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Thurstans S, Opondo C, Bailey J, Stobaugh H, Loddo F, Wrottesley SV, Seal A, Myatt M, Briend A, Garenne M, Mertens A, Wells J, Sear R, Kerac M. How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13596. [PMID: 38048342 PMCID: PMC11168354 DOI: 10.1111/mcn.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023]
Abstract
Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non-response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72-0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39-0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27-0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24-59 months) had a shorter mean LOS than younger children (6-23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols.
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Affiliation(s)
- Susan Thurstans
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Charles Opondo
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | | | | | | | - Andy Seal
- UCL Institute for Global HealthLondonUK
| | | | - André Briend
- Tampere Center for Child, Adolescent and Maternal Health ResearchTampere University and Tampere University HospitalTampereFinland
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Michel Garenne
- Institut de Recherche pour le Développement, UMI RésiliencesBondyFrance
- Department of Statistics and Population StudiesUniversity of the Western CapeCape TownSouth Africa
- FERDIUniversité d'AuvergneClermont‐FerrandFrance
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Andrew Mertens
- University of California, Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Jonathan Wells
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Rebecca Sear
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Marko Kerac
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
- Maternal, Adolescent, Reproductive & Child Health Centre (MARCH)London School of Hygiene & Tropical MedicineLondonUK
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Mahmud I, Guesdon B, Kerac M, Grijalva‐Eternod CS. Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13635. [PMID: 38433606 PMCID: PMC11168360 DOI: 10.1111/mcn.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
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Affiliation(s)
- Imteaz Mahmud
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Public HealthNorth South UniversityDhakaBangladesh
- The Power of NutritionLondonUK
| | | | - Marko Kerac
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Gong X, Tang Y, Zhang M, Yu Y, Hu W, Xu Y, Liu Y, Sun H, Yu G, Zhai C, Zong Q, Wang F, Zou Y. The Global Burden of Disease Attributable to Child and Maternal Malnutrition: 1990-2019. Pediatrics 2024; 154:e2023064167. [PMID: 38832449 DOI: 10.1542/peds.2023-064167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE With this study, we aimed to estimate the disease burden attributable to child and maternal malnutrition (CMM) throughout the world between 1990 and 2019. METHODS The number, age-standardized rate, population attributable fraction of deaths, disability-adjusted life-years, years of life lost, and years lived with disability associated with CMM were estimated using the Global Burden of Disease Study 2019 by age, sex, year, location, and sociodemographic index at the global level. The slope index of inequality and concentration index were employed to measure socioeconomic-related health inequalities across countries. RESULTS The number (million) of global deaths, disability-adjusted life-years, and years of life lost related to CMM were 2.9, 294.8, and 250.5 in 2019, showing decreases of 60.8, 57.4, and 60.7% since 1990. However, the number of years lived with CMM-related disability increased from 36.0 in 1990 to 44.3 in 2019. Additionally, the age-standardized rates of these 4 indicators showed varying degrees of decline. The global burden of CMM-related conditions differed with age and sex. The burden was the heaviest in western sub-Saharan Africa, especially in Chad. In terms of diseases, neonatal disorders represented the most significant burden attributed to CMM. Additionally, the CMM burden was more concentrated in regions with low sociodemographic indices, shown by the slope index of inequality and concentration index. CONCLUSIONS The findings of this study highlight the ongoing global burden of CMM, particularly in terms of years lived with disability. Population-wide actions targeting the effective treatment and relief of CMM may reduce the CMM-related disease burden.
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Affiliation(s)
- Xingyu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqin Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mingyi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yingying Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Barrios-Tascon A, Strehlau R, Patel F, Burke M, Shiau S, Shen Y, Arpadi SM, Abrams EJ, Tiemessen CT, Kuhn L. Growth Trajectories Over the First Year of Life Among Early-Treated Infants with Human Immunodeficiency Virus and Infants Who are Human Immunodeficiency Virus-Exposed Uninfected. J Pediatr 2024; 270:114018. [PMID: 38508485 PMCID: PMC11176027 DOI: 10.1016/j.jpeds.2024.114018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the role of early antiretroviral therapy (ART) on growth trajectories of infants with human immunodeficiency virus (IHIV) in the first year of life. STUDY DESIGN As part of a clinical trial of early ART in Johannesburg, South Africa (2015-2018), 116 IHIV diagnosed within 48 hours of birth were started on ART as soon as possible, and 80 uninfected infants born to mothers living with HIV (IHEU) were enrolled. Both groups were followed prospectively from birth through 48 weeks and growth parameters collected. The groups were compared and risk factors for poor growth investigated, in the full cohort and among IHIV separately. RESULTS IHIV had lower mean weight-for-age Z-scores (WAZ) than IHEU at 4 and 8 weeks (-1.17 [SE:0.14] vs -0.72 [0.14], P = .035 and -1.23 [0.15] vs -0.67 [0.14], P = .012). Although there was some closing of the gap over time, means remained lower in IHIV through 48 weeks. In length-for-age Z-scores (LAZ), differences widened over time and IHIV had lower Z-scores by 48 weeks (-1.41 [0.15] vs -0.80 [0.18], P = .011). Deficits in WAZ and LAZ in IHIV vs IHEU were most marked among girls. IHIV with pre-ART viral load ≥1000 copies/ml had significantly lower weight-for-length and mid-upper arm circumference Z-scores across all time points through 48 weeks. CONCLUSIONS IHIV on early ART had deficits in WAZ over the first 8 weeks of life and lower LAZ at 48 weeks than IHEU. Among IHIV, higher pre-ART viral load was associated with worse anthropometric indicators through 48 weeks.
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Affiliation(s)
- Ana Barrios-Tascon
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY.
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Wits RHI, Shandukani Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- VIDA Nkanyezi Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Yanhan Shen
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Stephen M Arpadi
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Elaine J Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY; ICAP, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Caroline T Tiemessen
- Centre for HIV and STIs, National Institutes for Communicable Diseases, A Division of the National Health Laboratory Service, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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Ikemi A, Horiuchi S. Mother's perception of early introduction of complementary feeding affecting stunting in Ghana: A qualitative research. Jpn J Nurs Sci 2024:e12611. [PMID: 38923823 DOI: 10.1111/jjns.12611] [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: 03/21/2024] [Revised: 05/12/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES The study aimed to explore mothers' perceptions for timely introduction of complementary feeding through interviews with 2-12-month-old infants' mothers in Ghana. METHODS Qualitative descriptive research with 16 semi-structured interviews with mothers attending the Child Welfare Clinic at Ejisu Hospital was conducted from June 2022 to May 2023. The study was guided by the Declaration of Helsinki, and all participants were instructed about informed consent for the study. Interviews and analysis were guided by Theory of Planned Behavior. NVivo 1.5 was used throughout the coding procedure. This study was conducted after the approval from St. Luke's International University. RESULTS Four themes were revealed: (1) attitude toward the behavior based on the mothers' experience raising children, (2) attitude toward the behavior influenced by subjective norm (grandmothers' recommendation), (3) attitude toward the behavior influenced by perceived behavioral control (difficulty in continuing breastfeeding), and (4) mothers who are worried about underweight despite timely introduction of complementary feeding. Attitudes toward the behavior were influenced by mothers' experiences raising children and grandmothers' recommendations. Surroundings disruptive of breastfeeding also influenced attitudes toward intentions and behavior. Moreover, some mothers suffered from underweight even if they introduce complementary feeding at an optimal time. CONCLUSION Supporting to continue breastfeeding and conducting re-education for grandmothers is a key recommendation for midwives and pediatric nurses. Moreover, pediatric nurses are required to further enhance not only health education regarding the timing of initiating complementary feeding but also support after the introduction.
