Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition

Risk factor analysis for stunting incidence using sparse categorical principal component logistic regression

The risk factors for stunting incidence involve categorical data in both the response and predictor variables. Therefore, we developed a sparse categorical principal component logistic regression model capable of handling data with multicollinearity. The parameters of the sparse categorical principal component logistic regression model were estimated using the maximum likelihood method and the Newton-Raphson iterative approach. The analysis yielded a likelihood ratio value of 144.81 and a chi-square statistic value of 11.07, indicating that all factors included in the model are statistically significant. The results highlight that medical history, inadequate complementary feeding, formula feeding, lack of complementary feeding programs, and lack of iron supplementation for mothers are highly associated with the risk of stunting in toddlers. This emphasizes the need for attention to maternal nutrition from pregnancy through breastfeeding, as well as the nutrition of the toddler. Some important points proposed in this method are:•Stunting data consists of categorical variables containing multicollinearity.•The method applied is sparse logistic regression combined with categorical principal component analysis.•Analysis of risk factors for stunting in toddlers is based on the child's own condition, as well as parental factors, namely age, education, and intake of additional food and supplementary tablets during pregnancy.

Spatio-temporal variation of child stunting and associated risk factors in Rwanda

BACKGROUND

The under-five child stunting has remained a public health problem in the world. In Rwanda, child stunting rates have fluctuated significantly and remained higher than the targets despite a continuing decline of the national average rate. The key drivers of the persistently high child stunting rates and their geographical variation in Rwanda are currently not well known. This study examined the spatial and temporal variation of the under-five child stunting rates and associated factors in Rwanda between 2010 and 2020.

METHODS

This study analysed data from the 2010 Rwanda Demographic and Health Survey (RDHS) (n = 4075), the 2014/15 RDHS (n = 3538), and the 2019/20 RDHS (n = 3809). A series of geo-additive binary logistic regression analyses were used to identify the key risk factors for child stunting and their variation in Rwanda between 2010 and 2020.

RESULTS

The results show significant variation in the key risk factors over the studied period. The child's gender, birth order, age, and birth weight, mother's height and marital status, number of antenatal care visits, household economic status, and altitude were consistently significant factors of child stunting in Rwanda. The influence of place of residence, mother's education, water source, and type of toilet facility varied. The district-level spatial effects significantly attenuated in the Eastern province while they intensified in the Western and Northern provinces.

CONCLUSIONS

The key risk factors for the under-five child stunting and their importance varied considerably over time in Rwanda. The findings suggest the need to improve the household-level welfare by strengthening targeted and district-tailored intervention programs from a multi-sectorial perspective, and sustain the programs outcomes beyond the intervention period.

Predictors of short stature in Israeli children aged 6-7 years: a retrospective cohort study

There are differences in the rates of short stature (WHO height-z score < -2SD) between the various sectors in Israeli children aged 6-7 years, with higher rates in the ultraorthodox Jewish population. We aimed to: (a) Compare the anthropometric data at 0-2 years of age and the obstetric and demographic data of children with short stature at 6-7 years of age with those of children with normal height. (b) Assess risk factors for short stature at the age of 6-7 years. (c) Evaluate the impact of clinical and socioeconomic factors on linear growth from birth to the age of 6-7 years. This was a retrospective cohort study. Anonymized anthropometric data measured at the first grade of school during 2015-2019 were collected from the Ministry of Health records. The participants were stratified into sectors according to the affiliation of their school. Retrospective growth and sociodemographic data were extracted for each child from the national birth registry and Maternal Child Health Clinics files. The cohort included 368,088 children, with a median age of 6.7 years (IQR 6.3,7.0). Short stature was more prevalent in ultraorthodox Jewish boys (3.8%) and girls (3.2%), and least prevalent in Arab boys (0.8%) and girls (0.7%) compared with all other sectors (P < 0.001). The rate of stunting in Bedouin children was similar to that in the general population (1.6%). In a logistic regression model, the variables that predicted short stature at the age of 6-7 years were female sex, longer gestation, lower height z-score at 2 months of age, birth weight < 90th percentile, being in the ultraorthodox Jewish sector, and a smaller change in height z-score until 2 years of age. Growth gaps between different sectors of school-aged Israeli children emerge during the first 2 years of life. The most vulnerable population for stunting is the ultraorthodox population. Public health services, including Maternal Child Health clinics and primary caregivers, should prioritize this group and closely monitor for growth faltering during the first and second years of life.

