROs had significantly longer durations of admission, more cultures, and utilized a larger number of antibiotics than the surviving patients (p = 0.02, p = 0.01, p = 0.04, respectively). This study provided a comprehensive update on the seriously alarming problem of MDROs, and its impacts on pediatric patients. The detected findings are crucial and are a helpful guide to decid for implementing effective strategies to mitigate MDROs.
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Affiliation(s)
- Fajr A. Saeedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Moustafa A. Hegazi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
- Department of Pediatrics, Faculty of Medicine in Mansoura, Mansoura University Children’s Hospital, Mansoura 35516, Egypt
| | - Hani Alsaedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ahmed Hussain Alganmi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Jawahir A. Mokhtar
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah 80215, Saudi Arabia;
- Vaccines and Immunotherapy Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah 80216, Saudi Arabia
| | | | - Hanaa Hamadallah
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ghassan S. Siam
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alaqla
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alsharabi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Sultan Ahmed Alotaibi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
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13
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van Dorst MMAR, Pyuza JJ, Nkurunungi G, Kullaya VI, Smits HH, Hogendoorn PCW, Wammes LJ, Everts B, Elliott AM, Jochems SP, Yazdanbakhsh M. Immunological factors linked to geographical variation in vaccine responses. Nat Rev Immunol 2024; 24:250-263. [PMID: 37770632 DOI: 10.1038/s41577-023-00941-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/30/2023]
Abstract
Vaccination is one of medicine's greatest achievements; however, its full potential is hampered by considerable variation in efficacy across populations and geographical regions. For example, attenuated malaria vaccines in high-income countries confer almost 100% protection, whereas in low-income regions these same vaccines achieve only 20-50% protection. This trend is also observed for other vaccines, such as bacillus Calmette-Guérin (BCG), rotavirus and yellow fever vaccines, in terms of either immunogenicity or efficacy. Multiple environmental factors affect vaccine responses, including pathogen exposure, microbiota composition and dietary nutrients. However, there has been variable success with interventions that target these individual factors, highlighting the need for a better understanding of their downstream immunological mechanisms to develop new ways of modulating vaccine responses. Here, we review the immunological factors that underlie geographical variation in vaccine responses. Through the identification of causal pathways that link environmental influences to vaccine responsiveness, it might become possible to devise modulatory compounds that can complement vaccines for better outcomes in regions where they are needed most.
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Affiliation(s)
- Marloes M A R van Dorst
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Jeremia J Pyuza
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gyaviira Nkurunungi
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Vesla I Kullaya
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | | | - Linda J Wammes
- Department of Medical Microbiology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Everts
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon P Jochems
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
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Stepniewska K, Allan R, Anvikar AR, Anyorigiya TA, Ashley EA, Bassat Q, Baudin E, Bjorkman A, Bonnet M, Boulton C, Bousema T, Carn G, Carrara VI, D'Alessandro U, Davis TME, Denoeud-Ndam L, Desai M, Djimde AA, Dorsey G, Etard JF, Falade C, Fanello C, Gaye O, Gonzalez R, Grandesso F, Grivoyannis AD, Grais RF, Humphreys GS, Ishengoma DS, Karema C, Kayentao K, Kennon K, Kremsner P, Laman M, Laminou IM, Macete E, Martensson A, Mayxay M, Menan HIB, Menéndez C, Moore BR, Nabasumba C, Ndiaye JL, Nhama A, Nosten F, Onyamboko M, Phyo AP, Ramharter M, Rosenthal PJ, Schramm B, Sharma YD, Sirima SB, Strub-Wourgaft N, Sylla K, Talisuna AO, Temu EA, Thwing JI, Tinto H, Valentini G, White NJ, Yeka A, Isanaka S, Barnes KI, Guerin PJ. Does acute malnutrition in young children increase the risk of treatment failure following artemisinin-based combination therapy? A WWARN individual patient data meta-analysis. Lancet Glob Health 2024; 12:e631-e640. [PMID: 38485430 PMCID: PMC10951956 DOI: 10.1016/s2214-109x(24)00003-2] [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: 06/21/2023] [Revised: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The geographical, demographic, and socioeconomic distributions of malaria and malnutrition largely overlap. It remains unknown whether malnutrition affects the efficacy of WHO-recommended artemisinin-based combination therapies (ACTs). A previous systematic review was inconclusive as data were sparse and heterogeneous, indicating that other methodological approaches, such as individual patient data meta-analysis, should be considered. The objective of this study was to conduct such a meta-analysis to assess the effect of malnutrition (wasting and stunting) on treatment outcomes in children younger than 5 years treated with an ACT for uncomplicated falciparum malaria. METHODS We conducted a meta-analysis of individual patient data from studies identified through a systematic review of literature published between 1980 and 2018 in PubMed, Global Health, and Cochrane Libraries (PROSPERO CRD42017056934) and inspection of the WorldWide Antimalarial Resistance Network (WWARN) repository for ACT efficacy studies, including children younger than 5 years with uncomplicated falciparum malaria. The association of either acute (wasting) or chronic (stunting) malnutrition with day 42 PCR-adjusted risk of recrudescence (ie, return of the same infection) or reinfection after therapy was investigated using Cox regression, and with day 2 parasite positivity using logistic regression. FINDINGS Data were included from all 36 studies targeted, 31 from Africa. Of 11 301 eligible children in 75 study sites, 11·5% were wasted (weight-for-height Z score [WHZ] <-2), and 31·8% were stunted (height-for-age Z score [HAZ] <-2). Decrease in WHZ was associated with increased risk of day 2 positivity (adjusted odds ratio 1·12, 95% CI 1·05-1·18 per unit; p=0·0002), treatment failure (adjusted hazard ratio [AHR] 1·14, 95% CI 1·02-1·26, p=0·016), and reinfection after therapy (AHR 1·09, 1·04-1·13, p=0·0003). Children with milder wasting (WHZ -2 to -1) also had a higher risk of recrudescence (AHR 1·85, 1·29-2·65, p=0·0008 vs WHZ ≥0). Stunting was not associated with reduced ACT efficacy. INTERPRETATION Children younger than 5 years with acute malnutrition and presenting with uncomplicated falciparum malaria were at higher risk of delayed parasite clearance, ACT treatment failure, and reinfections. Stunting was more prevalent, but not associated with changes in ACT efficacy. Acute malnutrition is known to impact medicine absorption and metabolism. Further study to inform dose optimisation of ACTs in wasted children is urgently needed. FUNDING Bill & Melinda Gates Foundation. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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15
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Nalwanga D, Bakker C, Kiggwe A, Negash AA, Ocan M, Briend A, Maitland K, Musiiime V, Karamagi C. Mortality among non-severely under nourished children with pneumonia globally: protocol for a systematic review and meta-analysis. Wellcome Open Res 2024; 8:551. [PMID: 38404639 PMCID: PMC10891427 DOI: 10.12688/wellcomeopenres.20200.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 02/27/2024] Open
Abstract
Background Pneumonia remains the commonest cause of ill health and mortality among children worldwide. Severe undernutrition increases the mortality risk among children with pneumonia. While children with pneumonia are at increased risk of developing malnutrition, the impact of pneumonia on mortality and nutritional status of non-severely undernourished children is not well described. The impact of nutritional supplementation on mortality and nutritional status in this population is not well understood. This review will collate available evidence on the all-cause mortality and anthropometric indices outcomes following pneumonia, as well as the impact of nutritional supplementation on mortality and anthropometry among non-severely malnourished children with pneumonia. Methods The review will be done using a priori criteria developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data will be obtained from data bases, grey literature, and bibliographies. An experienced librarian will conduct article search in PUBMED, MEDLINE, EMBASE, Web of Science, Google scholar, and Scopus. Retrieved articles will be entered in Endnote ver 9.0, duplicates removed, and transferred to Epi-reviewer for screening and data abstraction. Risk of bias in the included articles will be assessed using standard criteria. Heterogeneity will be assessed using I 2-statistic and sub-group analysis will be done. Data will be analysed using both narrative and quantitative synthesis. Quantitative synthesis will be done using DeSimonian and Laird Random-effects model in STATA ver 15.0. Conclusions The results will provide baseline information about the mortality and anthropometric outcomes of pneumonia among non-severely malnourished children as well as the potential effect of nutritional supplementation on these outcomes. This will provide a basis to explore the potential for nutritional supplementation improving clinical outcomes like mortality and occurrence of severe acute malnutrition among children with severe pneumonia worldwide. Registration The review has been registered in PROSPERO (CRD42021257272; 15 July 2021).
