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Shenoy PS, Chavan YB. What matters in good health status of 1-year-old children? - A cross-sectional study of the perinatal factors. J Family Med Prim Care 2024; 13:2589-2595. [PMID: 39071015 PMCID: PMC11272029 DOI: 10.4103/jfmpc.jfmpc_1124_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 07/30/2024] Open
Abstract
Background A healthy child can make way for a healthy adult. Some of the factors that can be used to determine the health of a young child are nutritional status of the child, the developmental milestones achieved, and frequency of illness. Objectives The health status of children and associated factors are determined. Methods This is a community-based cross-sectional study with 271 participants. The height and weight of the child were measured; questions were asked regarding developmental milestones achieved and frequent illnesses. An interview schedule was used to enquire about the determinants of health status. Descriptive statistics were done; Chi-square test and regression were used to determine association between the health status of children and determinants. Results A total of 127 (46.86%) were found to have a good health status. Family type (Chi square value 9.568; P value = 0.002), birth spacing (Chi square 20.540; P value < 0.001), term or pre-term birth (Chi square 4.598; P value = 0.032), chronic medical problem in the child (Chi square 11.074; P value = 0.001), and immunization status of the child (Chi square 5.666; P value = 0.017) were found to have significant association with the health status of the child. By logistic regression, pre-term child birth and family type were found to have higher odds. Conclusion For better health of the child, specific focus on birth spacing, term birth of baby, better care of the ill, and complete immunization play vital roles.
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Affiliation(s)
- Priyanka S. Shenoy
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Yuvaraj B. Chavan
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Kundu RN, Gautam RK, Chatterjee A, Bharati P, Liczbińska G, Malina RM. Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys. Eur J Clin Nutr 2024; 78:591-606. [PMID: 38467858 DOI: 10.1038/s41430-024-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. METHODS Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. RESULTS Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. CONCLUSIONS The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.
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Affiliation(s)
- Ramendra Nath Kundu
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Rajesh K Gautam
- Department of Anthropology, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India
| | - Arna Chatterjee
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Premananda Bharati
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India
| | - Grażyna Liczbińska
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland.
| | - Robert M Malina
- Professor Emeritus, Department of Kinesiology and Health Education, University of Texas, Austin, TX, 78705, USA
- Adjunct Professor, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
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Khan MN, Harris ML, Hassen TA, Bagade T, Shifti DM, Feyissa TR, Chojenta C. Effects of short birth interval on child malnutrition in the Asia-Pacific region: Evidence from a systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13643. [PMID: 38530129 PMCID: PMC11168362 DOI: 10.1111/mcn.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
Child malnutrition remains a significant concern in the Asia-Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia-Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia-Pacific region between September 2000 and May 2023. Fixed-effects or random-effects meta-analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta-analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97-1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88-6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national-level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia-Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population ScienceJatiya Kabi Kazi Nazrul Islam UniversityMymensinghBangladesh
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Melissa L. Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Tahir A. Hassen
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Desalegn M. Shifti
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Child Health Research CentreThe University of QueenslandBrisbaneAustralia
| | - Tesfaye R. Feyissa
- Deakin Rural Health, School of Medicine, Faculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
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Begna G, Bikila H, Biru B, Diriba D, Tolera C, Dessalegn R, Tafesse T, Amenu D. Determinants of severe acute malnutrition among children less than five years visiting health centers in Leqa Dulacha District, East Wallaga Zone, Oromia Region, Ethiopia: A case control study. Health Sci Rep 2024; 7:e1939. [PMID: 38706803 PMCID: PMC11066183 DOI: 10.1002/hsr2.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background In underdeveloped nations like Ethiopia, severe acute malnutrition (SAM) is one of the most pressing public health issues. Despite efforts to pinpoint the causes of SAM, the impact of parents' drug usage on their children's nutritional status remains unclear and unresolved. Objective The purpose of this research was to determine the risk factors for SAM in children under five who were attending medical facilities in the Leqa Dulacha district. Materials and Methods A health facility-based case-control study was carried out from March 1 to July 30, 2022, with 256 children under the age of five. Random sampling was used to identify study participants in a methodical manner. Mothers and other child caretakers were interviewed using a structured questionnaire and anthropometric measurements were performed using standardized, calibrated equipment. Epi-data version 3.1 was used to code and enter the data, and it was then exported to IBM SPSS for analysis. An analysis of multivariable binary logistic regression was conducted, and the measure of association employed was the adjusted odds ratio (AOR), with a 95% confidence interval (CI). Results A total of 96.5% of respondents responded. SAM in children was significantly correlated with the following factors: parent alcohol consumption [AOR = 3.142; 95% CI = (1.104, 8.945)]; child illness in the previous 15 days [AOR = 4.122; 95% CI = (1.686, 10.07)]; poor dietary diversity [AOR = 3.044; 95% CI = (1.189, 7.788)]; household food insecurity [AOR = 4.024; 95% CI = (1.544, 10.490)]; and parent chewing chat [AOR = 3.484; 95% CI = (1.329, 9.134)]. Conclusions A number of factors have been linked to SAM in children, including the use of health services, the child's illness within the previous 15 days, food security, child feeding practices, and parent substance use. Therefore, it is important to emphasize the value of health education programs on child feeding habits, particularly the significance of dietary diversity, and to work together to modify the way that parents raise their children.