Childhood stunting severity level and associated factors among under-five children in Tanzania: a multi-level ordinal logistic regression analysis using 2022 Tanzanian demographic and health survey

INTRODUCTION

Childhood stunting is a significant public health challenge in Tanzania, affecting over one-third of the children. It has long-term consequences for growth, development, and the overall health status. The high prevalence of stunting in Tanzania necessitates an understanding of its severity levels and determinants. Therefore, this study aimed to explore the varying severity levels of stunting and its associated factors among under-5 children in Tanzania, using data from the Demographic and Health Survey.

MATERIALS AND METHODS

A cross-sectional study utilizing secondary data from Tanzanian Demographic and Health Survey (TDHS) 2022 was employed. A weighted sample of 4,866 children under-5 years of age was included in the analysis. A multilevel ordinal logistic regression model was employed to account for the ordinal nature of stunting and hierarchical structure of the TDHS data. The Brant test was used to assess whether the proportional odds assumption was met, with a p-value greater than 0.05 indicating that the assumption was satisfied. The deviance measure was used to compare the fitness of the different models. A multilevel proportional odds model was used to investigate the impact of risk factors contributing to stunting.

RESULTS

The prevalence of stunting among Tanzanian under-5 children was 29.66%. Of these, 22.16% were moderately stunted, and 8.67% were severely stunted. Being Male, children aged 6-23 months, those born as part of multiple births, children from low- or middle-income households, those whose mothers have no formal or only primary education, and those living in areas with high poverty rates, children residing in the southern and southwestern highland administrative regions are more likely to experience severe stunting.

CONCLUSION

This study revealed that stunting among under-5 children in Tanzania remains a significant public health concern. By addressing these determinants, such as ensuring access to proper nutrition, improving maternal education, and promoting community awareness, Tanzania can make significant strides toward reducing the burden of stunting and improving the health and well-being of children under-5 years of age.

CLINICAL TRIAL NUMBER

Not applicable.

Adoption or Placement in Foster Care and Catch-up in Linear Growth and Development: A Meta-Analysis of Individual Participant Data

The ability of children to recover from linear growth retardation, often referred to as catch-up growth, has intrigued researchers for many decades. Whether adoption from a low-income to a high-income setting, which provides a comprehensive improvement in the conditions that cause children to not grow well, leads to catch-up growth is unknown. We estimated the association of adoption (or placement in foster care) with catch-up in linear growth and child development before 5 y of age. We conducted a 2-stage meta-analysis using individual participant data for linear growth. We obtained study-specific and subgroup estimates and pooled the estimates using random-effects models. Sensitivity analyses were used to assess the robustness of our findings. A review of child-development outcomes was conducted. We included 485 children under 5 y of age from 9 adoption studies. At baseline, children had a mean age of 15.8 mo and a length deficit of 3.9 cm. Adoption reduced this gap by 77% or 3.0 cm (95% confidence interval [CI]: 1.9, 4.1 cm; mean age: 32.3 mo). Catch-up growth was found in both girls (3.6 cm; 95% CI: 2.9, 4.2 cm) and boys (2.5 cm; 95% CI: 1.9, 3.1 cm) and in children adopted after the age of 24 mo (2.2 cm; 95% CI: 0.6, 3.7 cm). The sensitivity analyses did not change any of the substantive findings. The magnitude of catch-up in child development (mean reduction in deficit of 46%) was smaller than that in linear growth. Catch-up in linear growth in children under 5 is biologically possible when the environment is improved profoundly and comprehensively. Partial reversal of the accumulated height deficit is more likely than recovery in developmental outcomes, which highlights the need to ensure all children grow and develop in environments that prevent deficits from occurring rather than trying to correct them. This review was registered at PROSPERO as CRD42022298715 (https://www.crd.york.ac.uk/PROSPEROFILES/298715_PROTOCOL_20220429.pdf).