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Affiliation(s)
- Damalie Nalwanga
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Caitlin Bakker
- University Libraries, University of Minnesota, Minneapolis, Minneapolis, USA
| | - Andrew Kiggwe
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Abel Abera Negash
- Armauer Hansen Research Institute, Addis Ababa, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Andre Briend
- School Of Medicine, University of Tampere, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
| | - Kathryn Maitland
- Clinical, KERMI Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
| | - Victor Musiiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
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Sulistiyowati N, Tjandrarini DH, Titaley CR, Que BJ, Hidayangsih PS, Suparmi, Sudikno S, Purwatiningsih Y, Indrawati L, Siahaan S, Adyarani WP. Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months. Front Public Health 2024; 12:1340559. [PMID: 38504680 PMCID: PMC10948606 DOI: 10.3389/fpubh.2024.1340559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024] Open
Abstract
Background Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia. Methods Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression. Results The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045). Conclusion Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.
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Affiliation(s)
- Ning Sulistiyowati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | | | - Bertha J. Que
- Faculty of Medicine, Pattimura University, Ambon, Indonesia
| | - Puti Sari Hidayangsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Suparmi
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Sudikno Sudikno
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Yuni Purwatiningsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Lely Indrawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
| | - Selma Siahaan
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia
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Saito A, Kondo M. Continuum of care for maternal and child health and child undernutrition in Angola. BMC Public Health 2024; 24:680. [PMID: 38439029 PMCID: PMC10910721 DOI: 10.1186/s12889-024-18144-2] [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: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status. METHODS We used nationally representative data from the Angola 2015-2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels. RESULTS The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight. CONCLUSIONS The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
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Affiliation(s)
- Akiko Saito
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan
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18
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Das S, Baffour B, Richardson A. Trends in chronic childhood undernutrition in Bangladesh for small domains. POPULATION STUDIES 2024; 78:43-61. [PMID: 37647268 DOI: 10.1080/00324728.2023.2239772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/24/2023] [Indexed: 09/01/2023]
Abstract
Chronic childhood undernutrition, known as stunting, is an important population health problem with short- and long-term adverse outcomes. Bangladesh has made strides to reduce chronic childhood undernutrition, yet progress is falling short of the 2030 Sustainable Development Goals targets. This study estimates trends in age-specific chronic childhood undernutrition in Bangladesh's 64 districts during 1997-2018, using underlying direct estimates extracted from seven Demographic and Health Surveys in the development of small area time-series models. These models combine cross-sectional, temporal, and spatial data to predict in all districts in both survey and non-survey years. Nationally, there has been a steep decline in stunting from about three in five to one in three children. However, our results highlight significant inequalities in chronic undernutrition, with several districts experiencing less pronounced declines. These differences are more nuanced at the district-by-age level, with only districts in more socio-economically advantaged areas of Bangladesh consistently reporting declines in stunting across all age groups.
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19
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Aivey SA, Fukushima Y, Rahman MM, Nahar NS, Ahmed A, Prihanto JB, Hawlader MDH, Moriyama M. Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial. J Family Med Prim Care 2024; 13:1024-1036. [PMID: 38736776 PMCID: PMC11086752 DOI: 10.4103/jfmpc.jfmpc_1560_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 05/14/2024] Open
Abstract
Background Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education. Methods and Materials A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline. Results Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001). Conclusion The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.
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Affiliation(s)
- Sadia A. Aivey
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuko Fukushima
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Niru S. Nahar
- Department of Nursing Science, Grameen Caledonian College of Nursing, Dhaka, Bangladesh
| | - Ashir Ahmed
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Junaidi B. Prihanto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Physical Education, Universitas Negeri Surabaya (State University of Surabaya), Surabaya, East Java, Indonesia
| | | | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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20
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Sturgeon JP, Tome J, Dumbura C, Majo FD, Ngosa D, Mutasa K, Zyambo K, Besa E, Chandwe K, Kapoma C, Mwapenya B, Nathoo KJ, Bourke CD, Ntozini R, Chasekwa B, Smuk M, Bwakura-Dangarembizi M, Amadi B, Kelly P, Prendergast AJ. Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition. Sci Transl Med 2024; 16:eadh0673. [PMID: 38416844 PMCID: PMC7615785 DOI: 10.1126/scitranslmed.adh0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in children with comorbidities such as HIV; however, the underlying pathogenesis of complicated SAM is poorly understood. Targeted multiplex biomarker analysis in children hospitalized with SAM (n = 264) was conducted on plasma samples, and inflammatory markers were assessed on stool samples taken at recruitment, discharge, and 12 to 24 and 48 weeks after discharge from three hospitals in Zimbabwe and Zambia. Compared with adequately nourished controls (n = 173), we found that at baseline, complicated SAM was characterized by systemic, endothelial, and intestinal inflammation, which was exacerbated by HIV infection. This persisted over 48 weeks despite nutritional recovery and was associated with children's outcomes. Baseline plasma concentrations of vascular endothelial growth factor, glucagon-like peptide-2, and intestinal fatty acid-binding protein were independently associated with lower mortality or hospital readmission over the following 48 weeks. Following principal components analysis of baseline biomarkers, higher scores of a component representing growth factors was associated with greater weight-for-height z score recovery and lower mortality or hospital readmission over the 48 weeks. Conversely, components representing higher gut and systemic inflammation were associated with higher mortality or hospital readmission. These findings highlight the interplay between inflammation, which damages tissues, and growth factors, which mediate endothelial and epithelial regeneration, and support further studies investigating interventions to reduce inflammation and promote epithelial repair as an approach to reducing mortality and improving nutritional recovery.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kanekwa Zyambo
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Ellen Besa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Chanda Kapoma
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Benjamin Mwapenya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kusum J Nathoo
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Paul Kelly
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
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21
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Robyn S, Veronica N, Stephen B, Joanne P. Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment. BMC Pediatr 2024; 24:73. [PMID: 38262979 PMCID: PMC10804775 DOI: 10.1186/s12887-023-04508-x] [Citation(s) in RCA: 1] [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: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Malnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery. METHODS Children 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively. RESULTS Forty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score - 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score - 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable. CONCLUSION Malnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.
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Affiliation(s)
- Smith Robyn
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Ntsiea Veronica
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brown Stephen
- Department of Pediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | - Potterton Joanne
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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22
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Aivey SA, Rahman MM, Fukushima Y, Ahmed A, Prihanto JB, Sarker MHR, Hawlader MDH, Moriyama M. Nutritional status and prevalence of helminthic infection among primary school children in Bangladesh: A cross-sectional study. Jpn J Nurs Sci 2024; 21:e12568. [PMID: 37800657 DOI: 10.1111/jjns.12568] [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: 04/05/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
AIM Malnutrition and infectious diseases, such as helminthic infections, are widespread among primary school children, especially in low- and middle-income countries. However, there are limited studies on school health in Bangladesh, particularly in rural settings. This study aimed to explore the nutritional status and prevalence of helminthic infections in relation to associated health behavior, awareness, and knowledge regarding malnutrition and helminthic infections which were evaluated by school nurses among primary school children in Bangladesh. METHODS This was a descriptive, cross-sectional survey study with a total duration of 1 month, from September to October, 2021. This study formed part of a school nurse project as a cluster non-randomized clinical trial in Bangladesh. Selected variables from that clinical trial were analyzed and reported in the results section. The study participants were primary school children from four schools in rural Bangladesh. RESULTS In total, 604 children participated in the baseline survey and health checkups. Among them, 163 (27.0%) children were classified as malnourished according to the World Health Organization growth reference standard 2007. The prevalence of helminthic infections was 53 (8.8%). Approximately >50% of the children responded that they never/rarely practiced hygiene-related behaviors and had no awareness and knowledge regarding malnutrition and helminthic infections. However, differences between the variables were not statistically significant. CONCLUSION Children's nutritional status and prevalence of helminthic infections with related deprived health behaviors, and minimal awareness and knowledge, reinforce the importance of implementing educational interventions in the future.
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Affiliation(s)
- Sadia Alam Aivey
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuko Fukushima
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ashir Ahmed
- Faculty of Information Science and Electrical Engineering, Kyushu University, Japan
| | - Junaidi Budi Prihanto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Physical Education, Universitas Negeri Surabaya (State University of Surabaya), Surabaya, Indonesia
| | - Mohammad Habibur Rahman Sarker
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | | | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Widjaja NA, Hamidah A, Purnomo MT, Ardianah E. Effect of lactoferrin in oral nutrition supplement (ONS) towards IL-6 and IL-10 in failure to thrive children with infection. F1000Res 2023; 12:897. [PMID: 38434639 PMCID: PMC10904948 DOI: 10.12688/f1000research.130176.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/05/2024] Open
Abstract
Background Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which is able to upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. We conducted this study to investigate the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods We performed a quasi-experimental pre- and post-study in children aged 12-60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention. Conclusions In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio.ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.
