Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3-5 years of Chapra, Nadia District, West Bengal, India

Magnitude of under-nutrition among under five children in Ethiopia based on 2019 Mini-Ethiopia Demographic and Health Survey: Generalized Linear Mixed Model (GLMM)

INTRODUCTION

Malnutrition is a major public health problem that is experienced by many developing countries, like Ethiopia. Though some studies were conducted to identify the magnitude and determinants of acute malnutrition among under-five children, there is a lack of evidence that is representative of all children in Ethiopia. Hence, this national-level data could be representative of all targets and provide us with updated information on the nation-wide magnitude of nutritional status among children under the age of five in Ethiopia.

METHODS

This study used data from the 2019 Mini-Ethiopia Demographic and Health Survey (EDHS). Children aged 0-59 months with anthropometry data were included. Data processing and analysis were performed using STATA 15 software. Cross-tabulations and summary statistics were done to describe the study population. Generalized Linear Mixed Models (GLMMs) were used to estimate the association between nutritional status and explanatory variables and were expressed as an odds ratio with a 95% confidence interval (CI). Model comparison was done based on Akaike and Bayesian information criteria (AIC and BIC).

RESULTS

The magnitude of stunting was 37.71% [95%CI: 36.35-39.08], while the magnitude of wasting was 7.14% [95%CI: 6.52-7.91]. Living in Tigray [AOR = 2.90, 95%CI: 2.05-4.11], Amhara [AOR = 1.98, 95%CI: 1.41-2.79], having a child aged 24-35 [AOR = 3.79, 95%CI: 3.07-4.68], and being a rural resident were all significantly associated with stunting. Being born in Tigray [AOR = 1.75, 95% CI: 1.02-3.01], being born into the richest family [AOR = 0.74, 95% CI: 0.27-0.80], and being born from mothers aged 25-29 [AOR = 0.73, 95% CI: 0.55-0.96] were all significantly associated with wasting.

CONCLUSION

The magnitude of stunting and wasting is relatively high in Ethiopia. Region, place of residence, and age of the child were significantly associated with stunting, and region, wealth index, and age of the child were significantly associated with wasting. This result provides a clue to give due consideration to under-five children to mitigate the risks of malnutrition through various techniques.

Study on Dietary Pattern, Nutritional Status and Socio-Demographic Determinants of the Preschool Children Aged 3-6 Years

This study was undertaken to analyze the dietary pattern and nutritional status of preschool children and to check the association between diet and socio-demographic factors. Dietary Pattern of 390 preschool children from Udham Singh Nagar district of Uttarakhand state of India was assessed. 24-Hour dietary recall and food frequency questionnaire (FFQ) was used for collecting information regarding dietary intake for three consecutive days. Nutritional indices (weight for age, height for age, weight for height, and BMI for age Z score) were studied using WHO Anthro software. Results indicated that the nutrient intake was inadequate, with major children consuming less than 60% of the recommended intake. Family income, community, type of family, birth order (ordinal position), and the number of siblings were associated with dietary insufficiency (p < 0.05). Stunting and wasting were commonly prevalent in more number of girls as compared to boys, on the contrary; more boys were underweight as compared to girls. A higher proportion of girls 18% (95% C.I. 10.8, 25.3) were thin as compared to boys 15% (95% C.I. 8.4, 21.6).

Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016

The Integrated Child Development Services (ICDS) program launched in India in 1975 is one of the world’s largest flagship programs that aims to improve early childhood care and development via a range of healthcare, nutrition and early education services. The key to success of ICDS is in finding solutions to the historical challenges of geographic and socioeconomic inequalities in access to various services under this umbrella scheme. Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015–2016, this study presents (a) socioeconomic patterning in service uptake across rural and urban India, and (b) continuum in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0–72 months) in India. We used an intersectional approach and ran a series multilevel logistic regression (random effects) models to understand patterning in utilization among mothers across socioeconomic groups. We also computed the area under the receiver operating characteristic curve (ROC-AUC) based on a logistic regression model to examine concordance between service utilization across three different points. The service utilization (any service) by mothers during pregnancy was about 20 percentage points higher for rural areas (60.5 percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4; 39.1). We also found a lower uptake of services related to health and nutrition education during pregnancy (41.9 percent in rural) and early childcare (preschool) (42.4 percent). One in every two mother–child pairs did not avail any benefits from ICDS in urban areas. Estimates from random effects model revealed higher odds of utilization among schedule caste mothers from middle-class households in rural households. AUC estimates suggested a high concordance between service utilization by mothers and their children (AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if service utilization commences at pregnancy.