Association between wasting and inadequate breastfeeding practices among infants under six months in SNNPR and Somali regions of Ethiopia: A multilevel cross-sectional study

BACKGROUND

Wasting is a severe threat to children's survival and development. Attaining optimal breastfeeding practices for infants under six months of age remains a significant challenge in low-income countries. This study assessed the association between wasting and breastfeeding practices among infants under six months of age in the SNNPR and Somali regions of Ethiopia.

METHODS

The study used data from a large feasibility study conducted in the SNNPR and Somali regions of Ethiopia, from August-September 2021. This study involved 895 infants under six months of age with their mothers. The Poisson regression model with robust variance estimation was used to produce adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs).

RESULTS

The prevalence of wasting was 16.5% (95% CI: 14.2, 19.2) among infants under six months of age. Non-exclusive breastfeeding (APR = 1.50; 95% CI:1.02, 2.21), delayed initiation of breastfeeding (APR = 1.52; CI:1.00, 2.30), being male infants (APR = 1.50; 95% CI:1.09, 2.07), and mothers who attained primary level (APR = 0.62; 95% CI: 0.40, 0.95) or secondary level education (APR = 0.30; 95% CI: 0.09, 0.99) were independently associated with wasting in the multivariable analysis.

CONCLUSION

This study indicates a high prevalence of wasting among infants under six months of age. Non-exclusive breastfeeding and delayed initiation of breastfeeding were the modifiable factors significantly linked to infant wasting. Strengthening breastfeeding promotion and support may help reduce wasting in infants under six months.

Predicting stunting status among under-5 children in Rwanda using neural network model: Evidence from 2020 Rwanda demographic and health survey

Background

Stunting is a serious public health concern in Rwanda, affecting around 33.3% of children under five in 2020. The researchers have employed machine learning algorithms to predict stunting in Rwanda; however, few studies used ANNs, despite their strong capacity to predict stunting. The purpose of this study was to predict stunting in Rwanda using ANNs and the most recent DHS data from 2020.

Methods

DHS 2020 dataset was used to train and test an ANN model for predicting stunting in children. The dataset, which included various child, parental, and socio-demographic characteristics, was split into 80% training data and 20% testing and validation data. The model utilised a multilayer perceptron (MLP). Model performance was assessed using accuracy, precision, recall, and AUC-ROC. Feature importances were determined and highlighted the most critical predictors of stunting.

Results

An overall accuracy of 72.0% on the test set was observed, with an AUC-ROC of 0.84, indicating the model's good performance. Factors appear to contribute to stunting among the negative value aspects. First and foremost, the mother's height is important, as a lower height suggests an increased risk of stunting in children. Positive value characteristics, on the other hand, emphasise elements that reduce the likelihood of stunting. The timing of the initiation of breastfeeding stands out as a crucial factor, showing that early breastfeeding initiation has been linked with a decreased risk of stunting.

Conclusions

These findings suggest that ANNs can be a useful tool for predicting stunting in Rwanda and identifying the most important associated factors for stunting. These insights can inform targeted interventions to reduce the burden of stunting in Rwanda and other low- and middle-income countries. Potential targeted interventions include nutritional support programs for pregnant and lactating mothers, and providing educational programs for parents on nutrition and hygiene.

Prevalence of Being Obese, Overweight, and Underweight Among Jordanian Children and Adolescents Based on International Growth Standards

OBJECTIVES

The rise of obesity and other nutrition-related conditions among children and adolescents is a global challenge, particularly in the Middle East. This study aimed to determine the prevalence of being underweight, overweight, and obese among Jordanian children and adolescents using the body mass index (BMI) percentiles of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) standards.

METHODS

This retrospective cross-sectional/longitudinal study analyzed 58,474 (42.6% males; 57.4% females) height, weight, and BMI-for-age records from 31508 healthy Jordanian children and adolescents aged 2-19 years. The data were retrieved from the Ministry of Health's nationwide electronic database (2017-2023) and assessed using the CDC and WHO growth standards. Logistic regression was performed to assess the variables associated with overweight/obese status.