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Affiliation(s)
| | - Azizah Hamidah
- Child Health, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | | | - Eva Ardianah
- Child Health, Airlangga University, Surabaya, East Java, 60286, Indonesia
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24
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Mukhula VT, Harawa PP, Phiri C, Khoswe S, Mbale E, Tigoi C, Walson JL, Berkley JA, Bandsma R, Iroh Tam PY, Voskuijl W. Evaluating blood culture collection practice in children hospitalized with acute illness at a tertiary hospital in Malawi. J Trop Pediatr 2023; 70:fmad043. [PMID: 38055837 PMCID: PMC10699738 DOI: 10.1093/tropej/fmad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Blood culture collection practice in low-resource settings where routine blood culture collection is available has not been previously described. METHODOLOGY We conducted a secondary descriptive analysis of children aged 2-23 months enrolled in the Malawi Childhood Acute Illness and Nutrition (CHAIN) study, stratified by whether an admission blood culture had been undertaken and by nutritional status. Chi-square test was used to compare the differences between groups. RESULTS A total of 347 children were included, of whom 161 (46%) had a blood culture collected. Children who had a blood culture collected, compared to those who did not, were more likely to present with sepsis (43% vs. 20%, p < 0.001), gastroenteritis (43% vs. 26%, p < 0.001), fever (86% vs. 73%, p = 0.004), and with poor feeding/weight loss (30% vs. 18%, p = 0.008). In addition, hospital stay in those who had a blood culture was, on average, 2 days longer (p = 0.019). No difference in mortality was observed between those who did and did not have a blood culture obtained. CONCLUSION Blood culture collection was more frequent in children with sepsis and gastroenteritis, but was not associated with mortality. In low-resource settings, developing criteria for blood culture based on risk factors rather than clinician judgement may better utilize the existing resources.
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Affiliation(s)
- Victoria Temwanani Mukhula
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
| | - Philliness Prisca Harawa
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chisomo Phiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Stanley Khoswe
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Caroline Tigoi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Judd L Walson
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, USA
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Medicine, , University of Oxford, Oxford, UK
| | - Robert Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, , Malawi-Liverpool Wellcome Research Programme P.O. Box 30096, Chichiri, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, , Liverpool School of Tropical Medicine, Liverpool, UK
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Amsterdam Center for Global Health, University of Amsterdam & Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Islam MS, Chowdhury MRK, Bornee FA, Chowdhury HA, Billah B, Kader M, Rashid M. Prevalence and Determinants of Diarrhea, Fever, and Coexistence of Diarrhea and Fever in Children Under-Five in Bangladesh. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1829. [PMID: 38002920 PMCID: PMC10670412 DOI: 10.3390/children10111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017-2018 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the child's age (12-23 months), and the mother's education. Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh.
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Affiliation(s)
- Md. Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga 7200, Bangladesh; (M.S.I.); (M.R.K.C.)
| | - Mohammad Rocky Khan Chowdhury
- Department of Public Health, First Capital University of Bangladesh, Chuadanga 7200, Bangladesh; (M.S.I.); (M.R.K.C.)
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3004, Australia; (H.A.C.); (B.B.)
| | - Farzana Akhter Bornee
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh;
| | - Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3004, Australia; (H.A.C.); (B.B.)
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3004, Australia; (H.A.C.); (B.B.)
| | - Manzur Kader
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, 17177 Stockholm, Sweden;
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Health and Occupational Studies, University of Gävle, Kungsbacksvägen 47, 80176 Gävle, Sweden
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Picauly I, Adi AAAM, Meiyetriani E, Mading M, Weraman P, Nashriyah SF, Hidayat AT, Boeky DLA, Lobo V, Saleh A, Peni JA. Path analysis model for preventing stunting in dryland area island East Nusa Tenggara Province, Indonesia. PLoS One 2023; 18:e0293797. [PMID: 37917759 PMCID: PMC10621912 DOI: 10.1371/journal.pone.0293797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The problem of stunting is still a fundamental problem in Indonesia's human development. East Nusa Tenggara Province is an archipelago dryland area where in 2007-2021 it has contributed to the highest number of stunting children prevalence in Indonesia. This study aims to determine the relationship of variables in individual, household and district level with the prevalence of stunting. METHODS This type of research is observational study with a cross sectional design. This study used individual secondary data from the Indonesian Nutritional Status Survey in 2021 consisting of 7,835 toddlers and National Social Economics Survey 2021. RESULTS This research found that both specific & sensitive intervention programs had an influence in accelerating the decline in stunting prevalence (higher score on Z Score). Results also revealed the positive influence of the food access variable on nutritional intake. The results of the path analysis test showed that sensitive intervention program variables have a positive effect on food access variable and environmental variable (environmental sanitation) such as the habit of open defecation and healthcare. There was significant relationship on disease history, environment and intake to Height for Age (HAZ) score. CONCLUSIONS In conclusion, direct and indirect factors have important roles to prevent stunting. Sensitive and specific intervention program, food access, macro determinants and environment are the indirect indicators which contribute significantly to the stunting. The risk of children under five years old experiencing malnourished nutritional status increases with a history of infectious disease (diarrhea, ARI, worms). The risk of children under five years experiencing malnourished nutritional status decreases with adequate nutritional intake. It is hoped that there will be a special model of stunting control interventions at the individual level and at the family, household and district level that are integrated and of high quality through multisectoral cooperation in the dryland areas of the islands of East Nusa Tenggara Province.
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Affiliation(s)
- Intje Picauly
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | | | - Eflita Meiyetriani
- SEAMEO RECFON, Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Majematang Mading
- Lokalitbangkes Waikabubak, Ministry of Health, West Sumba, East Nusa Tenggara, Indonesia
| | - Pius Weraman
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | - Siti Fadhilatun Nashriyah
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Depok, Jakarta, Indonesia
| | - Ahmad Thohir Hidayat
- SEAMEO RECFON, Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Daniela L. Adeline Boeky
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | - Varry Lobo
- Lokalitbangkes Waikabubak, Ministry of Health, West Sumba, East Nusa Tenggara, Indonesia
| | | | - Jane A. Peni
- Health Polytechnique Kupang, Ministry of Health, Kupang City, East Nusa Tenggara, Indonesia
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Lambrecht NJ, Müller-Hauser AA, Sobhan S, Schmidt WP, Huda TMN, Waid JL, Wendt AS, Kader A, Gabrysch S. Effect of a Homestead Food Production Program on the Prevalence of Diarrhea and Acute Respiratory Infection in Children in Sylhet, Bangladesh: A Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2023; 109:945-956. [PMID: 37580032 PMCID: PMC10551083 DOI: 10.4269/ajtmh.23-0152] [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: 03/09/2023] [Accepted: 05/22/2023] [Indexed: 08/16/2023] Open
Abstract
Diarrhea and respiratory illness are leading causes of mortality and morbidity among young children. We assessed the impact of a homestead food production intervention on diarrhea and acute respiratory infection (ARI) in children in Bangladesh, secondary outcomes of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial. The trial enrolled 2,705 married women and their children 3 years or younger in 96 rural settlements (geographic clusters) in Sylhet Division, Bangladesh. The intervention promoted home gardening and poultry rearing alongside child nutrition and health counseling over 3 years (2015-2018). An 8-month food hygiene behavior change component using emotional drivers was delivered beginning in mid-2017. Caregiver-reported diarrhea and symptoms of ARI in the week preceding the survey were recorded every 2 months. We analyzed 32,460 observations of 3,276 children over 4 years and found that 3.9% of children had diarrhea and 3.4% had an ARI in the prior 7 days. There was no overall effect of the intervention on 7-day diarrhea period prevalence (odds ratio [OR], 0.92; 95% CI, 0.71-1.19), diarrhea point prevalence (OR, 1.03; 95% CI, 0.78-1.36), or 7-day ARI period prevalence (OR, 1.18; 95% CI, 0.88-1.60). There was no impact on diarrhea severity or differences in health-seeking behaviors. Our findings suggest that this homestead food production program was insufficient to reduce morbidity symptoms among children in a rural setting. More comprehensive water, sanitation, and hygiene measures, and behavioral recommendations may be needed to achieve impacts on child health.