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Affiliation(s)
- Garoma Begna
- Department of Public Health Emergency ManagementLeqa Dulacha District Health Office, East Wallaga ZoneNekemteEthiopia
| | - Haile Bikila
- Department of Public Health, Institutes of Health SciencesWallaga UniversityNekemteEthiopia
| | - Bayise Biru
- Department of Public Health, Institutes of Health SciencesWallaga UniversityNekemteEthiopia
| | - Debelo Diriba
- Department of Health and NutritionFood for Hungry Ethiopia, East Wallaga ZoneNekemteEthiopia
| | - Chimdesa Tolera
- Department of Public Health ManagementLeqa Dulacha District Health Office, East Wallaga ZoneNekemteEthiopia
| | - Ra'el Dessalegn
- Department of Health ScienceSibu Sire District, Sibu Sire Health Center, East Wollega Zone HealthNekemteEthiopia
| | | | - Dessalegn Amenu
- Department of Biology, College of Natural and Computational ScienceWollega UniversityNakemteEthiopia
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Kundu RN, Hossain MG, Haque MA, Mahumud RA, Pal M, Bharati P. Burden of undernutrition among under-five Bengali children and its determinants: Findings from Demographic and Health Surveys of Bangladesh and India. PLoS One 2024; 19:e0301808. [PMID: 38578746 PMCID: PMC10997093 DOI: 10.1371/journal.pone.0301808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/21/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Globally, undernutrition is the leading cause of mortality among under-five children. Bangladesh and India were in the top ten countries in the world for under-five mortality. The aim of the study was to investigate the nutritional status of Bengali under-five children. METHODS Data on 25938 under-five children were retrieved from the Bangladesh Demographic and Health Survey 2017-18 (BDHS) and the National Family Health Survey of India 2015-16 (NFHS-4). Stunting, wasting, underweight and thinness were considered to understand the nutritional status of under-five children. Binary logistic regression was used to identify associated factors of undernutrition among children. RESULTS Over one-quarter of Bengali under-five children were found to be suffering from the problem of stunting (31.9%) and underweight (28.1%), while other nutritional indicators raised serious concern and revealed inter-country disparities. In the cases of wasting, underweight and thinness, the mean z-scores and frequency differences between Bangladesh and India were significant. The nutritional status of Bengali under-five children appeared to have improved in Bangladesh compared to India. Child undernutrition had significant relations with maternal undernutrition in both countries. Girls in Bangladesh had slightly better nutritional status than boys. In Bangladesh, lack of formal education among mothers was a leading cause of child undernutrition. Stunting and underweight coexist with low household wealth index in both counties. CONCLUSIONS The research revealed that various factors were associated with child undernutrition in Bengalis. It has been proposed that programmes promoting maternal education and nutrition, along with household wealth index be prioritised. The study recommends that the Governments of Bangladesh and India should increase the budget for health of children so as to reach the sustainable development goals.
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Affiliation(s)
- Ramendra Nath Kundu
- Department of Anthropology, Former Senior Research Fellow (UGC-NET), West Bengal State University, West Bengal, India
| | - Md Golam Hossain
- Department of Statistics, Health Research Group, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Manoranjan Pal
- Indian Statistical Institute, Economic Research Unit, Kolkata, West Bengal, India
| | - Premananda Bharati
- Indian Statistical Institute, Biological Anthropology Unit, Kolkata, West Bengal, India
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Pabustan-Calleja A, Aguilar VB, Castillo-Reyes ML. Survival Analysis of Patients with Severe Acute Malnutrition Admitted at the In-patient Therapeutic Care of the Bicol Regional Training and Teaching Hospital. ACTA MEDICA PHILIPPINA 2024; 58:5-14. [PMID: 38966843 PMCID: PMC11219706 DOI: 10.47895/amp.vi0.5851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Background Severe acute malnutrition (SAM) in children under five years remains a major global health concern. It carries a burden to the overall health of a child, contributes to mortality, and adds financial strain to the family and the hospital. The Philippine Integrated Management of Acute Malnutrition was established to address acute malnutrition in Filipino children. Objective This study aimed to determine the factors affecting survival of patients admitted at Bicol Regional Training and Teaching Hospital (BRTTH) In-patient Therapeutic Care (ITC). Methods This is a retrospective cohort study design utilizing survival analysis. Accrual period was from January 1, 2018 to December 31, 2018. Follow-up ended on March 31, 2019. There were 154 admissions and excluded 17 missing charts. Survival analysis was done utilizing STATA 14. Results The prevalence of SAM requiring ITC admission was 3.0 percent. Majority belonged to 6-59 months of age (63%), with equal predilection for both sexes (1:1) and 71% came from the home province, Albay. Most of patients' caretakers had middle educational attainment. Sixty-eight percent (68%) were new patients, 16% readmitted, 15% transferred from the Out-patient Therapeutic Care (OTC) and <1% relapsed. The top three most common complications and co-morbidities include: pneumonia, low electrolytes, and fever. Sixty-three percent (63%) of patients at the ITC had a desirable treatment outcome, of which, 8% were cured and 55% transferred to OTC. Undesirable outcomes accounted for 37% of the cases which included non-cured, defaulter, and died at 12%, 8%, and 17%, respectively. The risk of dying was higher in SAM patients with parents having middle and low educational attainment as compared to those with high educational attainment (2-5 folds to 100-200 folds). SAM patients presenting with hypovolemic shock were likely to die by 1.5-19 times (1.5-19x) as compared to those without. SAM patients with malignancy were more likely to die 4-44 folds as compared to patients without malignancy. Conclusion and Recommendations Educational attainment of parents, malignancy, and hypovolemic shock were significant predictors of mortality. We recommend prompt intervention by educating families, strengthen policies targeting socio-economic determinants, capacitate medical staff, refine current clinical practice guidelines and treatment pathways to reduce the number of children who die from severe acute malnutrition.
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Affiliation(s)
| | - Vincent B Aguilar
- Department of Pediatrics, Bicol Regional Training and Teaching Hospital
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Lyimo EJ, Msangi M, Zangira AJ, Msaki RV, Lekey A, Rwenyagira M, Mwiru R, Codjia P, Ezekiel M, Leyna GH, Masumo RM. Healthcare-seeking behaviours among mother's having under-five children with severe wasting in Dodoma and Mbeya regions of Tanzania-A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001943. [PMID: 38190374 PMCID: PMC10773934 DOI: 10.1371/journal.pgph.0001943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
Maternal healthcare-seeking behaviour affects the health and well-being of under-five children. Drawing from the concepts of the health belief model, this study seeks to understand the determinants of health-seeking behaviours among mothers or caregivers of under-five-year-old children having severe wasting in Tanzania. A qualitative study employing the ethnography method conducted 32 semi-structured and narrative interviews with healthcare workers, community health workers, traditional healers, religious and village leaders, and mothers or caregivers of children who had acute malnutrition. The analysis of transcripts was done by qualitative content analysis. Further, the thematic analysis was carried out by assigning data into relevant codes to generate categories based on study objectives. Severe wasting among under-five-year-old children was not observed as a serious disease by the majority of mothers or caregivers. The study established that the health systems parameters such as the availability of the community health workers or healthcare providers and the availability of medicines and supplies to the health facility impact on mothers' or caregivers' healthcare-seeking behaviours. The findings also show that long distances to the health facility, behavioural parameters such as lack of awareness, negative perception of the management of severe wasting at the health facility, superstitious beliefs, women's workload, household food insecurity, and gender issues have a significant role in seeking healthcare. The results reaffirm how a programme on integrated management of severe wasting in Tanzania should encompass sociocultural factors that negatively influence mothers or caregivers of children with acute malnutrition. The programme should focus on engaging community structures including traditional healers, religious and village leaders to address prevailing local beliefs and sociocultural factors.