RESULTS

The prevalence of being underweight, overweight, and obese varied by the reference used, as more cases of being obese and underweight were reported when applying the CDC standards. The regression models showed the males had significantly lower odds of being overweight and obese than the females. Increased age was associated with higher odds of being overweight and obese, with annual increases observed across all age groups.

CONCLUSIONS

Using the WHO and CDC standards, the prevalence of being underweight was higher in the males aged 6 years and older, while being overweight and obese was more prevalent in the females. The observed annual increase in the prevalence of being overweight and obese underscores the need for targeted strategies. Growth references tailored to regional profiles may improve national nutrition policies for Jordanian children and adolescents.

Risk Factors of Standalone and Coexisting Forms of Undernutrition Among Children in Sub-Saharan Africa: A Study Using Data from 26 Country-Based Demographic and Health Surveys

INTRODUCTION

Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors.

METHODS

Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect.

RESULTS

The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35-34.82). Additionally, 20.49% (95% CI: 20.30-20.69) and 14.09% (95% CI: 13.92-14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother's educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0-23-month-old children. For 24-59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition.

CONCLUSIONS

Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.

Food security and its impact on growth among Sri Lankan children under five during the economic crisis in 2022

The recent economic recession has reportedly worsened food insecurity in Sri Lanka. We assessed food insecurity and its impact on the growth of children aged 6-59 months through a community-based, descriptive, cross-sectional study conducted in 2022. Food insecurity was measured using the Household Food Insecurity Access Scale, and anthropometric measurements (weight, length/height) were taken using standard techniques. Weight faltering was defined as inadequate or no weight gain (flattening) or a drop in weight gain, based on the trajectory of the weight curve over two points six months apart. Additionally, food insecurity, stunting, and wasting during crisis were compared with pre-crisis data. The study included 832 children, with half of the households experiencing moderate to severe food insecurity. One-fifth of the children showed growth faltering during the crisis, and 8.9% of those with growth faltering crossed one centile line (0.67 SD). Among children facing food insecurity, the rate of growth faltering had doubled, with the residential sector (i.e., estate) tripling the risk of weight faltering. The rates of food insecurity and growth issues were notably higher during the crisis compared to pre-crisis data. This study highlights the worsening food insecurity and its significant impact on growth faltering in children under five during the 2022 economic recession.

Early-life famine exposure and risk of osteoporosis and low bone mineral density: a systematic review and meta-analysis

BACKGROUND

Early-life exposure to famine has been hypothesized to influence long-term bone health, potentially increasing the risk of osteoporosis and fractures in later life. This systematic review and meta-analysis aimed to investigate the association between early-life famine exposure and the risk of osteoporosis, bone mineral density (BMD) loss, and fractures.

METHODS

A comprehensive literature search was conducted across MEDLINE/PubMed, Scopus, Web of Science, and Embase, supplemented by manual searches on Google Scholar. Observational studies examining the impact of early-life famine exposure on osteoporosis, BMD, and fracture risk were included. Data were extracted and quality assessed independently by two reviewers, and meta-analyses were performed using the Mantel-Haenszel method for odds ratios (OR) and Hedges' g for standardized mean differences (SMD). Heterogeneity was assessed using the I2 statistic, and meta-regression analyses were conducted to explore potential sources of heterogeneity.

RESULTS

From 6147 initial studies, 10 met the inclusion criteria, with 8 included in the meta-analysis. The early-life famine-exposed group showed a significantly higher incidence of osteoporosis (OR = 2.12, 95%CI [1.35, 3.34], I2 = 88%) and fractures (OR = 1.58, 95%CI [1.07, 2.33], I2 = 92%) compared to non-exposed individuals. Meta-regression indicated that higher female prevalence in studies made the association with osteoporosis stronger, while higher ages strengthened the association with fractures. Exposure during fetal and childhood stages was particularly associated with increased risks of osteoporosis and fractures. Additionally, famine exposure correlated with lower BMD, particularly in the heels, femoral neck, and total hip regions.