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Affiliation(s)
- Nathalie J. Lambrecht
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Anna A. Müller-Hauser
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Shafinaz Sobhan
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Wolf-Peter Schmidt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tarique Md. Nurul Huda
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
- Environmental Interventions Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jillian L. Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Amanda S. Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Abdul Kader
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Aderibigbe T, Walsh S, Henderson WA, Lucas RF. Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study. Front Public Health 2023; 11:1196510. [PMID: 37822543 PMCID: PMC10563511 DOI: 10.3389/fpubh.2023.1196510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Background In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Methods Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). Results The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Conclusion Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.
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Affiliation(s)
- Tumilara Aderibigbe
- School of Nursing, University of Connecticut, Storrs, CT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Wendy A. Henderson
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
| | - Ruth F. Lucas
- School of Nursing, University of Connecticut, Storrs, CT, United States
- School of Medicine, University of Connecticut, Storrs, CT, United States
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Mujtaba S, Patro IK, Patro N. Multiple Early Life Stressors as Risk Factors for Neurodevelopmental Abnormalities in the F1 Wistar Rats. Brain Sci 2023; 13:1360. [PMID: 37891729 PMCID: PMC10605318 DOI: 10.3390/brainsci13101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Cumulative exposure to multiple early life stressors is expected to affect behavioral development, causing increased susceptibility to neuropsychiatric disorders. The present study was designed to mimic such conditions in a rat model to study behavioral impairments during adolescence and adulthood. Female Wistar rats (n = 32; 140-150 gm) were switched to a low protein (LP; 8% protein) or control (20% protein) diet 15 days prior to conception, and then the diet regime was maintained throughout the experimental period. Pups born to control and LP dams were intraperitoneally injected with deltamethrin (DLT-pyrethroid insecticide; 0.7 mg/kg body weight; PND 1 to 7), lipopolysaccharide (LPS-bacterial endotoxin; 0.3 mg/kg body weight; PND 3 and 5), or DLT+LPS, on designated days forming eight experimental groups (Control, LP, Control+LPS, LP+LPS, Control+DLT, LP+DLT, Control+DLT+LPS and LP+DLT+LPS). Neurobehavioral assessments were performed in F1 rats (1, 3, 6 months) by open field, elevated plus maze, light and dark box, and rotarod tests. LP rats were found to be highly susceptible to either singular or cumulative exposure as compared to their age-matched control counterparts, showing significantly severe behavioral abnormalities, such as hyperactivity, attention deficits and low anxiety, the hallmark symptoms of neuropsychiatric disorders like schizophrenia and ADHD, suggesting thereby that early life multi-hit exposure may predispose individuals to developmental disorders.
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Affiliation(s)
- Syed Mujtaba
- School of Studies in Neuroscience, Jiwaji University, Gwalior 474011, India; (S.M.); (I.K.P.)
- School of Studies in Zoology, Jiwaji University, Gwalior 474011, India
| | - Ishan Kumar Patro
- School of Studies in Neuroscience, Jiwaji University, Gwalior 474011, India; (S.M.); (I.K.P.)
- School of Studies in Zoology, Jiwaji University, Gwalior 474011, India
| | - Nisha Patro
- School of Studies in Neuroscience, Jiwaji University, Gwalior 474011, India; (S.M.); (I.K.P.)
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Al-Taj MA, Al Serouri A, Al-Muradi AM, Al-Dharhani E, Al-faeq NN, Al-amodi FM, Abdulwahab MM, Nawfal AM, Alshemerry MH, Mujahed MA. Concurrent wasting and stunting among marginalised children in Sana'a city, Yemen: a cross-sectional study. J Nutr Sci 2023; 12:e91. [PMID: 37587974 PMCID: PMC10425760 DOI: 10.1017/jns.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Concurrent wasting and stunting (WaSt) is a serious form of malnutrition among young children, particularly vulnerable groups affected by the conflict. Understanding the prevalence and risk factors of WaSt among vulnerable children is important to develop effective intervention measures to reduce the burden of WaSt. The present study aimed to identify the prevalence of and risk factors for WaSt among marginalised children aged 6-59 months in Sana'a city, Yemen. A community-based cross-sectional design was conducted on a total sample size of 450 marginalised children aged 6-59 months who lived at home with their mothers. Multivariable logistic regression analysis was performed and the prevalence of WaSt was found to be 10⋅7 %. Children aged 24-59 months were protected from WaSt (adjusted odds ratio (AOR) 0⋅40, 95 % confidence interval (CI) 0⋅21, 0⋅75). A higher prevalence of WaSt was associated with male sex (AOR 2⋅31, 95 % CI 1⋅13, 4⋅71), no history of being breastfed (AOR 3⋅57, 95 % CI 1⋅23, 10⋅39), acute diarrhoea (AOR 2⋅12, 95 % CI 1⋅12, 4⋅02) and family income sources of assistance from others (AOR 2⋅74, 95 % CI 1⋅08, 6⋅93) or salary work (AOR 2⋅22, 95 % CI 1⋅10, 4⋅47). Continued breast- and bottle-feeding were not associated with WaSt in children aged 6-23 months. Mothers' age, education and work status, family size and drinking water source were not associated with WaSt. Overall, we found that the prevalence of WaSt among marginalised children remained high. Interventions to improve household income, hygienic conditions and child feeding practices are necessary to promote child growth.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulwahed Al Serouri
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | - Nada Nabil Al-faeq
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Ali Mujahed Nawfal
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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Weckman AM, McDonald CR, Ngai M, Richard-Greenblatt M, Leligdowicz A, Conroy AL, Kain KC, Namasopo S, Hawkes MT. Inflammatory profiles in febrile children with moderate and severe malnutrition presenting at-hospital in Uganda are associated with increased mortality. EBioMedicine 2023; 94:104721. [PMID: 37467665 PMCID: PMC10373657 DOI: 10.1016/j.ebiom.2023.104721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Children in Africa carry a disproportionate burden of malnutrition and infectious disease. Together, malnutrition and infection are major contributors to global child mortality; however, their collective impact on immune activation are not well described. METHODS This was a secondary analysis of a prospective cohort study of children hospitalized with acute febrile illness at a single centre in Uganda. We investigated the association between malnutrition (determined using the mid-upper arm circumference, MUAC), immune activation (as measured by inflammatory markers IL-6, IL-8, CXCL10, CHI3L1, sTNFR1, Cystatin C, granzyme B, and sTREM-1), and mortality. FINDINGS Of the 1850 children eligible for this secondary analysis, 71 (3.8%) and 145 (11.7%) presented with severe acute malnutrition (SAM, MUAC <115 mm) and moderate malnutrition (MUAC 115 to < 125 mm), respectively. SAM was associated with increased concentrations of CHI3L1, sTNFR1, Cystatin C, and sTREM-1, and decreased concentrations of CXCL10 and granzyme B, even after controlling for age, sex, and disease severity at presentation. There were 77 deaths (4.2%). SAM was associated with a 9.2-fold (95% CI 4.8-46), 17-fold (95% CI 3.9-74), and 13-fold (95% CI 3.5-52) increased odds of death in children with pneumonia, malaria, and diarrheal illness, respectively. Mediation analysis implicated sTREM-1 and CHI3L1 in the effect of SAM on mortality, suggesting that enhanced activation of these inflammatory pathways is associated with the increased mortality in undernourished children with pneumonia and malaria. INTERPRETATION Collectively, these data highlight systemic inflammation as a common pathway associated with malnutrition and infection that could be targeted to mitigate the burden of acute febrile illness in LMICs. FUNDING This work was supported in part by the Canadian Institutes of Health Research, and by kind donations from The Tesari Foundation and Kim Kertland. The funders had no role in design, analysis, or reporting of these studies.
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Affiliation(s)
- Andrea M Weckman
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Chloe R McDonald
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Michelle Ngai
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada
| | - Melissa Richard-Greenblatt
- Public Health Ontario, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Aleksandra Leligdowicz
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University and Robarts Research Institute, Western University, Canada
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Kevin C Kain
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Canada; Department of Medicine, University of Toronto, Canada; Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; Toronto General Research Institute, Toronto General Hospital, Toronto, Canada
| | - Sophie Namasopo
- Department of Paediatrics, Kabale Regional Referral Hospital, Kabale, Uganda
| | - Michael T Hawkes
- Division of Pediatric Infectious Diseases, University of Alberta, Edmonton, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada; Department of Paediatrics, Kabale Regional Referral Hospital, Kabale, Uganda; Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada.
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Khlevner J, Naranjo K, Hoyer C, Carullo AS, Kerr KW, Marriage B. Healthcare Burden Associated with Malnutrition Diagnoses in Hospitalized Children with Critical Illnesses. Nutrients 2023; 15:3011. [PMID: 37447337 DOI: 10.3390/nu15133011] [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: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.