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Affiliation(s)
- Ayame Ikemi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Sahiledengle B, Mwanri L. Determinants of aggregate anthropometric failure among children under-five years in Ethiopia: Application of multilevel mixed-effects negative binomial regression modeling. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003305. [PMID: 38833430 PMCID: PMC11149882 DOI: 10.1371/journal.pgph.0003305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Abstract
Undernutrition significantly contributes to failure to thrive in children under five, with those experiencing multiple forms of malnutrition facing the highest risks of morbidity and mortality. Conventional markers such as stunting, wasting, and underweight have received much attention but are insufficient to identify multiple types of malnutrition, prompting the development of the Composite Index of Anthropometric Failure (CIAF) and the Composite Index of Severe Anthropometric Failure (CISAF) as an aggregate indicators. This study aimed to identify factors associated with CIAF and CISAF among Ethiopian children aged 0-59 months using data from the 2019 Ethiopia Mini Demographic and Health Survey. The study included a weighted sample of 5,259 children and used multilevel mixed-effects negative binomial regression modeling to identify determinants of CIAF and CISAF. The result showed higher incidence-rate ratio (IRR) of CIAF in male children (adjusted IRR = 1.27; 95% CI = 1.13-1.42), children aged 12-24 months (aIRR = 2.01, 95%CI: 1.63-2.48), and 24-59 months (aIRR = 2.36, 95%CI: 1.91-2.92), those from households with multiple under-five children (aIRR = 1.16, 95%CI: 1.01-1.33), poorer households (aIRR = 1.48; 95%CI: 1.02-2.15), and those who lived in houses with an earthen floor (aIRR = 1.37, 95%CI: 1.03-1.82). Similarly, the factors positively associated with CISAF among children aged 0-59 months were male children (aIRR = 1.47, 95% CI = 1.21-1.79), age group 6-11 months (aIRR = 2.30, 95%CI: 1.40-3.78), age group 12-24 months (aIRR = 3.76, 95%CI: 2.40-5.88), age group 25-59 months (aIRR = 4.23, 95%CI: 2.79-6.39), children from households living with two and more under-five children (aIRR = 1.27, 95%CI:1.01-1.59), and children from poorer households (aIRR = 1.93, 95% CI = 1.02-3.67). Children were more likely to suffer from multiple anthropometric failures if they were: aged 6-23 months, aged 24-59 months, male sex, living in households with multiple under-five children, and living in households with poor environments. These findings underscore the need to employ a wide range of strategies to effectively intervene in multiple anthropometric failures in under-five children.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, SA 5000, Adelaide, Australia
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Negesse A, Girma T, Desalegn BB, Kerac M, Berhane M. The epidemiology and associated factors of non-exclusive breastfeeding: a comparative cross-sectional study of livelihood-secure and insecure areas. Front Nutr 2024; 11:1347780. [PMID: 38826580 PMCID: PMC11141399 DOI: 10.3389/fnut.2024.1347780] [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: 12/01/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Regardless of national commitment, non-exclusive breastfeeding (NEBF) is a public health problem that worsens over time. It can be associated with sociodemographic, economic, and environmental factors and may vary depending on livelihood security. Hence, this study aimed to determine the magnitude of NEBF and identify its associated factors by considering two areas with varied degrees of livelihood security. Methods This study represented a comparative cross-sectional survey of 1,060 under 6 months (u6m) infant-mother pairs. Both descriptive and analytic statistics were evaluated using STATA version 17 packages. A binary logistic regression was used to identify associated factors of NEBF. The odds ratio (OR) with a 95% confidence interval (CI) was used to measure the significance of the association at a p-value of <0.05. Results The pooled magnitude of 51% of NEBF mothers (95% CI: 48.0, 54.0) was 53.1% (95% CI: 49.2, 57.0) and 48.1% (95% CI: 43.4, 52.8) in livelihood-secure and livelihood-insecure areas, respectively. The lack of recollecting the infant's birth date by mothers (AOR = 2.4; 95% CI = 1.15-4.40) had the highest odds of NEBF while household heads with tertiary education (AOR = 0.14; 95% CI = 0.01-0.54) and the poorest households (AOR = 0.43; 95%CI = 0.20-0.82) had the lowest odds of NEBF in livelihood-secure areas but not in livelihood-insecure areas. Moreover, mothers with male infants (AOR = 1.9; 95% CI = 1.18-2.92) had high odds of NEBF in livelihood-insecure areas but not in livelihood-secure areas. Infants of 2 to less than 4-month-old (AOR = 8.5; 95% CI = 3.47-18.63) and 4 to less than 6-month-old (AOR = 22.2; 95% CI = 8.02-51.97) in livelihood-secure areas and infants of 2 to less than 4-month-old (AOR = 4.3; 95% CI = 1.29-11.67) and 4 to less than 6-month-old (AOR = 8.3; 95% CI = 2.44-22.39) in livelihood-insecure areas had high odds of NEBF. Conclusion Over half of the mothers were practicing NEBF, which represents a failure to meet national and international targets. Area vulnerability to livelihood security modifies factors of NEBF. Male infants in insecure areas, infants of unknown age in secure areas, and infants aged 2 months or older, regardless of setting, were more vulnerable to NEBF. However, households with the lowest wealth and higher household head educational status in livelihood-secure areas were less vulnerable to NEBF. Hence, livelihood-based interventions targeting mothers of 2 to less than 6-month-old infants, with emphasis on these factors, may help address and reduce NEBF.
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Affiliation(s)
- Ayenew Negesse
- Academic center of Excellence in Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa, Ethiopia
- Department of Human Nutrition, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- University of British Colombia (UBC), Vancouver, BC, Canada
| | - Beruk Berhanu Desalegn
- Academic center of Excellence in Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa, Ethiopia
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
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Magerko K, Humphrey J, Songok J, Musick B, Alera JM, Kipchumba B, Kosgei W, Mwangi W, Yang K, Wools-Kaloustian Z, McHenry MS. Impact of Maternal Viral Suppression on Growth Patterns for HIV-Exposed Uninfected Infants in Kenya. Int J MCH AIDS 2024; 13:e005. [PMID: 38742164 PMCID: PMC11090584 DOI: 10.25259/ijma_656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/29/2023] [Indexed: 05/16/2024] Open
Abstract
Background and Objective Children born to mothers living with human immunodeficiency virus (HIV) are at risk for poor health outcomes but data characterizing these associations are limited. Our objective was to determine the impact of maternal viral suppression on growth patterns and malnutrition for infants who are HIV-exposed but uninfected (HEU). Methods We conducted a retrospective cohort analysis of clinical data for infants who were HEU and their mothers (September 2015 - March 2019) in Kenya. Infants were stratified based on maternal viral suppression status (≥ or <1000 copies/mL); t-tests were used to compare groups. Growth indicators were evaluated with Chi-square, Fisher's exact, and area under the curve. Moderate-to-severe underweight status, stunting, and wasting were defined by weight-for-age (WFA), height-for-age (HFA), and weight-for-height (WFH), z-scores ≤2, and were used to define malnutrition. Multivariate logistic regression analyses were performed to evaluate potential associations with malnutrition indicators between WFH and HFA. Results Among 674 infants who were HEU, 48.7% were male and 85.0% had mothers who were virally suppressed. The median age at first and last clinic visits was 1.5 and 16.4 months, respectively. WFA and HFA z-scores over time differed by sex, and WFA and HFA differed based on maternal viral suppression (P < 0.05). Male infants had higher adjusted odds for stunted status, and as children aged, they had slightly increased odds of becoming underweight or stunted. Maternal viral suppression and timing of maternal antiretroviral therapy initiation in relation to the prevention of vertical transmission (PVT) enrollment did not significantly affect malnutrition indicators. Conclusion and Global Health Implications Maternal viral suppression status was not associated with increased odds of more severe malnutrition indicators in children who were HEU. However, overall growth patterns over time, measured by z-scores of growth indicators, did differ based on maternal viral suppression status, and to a lesser degree, by gender.
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Affiliation(s)
- Katherine Magerko
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - John Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Julia Songok
- Department of Pediatrics, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Joy Marsha Alera
- Department of Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Bett Kipchumba
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Wycliffe Kosgei
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Winfred Mwangi
- Department of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kara Yang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Ziyi Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Megan S. McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Widjaja NA, Hamida A, Purnomo MT, Satjadibrata A, Sari PP, Handini LS, Novi T, Hanindita MH, Irawan R. Effect of high-calorie formula on weight, height increment, IGF-1 and TLC in growth faltering children: A quasi-experimental study. Heliyon 2024; 10:e28834. [PMID: 38623243 PMCID: PMC11016603 DOI: 10.1016/j.heliyon.2024.e28834] [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: 05/27/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
High-calorie formulas have been used to promote catch-up growth in undernourished children. The level of insulin-like growth factor 1 (IGF-1) is closely related to weight and nutritional intake, whereas low a total lymphocyte count (TLC) is associated with impaired immune system function in undernourished children. This study was conducted to investigate the effect of high-calorie formula as an intervention on weight, height increment, IGF-1 and TLC in children with growth faltering or undernutrition. A quasi-experimental study with pre- and post-design was conducted in the outpatient clinic of a private hospital during October 2021-July 2022 on children with growth failure and underlying infection. For 90 days, subjects were given a high-calorie formula. An enzyme-linked immunosorbent assay was then conducted to measure IGF-1, followed by a complete blood count examination. Subjects were divided into two groups based on age: Group 1 (12-24 months) and Group 2 (>24-60 months). There was a significant increment in body weight and body length/height after intervention but no significant difference between the groups. The increment of body length/height after intervention was greater in Group 1 than Group 2 (p = 0.000) and reduced the incidence of stunted/severely stunted and wasted/severely wasted children (p > 0.05). IGF-1 increased after the intervention but with no significant difference (1.42 ± 8.31 ng/ml; p = 0.144). There was a significant reduction in TLC after the intervention (1194.34 + 4400.34 cells/mm3; p = 0.002) that was reduced in Group 1 and slightly increased in Group 2 (p = 0.003). Being underweight/severely underweight increased the risk of a low TLC by 27.658-fold but this risk was reduced by 25.904-fold after nutritional intervention. High-calorie formula intervention increases body weight and body length/height, reduces the incidence of underweight, stunted and wasted children and improves IGF-1 levels.
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Affiliation(s)
- Nur Aisiyah Widjaja
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
- Child Health, Husada Utama Hospital, Surabaya, Indonesia
| | - Azizah Hamida
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Marisa Tulus Purnomo
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Azarina Satjadibrata
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Putri Permata Sari
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | | | - Theresia Novi
- Clinical Pathology, Husada Utama Hospital, Surabaya, Indonesia
| | - Meta Herdiana Hanindita
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Roedi Irawan
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
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10
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Rahut DB, Mishra R, Bera S. Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutrition 2024; 120:112346. [PMID: 38320385 DOI: 10.1016/j.nut.2023.112346] [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] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. METHODS To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. RESULTS This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. CONCLUSIONS This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.
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Affiliation(s)
| | - Raman Mishra
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Subhasis Bera
- International School of Business and Media, Budge Budge, Kolkata, West Bengal, India
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11
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Singh G, Jha A. Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5. Cureus 2024; 16:e59410. [PMID: 38826598 PMCID: PMC11139634 DOI: 10.7759/cureus.59410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study found that the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack of access to a bank or a savings account, and lack of mobile phone ownership were found to be significant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.
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Affiliation(s)
- Gaurav Singh
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Anupriya Jha
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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12
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Chamanoor M, Juneja RK, Sami S, Arefin S, Al-Sabbagh D, Thota AN, Bint I Munir A, Kaka MC. Disparities in Place of Death Among Malnourished Individuals in the United States. Cureus 2024; 16:e55503. [PMID: 38571833 PMCID: PMC10990269 DOI: 10.7759/cureus.55503] [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: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Deficiencies or imbalances in a person's intake of nutrients are referred to as malnutrition. Malnutrition remains a significant public health concern in the United States, with potential consequences ranging from chronic disease to mortality. This study aims to assess the disparities in place of death due to malnutrition in the United States from 1999 to 2020, based on variables like age, gender, race, and location, utilizing the Centers for Disease Control and Prevention Information and Communication Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. METHODOLOGY Data regarding mortality due to malnutrition was extracted for the years 1999-2020 from the CDC WONDER database. Univariate regression analysis was performed to investigate disparities in the place of death based on variables. RESULTS Between 1999 and 2020, a total of 1,03,962 malnutrition-related deaths were recorded, with 31,023 in home and hospice care, 68,173 in medical and nursing facilities, and 4,766 in other places. The odds of death due to malnutrition at home or hospice were highest for the 85+ age group, female gender, census region 4 (West), and Asian or Pacific Islander race. CONCLUSIONS This study reveals a rising trend in mortality due to malnutrition in the United States, especially among certain demographic groups and in medical facilities and nursing homes. It emphasizes the need to understand the factors contributing to this increase in mortality rates. Future research should focus on these contributors to combat the rising burden of malnutrition-related mortality in the United States.