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Affiliation(s)
| | - Maria Msangi
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Rose V. Msaki
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Aika Lekey
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Ramadhan Mwiru
- The United Nations Children’s Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Patrick Codjia
- The United Nations Children’s Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Mangi Ezekiel
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Germana H. Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ray M. Masumo
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
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Asmare AA, Agmas YA. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr 2023; 9:82. [PMID: 37420303 DOI: 10.1186/s40795-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Malnutrition is the main cause of illness and death in children under the age of five. It affects millions of children worldwide, putting their health and future in jeopardy. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHOD The study was carried out in 10 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Zimbabwe, Kenya, Zambia, and Malawi. A weighted total sample of 53,322 children under the age of five was included. Given the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate binary logistic regression model was employed to analyze the relationship between stunting, wasting, and underweight. RESULT The study included 53,322 children, and 34.7%, 14.8%, and 5.1% were stunted, underweight, and wasted, respectively. Almost half of the children (49.8%) were female, and 22.0% lived in urban areas. The estimated odds of children from secondary and higher education mothers being stunted and wasted were 0.987; 95% CI: 0.979 - 0.994 and 0.999; 95% CI: 0.995 - 0.999, respectively, times the estimated odds of children from no education mothers. Children from middle-class families were less likely to be underweight than children from poorer families. CONCLUSION The prevalence of stunting was higher than in the sub-Saharan Africa region, but the prevalence of wasting and underweight was lower. According to the study's findings, undernourishment among young children under the age of five continues to be a significant public health issue in the East African region. Governmental and non-governmental organizations should therefore plan public health participation focusing on paternal education and the poorest households in order to improve the undernutrition status of children under five. Additionally, improving the delivery of healthcare at health facilities, places of residence, children's health education, and drinking water sources are essential for lowering child undernutrition indicators.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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Ghodsi D, Rasekhi H, Yari Z, Roustaee R, Nikooyeh B, Faramarzi A, Eini-Zinab H, Neyestani TR. Prediction and analysis of trends in the nutritional status of children under 5 years in Iran: reanalysis of the results of national surveys conducted between 1998 and 2020. Front Nutr 2023; 10:1083318. [PMID: 37252238 PMCID: PMC10213970 DOI: 10.3389/fnut.2023.1083318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aim Malnutrition is a major public health problem, especially in developing countries. The aim of this study was to analyze the trend in malnutrition among children under 5 years of age in Iran over recent decades and to estimate malnutrition status for 2020. Methods This study took the form of a secondary analysis of the reports and data from three cross-sectional national surveys on children's nutritional status conducted between 1998 and 2017. Anthropometric indices, including markers of underweight, wasting, stunting, overweight, and obesity, were used as indicators of the nutritional status of children under 5 years. Malnutrition indicators are reported separately based on regional food security status. Linear mixed-effects modeling was used to predict the status of malnutrition indicators for 2020. Results The results of this study indicated a downward trend in the prevalence of stunting, underweight, and wasting, from 15.4 to 4.8%, 10.9 to 4.3%, and 4.9 to 4.3%, respectively, between 1998 and 2017. The proportion of children at risk of overweight and prevalence of childhood overweight/obesity showed a downward trend between 2010 and 2017, from 3.73 to 3.02% and from 12.1 to 10.3%, respectively. However, the trend varied between different provinces. Estimates of the prevalence of malnutrition in 2020 also indicated a decrease in the prevalence of all indicators among children. Conclusion Despite the decreasing trend in malnutrition over the past three decades, the prevalence of stunting, underweight, and wasting is still high in food-insecure provinces. Moreover, following the COVID-19 pandemic and its economic consequences, an increase in the prevalence of malnutrition, especially in food-insecure provinces, is plausible.
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Affiliation(s)
- Delaram Ghodsi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rasekhi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Yari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roshanak Roustaee
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahereh Nikooyeh
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hassan Eini-Zinab
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R. Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ntambara J, Zhang W, Qiu A, Cheng Z, Chu M. Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis. Front Nutr 2023; 9:939747. [PMID: 36712519 PMCID: PMC9880174 DOI: 10.3389/fnut.2022.939747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear. Methods In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting. Results Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months. Conclusion The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.
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Alam MB, Shahid M, Alzghoul BI, Yang J, Zakar R, Malik NI, Bibi A, Tang K. The Effects of Financial Stress and Household Socio-Economic Deprivation on the Malnutrition Statuses of Children under Five during the COVID-19 Lockdown in a Marginalized Region of South Punjab, Pakistan. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010012. [PMID: 36670563 PMCID: PMC9857281 DOI: 10.3390/children10010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
The lockdown after the COVID-19 pandemic not only caused public health crises and income stress but also put millions at risk of food insecurity and malnutrition across the globe, especially in low and middle-income countries [LMICs]. This study evaluated the effects of financial stress and household socio-economic deprivation on the nutritional status of 1551 children under the age of five during COVID-19 in Pakistan. A self-administered questionnaire was used between November 2020 and April 2021 to collect information on age, height, children's weight, and socio-economic status from 1152 rural households from underdeveloped regions in Punjab, Pakistan. With the help of the proportionate simple random sampling method, this study employed a model (binary logistic regression) to calculate the likelihood of malnourishment. The findings showed that the stunting, underweight, and wasting prevalence rates during COVID-19 were 58.86%, 41.89%, and 8.11%, respectively, in the Bahawalpur region. According to the binary logistic regression analysis, among the household deprivation status (HDS) categories, the risks of childhood malnutrition were lesser in HDS-2 (OR = 0.05, 95% CI: 0. 005-0.879) and HDS-3 (OR = 0.04, 95% CI: 0.008-0.193). Similar to this, within the financial stress index (FSI) categories, the children in homes with medium financial stress had reduced odds of malnutrition (OR = 0.10, 95% CI: 0.018-0.567), and the children in households with low financial stress had reduced risks of malnutrition (OR = 0.006, 95% CI: 0.005-0.061). The proposed research found that stunting and underweight increased by 17.26% and 12.29% during the COVID-19 lockdown in the Bahawalpur region. Additionally, financial stress and socio-economic deprivation strongly affected children's nutritional statuses during the COVID-19 lockdown in the Bahawalpur region of Southern Punjab.