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Affiliation(s)
- Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Kelly Naranjo
- Department of Biology, New York University, New York, NY 10032, USA
| | - Christine Hoyer
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Angela S Carullo
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Kirk W Kerr
- Abbott Laboratories, Columbus, OH 43023, USA
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Yani FF, Julianty RJ, Tafroji W, Linosefa L, Ihsan I, Masnadi NR, Safari D. Nasopharyngeal carriage and antimicrobial susceptibility profiles of Streptococcus pneumoniae among children with pneumonia and healthy children in Padang, Indonesia. Access Microbiol 2023; 5:acmi000584.v3. [PMID: 37424548 PMCID: PMC10323794 DOI: 10.1099/acmi.0.000584.v3] [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: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Streptococcus pneumoniae is one of the pathogenic bacteria causing invasive pneumococcal diseases such as pneumonia, sepsis, and meningitis, which are commonly reported in children and adults. In this study, we investigated the nasopharyngeal carriage rates, serotype distribution, and antimicrobial susceptibility profiles of S. pneumoniae among children with pneumonia and healthy children under 5 years old in Padang, West Sumatra, Indonesia. Nasopharyngeal swabs were collected from 65 hospitalized children with pneumonia in a referral hospital and from 65 healthy children at two day-care centers from 2018 to 2019. S. pneumoniae was identified by conventional and molecular methods. Antibiotic susceptibility was performed with the disc diffusion method. Out of 130 children, S. pneumoniae strains were carried by 53% and 9.2 % in healthy children (35/65) and children with pneumonia (6/65), respectively. Serotype 19F was the most common serotype among the isolated strains (21%) followed by 6C (10%), 14, 34 (7 % each), and 1, 23F, 6A, 6B (5 % each). Moreover, 55 % of the strains (23/42) were covered by the 13-valent pneumococcal conjugate vaccine. Most isolates were susceptible to vancomycin (100%), chloramphenicol (93%), clindamycin (76%), erythromycin (71%), and tetracycline (69%). Serotype 19F was commonly found as a multi-drug resistant strain.
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Affiliation(s)
- Finny Fitry Yani
- Departement of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Departement of Paediatric, Dr. M. Djamil Hospital Padang, Kota Padang, Indonesia
| | - Riris Juita Julianty
- Departement of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Departement of Paediatric, Dr. M. Djamil Hospital Padang, Kota Padang, Indonesia
| | - Wisnu Tafroji
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency (BRIN), Cibinong, West Java, Indonesia
| | - Linosefa Linosefa
- Departement of Microbiology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
| | - Indra Ihsan
- Departement of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Departement of Paediatric, Dr. M. Djamil Hospital Padang, Kota Padang, Indonesia
| | - Nice Rachmawati Masnadi
- Departement of Child Health, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Departement of Paediatric, Dr. M. Djamil Hospital Padang, Kota Padang, Indonesia
| | - Dodi Safari
- Eijkman Research Center for Molecular Biology, National Research and Innovation Agency (BRIN), Cibinong, West Java, Indonesia
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Akanbonga S, Hasan T, Chowdhury U, Kaiser A, Akter Bonny F, Lim IE, Mahmud I. Infant and young child feeding practices and associated socioeconomic and demographic factors among children aged 6-23 months in Ghana: Findings from Ghana Multiple Indicator Cluster Survey, 2017-2018. PLoS One 2023; 18:e0286055. [PMID: 37294773 PMCID: PMC10256209 DOI: 10.1371/journal.pone.0286055] [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: 04/28/2022] [Accepted: 05/08/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms. OBJECTIVE This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6-23 months in Ghana. METHOD We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017-18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver's self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses. FINDINGS Among 2,585 IYC aged 6-23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD. CONCLUSION We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6-23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity.
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Affiliation(s)
- Samson Akanbonga
- Department of Nutrition and Dietherapy, Holy Family Hospital, Techiman, Ghana
| | - Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Adrita Kaiser
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Fatema Akter Bonny
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ignitius Ezekiel Lim
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
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Kassaw A, Kerebih G, Zeleke S, Chanie ES, Dessalegn N, Bante B, Teshome AA, Chekole B, Gelaw B, Bayih WA, Tesfaw A, Feleke DG, Kefale D, Azmeraw M, Chanie A, Awoke G, Moges N. Survival status and predictors of mortality from severe community-acquired pneumonia among under-five children admitted at Debre Tabor comprehensive specialized hospital: a prospective cohort study. Front Pediatr 2023; 11:1141366. [PMID: 37346893 PMCID: PMC10280987 DOI: 10.3389/fped.2023.1141366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/05/2023] [Indexed: 06/23/2023] Open
Abstract
Background Globally, Pneumonia continues to be the leading cause of mortality among under-five children. Ethiopia ranks fourth out of 15 countries worldwide in terms of the highest death rate of under-five children due to severe community-acquired pneumonia (SCAP). However, to date, there is no recent study that shows survival status and predictors of mortality from SCAP. Therefore, this study aimed to determine survival status and predictors of mortality from this dangerous disease among under-five children. Methods A facility-based prospective cohort study was conducted from 1 November 2021 to 31 October 2022 at Debre Tabor comprehensive specialized hospital. All under-five children with SCAP admitted during the study period were included. Participants were selected using a systematic sampling technique. The collected data were coded, edited, and entered into epi-data version 4.2 and then exported to STATA version 17 for further analysis. The Kaplan Meier failure estimate with log-rank test was employed to determine the survival estimates. A cox-proportional hazard regression model was fitted to identify significant variables. Results The overall incidence density rate of mortality was 5.7 /1000 children with a median hospital stay of 8.2 days. Heart disease (AHR: 4.37; 95%CI: 1.68-11.32), previous admission of SCAP (AHR: 3.87; 95% CI: 1.31-11.43), WFL < -3Z score (AHR: 3.57; 95% CI: 1.02-12.42), impaired consciousness level at admission 3.41(1.14-10.19), and pleural effusion (AHR: 3.42; 95%CI: 1.18-9.93) were significant predictors of mortality. Conclusion In this study, the survival probability of children with SCAP was low. Children with heart disease, previous admission of SCAP, WFL < -3Z score, impaired consciousness level at admission, and pleural effusion had low survival. Therefore, much emphasis is needed on children with SCAP, particularly those with identified predictors.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Kerebih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nigatu Dessalegn
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Mizan Tape University, Mizan Tape, Ethiopia
| | - Berihun Bante
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asefa Ageghehu Teshome
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Belete Gelaw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wolayta Sodo University, Wolayta, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw
- Department of Epidemiology and Biostatics, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dejen Getaneh Feleke
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aynadis Chanie
- Department of Comprehensive Nursing, Bahir Dar University, Tibebe Gion Specialized Hospital, Bahir Dar, Ethiopia
| | - Getaneh Awoke
- Department of Epidemiology, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Anwar F, Yalawar M, Suryawanshi P, Ghosh A, Jog P, Khadilkar AV, Kishore B, Paruchuri AK, Pote PD, Mandyam RD, Shinde S, Shah A. Effect of Oral Nutritional Supplementation on Adequacy of Nutrient Intake among Picky-Eating Children at Nutritional Risk in India: A Randomized Double Blind Clinical Trial. Nutrients 2023; 15:nu15112528. [PMID: 37299491 DOI: 10.3390/nu15112528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Nutrient inadequacies among picky-eaters have adverse effects on growth and development. Oral nutritional supplements (ONS) along with dietary counseling (DC), rather than DC alone as reported in our earlier publication, promoted growth among picky-eating Indian children aged from >24 m to ≤48 m with weight-for-height percentiles lying between the 5th and 25th (based on WHO Growth Standards) over 90 days. This paper presents the contribution of ONS to nutrient adequacy, dietary diversity, and food consumption patterns in children (N = 321). Weight, height, and dietary intakes, using 24-h food recalls, were measured at baseline (Day 1) and at Days 7, 30, 60, and 90. Nutrient adequacy, dietary diversity score (DDS), and food intake adequacy were calculated in both the supplementation groups (ONS1 + DC and ONS2 + DC; n = 107 in each group) and the control group (DC-only; n = 107). Supplements increased nutrient adequacy in both of the ONS + DC groups relative to control (p < 0.05). The proportions of children with adequate nutrient intakes increased significantly at Day 90 in the supplemented groups as compared to in the control group (p < 0.05), especially for total fat, calcium, vitamin A, vitamin C, and thiamin. Although no significant differences were observed in DDS in any of the groups, the percentage of children consuming ≥4 food groups in a day had increased in all the groups. Consumption of fruit and vegetables and cereals had increased significantly from baseline to Day 90. ONS along with dietary counseling was found to have improved nutritional adequacy without interfering with the normal food consumption patterns of picky-eating children at nutritional risk.