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Affiliation(s)
| | - Riyam Kaur Juneja
- Internal Medicine, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pune, IND
| | - Syed Sami
- Internal Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Shamsul Arefin
- Internal Medicine, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, GBR
| | - Daniah Al-Sabbagh
- Internal Medicine, University of Baghdad Al-Kindy College of Medicine, Baghdad, IRQ
| | - Akhila N Thota
- Medicine, Alluri Sitaram Raju Academy of Medical Sciences, Eluru, IND
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Dharod JM, Black MM, McElhenny K, Labban JD, DeJesus JM. Es Niño o Niña?: Gender Differences in Feeding Practices and Obesity Risk among Latino Infants. Curr Dev Nutr 2024; 8:102100. [PMID: 38425439 PMCID: PMC10904161 DOI: 10.1016/j.cdnut.2024.102100] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy. Objectives The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life. Methods Latino mother-infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants' lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk. Results The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (≥85th weight-for-length percentile). Infants' obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90). Conclusions The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls.
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Affiliation(s)
- Jigna M Dharod
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Maureen M Black
- RTI International, Research Triangle Park, NC, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristen McElhenny
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Jeffrey D Labban
- Office of Research, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Jasmine M DeJesus
- Department of Psychology, College of Arts and Sciences, University of North Carolina at Greensboro, Greensboro, NC, United States
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14
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Moore SE. Sex differences in growth and neurocognitive development in infancy and early childhood. Proc Nutr Soc 2024:1-8. [PMID: 38326969 DOI: 10.1017/s0029665124000144] [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] [Indexed: 02/09/2024]
Abstract
Undernutrition in early life remains a significant public health challenge affecting millions of infants and young children globally. Children who are wasted, stunted or underweight are at increased risk of morbidity and mortality. Undernutrition at critical periods also impacts on aspects of neurodevelopment, with longer-term consequences to educational performance and mental health outcomes. Despite consistent evidence highlighting an increased risk of neonatal and infant mortality among boys, a common assumption held across many disciplines is that girls are more vulnerable with respect to early-life exposures. In relation to undernutrition, however, recent evidence indicates the reverse, and in contexts of food insecurity, boys are at increased risk of undernutrition in early life compared to girls, with sex-specific risks for neurodevelopmental deficits. These effects appear independent of social factors that may favour boys, such as gender disparities in infant feeding practices and health-seeking behaviours. The observed vulnerability among boys may therefore be underpinned by biological processes such as differential energy requirements during periods of rapid growth. As boys have greater needs for growth and maintenance, then, in times of nutritional hardship, these needs may not be met resulting in risk of undernutrition and subsequent health consequences. In view of this emerging evidence, a greater understanding of the mechanisms behind this vulnerability among boys is needed and policy considerations to protect boys should be considered. This review will explore sex differences in risk of undernutrition and consider these in the context of existing programmes and policies.
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Affiliation(s)
- Sophie E Moore
- Department of Women and Children's Health, King's College London, LondonSE1 7EH, UK
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15
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Elmighrabi NF, Fleming CAK, Agho KE. Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019. Nutrients 2024; 16:473. [PMID: 38398798 PMCID: PMC10892369 DOI: 10.3390/nu16040473] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030.
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Affiliation(s)
- Nagwa Farag Elmighrabi
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Department of People Determination and Sustainable Development, Benghazi 18251, Libya
- Department of Nutrition, Faculty of Public Health, University of Benghazi, Benghazi 18251, Libya
| | - Catharine A. K. Fleming
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
| | - Kingsley E. Agho
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
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Azcorra H, Castillo-Burguete MT, Lara-Riegos J, Salazar-Rendón JC, Mendez-Dominguez N. Secular trends in the anthropometric characteristics of children in a rural community in Yucatan, Mexico. Am J Hum Biol 2024; 36:e23995. [PMID: 37740441 DOI: 10.1002/ajhb.23995] [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: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To analyze changes in height, weight, and body mass index (BMI = kg/m2 ) from 1986 to 2022 in 3-11 year old children from Dzeal, a rural Maya community in Yucatan, Mexico. MATERIALS AND METHODS From October-2022 to February-2023 (third-wave survey), we obtained anthropometric measurements of children (n = 80) and family socioeconomic data and compared them with data obtained in 1986 (n = 38) and 2000 (n = 76). Comparisons of anthropometric parameters by sex between years of measurement were performed graphically and through one-way ANOVA, splitting children into two age groups: 3-7 and 8-11. Bonferroni adjustments for multiple comparisons were used when ANOVAs were statistically significant (p < .05). RESULTS In girls, significant increases in height and weight between surveys were found in 3-7 and 8-11 age groups; in boys, significant increases were only found in the 8-11 age group. Regarding BMI, there were increases in 2022 compared with 1986/2000 in both sexes from 8 years onwards. Differences indicate increases of 3.9 and 4.4 cm per decade in girls aged 3-7 and 8-11, respectively, and increases in weight of 1.1 and 3.3 kg per decade, respectively. Increases in boys 8-11 years were 2.3 cm and 2.4 kg per decade. CONCLUSION Significant increases in growth parameters were observed in specific-age children in the community studied in the context of changes in livelihoods and improvements in household material conditions.
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Affiliation(s)
- Hugo Azcorra
- Centro de Investigaciones Silvio Zavala, Universidad Modelo, Mérida, Yucatán, Mexico
| | | | - Julio Lara-Riegos
- Facultad de Química, Universidad Autónoma de Yucatán, Mérida, Yucatán, Mexico
| | | | - Nina Mendez-Dominguez
- Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
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17
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Salazar Burgos RJ, Longhi HF, Marrodán Serrano MD. Composite indexes of anthropometric failure in children under 5 years of age in Argentina: Comparative analysis among regions: 2019-2020. Am J Hum Biol 2024; 36:e23994. [PMID: 37747256 DOI: 10.1002/ajhb.23994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVES Composite Index of Anthropometric Failure (CIAF) and Extended CIAF (ECIAF) allow for the identification of simultaneous presence of two or more types of malnutrition. The objective of this study was to analyze anthropometric failure in Argentinean children under 5 years old, taking into consideration regional and socioeconomic perspectives. MATERIALS AND METHODS Data from the National Survey of Children and Adolescents MICS 2019-2020 were used, which included 5473 children under 5 years old of both sexes residing in the six regions of Argentina. CIAF and ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting, and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. The data were analyzed according to region and wealth quintile. RESULTS In children aged 0-2.99 years, CIAF was 12.5% and ECIAF was 27.7%, with boys being more affected. In children aged 3-4.99 years, the rates were 9.7% and 22.3%, respectively, with girls showing a higher prevalence. The highest ECIAF was recorded in the Patagonia region (31.3%), while the highest ECIAF was observed in the poorest quintile. DISCUSSION The presence of double burden of malnutrition has been observed across all regions and household income levels. Additionally, overweight has shown a higher intensity in economically prosperous regions and households, while stunting has been more prevalent in economically disadvantaged areas.
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Affiliation(s)
- Ramiro Joaquín Salazar Burgos
- Escuela Universitaria de Enfermería, Facultad de Medicina, Universidad Nacional de Tucumán (UNT), Tucumán, Argentina
- Instituto de Investigaciones Territoriales y Tecnologicas para la Produccion del Hábitat (INTEPH), CONICET-Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Hugo Fernando Longhi
- Insituto Superior de Estudios Sociales (ISES), CONICET-Universidad Nacional de Tucumán, Tucumán, Argentina
- Facultad de Humanidades, Ciencias Sociales y de la Salud, Universidad Nacional de Santiago de Estero (UNSE), Santiago del Estero, Argentina
| | - María Dolores Marrodán Serrano
- Grupo de Investigación EPINUT, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Biodiversidad, Ecología y Evolución, Universidad Complutense de Madrid, Madrid, Spain
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Asgedom YS, Seifu BL, Mare KU, Asmare ZA, Asebe HA, Kase BF, Shibeshi AH, Tebeje TM, Sabo KG, Fente BM, Kassie GA, Lombebo AA. Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis. PLoS One 2024; 19:e0296451. [PMID: 38165921 PMCID: PMC10760711 DOI: 10.1371/journal.pone.0296451] [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: 07/21/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Stunting is a major public health problem affecting more than one-third of under five year's old children in Ethiopia. It has short and long (irreversible) consequences, including stunted growth, never reaching physical and cognitive potential, struggles in school, and increased morbidity and mortality due to infections. Though stunting is the leading cause of child mortality in Ethiopia, evidence is scarce on the prevalence and predictors of stunting among under-five years old children in Ethiopia. Therefore, this study aimed to estimate the prevalence and predictors of stunting severity among under-5 children in Ethiopia. MATERIALS AND METHODS This study was based on 2019 Mini-Ethiopian Demographic and Health Survey (EDHS) data. A weighted total sample of 4972 under-five years old children was included in the study. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using World Health Organization growth standards (Z-scores for Height-for-Age (HAZ)) to asses stunting level. Given the ordinal nature of stunting and the hierarchical nature of EDHS data, a multilevel ordinal logistic regression model was applied. Brant test was used to check the proportional odds assumption, which was satisfied (P-value ≥0.05). Moreover, deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariable analysis were considered. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported as associated factor to the severity levels of stunting in the multivariable multilevel proportional odds model. RESULTS The overall prevalence of stunting among under-5 children in Ethiopia was 35.7% [95% CI: 34.4%, 37.1%]. Of these, 12.1% were severely stunted, and 24.9% were moderately stunted. Being male [AOR = 0.83, 95% CI: 0.74, 0.93], children aged 6-23 months [AOR = 2.38, 95% CI: 1.84, 3.07], ≥ 24 months [AOR = 4.15, 95% CI: 3.26, 5.28], children whose maternal age 15-24 years [AOR = 0.73, 95% CI: 0.58, 0.92], children from the poorest, poorer, middle, and richer household wealth were [AOR = 1.84, 95% CI: 1.32, 2.57], [AOR = 1.66, 95% CI: 1.20, 2.31], [AOR = 1.78, 95% CI: 1.29, 2.44], and [AOR = 1.62, 95% CI: 1.20, 2.17], children whose maternal educational status of no formal education and primary education had [AOR = 1.90, 95% CI: 1.28, 2.82], [AOR = 1.78, 95% CI: 1.22, 2.60], Tigray [AOR = 2.95, 95% CI: 1.78, 4.86], Afar [AOR = 1.85, 95% CI: 1.11, 3.10], Amhara [AOR = 1.90, 95% CI: 1.14, 3.14] and Harari [AOR = 1.97, 95% CI: 1.20, 3.25]regions, low community maternal education [AOR = 0.76, 95% CI: 0.62, 0.92] were significantly associated with stunting severity levelling. CONCLUSION Stunting among children under five years of old in Ethiopia remains a major public health issue. Improving access to maternal education is related to appropriate child feeding practices and health, particularly in younger and uneducated mothers. Strengthening the family's wealth status is also recommended to reduce stunting. In addition, it is better to support strategies of preconception care for mothers during pregnancy to reduce stunting in the long term.