CONCLUSION

Early-life famine exposure is significantly associated with an increased risk of osteoporosis, fractures, and lower BMD in later life. These results emphasize the lasting effects on bones from early lack of nutrition and stress the importance of specific interventions for bone health in groups with past famine experiences. Future studies should investigate the reasons behind these connections and assess preventative approaches to reduce the negative effects on bone health in those impacted.

Multifaceted determinants of micronutrient status in early childhood in Iran : National food and nutrition surveillance

PURPOSE

This study examined the status and determinants of key micronutrients among 24-60 month children in underprivileged provinces of Iran, highlighting ongoing challenges despite intervention efforts.

METHODS

This study analyzed data from the National Food and Nutrition Surveillance program. A multistage cluster sampling method was used, recruiting 280 children per province from Khuzestan, Kerman, Ilam, Bushehr, Hormozgan, Kohgiluyeh va Boyerahmad, Sistan va Baluchestan and South Khorasan. Demographic, dietary, and anthropometric data were collected, and micronutrient status was assessed through hemoglobin, serum ferritin, zinc, retinol and 25-hydroxycalciferol assays.

RESULTS

This study included 2,247 children (42.2 ± 0.3 months). About 40% of children had low dietary diversity, and 48.4% were from low socioeconomic status (SES) families. Anemia was found in 24% of the children. Vitamin D and A deficiency affected 74%, and 22.3% of children, respectively. Notably, 39.1% had multiple micronutrient deficiencies. Father's occupation (odds ratio [OR] (95% confidence interval [CI]; freelance vs. employed: 1.86 (1.13, 3.06), worker vs. employed: 2.3 (1.43, 3.69)) and SES (middle vs. high: 2.15 (1.09, 4.2)) were significant predictors of anemia. Urban living and higher paternal education were protective against low ferritin. Children in lower SES categories and those with poor vitamin D status were more likely to have iron (1.53 (1.12, 2.09), p = 0.007) and zinc deficiencies (2.19 (1.46, 3.29) p < 0.001). Vitamin A and D statuses were mainly influenced by SES, food security, and supplement intake, respectively.

CONCLUSION

Our findings revealed high prevalence of micronutrient deficiencies among 24-60 month children residing in eight underprivileged provinces of Iran. Parental education, household SES and food security were the main determinants of micronutrient deficiencies among the studied children. Improvement of the households' food access through betterment of economic condition seems inevitable which in turn necessitates an inter-sectorial collaboration.

The role of parental child marriage in children's food security and nutritional status: a prospective cohort study in Indonesia

Objectives

Assessing children's food and nutrition security in Indonesia, especially among children from parents who experienced child marriage, is crucial for policymakers. This study investigates the role of parental child marriage in children's food security and nutritional status.

Methods

We analyze data from Indonesia Family Life Survey (IFLS) wave 4 (2007) and 5 (2014), involving 1,612 households. We employ OLS and binary logit regression analysis.

Results

Our analysis reveals that parental child marriage is associated with higher probability of children being stunted and experiencing food insecurity. Additionally, parental child marriage correlates with higher BMI-for-age z-scores, which increase the risk of obesity, and lower Food Consumption Scores (FCS).

Recommendation

Implementing community initiatives, economic empowerment, healthcare access, and gender-sensitive and integrated policies is crucial for enhancing food security and improving nutritional status among childen in families affected by child marriage.

Sex differences in growth and neurocognitive development in infancy and early childhood

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.

Are boys more vulnerable to stunting? Examining risk factors, differential sensitivity, and measurement issues in Zambian infants and young children

BACKGROUND

Stunting remains a considerable public health problem globally, and sex differences in prevalence have been documented. While many risk factors for stunting have been identified, few studies examine how these factors may contribute to sex differences. We test whether: (1) boys and girls are differentially exposed to stunting risk factors, (2) boys and girls respond differently to similar exposures, and (3) these associations are sensitive to the growth measures used.

METHODS

Data comes from 7486 Zambian infants, aged 0-23 months, participating in the SUN (Scaling Up Nutrition) 2.0 Program baseline survey. Surveys and dietary recalls were collected from primary caregivers, and anthropometry was collected for caregivers and children. Stunting was defined as height-for-age z-score (HAZ) <-2. Descriptive statistics and adjusted multilevel logistic regression models controlling for age and province were used to identify sex differences in exposures and risk factors for stunting, respectively. Interaction terms between exposure and infant sex were added to test for sex differences in response. Sensitivity testing with alternate measures of infant size, including height-for-age difference (HAD), was conducted.