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Affiliation(s)
- Fahmina Anwar
- Abbott Nutrition, Research & Development India, Mumbai 400051, India
| | - Menaka Yalawar
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Bengaluru 560045, India
| | - Pranali Suryawanshi
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Navi Mumbai 400708, India
| | - Apurba Ghosh
- Institute of Child Health, Kolkata 700017, India
| | | | | | - Bala Kishore
- Saint Theresa's Hospital, Hyderabad 500018, India
| | | | | | | | - Sandeep Shinde
- Pune Sterling Multispecialty Hospital, Pune 411044, India
| | - Atish Shah
- Sangini Hospital, Sangini Complex, Ahmedabad 380006, India
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Chilot D, Belay DG, Merid MW, Kibret AA, Alem AZ, Asratie MH, Teshager NW, Aragaw FM. Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: a cross-sectional study. BMJ Open 2023; 13:e070978. [PMID: 37160393 PMCID: PMC10174032 DOI: 10.1136/bmjopen-2022-070978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE This study aimed to assess the prevalence and determinants of the triple burden of malnutrition among mother-child pairs in low-income and middle-income countries. DESIGN Cross-sectional study. SETTING Low-income and middle-income countries. PARTICIPANTS Women and children. PRIMARY OUTCOME Triple burden of malnutrition (overweight/obese mother with undernourished and anaemic under 5 years child). METHODS Data for this study were drawn from recent 22 low-income and middle-income countries Demographic and Health Surveys. A total weighted sample of 116 795 mother-child pairs was included in the study. STATA V.14.2 was used to clean, code and analyse the data. Multilevel logistic regression was employed to identify factors associated with the problem. Adjusted OR (AOR) with 95% CI and a p<0.05 was reported to indicate statistical association. Model fitness and comparison were done using intraclass correlation coefficient, median OR, proportional change in variance and deviance. RESULT The pooled prevalence of the triple burden of malnutrition among mother-child pairs was 11.39%. It showed statistically significant positive associations with mothers aged ≥35 years (AOR 2.25, 95% CI 2.08 to 2.44), family size >10 (AOR 1.17, 95% CI 1.08 to 1.26), delivery by caesarean section (AOR 1.93, 95% CI 1.83 to 2.03), the richest household (AOR 1.72, 95% CI 1.56 to 1.88), grand multiparous (AOR 1.62, 95% CI 1.46 to 1.81), age of child 36-47 months (AOR 1.77, 95% CI 1.64 to 1.90), at a p<0.05. Whereas breast feeding (AOR 0.94, 95% CI 0.89 to 0.99), married mothers (AOR 0.87, 95% CI 0.78 to 0.96), female children (AOR 0.88, 95% CI 0.84 to 0.92), improved toilet (AOR 0.23, 95% CI 0.17 to 0.29), improved source of drinking water (AOR 0.28, 95% CI 0.21 to 0.35), rural residents (AOR 0.66, 95% CI 0.62 to 0.69) had a contrasting relationship with the triple burden of malnutrition. CONCLUSION About 1 out of 10 households suffer from the triple burden of malnutrition in low-income and middle-income countries. This study revealed that several maternal, child, household and community-level factors have a significant impact on the triple burden of malnutrition among mother-child pairs.
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Affiliation(s)
- Dagmawi Chilot
- Department of Human Physiology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of women and family health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Nahom Worku Teshager
- Department of pediatrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Konyole SO, Omollo SA, Kinyuru JN, Owuor BO, Estambale BB, Ritz C, Michaelsen KF, Filteau SM, Wells JC, Roos N, Friis H, Owino VO, Grenov B. Associations between Stunting, Wasting and Body Composition: A Longitudinal Study in 6- to 15-Month-Old Kenyan Children. J Nutr 2023; 153:970-978. [PMID: 36796480 DOI: 10.1016/j.tjnut.2023.02.014] [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: 09/03/2022] [Revised: 12/23/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Early growth and body composition may influence the risk of obesity and health in adulthood. Few studies have examined how undernutrition is associated with body composition in early life. OBJECTIVES We assessed stunting and wasting as correlates of body composition in young Kenyan children. METHODS Nested in a randomized controlled nutrition trial, this longitudinal study assessed fat and fat-free mass (FM, FFM) using deuterium dilution technique among children at age 6 and 15 months. This trial was registered at http://controlled-trials.com/ (ISRCTN30012997). Cross-sectional and longitudinal associations between z-score categories of length-for-age (LAZ) or weight-for-length (WLZ) and FM, FFM, fat mass index (FMI), fat-free mass index (FFMI), triceps, and subscapular skinfolds were analyzed by linear mixed models. RESULTS Among the 499 children enrolled, breastfeeding declined from 99% to 87%, stunting increased from 13% to 32%, and wasting remained at 2% to 3% between 6 and 15 mo. Compared with LAZ >0, stunted children had a 1.12 kg (95% CI: 0.88, 1.36; P < 0.001) lower FFM at 6 mo and increased to 1.59 kg (95% CI: 1.25, 1.94; P < 0.001) at 15 mo, corresponding to differences of 18% and 17%, respectively. When analyzing FFMI, the deficit in FFM tended to be less than proportional to children's height at 6 mo (P ≤ 0.060) but not at 15 mo (P > 0.40). Stunting was associated with 0.28 kg (95% CI: 0.09, 0.47; P = 0.004) lower FM at 6 mo. However, this association was not significant at 15 mo, and stunting was not associated with FMI at any time point. A lower WLZ was generally associated with lower FM, FFM, FMI, and FFMI at 6 and 15 mo. Differences in FFM, but not FM, increased with time, whereas FFMI differences did not change, and FMI differences generally decreased with time. CONCLUSIONS Overall, low LAZ and WLZ among young Kenyan children were associated with reduced lean tissue, which may have long-term health consequences.
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Affiliation(s)
- Silvenus O Konyole
- Department of Nutritional Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya.
| | - Selina A Omollo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - John N Kinyuru
- Department of Food Science and Technology, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Benson B Estambale
- Division of Research, Innovations and Outreach, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne M Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Victor O Owino
- Nutritional and Health-Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Goyal M, Singh N, Kapoor R, Verma A, Gedam P. Assessment of Nutritional Status of Under-Five Children in an Urban Area of South Delhi, India. Cureus 2023; 15:e34924. [PMID: 36938241 PMCID: PMC10016022 DOI: 10.7759/cureus.34924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Malnutrition among children continues to be a severe public health problem worldwide, whether in a developing country like India or a developed nation. Correct estimation of the problem is a prerequisite to planning the measures to control it. Objective To estimate the prevalence of undernutrition among children under five years of age by utilizing the Composite Index of Anthropometric Failure and the WHO growth charts. Methods From January to March 2020, 1332 children under the age of five years participated in a facility-based, descriptive, cross-sectional study at Fatehpur Beri, Urban Primary Health Center. An anthropometric assessment for each participant was done as per the WHO criteria. The data were entered into a Microsoft Office Excel spreadsheet (Microsoft Corporation, Redmond, WA) and analyzed with WHO Anthro software (WHO, Geneva, Switzerland) and a licensed version of SPSS 21 (IBM Corp., Armonk, NY). Continuous data were expressed using appropriate measures of central tendency, while categorical data were expressed in either frequency or proportions. Results The mean age of the study participants was 23.04 ± 18.24 months, and males (53.3%) were more than (46.7%) females. The prevalence of being underweight was 24.5% (327/1332), of which 24.1% (79/327) of children were severely underweight. Of the total study participants, 27.3% (362/1332) were stunted, and 17.8% (237/1332) were wasted, of which 29.1% (69/237) were severely wasted. The prevalence of anthropometric failure was 45%. Conclusions According to the findings of this study, the prevalence of undernutrition among the study participants was substantial. Furthermore, considering weight for age as the sole criterion may underestimate the true prevalence of malnutrition. The findings have critical implications for future interventions and initiatives among children in India.