Composite Index of Anthropometric Failure (CIAF) among Sonowal Kachari tribal preschool children of flood effected region of Assam, India

Undernutrition is considered to be a serious public health problem in most of the developing countries. Globally, the anthropometric measures are widely used to estimate the magnitude of undernutrition in children. The Composite Index of Anthropometric Failure (CIAF) provides the overall magnitude of undernutrition as an aggregate single measure over the conventional anthropometric indices and helps in identification of single or double or multiple anthropometric failures in preschool children. The present investigation assesses the age-sex specific prevalence of undernutrition using both conventional anthropometric measures and CIAF among Sonowal Kachari tribal preschool children of Assam, India. This cross-sectional investigation was carried out among 362 (162 boys and 190 girls) Sonowal Kachari tribal children younger than 5 years of flood affected regions of Lakhimpur district of Assam, India. Anthropometric measurements of height and weight were measured using standard procedures. Age-sex specific Z-score value of weight-for-age, height-for-age and weight-for-height were calculated by using WHO-Anthro, v. 3.2.2. A child Z-score <−2.00 of any anthropometric indices was considered to be undernourished and the standard CIAF classification was used to calculate the prevalence of undernutrition. The overall prevalence of wasting, underweight, stunting and CIAF was observed to be 11.6%, 22.9%, 36.2%, and 48.6%, respectively. The sex-specific prevalence of wasting (15.8% vs. 6.9%), underweight (30.5% vs. 14.5%) and stunting (42.1% vs. 29.6%) observed to be significantly higher among girls than boys (p<0.05). The girls (61.05%) were found to be more affected than boys (34.9%) by CIAF (p<0.01). The present investigation reported higher magnitude of undernutrition using CIAF over conventional anthropometric measures, hence the CIAF is relatively better indicator that reflects higher magnitude of undernourishment as compared to any conventional anthropometric indices in children. This research investigation has also reinforced the importance of appropriate intervention programme and strategies needed to reduce the prevalence of undernutrition in childhood and in population as a whole.

Socio-economic and demographic correlates of stunting among adolescents of Assam, North- east India

The prevalence of stunting (low height-for-age) is a key indicator of long-term chronic undernutrition which reflects an anthropometric failure to reach linear growth potentials due to prolonged food deprivation and/or disease or illness during the early stage of life. The present study assesses the prevalence and socio-economic and demographic correlates of stunting among adolescents of the North-east India. This cross-sectional study was undertaken among 1,818 (830 boys; 988 girls) adolescents (aged 10-18 years) belonging to ethnically heterogeneous populations of Karbi Anglong district of Assam, using stratified random sampling method. Anthropometric measurements of height and weight were recorded using standard procedures. Socio-economic and demographic variables were obtained using pre-structured schedule. The age-sex specific L, M and S reference values were used to calculate height-for-age Z-score (HAZ). According to WHO, HAZ found to be <−2SD was classified as stunting. The data were analysed using descriptive statistics, t-test, ANOVA, chi-square analyses, binary and step-wise multiple logistic regression analysis in SPSS (version, 17.0). The prevalence of stunting was observed to be significantly higher among boys (48.4%) than girls (37.8%) (p<0.01). Age-sex specific prevalence was found to be higher among boys than girls aged 14-18 years and contrary were observed among girls aged 10-14 years (p>0.05). The binary logistic regression analysis showed that several socio-economic and demographic variables were significantly associated with stunting (p<0.05). The step-wise multiple logistic regression analysis showed that sex (boys), age groups (13-15 years and 16-18 years), father’s occupation (cultivator) and Rupees ≤5000 household income was significantly associated with stunting (p<0.05). Appropriate nutritional intervention programmes and dissemination of knowledge at population level related to undernutrition are necessary to ameliorate their nutritional status.

Association of some socio-economic and socio-demographic variables with wasting among pre-school children of North Bengal, India

BACKGROUND

Undernutrition is a global public health problem that causes premature morbidity and ill-health conditions and has long-lasting physiological effects in children. The present study assesses the prevalence of wasting [low mid-upper arm circumference (MUAC)-for-age] among children and to determine the association of wasting with different socio-economic and socio-demographic variables.