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Affiliation(s)
- Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Zufan Alamire Asmare
- Department of Ophthalmology, School of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Abdu Hailu Shibeshi
- Department Statistics, College of Natural and Computational Science, Samara University, Afar, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Bezawit Melaku Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [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: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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20
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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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21
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Littlejohn PT, Metcalfe-Roach A, Cardenas Poire E, Holani R, Bar-Yoseph H, Fan YM, Woodward SE, Finlay BB. Multiple micronutrient deficiencies in early life cause multi-kingdom alterations in the gut microbiome and intrinsic antibiotic resistance genes in mice. Nat Microbiol 2023; 8:2392-2405. [PMID: 37973864 DOI: 10.1038/s41564-023-01519-3] [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: 08/23/2022] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
Globally, ~340 million children suffer from multiple micronutrient deficiencies, accompanied by high pathogenic burden and death due to multidrug-resistant bacteria. The microbiome is a reservoir of antimicrobial resistance (AMR), but the implications of undernutrition on the resistome is unclear. Here we used a postnatal mouse model that is deficient in multiple micronutrients (that is, zinc, folate, iron, vitamin A and vitamin B12 deficient) and shotgun metagenomic sequencing of faecal samples to characterize gut microbiome structure and functional potential, and the resistome. Enterobacteriaceae were enriched in micronutrient-deficient mice compared with mice fed an isocaloric experimental control diet. The mycobiome and virome were also altered with multiple micronutrient deficiencies including increased fungal pathogens such as Candida dubliniensis and bacteriophages. Despite being antibiotic naïve, micronutrient deficiency was associated with increased enrichment of genes and gene networks encoded by pathogenic bacteria that are directly or indirectly associated with intrinsic antibiotic resistance. Bacterial oxidative stress was associated with intrinsic antibiotic resistance in these mice. This analysis reveals multi-kingdom alterations in the gut microbiome as a result of co-occurring multiple micronutrient deficiencies and the implications for antibiotic resistance.
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Affiliation(s)
- Paula T Littlejohn
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Avril Metcalfe-Roach
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ravi Holani
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
| | - Haggai Bar-Yoseph
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yiyun M Fan
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah E Woodward
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - B Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada.
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada.
- Biochemistry and Molecular Biology Department, University of British Columbia, Vancouver, British Columbia, Canada.
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22
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Jones-Antwi R, Cunningham SA. Unhealthy weight among young children in the Middle East and North African region. Public Health Nutr 2023; 26:2383-2395. [PMID: 37606074 PMCID: PMC10641650 DOI: 10.1017/s1368980023001684] [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: 08/03/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years. DESIGN Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight. SETTING Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen). PARTICIPANTS Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961). RESULTS Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls. CONCLUSION Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.
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Sahiledengle B, Mwanri L, Blumenberg C, Agho KE. Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey. BMC Public Health 2023; 23:2040. [PMID: 37853384 PMCID: PMC10585928 DOI: 10.1186/s12889-023-16907-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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia. METHODS The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition. RESULTS The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted. CONCLUSION Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide Campus, SA, 5000, Australia
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Musa IR, Omar SM, AlEed A, Al-Nafeesah A, Adam I. Mid-upper arm circumference as a screening tool for identifying underweight adolescents. Front Nutr 2023; 10:1200077. [PMID: 37867488 PMCID: PMC10587426 DOI: 10.3389/fnut.2023.1200077] [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: 04/04/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Mid-upper arm circumference (MUAC) is a potentially credible alternative method for body mass index (BMI) to assess nutritional status. We aimed to assess the correlation between MUAC and BMI- Z-score and to identify a reliable MUAC cut-off point to detect underweight (BMI- Z-score of < -2 standard deviation) Sudanese adolescents. Methods A cross-sectional study was conducted in eastern Sudan. After obtaining adolescents' age and sex, their weight, height, and MUAC were measured using the standard procedures. The MUAC (cm) cut-off corresponding to underweight was calculated using receiver operating characteristic (ROC) curve analysis. Results In total, 390 adolescents were enrolled in the study and 205 (52.6%) of them were females. The median (interquartile range, IQR) age was 15.1 (14.0-16.3) years. The medians (IQR) of MUAC and BMI- Z-score were 22.0 (20.0-24.0) cm and - 0.62 (-1.5-0.3), respectively. MUAC was positively correlated with BMI Z-score in all participants (r = 0.534, p < 0.001), in females (r = 0.715, p < 0.001), and in males (r = 0.404, p < 0.001). Of the 390 enrolled adolescents, 61(15.6%) were underweight. The MUAC cut-off for underweight was ≤21.2 cm in all participants (Youden's Index, YI = 0.50; sensitivity = 82.0%; specificity = 68.0%, AUROCC = 0.78), in females (YI = 0.66, sensitivity = 86.0%, specificity = 80.0%, AUROCC = 0.87), and in males (YI = 0.32, sensitivity = 80.0%, specificity = 52.0%, AUROCC = 0.69). Conclusion MUAC has good accuracy results and can be adopted for community-based screening of underweight adolescents.
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Affiliation(s)
- Imad R. Musa
- Royal Commission Hospital at AL Jubail Industrial City, Al Jubail, Saudi Arabia
| | - Saeed M. Omar
- Faculty of Medicine, Gadarif University, Gadarif, Sudan
| | - Ashwaq AlEed
- Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
- Department of Pediatrics, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Abdullah Al-Nafeesah
- Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Anuradha K, Ketan G, Vaman K, Veena E. Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys. Indian J Pediatr 2023; 90:982-987. [PMID: 35713770 DOI: 10.1007/s12098-022-04143-x] [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: 08/11/2021] [Accepted: 12/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4). METHODS National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ. RESULTS A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 ± 1.8 to -1.5 ± 1.7) but relatively less improved weight for age (-1.8 ± 1.4 to -1.5 ± 1.2), the change in wasting status was either nil or meagre (-0.8 ± 1.4 to -0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05). CONCLUSION Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.
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Affiliation(s)
- Khadilkar Anuradha
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Gondhalekar Ketan
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Khadilkar Vaman
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ekbote Veena
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
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Boua PR, Rouamba T, Bambara E, Kaboré S, Compaore EWR, Ouedraogo B, Tinto H, Newell ML, Ward K, Sorgho H. Undernutrition in children aged 0-59 months by region and over time: secondary analysis of the Burkina Faso 2012-2018 National Nutrition Surveys. BMJ Open 2023; 13:e066509. [PMID: 37673454 PMCID: PMC10496659 DOI: 10.1136/bmjopen-2022-066509] [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: 07/22/2022] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
The global burden of undernutrition remains high, responsible for significant under-five mortality in resource-limited settings. Numerous sustainable development goals (SDGs) are linked to nutrition, and nationally representative nutrition surveillance is a key activity to track progress towards SDGs and guide efficient programmes. OBJECTIVES The aim of this study is to look at spatial and temporal trends in undernutrition in children under 5 years age in Burkina Faso. SETTING We used data from annual National Nutrition Surveys using Standardised Monitoring and Assessment of Relief and Transitions methodology (anthropometry, morbidity) over 7 years (2012-2018) in Burkina Faso. PARTICIPANTS Children of under 5 years from households selected through systemic sampling at countrywide level. MAIN OUTCOME MEASURES Prevalence of stunting (height-for-age z-score, <-2), underweight (weight-for-age z-score, <-2) and wasting (weight-for-height z-score, <-2) at regional and national. We used general linear mixed models, adjusted by age, survey year, sex, presence of fever and/or diarrhoea, and poverty index to quantify the risk of undernutrition over time and by region of residence. RESULTS Between 2012 and 2018, decreases were observed overall in the prevalence of growth retardation (stunting) decreased from 33.0% (95% CI 32.3 to 33.8) in 2012 to 26.7% (95% CI 26.2 to 27.3) in 2018. Underweight reduced from 24.4% (95% CI 23.7 to 25.1) to 18.7% (95% CI 18.2 to 19.2) for the same period and wasting decreased from 10.8% (95% CI 10.3 to 11.3) in 2012 to 8.4% (95% CI 8.1 to 8.8) in 2018. However, there was substantial variation across the country, with increased risk of undernutrition in the regions of Sahel, East and Cascades primarily. High-risk regions were characterised by a lower poverty index and limited access to healthcare services. CONCLUSIONS Our findings could inform national policymakers in refining and optimising resource allocation based on the identification of high-risk areas.