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Affiliation(s)
- Mohit Goyal
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Nidhi Singh
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Richa Kapoor
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Anita Verma
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Pratima Gedam
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Infection-elicited microbiota promotes host adaptation to nutrient restriction. Proc Natl Acad Sci U S A 2023; 120:e2214484120. [PMID: 36652484 PMCID: PMC9942920 DOI: 10.1073/pnas.2214484120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The microbiota performs multiple functions vital to host fitness, including defense against pathogens and adaptation to dietary changes. Yet, how environmental challenges shape microbiota resilience to nutrient fluctuation remains largely unexplored. Here, we show that transient gut infection can optimize host metabolism toward the usage of carbohydrates. Following acute infection and clearance of the pathogen, mice gained more weight as a result of white adipose tissue expansion. Concomitantly, previously infected mice exhibited enhanced carbohydrate (glucose) disposal and insulin sensitivity. This metabolic remodeling depended on alterations to the gut microbiota, with infection-elicited Betaproteobacteria being sufficient to enhance host carbohydrate metabolism. Further, infection-induced metabolic alteration protected mice against stunting in the context of limited nutrient availability. Together, these results propose that alterations to the microbiota imposed by acute infection may enhance host fitness and survival in the face of nutrient restriction, a phenomenon that may be adaptive in settings where both infection burden and food precarity are prevalent.
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Williams PCM, Beardsley J, Isaacs D, Preisz A, Marais BJ. The impact of climate change and biodiversity loss on the health of children: An ethical perspective. Front Public Health 2023; 10:1048317. [PMID: 36743159 PMCID: PMC9895790 DOI: 10.3389/fpubh.2022.1048317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 01/22/2023] Open
Abstract
The reality of human induced climate change is no longer in doubt, but the concerted global action required to address this existential crisis remains inexcusably inert. Together with climate change, biodiversity collapse is increasingly driving the emergence and spread of infectious diseases, the consequences of which are inequitable globally. Climate change is regressive in its nature, with those least responsible for destroying planetary health at greatest risk of suffering the direct and indirect health consequences. Over half a billion of the world's children live in areas vulnerable to extreme weather events. Without immediate action, the health of today's children and future generations will be compromised. We consider the impact of biodiversity collapse on the spread of infectious diseases and outline a duty of care along a continuum of three dimensions of medical ethics. From a medical perspective, the first dimension requires doctors to serve the best interests of their individual patients. The second dimension considers the public health dimension with a focus on disease control and cost-effectiveness. The neglected third dimension considers our mutual obligation to the future health and wellbeing of children and generations to come. Given the adverse impact of our ecological footprint on current and future human health, we have a collective moral obligation to act.
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Affiliation(s)
- Phoebe C. M. Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
- School of Women and Children's Health, The University of NSW School of Women's and Children's Health, Sydney, NSW, Australia
| | - Justin Beardsley
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
| | - David Isaacs
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Anne Preisz
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Ben J. Marais
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Darlington, NSW, Australia
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
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Chilot D, Diress M, Yismaw Gela Y, Sinamaw D, Simegn W, Andualem AA, Seid AM, Bitew DA, Seid MA, Eshetu HB, Kibret AA, Belay DG. Geographical variation of common childhood illness and its associated factors among under-five children in Ethiopia: spatial and multilevel analysis. Sci Rep 2023; 13:868. [PMID: 36650192 PMCID: PMC9845232 DOI: 10.1038/s41598-023-27728-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
Although substantial progress has been made in reducing child mortality over the last three decades, the magnitude of the problem remains immense. Ethiopia is one of the countries with a high under-five mortality rate due to childhood illnesses including acute respiratory infections, diarrhea, and fever that varies from place to place. It is vital to have evidence of the factors associated with childhood illnesses and the spatial distribution across the country to prioritize and design targeted interventions. Thus, this study aimed to investigate the spatial cluster distribution and associated factors with common childhood illnesses. Secondary data analysis based on the 2016 Ethiopian Demographic and Health Survey data was carried out. A total weighted sample of 10,417 children was included. The study used ArcGIS and SaTScan software to explore spatial distribution. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with the problem. ICC, MOR, PCV, and deviance (-2LLR) were used to check model fitness and model comparison. In this study, the prevalence of common childhood illnesses among under-five children was 22.5% (95% CI: 21.6-23.3%). The spatial analysis depicted that common childhood illnesses have significant spatial variation across Ethiopia. The SaTScan analysis identified significant primary clusters in Tigray and Northern Amhara regions (log-likelihood ratio (LLR) = 60.19, p < 0.001). In the multilevel analysis, being rural residence [AOR = 1.39, 95% CI (1.01-1.98)], small child size at birth [AOR = 1.36, 95% CI (1.21-1.55)], high community poverty [AOR = 1.26, 95% CI (1.06-1.52)], mothers aged 35-49 [AOR = 0.81, 95% CI (0.69-0.94)], the household had electricity [AOR = 0.77, 95% CI (0.61-0.98)], the household had a refrigerator [AOR = 0.60, 95% CI (0.42-0.87)], improved drinking water [AOR = 0.82, 95% CI (0.70-0.95)], improved toilet [AOR = 0.72, 95% CI (0.54-0.94)], average child size at birth [AOR = 0.83, 95% CI (0.75-0.94)] were significantly associated with common childhood illnesses. Common childhood illnesses had spatial variations across Ethiopia. Hotspot areas of the problem were found in the Tigray, Northern Amhara, and Northeast SNNPR. Both individual and community-level factors affected common childhood illnesses distribution and prevalence in Ethiopia. Therefore, public health intervention should target the hotspot areas of common childhood illnesses to reduce their incidence in the country.
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Affiliation(s)
- Dagmawi Chilot
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Abdulwase Mohammed Seid
- Department of Clinical Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Education and Behavioral Sciences, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Takele K, Zewotir T, Ndanguza D. A combined model of child malnutrition and morbidity in Ethiopia using structural equation models. Sci Rep 2023; 13:471. [PMID: 36627330 PMCID: PMC9832113 DOI: 10.1038/s41598-023-27440-7] [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: 02/12/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68-0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88-0.99), 48 months and above (AOR = 0.71, 95% CI 0.65-0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78-0.91), high-income households (AOR = 0.66, 95% CI 0.61-0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75-0.85) and higher education level (AOR = 0.57, 95% CI 0.41-0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77-0.99), fourth and higher (AOR = 0.88, 95% CI 0.79-0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64-0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80-0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94-0.097), from middle income (AOR = 0.97, 95% CI 0.96-0.99), high-income households (AOR = 0.94, 95% CI 0.93-0.96), birth spacing 24-47 months (AOR = 0.99, 95% CI 0.98-1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94-0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices.
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Affiliation(s)
- Kasahun Takele
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda.
| | - Temesgen Zewotir
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Denis Ndanguza
- grid.10818.300000 0004 0620 2260College of Science and Technology, University of Rwanda, Kigali, Rwanda
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Woeltje MM, Evanoff AB, Helmink BA, Culbertson DL, Maleta KM, Manary MJ, Trehan I. Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: analysis of operational data. Public Health Nutr 2023; 26:246-255. [PMID: 34915944 PMCID: PMC11077441 DOI: 10.1017/s1368980021004894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. DESIGN Review of operational acute malnutrition treatment records. SETTING Twenty-one outpatient therapeutic feeding clinics in rural Malawi. PARTICIPANTS Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials. RESULTS A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75·4 %) achieved nutritional recovery; in comparison, 56 (75·7 %) of those with severe acute malnutrition 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81·3 %) recovered; in comparison, 241 (85·2 %) of those aged 6-9 months recovered. CONCLUSIONS In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.
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Affiliation(s)
- Maeve M Woeltje
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
| | | | - Beth A Helmink
- Department of Surgery, Washington University in St. Louis, St Louis, USA
| | | | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mark J Manary
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Washington University in St. Louis, St Louis, USA
| | - Indi Trehan
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
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Folayan MO, Finlayson T, Oginni AB, Alade MA, Adeniyi AA, El Tantawi M. Is oral rehydration therapy associated with early childhood caries in children resident in Ile-Ife, Osun State, Nigeria? Int J Paediatr Dent 2023; 33:74-81. [PMID: 35771168 DOI: 10.1111/ipd.13016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral rehydration therapy may increase the risk of early childhood caries (ECC) because of reduced pH in the oral environment. AIM To investigate associations between the use of oral rehydration therapy and the prevalence and severity of ECC in children resident in the Ife Central Local Government Area of Osun State, Nigeria. DESIGN This observational study assessed the prevalence and severity of caries, using the International Caries Detection and Assessment System (ICDAS) II index. The outcome variables were the prevalence and severity of ECC. The explanatory variable was the use of oral rehydration solution for the management of diarrhea in the 12 months preceding the study. A multivariable logistic regression analysis was conducted to determine associations between the explanatory and outcome variables. RESULTS Only 217 (14%) of the 1564 children had used oral rehydration solution for the management of diarrhea. Seventy-three (4.7%) children had ECC. The use of oral rehydration solution was not significantly associated with the prevalence and severity of ECC. CONCLUSION The study findings suggest that the use of oral rehydration therapy in the management of diarrhea may not be a risk factor for ECC in communities with low prevalence and severity of ECC and high prevalence of gastroenteritis.