RESULTS

Boys were more likely to be stunted than girls (34.5% vs. 25.7%, respectively). Numerous maternal, care giving, diet, and household characteristics were associated with the risk of stunting, but few sex differences were seen in exposure to these factors. Only one risk factor-maternal marital status-showed evidence of moderation by sex at the p < 0.05 level, while a limited number of risk factors did so at the p < 0.10 level. At all ages, boys were longer than girls, and there were no sex-specific differences in the patterns of HAZ or HAD with age. Results were robust to alternate specifications.

CONCLUSIONS

Our results show that Zambian boys have lower mean HAZ scores than girls and a greater prevalence of stunting throughout the first two years We do not find strong evidence that infant feeding practices, environmental exposures, or care giving differ consistently between boys and girls or that boys and girls respond differently to these exposures. Our results instead indicate that further investigation of prenatal factors and/or measurement issues is needed.

The Association Between Maternal Age at Childbirth and Child Nutritional Outcomes: A Cross-sectional Study From Serbian Roma Communities

Objectives. Extremes of maternal age at childbirth may influence child nutritional outcomes, but this is under-researched in Roma populations. Methods. The study was a secondary data analysis of Multiple Indicator Cluster Surveys for Serbian Roma settlements and included 2564 children aged 0 to 59 months. Results. About 19% of children were stunted, 9% underweight, 16% were unwanted and born with a low birth weight. Logistic and linear regressions show that maternal age at childbirth had no association with either nutritional or growth outcomes of Roma children (P > .05). Instead, child characteristics: being born as a boy, low birth weight, unwanted, younger age, and maternal characteristics: short birth spacing, higher parity and low socioeconomic status were associated with children's malnutrition. Conclusion. Maternal age at childbirth per se does not increase the chances of poor child health outcomes, as the risks seem to be related more to individual child and maternal characteristics and maternal behavioral patterns.

Adolescents' dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya's urban slums

BACKGROUND

The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent's dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya's urban slums.

METHODS

Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM.

RESULTS

Two DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85-6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97-9.32), while longer residency in the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25-0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16-6.71). The DPs were not associated with thinness or stunting.

CONCLUSION

The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Micronutrient status and associated factors of anemia among undernourished children of 5-18 years: First study from Himalayan foothills

Purpose

Undernutrition in children is a critical worldwide concern that hampers both their physical and cognitive growth. The nutritional status of school-going children and adolescents remains insufficiently addressed with no comprehensive data. This is the first study from the Himalayan foothills that aims to assess the clinical and laboratory aspects of anemia with micronutrient status in undernourished children above the age of five along with association of clinical features with anemia severity.

Materials and Methods

A cross-sectional study was conducted involving children aged 5-18 years with undernutrition in a tertiary hospital in North India over eighteen months. We observed the prevalence of anemia, its morphological type, micronutrient status, clinical features, and demographic parameters of these children. The association of various clinical features and anthropometric parameters with the severity of anemia was determined.

Results

Of the 200 children who were enrolled in the study, 77% were found anemic, with the proportion of mild, moderate, and severe anemia being 18.2%, 46.8%, and 35%, respectively. Iron (67%) was the most common micronutrient deficient in these children with a significant number suffering from vitamin B12 (53.9%) deficiency. Folic acid deficiency was relatively low (10.4%). Body mass index (P = 0.009), fatigability (P = 0.001), pallor (P ≤ 0.001), poor academic performance (P = 0.023), and knuckle hyperpigmentation (P = 0.018) were significantly associated with the severity of anemia.

Conclusion

Despite the significant tread in various aspects of human development, undernutrition and anemia remain a formidable challenge, especially in developing countries. A high proportion of anemia in undernutrition indicates the gravity of the issue, yet not received the deserved attention.