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Affiliation(s)
- Palwende Romuald Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
- Sydney Brenner Institute for Molecular Biosciences, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
| | - Estelle Bambara
- Direction de la Nutrition, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Saidou Kaboré
- Direction de la Nutrition, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ella W R Compaore
- Laboratoire de Biochimie, Biotechnologie, Technologie Alimentaire et Nutrition (LABIOTAN), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Boureima Ouedraogo
- Institut National de Statistique et de la Démographie, Ouagadougou, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
| | - Marie-Louise Newell
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Kate Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Global Health Research Institute, University of Southampton, Southampton, UK
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
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Roba AA, Başdaş Ö. Multilevel analysis of trends and predictors of concurrent wasting and stunting among children 6-59 months in Ethiopia from 2000 to 2019. Front Nutr 2023; 10:1073200. [PMID: 37720379 PMCID: PMC10502729 DOI: 10.3389/fnut.2023.1073200] [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: 10/18/2022] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Emerging evidence indicates that children can be concurrently wasted and stunted (WaSt), increasing their mortality risk. However, more is needed to know about WaSt in Ethiopia. Therefore, this study aimed to determine the trends and predictors of WaSt using Ethiopian Demographic and Health Survey datasets from 2000 and 2019. Methods The study included a total weighted sample of 34,930 children aged 6-59 months. Descriptive and weighted multilevel mixed-effects (fixed and random effects) logistic regression analyses were carried out. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Results The prevalence of WaSt was 1,682 (4.82%) with a significantly decreasing trend, yielding a percent change of -57.51% (-69.37% to -23.52%) from 2000 to 2019. In the adjusted model, the odds of WaSt increased in boys, children with a shorter preceding birth interval, small birth size, delayed initiation of complementary foods, diarrhea, fever, and anemia, mother's lack of formal education, and being a farmer, and poor/middle wealth index, and lack of mass media exposure. WaSt was inversely related to the child's age. Adjusted ICC and MOR were 31.16% and 3.20%, respectively. Conclusion and recommendations The study highlights the importance of considering individual and community-level factors to address WaSt, such as timely initiation of complementary foods, improving access to health services, quality diet, and prevention of communicable diseases. Furthermore, programs that have positive impacts on formal education and employment opportunities for girls, as well as that increase access to mass media, are required.
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Affiliation(s)
- Aklilu Abrham Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
| | - Öznur Başdaş
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
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28
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Pradhan MR, Shete MR. Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Nutr Health 2023; 29:575-590. [PMID: 35238244 DOI: 10.1177/02601060221085809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.
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Affiliation(s)
- Manas Ranjan Pradhan
- Assistant Professor, Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
| | - Mahesh Rajendra Shete
- Data Analyst, Max Institute of Healthcare Management, Indian School of Business, Mohali, India
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29
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Mertens A, Benjamin-Chung J, Colford JM, Coyle J, van der Laan MJ, Hubbard AE, Rosete S, Malenica I, Hejazi N, Sofrygin O, Cai W, Li H, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Jilek W, Subramoney V, Hafen R, Häggström J, Norman T, Brown KH, Christian P, Arnold BF. Causes and consequences of child growth faltering in low-resource settings. Nature 2023; 621:568-576. [PMID: 37704722 PMCID: PMC10511328 DOI: 10.1038/s41586-023-06501-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/31/2023] [Indexed: 09/15/2023]
Abstract
Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | | | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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30
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Murasko J. Height, wealth, and schooling outcomes in young women from lower- and middle-income countries. J Biosoc Sci 2023; 55:873-892. [PMID: 36482751 DOI: 10.1017/s0021932022000438] [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] [Indexed: 12/13/2022]
Abstract
This study evaluates a large (N > 366,000) sample of young women (15-18 years) from 64 lower- and middle-income countries for associations between height, household wealth, and schooling outcomes, with a focus on secondary school attendance. A pooled sample and regional samples (Latin America, South/Southeast Asia, East Africa, and West Africa) are evaluated. A dual purpose is to evaluate both associations between height and schooling, and potential height-wealth interactions such that height associations to schooling vary over levels of wealth. Ordered probit analysis indicates positive marginal probabilities from height on secondary school attendance in all samples, with diminishing probabilities in the Latin America and South/SE Asia samples, and flat/increasing probabilities in the African samples. For South/SE Asia and taller women in Latin America, height associations are stronger at lower household wealth. For both African samples and shorter women in Latin America, height associations are stronger at higher wealth. The findings suggest that the height-schooling relationship may derive from the influence from early-life health, and may also be affected by differences in health and education environments as suggested by variations across regions and height-wealth interactions within regions.
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Affiliation(s)
- Jason Murasko
- Professor, Economics, University of Houston - Clear Lake, 2700 W Bay Area Blvd, Houston, TX77058, USA
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31
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Cheng M, Sommet N, Kerac M, Jopp DS, Spini D. Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002161. [PMID: 37585364 PMCID: PMC10431657 DOI: 10.1371/journal.pgph.0002161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/20/2023] [Indexed: 08/18/2023]
Abstract
Child undernutrition and later-life non-communicable diseases (NCDs) are major global health issues. Literature suggests that undernutrition/famine exposure in childhood has immediate and long-term adverse health consequences. However, many studies have theoretical and methodological limitations. To add to the literature and overcome some of these limitations, we adopted a life course perspective and used more robust methods. We investigated the association between exposure to the 1959-1961 Chinese famine and later-life NCDs and if this association depends on: life stage at exposure, famine severity, and sex. We conducted a secondary data analysis of a large-scale, nationally representative, longitudinal study-the China Health and Retirement Longitudinal Study (2011-2018, 11,094 participants). We measured famine exposure/severity using self-reported experience, life stage using age at exposure, and health using the number of NCDs. We performed Poisson growth curve models. We obtained three findings. First, compared with unexposed participants, those exposed before age 18 had a higher risk of later-life NCDs, particularly if exposed in-utero (IRR = 1.90, 95% CI [1.70, 2.12], p < .001) and in the "first 1,000 days" of life (IRR = 1.86, 95% CI [1.73, 2.00], p < .001; for 0-6 months group, IRR = 1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects among participants moderately and severely exposed were similar (IRR = 1.18, 95% CI [1.09, 1.28], p < .001 and IRR = 1.24, 95% CI [1.17, 1.32], p < .001). Third, the famine effects did not differ between females and males (IRR = 0.98, 95% CI [0.90, 1.07], p = .703). In an individual's life course, in-utero and the "first 1,000 days" are a particularly sensitive time period with marked long-term implications for NCDs if undernutrition/famine is experienced in this period. However, this window remains open until young adulthood. This highlights the need to invest more in preventing and treating child/adolescent undernutrition to tackle later-life NCDs.
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Affiliation(s)
- Mengling Cheng
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Sommet
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Marko Kerac
- Centre for Maternal Adolescent Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniela S. Jopp
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Dario Spini
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Elmighrabi NF, Fleming CAK, Agho KE. Wasting and Underweight in Northern African Children: Findings from Multiple-Indicator Cluster Surveys, 2014-2018. Nutrients 2023; 15:3207. [PMID: 37513624 PMCID: PMC10384034 DOI: 10.3390/nu15143207] [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: 06/21/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Northern Africa faces multiple severe detrimental factors that impact child nutrition. This study aimed to identify the predictors for wasting and underweight in children aged 0-59 months in Northern Africa. We analysed pooled cross-sectional data from multiple-indicator cluster surveys conducted in four countries (Algeria, Egypt, Sudan, and Tunisia) involving 37,816 children aged 0-59 months. A logistic regression analysis was used, considering clustering and sampling weights, to identify factors associated with wasting and underweight among children aged 0-23, 24-59, and 0-59 months. Among children aged 0-59 months, the overall prevalence was 7.2% (95% CI: 6.8-7.5) for wasting and 12.1% (95% CI:11.7-12.5) for underweight. Sudan and Algeria had the highest rates of wasting, while Sudan and Egypt had the highest rates of underweight. Multiple regression analyses indicate that factors associated with wasting and being underweight include child age, country, rural residency, poor wealth index, being male, birth order, maternal education, body mass index, media use, lack of diverse foods, longer duration of breastfeeding, perceived small baby size, and diarrhoea. These findings highlight the importance of implementing targeted health and nutrition initiatives, such as maternal education, family planning, and community engagement. Priority should be given to children from underprivileged areas who lack proper dietary variety.
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Affiliation(s)
- Nagwa Farag Elmighrabi
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
- Organization of People of Determination and Sustainable Development, Benghazi, Libya
- Department of Nutrition, Faculty of Public Health, University of Benghazi, Benghazi 1038, Libya
| | - Catharine A K Fleming
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
| | - Kingsley E Agho
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
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Nemerimana M, Havugarurema S, Nshimyiryo A, Karambizi AC, Kirk CM, Beck K, Gégout C, Anderson T, Bigirumwami O, Ubarijoro JM, Ngamije PK, Miller AC. Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda. PLoS One 2023; 18:e0283504. [PMID: 37418456 PMCID: PMC10328318 DOI: 10.1371/journal.pone.0283504] [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: 01/06/2022] [Accepted: 03/11/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Stunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age. METHODS This retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ <-3 based on the 2006 WHO child growth standards. Stunting recovery at 24 months of age was defined as the child's LAZ changing from <-2 to > -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother's socio-demographic and clinical characteristics. RESULTS Of the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07-0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16-0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1-0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model. CONCLUSION A substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.