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Affiliation(s)
| | | | | | - Michael Abimbola Alade
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Hotez PJ. Malnutrition vaccines for an imminent global food catastrophe. Trends Pharmacol Sci 2022; 43:994-997. [PMID: 36100482 PMCID: PMC9463047 DOI: 10.1016/j.tips.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 01/13/2023]
Abstract
Together with climate change, both the geopolitical events in Ukraine and social disruptions in supply chains from the COVID-19 pandemic could produce global food shortages or even mass starvation events. Promising new interventions include vaccines to prevent infectious causes of malnutrition or infections disproportionately causing death among the malnourished.
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Affiliation(s)
- Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA,Department of Biology, Baylor University, Waco, TX, USA,James A. Baker III Institute for Public Policy, Rice University, Houston, TX, USA,Hagler Institute for Advanced Study, and the Scrowcroft Institute of International Affairs, at Texas A&M University, College Station, TX, USA,Correspondence:
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Is Infant and Young Child-feeding (IYCF) a potential double-duty strategy to prevent the double burden of malnutrition among children at the critical age? Evidence of association from urban slums in Pune, Maharashtra, India. PLoS One 2022; 17:e0278152. [PMID: 36455056 PMCID: PMC9714859 DOI: 10.1371/journal.pone.0278152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study characterized undernutrition among children (0-24 months) by age groups specified for Infant and Young Child-feeding (IYCF) and determined the association between child malnutrition and IYCF. METHODS This cross-sectional survey recruited mother-children dyads (N = 1443). WHO standards were used to assess nutritional status and IYCF indicators. Multivariate analyses were performed to assess the association between IYCF and nutritional indicators. RESULTS Stunting, underweight, wasting, overweight, and obesity were prevalent in 33.1%, 26%, 20.2%, 4.6%, and 2.9% of the children, respectively. Age-wise distribution of undernutrition identified severity of stunting and underweight at 10-24 months (median < -1.6 SD; < -1.2 SD; 25th percentile at -2.6 & -2.2 SD respectively) and wasting highest at 0-6 months (25th percentile close to -2SD). Boys manifested higher stunting (lower value -5.2 SD) and were more wasted (lower value -4.7 SD). IYCF prevalence recorded early initiation at 45.2%, exclusive breastfeeding at 23.1%, and prelacteal and bottle-feeding at 37.5 and 22.5% respectively. Child minimum diet diversity (MDD) ≥4 was not achieved by 84%. Minimum meal frequency and minimum acceptable diet were achieved by 75% and 14% respectively. Bottle-feeding increased the odds of wasting [AOR: 1.501 (95% CI: 1.062-2.121)], severe stunting [AOR: 1.595 (95% CI: 1.079-2.358)] and underweight [AOR: 1.519 (95% CI 1.102-2.094)]. Wasting according to BAZ scores was associated with delayed initiation of breastfeeding [AOR: 1.387 (95% CI: 1.018-1.889)] and bottle feeding [AOR: 1.538 (95% CI: 1.087-2.175)]. Delayed introduction of complementary feeding increased the odds of severe stunting [AOR: 2.189 (95% CI: 1.090-4.399)]. Formula feeding increased the odds of underweight [AOR: 1.738 (95% CI: 1.046-2.888)] and obesity [AOR: 4.664 (95% CI: 1.351-16.10)]. Prelacteal feeding increased the odds of severe forms of stunting and underweight by 56% and 79% respectively, and overweight by 96%. CONCLUSION Setting and age-specific interventions to improve age-appropriate child-feeding practices are vital to address the double burden of malnutrition in the critical age group.
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Ezzat MA, Albassam EM, Aldajani EA, Alaskar RA, Devol EB. Implementation of new indicators of pediatric malnutrition and comparison to previous indicators. Int J Pediatr Adolesc Med 2022; 9:216-224. [PMID: 36937329 PMCID: PMC10019954 DOI: 10.1016/j.ijpam.2022.12.003] [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: 10/17/2022] [Revised: 12/11/2022] [Accepted: 12/27/2022] [Indexed: 01/08/2023]
Abstract
Background Early identification of childhood malnutrition is imperative to improve overall health outcomes, and more importantly, to start early intervention to decrease the risk of future complications. This study aimed to evaluate new malnutrition Z-score growth indicators for detecting pediatric malnutrition and degrees of severity and compare their accuracy with that of growth chart centiles. Patients and Methods This retrospective study included 475 pediatric patients from several pediatric nutrition clinics for six months. The participant's weight, height, age, and growth parameters were recorded using both traditional growth charts (centiles) and updated malnutrition indicators (z-scores). The percentage and degree of malnutrition using centiles and Z-scores were compared. Results In children aged <2 years, the percentage of malnutrition was 4.7% higher when measured using new malnutrition indicators (weight-for-length Z-score) compared with (weight-for-length centiles). Our results also showed 9.6% higher number of malnourished children >2 years of age when BMI-for-age Z-score was used compared to weight-for-height centiles while there were 15.8% higher malnourished children when BMI-for-age Z-score was compared to BMI-for-age centiles for the same group. We found a significant difference (X2 = 202.548, P=<.0001) between the degree of malnutrition in children aged >2 years using BMI-for-age Z-score (normal vs. malnourished) and the degree of malnutrition using BMI centiles (normal vs. malnourished). Approximately 34% of the children classified as normal using centiles were classified as malnourished using Z-scores. Comparing the degrees of Malnutrition, approximately 23% (45 of 196) of children classified as normal based on centiles were classified as having mild malnutrition when Z-scores were used, and 42% (80 of 192) of children who were classified as having mild malnutrition based on centiles were classified as having moderate malnutrition when Z-scores were used. Conclusions In our study, a higher percentage of children showed malnutrition when assessed using the Z-score (BMI-for-age for children >2 years/weight-for-length for children <2 years of age) than the centiles growth chart.
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Affiliation(s)
- Mai Adnan Ezzat
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Corresponding author. Nutrition Department, King Faisal Specialist Hospital and Research Center, Saudi Arabia.
| | - Ebtsam Mohmmed Albassam
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Eman Abdullah Aldajani
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raneem Abdulaziz Alaskar
- Department of Nutrition, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Edward Bentz Devol
- King Faisal Specialist Hospital and Research Centre, Department of Biostatistics, Riyadh, Saudi Arabia
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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Chisala M, Nyangulu W, Nyirenda J, Iroh Tam PY. Respiratory and diarrhoeal pathogens in Malawian children hospitalised with diarrhoea and association with short-term growth: A prospective cohort study. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.14061.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Pneumonia and diarrhoea are the leading causes of childhood mortality and morbidity worldwide. The gut-lung axis is associated with disease, and these common infections, especially the parasite Cryptosporidium, are associated with malnutrition. We sought to evaluate the association of respiratory and gastrointestinal (GI) pathogens with short-term growth among children hospitalised with diarrhoeal disease. Methods: In this sub-study, we followed 27 children (two-24 months) who tested positive for Cryptosporidium spp. for eight weeks with two weekly sampling of the respiratory and GI tract. Respiratory and stool pathogens were detected using quantitative molecular methods. Nutritional outcomes were assessed as length-for-age (LAZ), weight-for-length (WLZ) and weight-for-age (WAZ) z-scores. Changes over the study period were compared using repeated analysis of variance and mixed effects model analysis. Results: In this period,104 sputum and stool samples were collected. All stool samples had at least one pathogen detected, with an average of 5.1 (SD 2.1) stool pathogens, compared to 84% of the sputum samples with an average 3.5 (SD 1.8). Diarrhoeagenic E. coli were the most common stool pathogens (89%), followed by Cryptosporidium (57.6%) and Adenovirus pan (41%). In sputum, Streptococcus pneumoniae was the most prevalent pathogen (84%), followed by hinovirus (56%) and Moraxella catarrhalis (50%). There was a significant change in WAZ over the follow-up period. Children who had ≥3 GI pathogens had significantly a lower LAZ mean score at enrolment (-1.8 [SD 1.4]) and across the follow-up period. No relationship between respiratory pathogens and short-term growth was observed. Out of 49 sputum samples that had ≥3 pathogens, 42 (85%) concurrent stool samples had ≥3 GI pathogens. Conclusions: Among young children hospitalised with diarrhoea, multiple GI and respiratory pathogens were prevalent over an eight-week follow-up period. The presence of more GI, but not respiratory, pathogens was significantly associated with reduced short-term growth.
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