METHODS

The present cross-sectional study was conducted among 1222 pre-school children (boys: 589; girls: 633), aged 1-5 years, in Darjeeling district, North Bengal, India, using multistage stratified random sampling method. The MUAC was measured using the standard anthropometric procedure. Low MUAC-for-age was assessed by comparing with a standard age-sex-specific reference population (WHO, 1995). Children with MUAC value were found to be the z-scores <-3SD, and <-2 SD were considered to be severely and moderately wasted, respectively. The socio-economic and socio-demographic variables were recorded using structured schedule methods. The data were statistically analyzed based on descriptive statistics, chi-square analysis and logistic regression using SPSS (version, 17.0).

RESULTS

The age-specific mean MUAC ranged from 126.1-142.5 mm (boys) and 126.9-136.4 mm (girls). The prevalence of wasting was very high (boys: 62.3%; girls: 63.3%) (p>0.05). The logistic regression analysis observed that age, gender, birth order, area (rural), maternal education, household income and mothers' age were significantly associated with the prevalence of wasting (p<0.05).

CONCLUSION

Using MUAC-for-age, a high prevalence of wasting was observed among the children. Birth order, maternal education and maternal occupation were important determinants of wasting. There is an urgent requirement of nutritional intervention programmes to ameliorate the nutritional status of the children.

Food Price Spikes Are Associated with Increased Malnutrition among Children in Andhra Pradesh, India

BACKGROUND

Global food prices have risen sharply since 2007. The impact of food price spikes on the risk of malnutrition in children is not well understood.

OBJECTIVE

We investigated the associations between food price spikes and childhood malnutrition in Andhra Pradesh, one of India's largest states, with >85 million people. Because wasting (thinness) indicates in most cases a recent and severe process of weight loss that is often associated with acute food shortage, we tested the hypothesis that the escalating prices of rice, legumes, eggs, and other staples of Indian diets significantly increased the risk of wasting (weight-for-height z scores) in children.

METHODS

We studied periods before (2006) and directly after (2009) India's food price spikes with the use of the Young Lives longitudinal cohort of 1918 children in Andhra Pradesh linked to food price data from the National Sample Survey Office. Two-stage least squares instrumental variable models assessed the relation of food price changes to food consumption and wasting prevalence (weight-for-height z scores).

RESULTS

Before the 2007 food price spike, wasting prevalence fell from 19.4% in 2002 to 18.8% in 2006. Coinciding with India's escalating food prices, wasting increased significantly to 28.0% in 2009. These increases were concentrated among low- (χ(2): 21.6, P < 0.001) and middle- (χ(2): 25.9, P < 0.001) income groups, but not among high-income groups (χ(2): 3.08, P = 0.079). Each 10.0 rupee ($0.170) increase in the price of rice/kg was associated with a drop in child-level rice consumption of 73.0 g/d (β: -7.30; 95% CI: -10.5, -3.90). Correspondingly, lower rice consumption was significantly associated with lower weight-for-height z scores (i.e., wasting) by 0.005 (95% CI: 0.001, 0.008), as seen with most other food categories.

CONCLUSION

Rising food prices were associated with an increased risk of malnutrition among children in India. Policies to help ensure the affordability of food in the context of economic growth are likely critical for promoting children's nutrition.

Nutritional status among boys and girls of a central Indian Town (Sagar)

The prevalence of undernutrition is a significant area of concern in many developing countries, where it is a major public health problem. The aim of the study was to assess the prevalence of undernutrition among school-going boys and girls of central Indian city Sagar, MP. A total of 612 individuals (312 girls and 300 boys) aged 5–18 years were examined and compared to the NCHS reference data. The nutritional status was assessed using following anthropometric indicators: body height and weight, body mass index (BMI) and composite index of anthropometric failure (CIAF). It was found that girls were heavier (1 kg) and taller (2–5 cm) than boys up to 15 and 13 years of age, respectively. After that, boys became taller with 1 to 13 cm. The mean BMI of boys was higher to girls up to 10 year of age after that the trend was reversed. Comparison of the present findings with NCHS reference data revealed that Indian girls and boys were lagging behind. The difference in body weight between the reference data and the present sample was around 5 to 6 kg. The pattern of difference in body height revealed small amount during early childhood (6.6.cm and 9.6 cm in girls and boys 5 years of age). This difference more than doubled at the age of 14 years in girls 16.7 cm and in boys 17.5 cm (p<0.01). Similar pattern was found for BMI with 6.5 kg/m2 and 6.3 kg/m2 in 14 years old girls and 16 years old boys (p<0.01). Z-score values of weight-for-age, height-for-age and BMI-for-age revealed that that boys were more likely to be stunted than girls whereas girls were more likely to be underweight and undernourished than boys. In terms of CIAF 10.6% girls and 10% boys were undernourished. The results of the present study indicate that there is great need for implementation of health programmes to eliminate gender inequalities and improve children’s health.