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Affiliation(s)
| | | | | | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Todd Anderson
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Yogesh M, Ram R, Patel M, Makwana N. Converging Pathways: Exploring the Interplay of Malnutrition, Sarcopenia, and Frailty in Nursing Home Residents: A Cross-sectional Study. J Midlife Health 2023; 14:218-223. [PMID: 38312769 PMCID: PMC10836441 DOI: 10.4103/jmh.jmh_161_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: 08/19/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 02/06/2024] Open
Abstract
Background Within the context of nursing home care, malnutrition, sarcopenia, and frailty stand as notable conditions, each exerting distinct yet interconnected impacts on residents' well-being. The objective of this cross-sectional study is to elucidate the intricate interplay among malnutrition, sarcopenia, and frailty among nursing home residents. Methodology It is a community-based, cross-sectional, descriptive study among nursing home residents of Vatsalyadham Vrudhsharam, which is an institution for aged old-age people in Jamnagar from April 2023 to July 2023. The estimated minimum sample size was 345. A self-structured questionnaire was used to collect the data containing sociodemographic characteristics, anthropometric assessment, and bio-impedance indices. The handgrip was measured by a hand dynamometer. Assessment of the risk of malnutrition was performed using the Mini Nutritional Assessment-Short Form questionnaire and was confirmed by the Global Leadership Initiative for Malnutrition (GLIM) criteria. Sarcopenia was assessed by a bio-impedance analyzer using the Asian Working Group of Sarcopenia 2019. Frailty was assessed using the fatigue, resistance, ambulation, illness, and loss (FRAIL) screener. Descriptive statistics were used for the representation of percentages and frequencies. Both Chi-square and logistic regression analyses were used for the association. P < 0.05 was considered statistically significant, respectively. Results About 345 participants were included, and mean age of the participants was 85 ± 5.6 years, about 159 (49%) participants belonged to the age group of more than 80 years, 220 (63.7%) were males, then malnutrition was diagnosed by GLIM criteria, about 154 (44.6%) were found to have malnutrition. Sarcopenia was found in 184 (53%) participants. The FRAIL screening was used to identify frailty, according to that prefrail was around 170 (49%) and frail was about 122 (35%), respectively. Age, gender, and history of falls were associated with frailty and sarcopenia (P < 0.001). Only, age and gender were associated with malnutrition but not a history of falls. Conclusion The findings of this study suggest that frailty, sarcopenia, and malnutrition are prevalent among nursing home residents. Health-care providers should identify and manage these conditions in older adults to improve their quality of life.
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Affiliation(s)
- M Yogesh
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Rohitkumar Ram
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Monika Patel
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Naresh Makwana
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
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Gaiser ML, Winkler AS, Klug SJ, Nkurunziza S, Stelzle D. Determinants of stunting among children under age five in Burundi: Evidence from the 2016-2017 Burundi Demographic and Health Survey (BDHS 2016-17). Food Sci Nutr 2023; 11:4100-4112. [PMID: 37457191 PMCID: PMC10345696 DOI: 10.1002/fsn3.3400] [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: 10/04/2022] [Revised: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023] Open
Abstract
Burundi has one of the highest prevalence of stunting in the world. This study aimed to identify determinants of stunting among children under age five in Burundi. A total of 4993 children with anthropometric measurements from the 2016-2017 Burundi Demographic and Health Survey were included in the study. Stunting was assessed from the height-for-age Z-scores (HAZ). Logistic regression models were analyzed to identify demographic, maternal, child-related, and structural variables that influence stunting. In total, 56.9% of children under age five were stunted, of those 31.0% moderately and 25.9% severely. Multivariable logistic regression indicated that older children, male children (adjusted OR (aOR) = 1.41, 95% CI 1.24-1.61), and children who were perceived as small (aOR = 2.00, 95% CI 1.55-2.59) or very small at birth (aOR = 2.37, 95% CI 1.57-3.59) were significantly more likely to be stunted. Moreover, children of single mothers, with lower levels of education, who were underweight at the time of the survey (aOR = 1.95, 95% CI 1.42-2.68), who had short stature (aOR = 3.76, 95% CI 2.50-5.66) or who conceived more than four children (aOR = 1.22, 95% CI 1.05-1.42) were more commonly stunted. Stunting was more prevalent in rural areas (aOR = 2.53, 95% CI 1.72-3.73) and in households with no access to improved types of toilet facilities (aOR = 1.27, 95% CI 1.10-1.45). The results of this study show that the prevalence of stunting in children under age five in Burundi is alarmingly high and underscores the urgent need for decisive and determined action.
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Affiliation(s)
- Manuel L. Gaiser
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
| | - Andrea S. Winkler
- Center for Global Health, Department of NeurologyTechnical University of MunichMunichGermany
- Department of Community Medicine and Global Health, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
| | - Sandra Nkurunziza
- Health Community Department, Faculty of MedicineUniversity of BurundiBujumburaBurundi
| | - Dominik Stelzle
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
- Center for Global Health, Department of NeurologyTechnical University of MunichMunichGermany
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Roy TB, Das T, Das P, Das P. Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context. BMC Nutr 2023; 9:69. [PMID: 37328887 DOI: 10.1186/s40795-023-00725-w] [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: 01/22/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023] Open
Abstract
Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India's Demography and Health Survey (DHS) conducted in 2019-2021. A total of 1, 46,521 children aged 0-59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons.
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Affiliation(s)
- Tamal Basu Roy
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
| | - Tanu Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134.
| | - Partha Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
| | - Priya Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
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Khura B, Mohanty P, Gandhi AP, Patnaik L, Mewara A, Pradhan K, Padhi BK. Mapping Concurrent Wasting and Stunting Among Children Under Five in India: A Multilevel Analysis. Int J Public Health 2023; 68:1605654. [PMID: 37350797 PMCID: PMC10282129 DOI: 10.3389/ijph.2023.1605654] [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: 12/04/2022] [Accepted: 05/05/2023] [Indexed: 06/24/2023] Open
Abstract
Objectives: The study aims to examine the coexisting forms, patterns, and predictors of concurrent wasting and stunting (WaSt) among children under five in India. Methods: We used data from the National Family Health Survey to understand the trend and association of WaSt among children under five-year-old in India. Univariate analysis and cross-tabulations were performed for WaSt cases. The association was determined using multilevel binary logistic regression and multilevel regression, and the results were provided as adjusted odds ratios (aOR) with 95% confidence intervals at the significance level of p < 0.05. Results: The prevalence of WaSt has decreased from 8.7% in 2005-06 to 5.2 percent in 2019-2020. The proportion of WaSt children grew rapidly from 6 to 18 months, peaked at 19 months (8%), then dropped after 24 months. The prevalence of concurrent wasting and stunting is higher among boys compared to girls. Compared to children of different birth orders, those in the higher birth order are 1.2 times more likely to be WaSt cases (aOR = 1.20, 95% CI = 1.09, 1.33). The education of the mother is strongly correlated with WaSt instances, and children of more educated mothers have a 47% lower chance of being WaSt cases (aOR = 0.63, 95% CI = 0.57, 0.71). Children from wealthy families are 52% less likely to be WaSt cases (aOR = 0.48, 95% CI = 0.43, 0.55). Conclusion: This study emphasizes the importance of concurrent wasting and stunting and its relationship with socioeconomic factors among children under five in India.
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Affiliation(s)
- Bikash Khura
- International Institute for Population Sciences, Mumbai, India
| | - Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to Be University, Bhubaneswar, India
| | - Aravind P Gandhi
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, India
| | - Lipilekha Patnaik
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to Be University, Bhubaneswar, India
| | - Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 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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Santos-Díaz AI, Solís-López J, Díaz-Torres E, Guadarrama-Olmos JC, Osorio B, Kroll T, Webb SM, Hiriart M, Jiménez-Estrada I, Missirlis F. Metal ion content of internal organs in the calorically restricted Wistar rat. J Trace Elem Med Biol 2023; 78:127182. [PMID: 37130496 DOI: 10.1016/j.jtemb.2023.127182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Despite the agreed principle that access to food is a human right, undernourishment and metal ion deficiencies are public health problems worldwide, exacerbated in impoverished or war-affected areas. It is known that maternal malnutrition causes growth retardation and affects behavioral and cognitive development of the newborn. Here we ask whether severe caloric restriction leads per se to disrupted metal accumulation in different organs of the Wistar rat. METHODS Inductively coupled plasma optical emission spectroscopy was used to determine the concentration of multiple elements in the small and large intestine, heart, lung, liver, kidney, pancreas, spleen, brain, spinal cord, and three skeletal muscles from control and calorically restricted Wistar rats. The caloric restriction protocol was initiated from the mothers prior to mating and continued throughout gestation, lactation, and post-weaning up to sixty days of age. RESULTS Both sexes were analyzed but dimorphism was rare. The pancreas was the most affected organ presenting a higher concentration of all the elements analyzed. Copper concentration decreased in the kidney and increased in the liver. Each skeletal muscle responded to the treatment differentially: Extensor Digitorum Longus accumulated calcium and manganese, gastrocnemius decreased copper and manganese, whereas soleus decreased iron concentrations. Differences were also observed in the concentration of elements between organs independently of treatment: The soleus muscle presents a higher concentration of Zn compared to the other muscles and the rest of the organs. Notably, the spinal cord showed large accumulations of calcium and half the concentration of zinc compared to brain. X-ray fluorescence imaging suggests that the extra calcium is attributable to the presence of ossifications whereas the latter finding is attributable to the low abundance of zinc synapses in the spinal cord. CONCLUSION Severe caloric restriction did not lead to systemic metal deficiencies but caused instead specific metal responses in few organs.
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Affiliation(s)
- Alma I Santos-Díaz
- Department of Physiology, Biophysics and Neuroscience, Cinvestav, 07360 Mexico City, Mexico
| | | | - Elizabeth Díaz-Torres
- Department of Physiology, Biophysics and Neuroscience, Cinvestav, 07360 Mexico City, Mexico
| | | | - Beatriz Osorio
- Department of Physiology, Biophysics and Neuroscience, Cinvestav, 07360 Mexico City, Mexico
| | - Thomas Kroll
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA
| | - Samuel M Webb
- Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA
| | - Marcia Hiriart
- Institute of Cellular Physiology, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Ismael Jiménez-Estrada
- Department of Physiology, Biophysics and Neuroscience, Cinvestav, 07360 Mexico City, Mexico
| | - Fanis Missirlis
- Department of Physiology, Biophysics and Neuroscience, Cinvestav, 07360 Mexico City, Mexico.