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Affiliation(s)
- Muhammad Babar Alam
- Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore 54000, Pakistan
- World Health Organization, Peshawar 25000, Pakistan
| | - Muhammad Shahid
- World Health Organization, Peshawar 25000, Pakistan
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Bashar Isam Alzghoul
- Respiratory Care Department, College of Applied Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University-Dammam, Jubail 35816, Saudi Arabia
| | - Juan Yang
- Chinese Academy of Sciences and Technology for Development, Beijing 100038, China
- Correspondence: (J.Y.); (K.T.); Tel.: +86-13671129425 (K.T.)
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore 54000, Pakistan
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan
| | - Asma Bibi
- Independent Researcher, Lahore 54000, Pakistan
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
- Correspondence: (J.Y.); (K.T.); Tel.: +86-13671129425 (K.T.)
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Hossain MM, Abdulla F, Rahman A. Prevalence and determinants of wasting of under-5 children in Bangladesh: Quantile regression approach. PLoS One 2022; 17:e0278097. [PMID: 36417416 PMCID: PMC9683614 DOI: 10.1371/journal.pone.0278097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Wasting is perhaps one of the signs of malnutrition that has been linked to the deaths of children suffering from malnutrition. As a result, understanding its correlations and drivers is critical. Using quantile regression analysis, this research aims to contribute to the discussion on under-5 malnutrition by analyzing the predictors of wasting in Bangladesh. METHODS AND MATERIALS The dataset was extracted from the 2017-18 Bangladesh demographic and health survey (BDHS) data. The weight-for-height (WHZ) z-score based anthropometric indicator was used in the study as the target variable. The weighted sample constitutes 8,334 children of under-5 years. However, after cleaning the missing values, the analysis is based on 8,321 children. Sequential quantile regression was used for finding the contributing factors. RESULTS The findings of this study depict that the prevalence of wasting in children is about 8 percent and only approximately one percent of children are severely wasted in Bangladesh. Age, mother's BMI, and parental educational qualification, are all major factors of the WHZ score of a child. The coefficient of the female child increased from 0.1 to 0.2 quantiles before dropping to 0.75 quantile. For a child aged up to three years, the coefficients have a declining tendency up to the 0.5 quantile, then an increasing trend. Children who come from the richest households had 16.3%, 3.6%, and 15.7% higher WHZ scores respectively than children come from the poorest households suggesting that the risk of severe wasting in children under the age of five was lower in children from the wealthiest families than in children from the poorest families. The long-term malnutrition indicator (wasting) will be influenced by the presence of various childhood infections and vaccinations. Furthermore, a family's economic position is a key determinant in influencing a child's WHZ score. CONCLUSIONS It is concluded that socioeconomic characteristics are correlated with the wasting status of a child. Maternal characteristics also played an important role to reduce the burden of malnutrition. Thus, maternal nutritional awareness might reduce the risk of malnutrition in children. Moreover, the findings disclose that to enrich the nutritional status of children along with achieving Sustainable Development Goal (SDG)-3 by 2030, a collaborative approach should necessarily be taken by the government of Bangladesh, and non-governmental organizations (NGOs) at the community level in Bangladesh.
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Affiliation(s)
- Md. Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- School of Mathematics, Statistics & Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail: (MMH); (FA)
| | - Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al Kabir Technical University (RTM-AKTU), Sylhet, Bangladesh
- * E-mail: (MMH); (FA)
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Eldah TT, Mary M, Selina RN, Cecilia MT. Perceptions of Caregivers Regarding Malnutrition in Children under Five in Rural Areas, South Africa. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1784. [PMID: 36421232 PMCID: PMC9689243 DOI: 10.3390/children9111784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 09/25/2023]
Abstract
Children under five depend on the caregivers to provide them with nutritious food to combat malnutrition. Several studies have been conducted about malnutrition in children, yet limited attention has been paid to the caregivers. Thus, the study investigated the perceptions of caregivers with regard to non-nutritious foods in rural areas in South Africa. This study explored caregiver's perception regarding non-nutritious food in children below five. This was done in primary health care clinics of Tshilwavhusiku local areas of Makhado Municipality in Vhembe District, South Africa. A qualitative approach was adopted. Nine caregivers were sampled randomly. In-depth individual interviews were conducted, and Tesch's analytical approach was adopted to analyze the data measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The study revealed that caregivers were lacking knowledge regarding nutritious food to be given to their children and signs of malnutrition were also not known. It is imperative to ensure the improvement of caregivers' knowledge regarding nutritious food and children's nutritional status in order to reduce the malnutrition rate.
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Affiliation(s)
| | - Maluleke Mary
- Department of Advanced Nursing Science, University of Venda, Private Bag X 5050, Thohoyandou 0950, South Africa
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Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia. Heliyon 2022; 8:e10791. [PMID: 36203897 PMCID: PMC9529577 DOI: 10.1016/j.heliyon.2022.e10791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/10/2021] [Accepted: 09/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite consistent efforts to reduce child undernutrition, severe acute malnutrition (SAM) continues to be a serious obstacle to child survival and development in Ethiopia. This study aimed to identify severe acute malnutrition and associated factors among children aged 6–59 months in Ethiopia. Methods A cross-sectional study was undertaken with 384 under-five children from February to March, 2020 in Ethiopia. A mid-upper arm circumference (MUAC) tape, weight scale, height board (standing) and recumbent length measurements (for children <24 months) were measured. To determine the variables associated with SAM, adjusted odds ratio was computed using multivariable analysis and p < 0.05 was declared as significant. Results The prevalence of acute undernutrition was 26%; 18% and 8% of the children were moderately and severely undernourished, respectively. Family size (≥5 members) (AOR: 3.71, 95% CI: 1.55–8.89), younger age group (6–11 months) (AOR: 4.80, 95% CI: 1.61–14.31) and history of diarrhea in the two weeks prior to the survey (AOR: 5.36, 95% CI: 1.97–14.61) were independently associated with SAM in the study population. Conclusion Large family size, child age, diarrheal and household insecurity were important determinants of SAM among children. Therefore, aligning social protection programmes and improving health related interventions along with improving optimal breastfeeding, prevention and control of child morbidity, and strengthening family planning services are recommended to reduce child SAM.