Undernutrition and its correlates among children of 3-9 years of age residing in slum areas of Bhubaneswar, India

Undernutrition among children is a major public health concern worldwide, more prevalent in Asia and Africa. It manifests itself in various forms such as wasting or stunting or underweight and retards physical and mental development, increases susceptibility to infection, and reduces educational attainment and productivity. The present study was undertaken to assess the level of wasting, stunting, and underweight and determine its associates among slum children of 3–9 years of age, residing in Bhubaneswar city, India. After obtaining informed consent, a total of 249 children from 249 households were studied and their parents/guardians were interviewed to collect all relevant information. 23.3%, 57.4%, and 45.4% of children were found to have wasting, stunting, and underweight, respectively. Variables like birth order of child, period of initiation of breastfeeding and mother's education were found to be strong predictors of wasting, whereas toilet facility in household and practice of drinking water storage were significantly associated with stunting among slum children as revealed in multiple regression analysis. Thus, a multipronged approach is needed such as giving priority to improve education for slum community especially for women, creating awareness regarding benefits of early initiation of breastfeeding, small family size, and proper storage of drinking water, and providing toilet facility in slum households which could improve the nutritional status of slum children.

First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of Pediatric Population in the Middle East and North Africa (MENA): the CASPIAN-III study

BACKGROUND

The World Health Organization (WHO) is in the process of establishing a new global database on the growth of school children and adolescents. Limited national data exist from Asian children, notably those living in the Middle East and North Africa (MENA). This study aimed to generate the growth chart of a nationally representative sample of Iranian children aged 10-19 years, and to explore how well these anthropometric data match with international growth references.

METHODS

In this nationwide study, the anthropometric data were recorded from Iranian students, aged 10-19 years, who were selected by multistage random cluster sampling from urban and rural areas. Prior to the analysis, outliers were excluded from the features height-for-age and body mass index (BMI)-for-age using the NCHS/WHO cut-offs. The Box-Cox power exponential (BCPE) method was used to calculate height-for-age and BMI-for-age Z-scores for our study participants. Then, children with overweight, obesity, thinness, and severe thinness were identified using the BMI-for-age z-scores. Moreover, stunted children were detected using the height-for-age z-scores. The growth curve of the Iranian children was then generated from the z-scores, smoothed by cubic S-plines.

RESULTS

The study population comprised 5430 school students consisting of 2312 (44%) participants aged 10-14 years , and 3118 (58%) with 15-19 years of age. Eight percent of the participants had low BMI (thinness: 6% and severe thinness: 2%), 20% had high BMI (overweight: 14% and obesity: 6%), and 7% were stunted. The prevalence rates of low and high BMI were greater in boys than in girls (P < 0.001). The mean BMI-for-age, and the average height-for-age of Iranian children aged 10-19 years were lower than the WHO 2007 and United states Centers for Disease Control and Prevention 2000 (USCDC2000) references.

CONCLUSIONS

The current growth curves generated from a national dataset may be included for establishing WHO global database on children's growth. Similar to most low-and middle income populations, Iranian children aged 10-19 years are facing a double burden of weight disorders, notably under- and over- nutrition, which should be considered in public health policy-making.

Socio-economic and demographic factors affecting the Composite Index of Anthropometric Failure (CIAF)

BACKGROUND

The present cross-sectional study evaluates the utility of the Composite Index of Anthropometric Failure (CIAF) over conventional nutritional indices for nutritional assessment. It also assesses the impact of various socio-economic and demographic factors on the CIAF.

SUBJECTS AND METHODS

Height, weight, age, socio-economic and demographic data were recorded from 3444 children (1682 boys; 1762 girls) aged 1-12 years and residing in Darjeeling district, West Bengal, India. The conventional anthropometric indices and CIAF were compared with the NCHS reference data to assess prevalence of under-nutrition. A multinomial logistic regression was used to assess the impact of different socio-economic and demographic variables on the CIAF.