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40
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Quinn EA, Sangmo J, Burack S, Childs G. Childhood growth and education migration among ethnic Tibetan children from Nepal. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 180:427-441. [PMID: 36790581 DOI: 10.1002/ajpa.24652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/17/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Ethnographic work among high altitude populations has shown that children are highly mobile-the most recent expression of this is the educational migration of children born at high altitude to boarding schools at lower altitudes. The impact of these patterns of migration on size for age are unknown. AIM We investigated the association between growth in weight and height and educational migration in ethnic Tibetan children living in and out of their natal communities. SUBJECTS AND METHODS Five hundred and fifty eight children ages three to sixteen from the Nubri Valley, Nepal participated in this study. Three hundred children were living in natal villages and 258 were attending boarding schools in Kathmandu. Height, weight, and skinfold thicknesses were collected and matched to demographic data from the community. RESULTS There was no association between altitude of family residence and size for age z-scores. Males had lower z-scores than females; z-scores for both groups declined with age. Differences in size for age among children in boarding schools were associated with two factors: sex and type of boarding school (individual sponsor or group funded). Individuals attending individually sponsored schools had greater size for age compared to children in group funded schools or in their natal villages; younger children in collectively funded schools were smaller than village peers. CONCLUSIONS Despite popular perceptions, educational outmigration in Himalayan communities may not be associated with improved child growth outcomes and investment in community level schools may be a practical solution for improving child growth and physical and mental health.
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Affiliation(s)
- Elizabeth A Quinn
- Department of Anthropology, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Jhangchuk Sangmo
- Community Gomba Education Initiative in Nepal (CGEIN), Gorkha District, Nepal
| | - Sarah Burack
- Department of Surgery, School of Medicine, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Geoff Childs
- Department of Anthropology, Washington University in St. Louis, Saint Louis, Missouri, USA
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Strauß H, Venables P, Zentner M. Associations between early childhood poverty and cognitive functioning throughout childhood and adolescence: A 14-year prospective longitudinal analysis of the Mauritius Child Health Project. PLoS One 2023; 18:e0278618. [PMID: 36827363 PMCID: PMC9956590 DOI: 10.1371/journal.pone.0278618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/20/2022] [Indexed: 02/26/2023] Open
Abstract
Associations between childhood poverty and cognitive outcomes have been examined from multiple perspectives. However, most evidence is based on cross-sectional data or longitudinal data covering only segments of the developmental process. Moreover, previous longitudinal research has mostly relied on data from Western nations, limiting insights of poverty dynamics in low- and middle-income countries. Here, we use data from the Mauritius Child Health Project, a large-scale prospective longitudinal study conducted in a then low-income country, to examine long-term associations between poverty in early childhood and cognitive performance across childhood and adolescence. Poverty-related factors were assessed at age 3 years and comprised indicators of psychosocial adversity and malnutrition. Cognitive functioning was assessed at ages 3 and 11 years by using standardized intelligence measures and at age 17 years by means of a computerized test battery. Using multiple hierarchical regression models, we found that chronic malnutrition and parental characteristics showed similar-sized, independent associations with initial cognitive functioning at age 3 as well as at age 11 years. For age 17 years, however, associations with early childhood risk factors vanished and instead, cognitive functioning was predicted by performance on prior cognitive assessments. Sex was also found to be a powerful predictor of cognitive trajectories, with boys improving and girls worsening over time, regardless of the level of their initial exposure to risk. The current findings indicate that, to prevent cognitive impairment, interventions tackling poverty and malnutrition should focus on the infancy period and be designed in a gender-sensitive way.
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Affiliation(s)
- Hannah Strauß
- Personality, Emotion and Music Laboratory, Department of Psychology, University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Peter Venables
- Department of Psychology, University of York, York, United Kingdom
| | - Marcel Zentner
- Personality, Emotion and Music Laboratory, Department of Psychology, University of Innsbruck, Innsbruck, Austria
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Khara T, Myatt M, Sadler K, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald C, Mertens A, Mwangome M, O’Brien K, Stobaugh H, Taneja S, West KP, Briend A. Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts. Public Health Nutr 2023; 26:1-17. [PMID: 36734049 PMCID: PMC10131149 DOI: 10.1017/s136898002300023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. DESIGN A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled. SETTING Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread. PARTICIPANTS Children aged 6 to 59 months. RESULTS Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC < 115 mm or WAZ < -3) and (WAZ < -3) had the highest informedness in predicting mortality. A combined case definition (MUAC < 115 mm or WAZ < -3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ < -3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC < 115 mm or WAZ < -3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC < 115 mm alone. CONCLUSIONS A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
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Affiliation(s)
- Tanya Khara
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Mark Myatt
- Brixton Health, Llwyngwril, Gwynedd, Wales, UK
| | - Kate Sadler
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université libre de Bruxelles
| | - James A Berkley
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Erin Boyd
- USAID/Bureau of Humanitarian Assistance, USA
| | - Michel Garenne
- IRD, UMI Résiliences, Paris, France
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
- FERDI, Université d’Auvergne, Clermont-Ferrand, France
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Epicentre, Paris, France
| | - Natasha Lelijveld
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Christine McDonald
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Nutrition, University of California, Davis, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | | | - Kieran O’Brien
- The F.I. Proctor Foundation, University of San Francisco, San Francisco, USA
| | - Heather Stobaugh
- Action Against Hunger USA, New York, NY, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sunita Taneja
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - André Briend
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Fredericksberg, Denmark
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Sello M, Adedini SA, Odimegwu C, Petlele R, Tapera T. The Relationship between Childcare-Giving Arrangements and Children's Malnutrition Status in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2572. [PMID: 36767937 PMCID: PMC9915111 DOI: 10.3390/ijerph20032572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Multiple caregiving arrangements have become common for childcare globally, and South Africa is no exception. Previous childcare studies mainly focused on the caregiver and household characteristics. Evidence on the influence of childcare on malnutrition is sparse. This study aimed to examine the relationship between exposure to secondary and multiple forms of care and child malnutrition, with a particular focus on child stunting and overweight among children. A cross-sectional study of a sample of 2966 dyads of mothers and children under five were analysed from the 2017 National Income Dynamics Study (NIDS) Wave 5. Descriptive and inferential statistics were used to analyse the data. The results indicated that 22.16% of the children were stunted and that 16.40% were overweight. Most children were mainly cared for at home (67.16%) during the day. Some results of the obtained multivariable analyses show that lack of being cared for in a crèche or school during the day was significantly associated with stunting (odds ratio (OR) 2; confidence interval (CI) 1.10-3.62, p < 0.05) and overweight (OR) 3.82; (CI) 1.60-9.08, p < 0.05). Furthermore, in this study, 69.88% of children who were cared for at home by the primary caregiver had no other forms of multiple care arrangements. The results showing high stunting and overweight rates among children cared for at home suggest that the government needs to look into supporting caregiver parenting. The high unemployment rates in the country highlight the importance of socioeconomic status in childcare and its implication for children's nutritional outcomes. The study's findings suggest the need for innovative strategies to address the challenges associated with multi-caregiving which negatively affects children's nutritional outcomes.
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Affiliation(s)
- Matshidiso Sello
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg 2092, South Africa
| | - Sunday A. Adedini
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye-Ekiti 371104, Nigeria
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Rebaone Petlele
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Talent Tapera
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
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Marume A, Archary M, Mahomed S. Predictors of stunting among children aged 6-59 months, Zimbabwe. Public Health Nutr 2023; 26:1-14. [PMID: 36621006 PMCID: PMC10131138 DOI: 10.1017/s1368980023000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Stunted children have an increased risk of diminished cognitive development, diabetes, degenerative and CVD later in life. Numerous modifiable factors decrease the risk of stunting in children. This study aimed to assess the role of the individual, household and social factors on stunting in Zimbabwean children. DESIGN A 1:2 unmatched case-control study. SETTING This study was conducted in two predominantly rural provinces (one with the highest national prevalence of stunting and one with the lowest prevalence) in Zimbabwe. PARTICIPANTS Data were obtained from the caregivers of 150 children aged between 6 and 59 months with stunting and from the caregivers of 300 children without stunting. RESULTS Multiple (39) correlates of stunting were identified. Child's age, birth length, birth weight, and weight-for-age outcome (child-related factors), caregiver's age, maternal HIV status, occupation, and education (parental factors), breast-feeding status, number of meals, and dietary quality (dietary factors), child's appetite, diarrhoeal and worm infection (childhood illnesses), income status, access to safe water, access to a toilet, health clubs and maternal support in infant feeding (household, socio-cultural factors) were all found to be significant predictors of childhood stunting. CONCLUSION Nearly all aspects under review from the individual-, household- to social-level factors were significantly associated with childhood stunting. These findings add to the growing body of evidence supporting the WHO stunting framework and strengthen the need to focus interventions on a multi-sectoral approach to effectively address stunting in high prevalence countries.
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Affiliation(s)
- Anesu Marume
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Ministry of Health and Child Care, Parirenyatwa Hospital, A178 Avondale, Harare, Zimbabwe
| | - Moherndran Archary
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
| | - Saajida Mahomed
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Yani DI, Rahayuwati L, Sari CWM, Komariah M, Fauziah SR. Family Household Characteristics and Stunting: An Update Scoping Review. Nutrients 2023; 15:nu15010233. [PMID: 36615889 PMCID: PMC9824547 DOI: 10.3390/nu15010233] [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: 12/09/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Stunting remains a public health concern in developing countries. Factors related to stunting have been categorized using various frameworks. Family plays an important role in providing nutrients for children; however, no review specifies this aspect for identifying family characteristics related to stunting. This study aimed to identify family household characteristics related to stunting among children aged less than 5 years. A scoping review was undertaken with sources from PubMed, CINAHL, and Scopus, using the keywords "family characteristics" AND "growth". Inclusion criteria were (1) correlational study; (2) published between 2018 and 31 July 2022; (3) families with children under the age of 5 years; and (4) independent variable any measure of stunting factors from family and household factors. Of 376 articles, only 20 met the inclusion criteria of the study. The family household characteristics included individual factors (sex age, history of diarrhea, and birthplace), family factors (family headship, primary caregiver/mother, social-cultural orientation, and family system factors), and environmental factors. Various child variables, family factors, and environmental factors (the type of home, floor type, water access, source of drinking water, and household electricity) were identified as being associated with stunting. Therefore, these factors should be evaluated to prevent and control stunting, and they should be incorporated into health programs targeting stunting.