A systematic review of parenting and feeding practices, children's feeding behavior and growth stunting in Asian countries

This systematic review evaluates studies focusing on parenting and feeding practices, children's feeding behavior, and growth stunting in Asian countries. Eight electronic databases were searched to screen studies published between Jan 2015 and May 2021. There were contradictory findings related to gender differences in growth stunting and factors that reinforce/facilitate or inhibit acquisition of optimum growth in children. Theme of parenting practices showed that time spent on childcare, traditional beliefs about child-care feeding and responsive feeding were also contributing factors. Amidst economic improvement, political, social changes, and worldwide execution of various nutritional programs, stunting continues to be relentlessly persistent and widespread in Asia. Undernutrition disturbs areas of the mind involved in reasoning, reminiscence, locomotor skills and also an adverse influence on the physical and psychological growth of children and ensuing learning capabilities. Stunted children have more anxiety and depression and lower self-esteem than non-stunted children. A public health strategy is required to: (i) properly examine stunting with time through collaborated efforts of community members and various sectors, (ii) tackle malnutrition with steps to enhance maternal nutrition during pregnancy, infant feeding practices and (iii) involvement of effective multi-sectoral partnership programs for management of stunting.

Malnutrition in infants aged 6-23 months in China's poorest rural counties from 2016 to 2021: cross sectional study

OBJECTIVES

To assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China's poorest rural counties.

DESIGN

Six consecutive cross sectional surveys were conducted annually.

SETTING

The study was conducted in 116 counties in 19 provinces from 2016 to 2021, representing China's 832 poorest counties.

PARTICIPANTS

A total of 210 088 participants were selected through a multistage cluster sampling procedure; all participants were infants aged 6-23 months.

MAIN OUTCOME MEASURES

Prevalence of anaemia, stunting, wasting, overweight, and growth status in children (measured by length-for-age and weight-for-length z scores).

RESULTS

Four main malnutrition forms were prevalent in 2016: anaemia (prevalence 18.3%), stunting (7.5%), wasting (4.7%), and overweight (3.1%). The prevalence of any two coexisting malnutrition forms was low. All four forms of malnutrition decreased from 2016 to 2021. Anaemia decreased by more than half, with an annual reduction rate of 9.11% (95% confidence interval (CI) 4.83% to 13.20%). Stunting was reduced by over a third, with an annual reduction rate of 10.44% (7.56% to 13.22%), which is faster than the World Health Organization's target of 3.9%. Differences in child growth by county gross domestic product quarters were small and decreased over time, but growth differences related to education persisted. Infants whose mothers completed education up to primary school level had approximately twice the risk of stunting (adjusted rate ratio 2.29 (95% CI 1.87 to 2.81)) and wasting (1.73 (1.40 to 2.13)) compared with children whose mothers had an education level of a college degree or above. Boys had poorer growth and higher anaemia than did girls. For all outcomes, differences related to sex and education were greatest at 6 months of age.

CONCLUSIONS

Education related inequalities in growth of infants persists, with these differences particularly affecting children whose mothers completed education only up to primary school level.

Mother's perception of early introduction of complementary feeding affecting stunting in Ghana: A qualitative research

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.

Deconstructing the sex gap in child undernutrition in India: Are Indian boys at elevated risk of anthropometric failure than the girls?

BACKGROUNDS & OBJECTIVES

The privileging of boys in immunization coverage, breastfeeding, and other child care practices in Indian patriarchal society raises questions about whether there are sex differences in the prevalence of undernutrition among children. This study evaluates the sex gap in the prevalence of Composite Index of Anthropometric Failure (CIAF) among Indian children from 2015-16 to 2019-21. Additionally, it seeks to identify the sex-specific determinants and persistent sex gap at national and subnational levels (social, economic, religious, and geopolitical regions) in anthropometric failure among the children from 2015-16 to 2019-21.

MATERIALS AND METHODS

The study utilizes the 4th (2015-16) and 5th (2019-21) rounds of the National Family Health Survey data. Logistic regression models and the Fairlie decomposition technique were employed to explore the persistent and significant sex gap in the prevalence of CIAF, as well as the sex-specific determinants of CIAF among children in 2015-16 and 2019-21.