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Irenso AA, Zheng M, Campbell KJ, Chamberlain D, Laws R. The influence of household structure and composition on the introduction of solid, semisolid and soft foods among children aged 6-8 months: An analysis based on Ethiopia Demographic and Health Surveys. MATERNAL & CHILD NUTRITION 2022; 19:e13429. [PMID: 36148628 PMCID: PMC9749599 DOI: 10.1111/mcn.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022]
Abstract
The early and late introduction of complementary food, both prevalent in Ethiopia, are associated with morbidities, growth faltering and developmental risks in children. The interhousehold network around the primary caregiver's intrahousehold network is critical in influencing the age of introducing complementary foods. This study examined the influence of household composition and structures on complementary food introduction. This is a secondary data analysis of four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. The household structure and composition variables were calculated from household members' kinship status and attribute, respectively. The introduction of solid, semisolid or soft foods was dichotomised as whether the children within 6 to 8 months have been given complementary foods. Multivariable logistic regression with adjustment for the primary caregiver and household characteristics was run to examine the associations between household structure and composition variables and the introduction of complementary foods. The marginal effects (ME) were calculated to facilitate the practical interpretation of the study findings. Large households (>3 nonredundant contacts) with extended family or unrelated people (high effective size, ME = 6.01%, 95% confidence interval [CI]: -8.53, -3.49) lowered the proportion of children starting food within the recommended 6-8 months. Households with close kins (high constraint) (ME = 7.22%, 95% CI: -13.65, 28.09) and greater age diversity (ME = 0.65%, 95% CI: 0.15, 1.15) increased the proportion of children receiving complementary food at an appropriate age. This study revealed that interhousehold structure and composition influence the age of introduction of complementary foods. These factors, therefore, need to be considered in designing interventions to improve age at the introduction of complementary foods.
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Affiliation(s)
- Asnake Ararsa Irenso
- School of Public HealthAmbo UniversityAmboEthiopia,School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Miaobing Zheng
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Karen J. Campbell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
| | - Dan Chamberlain
- Centre for Social Impact UNSWUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rachel Laws
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityBurwoodVictoriaAustralia
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Asmare AA, Agmas YA. Determinants of coexistence of stunting, wasting, and underweight among children under five years in the Gambia; evidence from 2019/20 Gambian demographic health survey: application of multivariate binary logistic regression model. BMC Public Health 2022; 22:1621. [PMID: 36028850 PMCID: PMC9414138 DOI: 10.1186/s12889-022-14000-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malnutrition happens when there are insufficient amounts of nutrients and energy consumed improperly. Included are both undernutrition and overnutrition. This study is aimed to evaluate the relationship among undernutrition indicators of stunting, underweight, and wasting among those under 5 years given other predictors. Methods The data were obtained from the measure of DHS program. A total of 2399 under-five children were involved in this study. A multivariate binary logistic regression model is used to assess the association between stunting, wasting, and being underweight given the effect of other predictors. Results Of the 2399 under-five children considered in this study, 13.5, 18.7, and 5.9% of them suffered from stunting, underweight, and wasting, respectively. The majority of children (40.1%) were obtained from the Brikama local government area of Gambia; more than half of the children (52.9%) were male, and 63.3% of children lived in urban areas. The association between stunting and underweight, underweight and wasting, and stunting and wasting was measured by the odds ratio (OR) of 15.87, 46.34, and 1.75, respectively, given the other predictors. The estimated odds ratio for children who had an average birth size to become stunted, underweight, and wasted were 0.965, 0.885, and 0.989 times the estimated odds ratio of children who had a small birth size, respectively. Conclusion The prevalence of stunting and wasting for under-five children in Gambia was lower than the world prevalence, but the prevalence of being underweight was higher. Children who are underweight have a significant association with both stunting and wasting. The age of the child, the child’s anemia level, and the birth type of the child are the common important determinants of stunting and underweight. The small birth size of a child was highly associated with a higher risk of stunting, underweight, and wasting among under five-year-olds.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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Factor associated with anthropometric failure among under-five Bengali children: A comparative study between Bangladesh and India. PLoS One 2022; 17:e0272634. [PMID: 35930584 PMCID: PMC9355208 DOI: 10.1371/journal.pone.0272634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Child undernutrition is a burden and the leading cause of child mortality in low-and middle-income countries like Bangladesh and India. Currently, this issue is a matter of great concern, inasmuch as achieving the Sustainable Development Goals (SDGs). The study intends to determine the factors of child undernutrition using a single composite index of anthropometric failure (CIAF) among the Bengali population. Methods Unit level data on 14055 under 5 children were extracted from the Bangladesh Demographic and Health Survey 2017–18 (BDHS) and the 4th National Family Health Survey of India (NFHS-4). To understand child undernutrition and generate CIAF, data on height-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight) were used by WHO guidelines. These three undernutrition indicators were combined into a single undernutrition indicator called anthropometric failure (anth-failure) using the CIAF concept. Explanatory factors of anth-failure included data on maternal health, socio-demographic and birth-related variables. Differences of frequency were determined by Z-proportional and Chi-square tests; predictors of anth-failure were determined by binary logistic regression. Cut off point of p-value was taken as 0.05 to test the significance. Results Inter-country disparities were revealed, about half of Bengali children in India and two-fifths in Bangladesh being prone to anth-failure. Stunting and underweight were more prevalent in both countries than wasting. Maternal undernutrition, lack of maternal education, and poor wealth index were common factors of anth-failure for both countries. Children in Bangladesh developed anth-failure after the end of breastfeeding period, indicating a lack of nutritious food. Lack of antenatal care was another significant factor in Bangladesh. In India, the first child suffered from anth-failure due to lack of maternal education. Conclusions This study provides a better understanding of multifactorial impact on child undernutrition. It is proposed that the emphasis should be on initiatives that improve maternal education and nutrition, child food security, boost household wealth index, and enhance mothers’ access to health care. The study strongly recommends that the governments of Bangladesh and India invest financially in preventing child malnutrition, which will contribute to achieving the first four SDGs.