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Affiliation(s)
- Desy Indra Yani
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
- Correspondence: ; Tel.: +62-227796647
| | - Laili Rahayuwati
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Citra Windani Mambang Sari
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Maria Komariah
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Sherllina Rizqi Fauziah
- Study Program of Bachelor of Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung 45363, Indonesia
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Abdulla F, Rahman A, Hossain MM. Prevalence and risk predictors of childhood stunting in Bangladesh. PLoS One 2023; 18:e0279901. [PMID: 36701381 PMCID: PMC9879476 DOI: 10.1371/journal.pone.0279901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh. METHODS AND MATERIALS In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution. RESULTS The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children. CONCLUSIONS To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.
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Affiliation(s)
- Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al-Kabir Technical University, Sylhet, Bangladesh
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Md. Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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He Z, Ghose B, Cheng Z. Diarrhea as a Disease of Poverty Among Under-Five Children in Sub-Saharan Africa: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231202988. [PMID: 37791742 PMCID: PMC10552484 DOI: 10.1177/00469580231202988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
The objective of this study was to assess the prevalence of diarrhea among under-five children in low-middle-income countries and identify the sociodemographic factors associated with it. Data of 36 countries in sub-Saharan Africa from demographic and Health Surveys (2006-2018) comprising 251 341 mother-child (singleton) dyads were analyzed to estimate the prevalence and various modifiable and non-modifiable risk factors of diarrhea. Occurrence of diarrhea during the last 2 weeks was the outcome variable which was measured by mothers' observation of the condition. The overall prevalence of having diarrhea during last 2 weeks was 18.44% (19.12% among boys and 17.75% among girls). Boys had higher percentage of having diarrhea than girls in all countries except in Libya. The risk ratios of having diarrhea decreased progressively with higher wealth quintiles; the risks of were respectively 7% [RR = 0.93, 95% CI = 0.91; 0.97], 11% [RR = 0.89, 95% CI = 0.86; 0.92] and 18% [RR = 0.82, 95% CI = 0.78; 0.85] lower for households in the middle, richer and richest households. Rural residency was associated with lower risks [RR = 0.95, 95% CI = 0.93; 0.98] and not having access to improved water [RR = 1.05, 95% CI = 1.03; 1.08] and toilet facilities [RR = 0.04, 95% CI = 1.01; 1.07] were associated with higher risks of diarrhea. Regarding children's characteristics, higher age groups, birth order were associated with higher risks and female sex with lower risks. Children with mothers in the higher age groups and with above secondary level education had lower risks, and primary education had higher risks of diarrhea. Meta-analysis of 36 countries revealed a significantly negative association between wealth quintile and diarrhea (Odds ratio = 0.72, 95% CI = 0.69; 0.74). Findings indicate the presence of a significant wealth gradient in the burden of diarrheal diseases among under-five children in sub-Saharan Africa, and underscores the need for paying special attention to the marginalized communities when designing intervention programs.
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Affiliation(s)
- Zhifei He
- Southwest University of Political Science and Law, Chongqing, China
| | | | - Zhaohui Cheng
- Chongqing Health Statistics Information Center, Chongqing, China
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Harper A, Rothberg A, Chirwa E, Sambu W, Mall S. Household Food Insecurity and Demographic Factors, Low Birth Weight and Stunting in Early Childhood: Findings from a Longitudinal Study in South Africa. Matern Child Health J 2023; 27:59-69. [PMID: 36169906 PMCID: PMC9516515 DOI: 10.1007/s10995-022-03555-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Low birthweight (LBW) as well as early childhood stunting are risk factors for increased childhood morbidity in low-and middle-income countries (LMIC). The Covid 19 pandemic has exacerbated food insecurity and unemployment globally, prompting concerns for maternal and child health. OBJECTIVES We used data from the great recession of 2008 to examine the relationship between household food security and other risk factors with LBW and stunting using a longitudinal sample of South African women and their offspring. METHODS Food security indicators, alcohol use, blood pressure and other characteristics were examined in relation to LBW (≤ 2500 g), stunting (height for age ≤ 2SD) and severe stunting (height for age ≤ 3SD). Regression modelling with clustering at maternal ID level were employed to adjust for maternal characteristics and women who gave birth more than once during the reference period. RESULTS Birthweight data were available for 1173 children and height for age 1216 children. The prevalence of LBW was 14.7% while stunting and severe stunting was 17.8% and 14.5%. Child hunger in the household, maternal hypertension and alcohol use were associated with low birthweight. Food expenditure below the Stats SA poverty line and low dietary diversity was associated with stunting and severe stunting respectively. Maternal height and low birthweight were associated with both stunting and severe stunting. CONCLUSIONS FOR PRACTICE Interventions that can improve household food security and nutritional status during the periconceptional and antenatal period may reduce the prevalence of low birthweight and subsequent stunting in low- and middle-income countries.
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Affiliation(s)
- Abigail Harper
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, 2193 South Africa
| | - Alan Rothberg
- School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2193 South Africa
| | - Esnat Chirwa
- Medical Research Council Gender and Health Research Unit, Pretoria, 0002 South Africa
| | - Winnie Sambu
- School of Economics, University of Cape Town, Cape Town, 7701 South Africa
| | - Sumaya Mall
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, 2193 South Africa
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Thurstans S, Wrottesley SV, Fenn B, Khara T, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald CM, Mertens A, Mwangome M, O'Brien KS, Stobaugh H, Taneja S, West KP, Guerrero S, Kerac M, Briend A, Myatt M. Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis. MATERNAL & CHILD NUTRITION 2023; 19:e13431. [PMID: 36164997 PMCID: PMC9749608 DOI: 10.1111/mcn.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6-59 months by age and sex. We categorised children into younger (6-23 months) and older (24-59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < -2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.
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Affiliation(s)
- Susan Thurstans
- London School of Hygiene and Tropical MedicineLondonUK
- Emergency Nutrition NetworkKidlingtonUK
| | | | | | | | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of public HealthUniversité libre de BruxellesBrusselsBelgium
| | - James A. Berkley
- Centre for Tropical Medicine & Global HealthUniversity of OxfordOxfordUK
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Robert E. Black
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | - Erin Boyd
- USAID/Bureau of Humanitarian AssistanceWashington DCUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Michel Garenne
- IRDUMI RésiliencesParisFrance
- Institut PasteurEpidémiologie des Maladies EmergentesParisFrance
- FERDIUniversité d'AuvergneClermont‐FerrandFrance
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheila Isanaka
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- EpicentreParisFrance
| | | | - Christine M. McDonald
- Departments of Pediatrics, and Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NutritionUniversity of CaliforniaDavisUSA
| | - Andrew Mertens
- Division of Epidemiology & BiostatisticsUniversity of CaliforniaBerkeleyUSA
| | - Martha Mwangome
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Kieran S. O'Brien
- Francis I. Proctor FoundationUniversity of CaliforniaSan FranciscoUSA
| | - Heather Stobaugh
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- Action Against Hunger USANew YorkNew YorkUSA
| | - Sunita Taneja
- Center for Health Research and DevelopmentSociety for Applied StudiesNew DelhiIndia
| | - Keith P. West
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | | | - Marko Kerac
- London School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Center for Child Health Research, Faculty of Medicine and Medical TechnologyTampere UniversityTampereFinland
- Department of Nutrition, Exercise, and SportsUniversity of CopenhagenFredericksbergDenmark
| | - Mark Myatt
- Brixton Health, LlwyngwrilGwyneddWalesUK
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Ngassa AB, Meriki HD, Mbanga CM, Nzefa LD, Mbhenyane X, Tambe AB. Key predictors of undernutrition among children 6-59 months in the Buea Health District of the Southwest region of Cameroon: a cross sectional community-based survey. BMC Nutr 2022; 8:148. [PMID: 36514089 PMCID: PMC9745983 DOI: 10.1186/s40795-022-00646-0] [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: 05/26/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the 2018 Demographic and Health Survey, undernutrition remains a public health problem among Cameroonian children under-five. This varies across the country, greatest in areas with ongoing humanitarian crisis, such as the Southwest region. However, data on the burden of undernutrition in the Southwest region is sparse. This study aimed to assess the prevalence and predictors of undernutrition among children under-five in the Buea health district of the Southwest region of Cameroon. METHODS This was a community based cross-sectional study of 321 children under-five/caretaker pairs, surveyed from households selected using multistage randomized sampling. Data were collected by trained data collectors, with the aid of a structured, pre-tested questionnaire that captured information on sociodemographic characteristics, food security, dietary diversity and anthropometric measurements. The weight, height/length and mid upper arm circumference (MUAC) were measured using standardized instruments. Stunting, Wasting and Underweight of children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. Data was analysed using SPSS version 27.0. Predictors of malnutrition were obtained using multivariate logistic regression, adjusting for potential confounders. RESULTS Overall, 31.8% (102/321) of the children were undernourished (26.5% stunted, 1.6% underweight, 3.7% wasted). Drinking water from inappropriate sources (OR: 2.32, 95% CI: 1.30-4.15) and a Dietary Diversity Score < 4 (OR: 2.59, 95%CI: 1.46-4.61) were independently associated with increased risk of stunting. Children of the male sex were more likely to be wasted than females (OR: 5.34, 95%CI: 1.09-26.14). CONCLUSION Childhood undernutrition, particularly stunting is common in the Buea Health District. Risk factors of undernutrition identified are potentially modifiable, highlighting the need for nutrition specific and sensitive interventions to improve dietary diversity, and the need to improve access to safe drinking water, and educate caretakers on the importance of clean potable water, good sanitation and hygiene for the proper growth and development of their children.
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Affiliation(s)
- Andinwoh Betterdel Ngassa
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon
| | - Henry Dilonga Meriki
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon
| | - Clarence Mvalo Mbanga
- Clinton Health Access Innitiative, Cameroon office, 3rd Floor, Y-Building Rue 1775 Nouvelle Route Bastos, Yaounde, Cameroon
| | - Léonie Dapi Nzefa
- grid.8148.50000 0001 2174 3522Department of Social Work, Faculty of Social Sciences, Linnaeus University, Växjö, Sweden
| | - Xikombiso Mbhenyane
- grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town, South Africa
| | - Ayuk Betrand Tambe
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon ,grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town, South Africa
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