RESULTS

The study reveals a significant sex gap (approximately 4%-points), with boy's disadvantage in the prevalence of CIAF from 2015-16 to 2019-21 at both the national and subnational levels (social, religious, socioeconomic groups, and geopolitical regions). The gap is more pronounced in the first year of life and decreases in later stages. A comparatively faster CIAF decline among girls from 2016 to 2021 has widened the sex gap in final year than the previous. Child, mother, household, community, and geographic backgrounds explains about 5%-6% of the sex gap in the prevalence of CIAF from 2015-16 to 2019-21. The remaining 94%-95% of the unexplained sex gap may be attributed to biological factors or other factors. Currently, a heightened boy's disadvantage in CIAF risk is observed in ST community, wealthiest families, and the northern India.

CONCLUSION

The findings suggest a special attention for boys under 3 years to offset biological disadvantages like greater disease sensitivity and fragility compared to girls early on.

Detecting Age Prone to Growth Retardation in Children Through a Bi-Response Nonparametric Regression Model with a Penalized Spline Estimator

Background

The growth of children aged 0-60 months can impact their subsequent growth and development. This study aims to identify the vulnerable age for boys and girls, who experience growth retardation within this age range.

Methods

The study design used was a cross-sectional approach in which each child's measurement data was only taken once. The data were obtained from weighing results at the Health Integrated Service Post in South Sulawesi Province in 2022. The number of data analyzed was 698 children, namely 369 boys and 329 girls by considering the factors of age, weight, and height. We used a nonparametric bi-response regression model estimated using a penalized spline. The knots used are 12, 24, 36, and 48 on each model.

Results

The value of the penalized spline regression coefficient in the model indicates that the child's growth is slowed down and is not within normal limits. This can be seen in the weight and height of boys from the age of reaching 12 months to 24 months, only increasing by about 0.3 kg and 0.3 cm. For girls, the problem occurs from the age of 24 to 36 months, namely their weight increases by about 0.6 kg, and their height increases by about 1 cm.

Conclusions

The analysis results show that boys' growth slows down at 2 years of age and continues until 5 years of age. In the case of girls, their growth begins to slow when they are 3 years old until they reach 5 years old.

Association of parental level of education and child factors on length-for-age indicator among socially vulnerable children aged 6-24 months from a Brazilian state using structural equation modelling

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

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.

Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis

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.

The Global Burden of Disease Attributable to Child and Maternal Malnutrition: 1990-2019

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.

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

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.

Determinants of aggregate anthropometric failure among children under-five years in Ethiopia: Application of multilevel mixed-effects negative binomial regression modeling

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.

The epidemiology and associated factors of non-exclusive breastfeeding: a comparative cross-sectional study of livelihood-secure and insecure areas

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.

Impact of Maternal Viral Suppression on Growth Patterns for HIV-Exposed Uninfected Infants in Kenya

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.

Effect of high-calorie formula on weight, height increment, IGF-1 and TLC in growth faltering children: A quasi-experimental study

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.

Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia

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.

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

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.

Disparities in Place of Death Among Malnourished Individuals in the United States

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.

Es Niño o Niña?: Gender Differences in Feeding Practices and Obesity Risk among Latino Infants

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.

Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019

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.

Secular trends in the anthropometric characteristics of children in a rural community in Yucatan, Mexico

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.

Composite indexes of anthropometric failure in children under 5 years of age in Argentina: Comparative analysis among regions: 2019-2020

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.

Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis

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.

Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia

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.

Effect of lactoferrin in oral nutrition supplement (ONS) towards IL-6 and IL-10 in failure to thrive children with infection

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.

Multiple micronutrient deficiencies in early life cause multi-kingdom alterations in the gut microbiome and intrinsic antibiotic resistance genes in mice

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.

Unhealthy weight among young children in the Middle East and North African region

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.

Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey

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.

Mid-upper arm circumference as a screening tool for identifying underweight adolescents

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.

Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys

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.

Undernutrition in children aged 0-59 months by region and over time: secondary analysis of the Burkina Faso 2012-2018 National Nutrition Surveys

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.

Multilevel analysis of trends and predictors of concurrent wasting and stunting among children 6-59 months in Ethiopia from 2000 to 2019

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.

Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India

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.