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Reséndiz O, Torres C, Arredondo A, García Y, Orozco E. Determinantes de la inseguridad alimentaria y su asociación con prácticas de alimentación y lactancia materna en el primer año de vida. Glob Health Promot 2022; 29:17579759221076881. [PMID: 35916191 DOI: 10.1177/17579759221076881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJETIVO analizar los determinantes de la Inseguridad Alimentaria (IA) y su relación con las Prácticas de Alimentación (PA) y las Prácticas de Lactancia Materna (PLM) en el primer año de vida. MÉTODOS análisis de tipo cuantitativo sobre el binomio madre-hijo de una cohorte en México. Los datos de interés fueron el estado de seguridad alimentaria (SA), las PA y las PLM. Se desarrolló un modelo de regresión para evaluar determinantes asociados a la IA y un análisis de medias para determinar el impacto de la IA en las PA y las PLM. RESULTADOS el 54.1% de hogares presentó algún grado de IA. Las madres con pareja (OR = 0.25; p = 0.05) y con escolaridad superior (OR = 0.50; p = 0.04) tuvieron menor riesgo de padecer IA. En contraste, los hogares con mujeres mayores de 25 años estuvieron más expuestos a la IA (OR = 3.0; p = 0.00). Los hogares con IA introducen alimentos no recomendados como dulces, galletas o pastelitos (p = 0.00) y bebidas no lácteas azucaradas (p = 0.05) de forma prematura.Conclusiones:la IA requiere mayor atención por sus efectos en las PA y las PLM, las cuales son consideradas como factores asociados al desarrollo de mala nutrición.
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Affiliation(s)
| | - Christian Torres
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | | | - Yair García
- Universidad Autónoma de Querétaro, Queretaro, México
| | - Emanuel Orozco
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Shahid M, Liu Y, Ameer W, Qureshi MG, Ahmed F, Tang K. Comparison of Different Nutritional Screening Approaches and the Determinants of Malnutrition in Under-Five Children in a Marginalized District of Punjab Province, Pakistan. CHILDREN 2022; 9:children9071096. [PMID: 35884079 PMCID: PMC9316579 DOI: 10.3390/children9071096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
Objectives: This research measures the occurrence of malnutrition amongst under-five children in the Rahimyar Khan district of Southern Punjab in Pakistan. Employing different anthropometric measurement approaches such as (1) conventional indices (HAZ, WAZ, and WHZ), (2) CIAF, (3) BMI-for-age, and (4) MUAC, we compare their estimated results and examine the relationship between socioeconomic determinants and different anthropometric indicators. Methods: The study employs a proportional purposive random sampling method to collect data from 384 rural households in the community-based study using a self-administered survey and following the Lady Health Workers (LHWs) registered records. The nutritional status of 517 under-five children is measured with references to WHO (2009) child growth standards. Furthermore, the investigation used the model of binary logistic regression to measure the impact of socioeconomic factors on child malnutrition. Results: Compared with other approaches, the CIAF identifies more malnourished children (63%). The results of binary logistic regression illustrate that all the explanatory variables indicate a more significant empirical association with CIAF than conventional indices, BMI-for-age, and MUAC. Conclusion: CIAF is a more reliable tool for assessing child nutrition because it not only demonstrates more accurate estimates of malnutrition but also recognizes children with multiple anthropometric failures.
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Affiliation(s)
- Muhammad Shahid
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China;
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China
| | - Yongshuan Liu
- Party Committee Office, University of International Business and Economics (UIBE), Beijing 100029, China;
| | - Waqar Ameer
- Department of Economics, Shandong Business and Technology University, Yantai 264005, China;
| | - Madeeha Gohar Qureshi
- Department of Economics, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Farooq Ahmed
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China;
- Department of Anthropology, Quaid-i-Azam University, Islamabad 44400, Pakistan
- Correspondence: (F.A.); (K.T.); Tel.: +86-13671129425 (K.T.)
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China;
- Correspondence: (F.A.); (K.T.); Tel.: +86-13671129425 (K.T.)
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Gebremaryam T, Amare D, Ayalew T, Tigabu A, Menshaw T. Determinants of severe acute malnutrition among children aged 6-23 months in bahir dar city public hospitals, Northwest Ethiopia, 2020: a case control study. BMC Pediatr 2022; 22:296. [PMID: 35596187 PMCID: PMC9123747 DOI: 10.1186/s12887-022-03327-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Severe acute malnutrition is a major problem among developing countries and it is one of the major causes of mortality and morbidity in Ethiopia. The impact is more severe among children aged 6–23 months. Severely malnourished children are nine times more likely to die than healthy children. Identification of the determinants of severe acute malnutrition under the age of two years can significantly reduce the burden of child morbidity and mortality. Therefore, this study was aimed to assess determinants of severe acute malnutrition among children aged 6–23 months at Bahir Dar city public hospitals, Northwest Ethiopia, 2020. Methods Institutional-based unmatched case–control study was conducted among a total sample size of 201 children (67 cases and 134 controls) in Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized teaching hospital, from February 2020–March 2020. Children diagnosed with severe acute malnutrition were considered as cases and children with other problems were control groups. The study participants were randomly selected from pediatrics units in the two specialized hospitals. Data were collected using a structured pretested questionnaire through interviews and anthropometric measurements. The data were entered into Epi data version 3.1 and exported to SPSS software version 23 for analysis. Variables with (p < 0.25) in the bivariable analysis were entered into multivariable logistic regression. For multivariable analysis, a backward method was selected with a 95% confidence interval. Statistical significance was declared at P < 0.05. Results In this study, 67 cases and 134 controls of children with their mothers had participated with an overall response rate of 100%. Family size > 5 [(AOR = 3.89, 95% CI:(1.19, -12.70)], average perceived birth weight [(AOR = 0.048, 95% CI: 0.015, -0.148)] and large perceived birth weight [(AOR = 0.023, 95% CI:(0.002, -0.271)], introduction of complementary feeding before six months [(AOR = 6.21, 95% CI: (1.44, -26.76)] and dietary diversity score < 5 groups [(AOR = 9.20, 95% CI; 3.40, -19.83)were significant factors associated with severe acute malnutrition. Conclusion In this study, dietary diversity, family size, perceived birth weight, and initiation of complementary feeding were significantly associated with severe acute malnutrition. Therefore, emphasis should be given to improving infant and young child feeding practices, especially timely initiation of complementary feeding and dietary diversity. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03327-w.