RESULTS

Prevalence of under-nutrition was observed to be 21.5% (wasting), 43.3% (stunting) and 52.0% (underweight). This increased to 63.6% using the CIAF. The multinomial logistic regression odds showed that children suffering from double and multiple failures were significantly associated with the socio-economic and demographic variables.

CONCLUSION

The CIAF provides more precision in identifying the nutritionally vulnerable segment of the population. The disaggregation of CIAF has an adequate potential to enhance the efficacy of a nutritional intervention programme by identifying double or multiple failures.

Prevalence of undernutrition among Kora-Mudi children aged 2-13 years in Paschim Medinipur District, West Bengal, India

BACKGROUND

nutritional status of tribal children in West Bengal has not been investigated adequately. The present study was undertaken to determine the prevalence of underweight, stunting and wasting in Kora-Mudi children of Paschim Medinipur, West Bengal, India.

METHODS

a cross sectional study was undertaken in two villages of the Paschim Medinipur District. Of 119 children aged 2-13 years, 59 boys and 60 girls were studied. Height and weight measurements were made by standard techniques. Children were considered as underweight, stunting and wasting if their weight-for-age, height-for-age and weight-for-height Z-scores <-2.0 SD of the National Center for Health Statistics reference standards.

RESULTS

the overall prevalence of underweight, stunting and wasting was 52.9%, 49.6% and 22.7%, respectively. About 16.0%, 24.4% and 1.7% of children were found to be severely underweight, stunted and wasted. The prevalence of underweight, stunting and wasting was higher in preschool children than in school going children. The chance of underweight, stunting and wasting was 1.80, 1.10 and 1.58 times greater in preschool children than in school going children. Moreover, the prevalence of underweight, stunting and wasting was higher in boys than in girls. The boys had 1.45, 1.66 and 2.02 times greater risk to be underweight, stunted and wasted. According to the WHO classification of severity in malnutrition, the overall prevalence of underweight, stunting and wasting was as high as ≥ 30%, ≥ 40 and ≥ 15%.

CONCLUSIONS

the nutritional status of Kora-Mudi children in West Bengal is critical. Appropriate measures should be taken by the respective authorities to improve childhood health and nutritional status.

Mid-upper Arm Circumference Based Undernutrition among Bengalee Children of Chapra, West Bengal, India

OBJECTIVE

To investigate age and sex variations in undernutrition using mid-upper arm circumference (MUAC) cut-off values among 2016 (930 boys and 1086 girls). 3-5 years old rural children of Bengalee ethnicity at 66 Integrated Child Development Services (ICDS) Centers of Nadia District, West Bengal, India.

METHODS

In a cross sectional study in west Bengal of India, MUAC was measured using standard technique. A total of 2028 children (935 boys and 1093 girls) from 66 ICDS centers were enrolled in this study. The response rate was approximately 95%.

FINDINGS

Mean MUAC among boys was higher than girls at all ages except 5 years. Significant sex differences were not observed over ages. The age-combined rates of overall (moderate and severe) undernutrition among boys (38.49%) was higher than among girls (32.22%).The age-combined rates of moderate undernutrition were 36.34% and 31.03% among boys and girls, respectively. The rates of severe undernutrition were 2.15% and 1.20% among boys and girls, respectively. There were sex differences in both moderate and severe undernutrition. In general, there was an increasing trend in the rates of overall undernutrition from 3 to 5 years in both sexes.

CONCLUSION

These children were experiencing severe nutritional stress.

Report on "anthropometric failure" among rural 2-6 years old Indian Bauri caste children of West Bengal

This study was undertaken to determine the overall prevalence of undernutrition using the composite index of anthropometric failure (CIAF) among the Bauri caste rural preschool children of the Purulia District, West Bengal, India. A total of 347 children (185 boys and 162 girls) aged 2-6 years were measured. Stunting, underweight and wasting were used to evaluate the nutritional status of the subjects (compared with children of the United States NCHS reference sample) and CIAF for the total children. Among the studied Bauri children, 39.2% were stunted, 51.2% - underweight and 26.6% - wasted. The CIAF showed a higher prevalence of undernutrition, with a total of 66.3% of Bauri caste preschool children suffering from at least one type of "anthropometric failure". Among the studied children only 33.7% showed no failure. Valuable health and nutrition promotional programs can be formulated based on the CIAF findings with the ultimate objective of reducing childhood undernutrition in a population of India.