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Affiliation(s)
- Tigist Gebremaryam
- College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Desalegne Amare
- School of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilksew Ayalew
- School of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Agimasie Tigabu
- College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tiruye Menshaw
- College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Kibemo B, Mulugeta A, Hailu D, Gelaw B. The association of socio-demographic and environmental factors with stunting among under-five children in Hawassa City, Sidama National Regional State, Ethiopia. J Nutr Sci 2022; 11:e33. [PMID: 35620765 PMCID: PMC9108000 DOI: 10.1017/jns.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Undernutrition in children is a challenging problem in developing countries, including Ethiopia. Stunting is the most prevalent form of undernutrition. The majority of studies on childhood stunting and its associated factors focused on children, maternal and socioeconomic components. However, a few studies reported poor WaSH status and antibiotic exposure as environmental risk factors for child stunting, and the case of socio-demographic factors also lacks consistency. Concerning this, there is a lack of information in Ethiopia. Therefore, the present study assessed the association of socio-demographic, WaSH, and antibiotic exposure with stunting among under-five children. A cross-sectional study was conducted involving 340 mother-child pairs. Anthropometric data were collected using standard and calibrated height and weight scales. For factorial data, an interviewer-guided standard questionnaire was used. Logistic regression analyses were used to identify factors determining childhood stunting. In the present study, the prevalence of stunting, underweight and wasting was 14⋅7 % (95 % CI 10⋅9, 18⋅5), 4⋅4 % (95 % CI 2⋅4, 6⋅8) and 2⋅1 % (95 % CI 0⋅6, 3⋅5), respectively. Low dietary diversity, being born from a mother with an education level of secondary school, and belonging to a female-headed household were positively associated (P < 0⋅05) with stunting. The prevalence of overall undernutrition was lower (21⋅2 %) in the study area. Stunting was significantly associated with dietary diversity, maternal educational level and sex of households head. The government policy should focus on enhancing the dietary diversity of households, and encouraging women's education.
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Affiliation(s)
- Berhanu Kibemo
- School of Nutrition, Food Science and Technology, College of Agriculture, University of Hawassa, Hawassa, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Dejene Hailu
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shahid M, Cao Y, Ahmed F, Raza S, Guo J, Malik NI, Rauf U, Qureshi MG, Saheed R, Maryam R. Does Mothers' Awareness of Health and Nutrition Matter? A Case Study of Child Malnutrition in Marginalized Rural Community of Punjab, Pakistan. Front Public Health 2022; 10:792164. [PMID: 35211439 PMCID: PMC8863129 DOI: 10.3389/fpubh.2022.792164] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal nutritional awareness might reduce the risk of malnutrition in children. This study assesses the impact of mothers' nutritional and health awareness (MNHA) on the nutritional status of pre-school children in rural South Punjab. Using a proportionate purposive simple random sampling technique we collect data with the help of a self-administered questionnaire on height, age, the weight of children, and socio-economic profile from 384 rural households in one of the marginalized districts of Punjab. The study applied the binary logistic regression model to compute the probability of malnutrition. The results indicate that malnutrition was high in the district (the prevalence rate for underweight is 46.1%, for stunting 34.83%, and for wasting is 15.49%). Around 91.84% of malnourished children belonged to the low MNHA category compared to medium (5.61%) and high (2.55%) MNHA categories. The results further show that the prevalence of moderate and severe stunting, wasting, and underweight in low MNHA categories was much higher with large differences compared to both medium and high MNHA categories. The binary logistic regression results depict that, across the household deprivation index (HDS), the odds of a child becoming malnourished were lower in households HDS-2 category (OR = 0.02, 95% CI: 0.01–0.89), and odds were also lower in households HDS-3 category (OR = 0.001, 95% CI: 0.001–0.16). Similarly, across the scores of MNHA index, the odds of malnutrition were lower among the children of those mothers who had medium MNHA (OR = 0.04, 95% CI: 0.002–1.24), and also the probability of child malnutrition was lower among the children of mothers who had high MNHA (OR = 0.008, 95% CI: 0.002–0.29). The study urges that well-resourced, targeted, and coordinated health and nutritional education and awareness programs are required to tackle malnutrition.
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Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing, China
| | - Yang Cao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing, China
| | - Farooq Ahmed
- Department of Anthropology, Quaid-I-Azam University, Islamabad, Pakistan.,Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Saqlain Raza
- Respiratory Care Department, College of Applied Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University, Al Jubail, Saudi Arabia
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Umara Rauf
- Department of Psychology, Government College Women University Sialkot, Sialkot, Pakistan
| | - Madeeha Gohar Qureshi
- Department of Economics, Pakistan Institute of Development Economics (PIDE), Islamabad, Pakistan
| | - Rafit Saheed
- School of Public Policy, Pakistan Institute of Development Economics (PIDE), Islamabad, Pakistan
| | - Rohma Maryam
- Department of Biotechnology, Quaid-I-Azam University, Islamabad, Pakistan
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Shrestha ML, Perry KE, Thapa B, Adhikari RP, Weissman A. Malnutrition matters: Association of stunting and underweight with early childhood development indicators in Nepal. MATERNAL & CHILD NUTRITION 2022; 18:e13321. [PMID: 35050554 PMCID: PMC8932687 DOI: 10.1111/mcn.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/28/2022]
Abstract
Malnutrition is a threat to optimal child development, with its occurrence during foetal and infancy stages associated with poor cognitive, motor and socio‐emotional skills. However, information on the effects of various types of malnutrition on early childhood development (ECD) is limited in Nepal. To assess the association of stunting, wasting and underweight (three prominent forms of malnutrition) with the four domains of the ECD index (literacy‐numeracy, physical, social‐emotional and learning development) among children 36–59 months of age, we conducted an adjusted logistic regression using Nepal's national household Multiple Indicator Cluster Survey (MICS) 2019 data set. The study sample consisted of children aged 36–59 months (n = 2871). Children were considered developmentally on track if they met criteria in each of the four ECD domains. Regarding ECD status of children 36–59 months old, 35% of children were not developmentally on track for the ECD index. The adjusted odds ratio indicated that stunting was associated with lower odds of not being developmentally on track according to the ECD index as well as the literacy‐numeracy, physical and learning domains of the ECD index. Likewise, underweight was associated with lower odds of not being developmentally on track according to the ECD index, primarily for ECD domains of literacy‐numeracy, physical and learning. Notably, no association between wasting and ECD indicators was observed. Children's nutrition status impacts child development outcomes. Adding ECD interventions, such as responsive and stimulating caregiving, within nutrition programmes among children who are stunted and underweight could improve child development outcomes. In Nepal, 35% of children in our data set did not display optimal early childhood development (ECD). Children who are malnourished, especially indicating signs of stunting and underweight, are likely to exhibit poor ECD indicators and may have limited cognitive capabilities in adulthood. Wasting demonstrated no notable association with ECD indicators. Study findings suggest that ECD interventions among children who are stunted and underweight could support optimal childhood development globally. Establishing partnerships between nutrition and ECD sectors to adopt the Nurturing Care Framework, especially targeting the first 5 years of life, would contribute to childhood development efforts.
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Affiliation(s)
| | | | | | | | - Amy Weissman
- FHI 360 Asia Pacific Regional Office Bangkok Thailand
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Ahmed AT, Abas AH, Elmi A, Omer A. Determinants of severe acute malnutrition among children aged 6-36 months in Kalafo district (riverine context) of Ethiopia. Sci Rep 2022; 12:5198. [PMID: 35338207 PMCID: PMC8956698 DOI: 10.1038/s41598-022-09184-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/17/2022] [Indexed: 12/26/2022] Open
Abstract
Malnutrition remains prevalent and existing health problem globally. Particularly Undernutrition is a major public health issue in developing countries. Globally the causes of severe acute undernutrition varies across context. The aim of this study was to identify the determinants of severe acute malnutrition to uncover contextual factors based on UNICEF conceptual framework, as there was no study done in a similar context in Ethiopia. Health facility based (health post) un-matched case control study with Key informant interview was conducted to identify determinant factors of severe acute malnutrition (SAM) among children between 6 and 36 months. 246 children (82 cases and 164) with their mothers or care takers participated the study which was conducted between December 20, 2019 to January 20, 2020 in Kalafo district in Shebele River. Odds ratio with 95% confidence interval was calculated to identify the determinants of SAM among children aged 6-36 months using multivariate logistic regression. The odds of severe acute malnutrition was 2.28 (1.22, 4.26); 4.68 (2.29, 9.58); 2.85 (1.26, 6.45); 2.39 (1.16, 4.96) and 3.262 (1.46, 7.31) and 3.237 (1.45, 7.23); respectively for mothers with three or more under five children, Children with inadequate dietary diversity, experienced diarrhea in past 2 weeks, their mothers had not nutrition counselling during pregnancy and younger (6-11 and 12-17 months) children as compared to controls. The finding of this study reveals the main determinants of severe acute malnutrition in riverine context are multi-level. In addition to this, poor childcare and polygamy identified in qualitative finding. Decisive and multi-sectoral approach is required to addressing SAM in the riverine area.
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Affiliation(s)
- Ahmed Tahir Ahmed
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia.
| | - Abdulahi Haji Abas
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
| | - Abdifatah Elmi
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
| | - Abdilahi Omer
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
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25
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Time to relapse of severe acute malnutrition and risk factors among under-five children treated in the health posts of Hadiya Zone, Southern Ethiopia. J Nutr Sci 2022; 10:e105. [PMID: 35059186 PMCID: PMC8727703 DOI: 10.1017/jns.2021.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/05/2021] [Accepted: 11/18/2021] [Indexed: 11/06/2022] Open
Abstract
Relapse/repeated episodes are defined as the admission of a child with a diagnosis of severe acute malnutrition (SAM) after being discharged with a status of recovery. However, there is a lack of study that documented the time to relapse of SAM and its risk factors. The present study aimed to identify the time of relapse and its risk factor among under-five children discharged after undergoing treatment for SAM in health facilities of Hadiya Zone, South Ethiopia. An institution-based retrospective cohort study was carried out in the Hadiya Zone of Southern Ethiopia among under-five children. Data were collected from 760 cards of severe acute malnourished children over the past 5 years spanning from 2014/15 to 2019/20. Both first admission and relapse data were abstracted from the records of the SAM children from 1 August to 30 August 2020 and cards of children that were admitted to program by transferee with complete records were included. After checking all the assumptions, multivariable Cox Proportional Hazards model was fitted to isolate independent determinants of time to cure. All tests were two-sided and statistical significance at P-values < 0⋅05. The mean(±sd) time for relapse of SAM among under-five children was 22(±9⋅9) weeks from discharge to relapse time. On multivariable Cox Proportional Hazards model, the hazard of relapse for SAM was significantly higher for children who had oedema (AHR 2⋅02, 95 % CI 1⋅17, 3⋅50), age of 6-11 months (AHR 5⋅2, 95 % CI 1⋅95, 13⋅87) had discharge MUAC not cured (AHR12, 95% CI 7⋅90, 19⋅52). The finding showed that children discharged from SAM are likely to have relapse in 3 weeks time.
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Chowdhury MRK, Khan HTA, Rashid M, Mondal MNI, Bornee FA, Billah B. Prevalence and correlates of severe under-5 child anthropometric failure measured by the composite index of severe anthropometric failure in Bangladesh. Front Pediatr 2022; 10:978568. [PMID: 36186640 PMCID: PMC9516305 DOI: 10.3389/fped.2022.978568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although Bangladesh has made noticeable progress in reducing the prevalence of stunting, wasting, and being underweight among under-5 children, it has not been very successful in reducing overall severe anthropometric failure (SAF) among them. Therefore, the study aims to identify the prevalence and risk factors of SAF measured by the Composite Index of Severe Anthropometric Failure (CISAF) among under-5 children in Bangladesh. METHODS Data was drawn from a cross-sectional Bangladesh Demographic Health Survey (BDHS) conducted in 2017-2018. A bivariate analysis (Chi-square test) and logistic regression analysis were used to estimate the unadjusted, and age and sex-adjusted prevalence of SAF. Odds ratio (OR) and confidence interval (CI) were assessed using logistic regression analysis to identify the various risk factor of SAF. RESULTS The overall adjusted prevalence of under-5 child SAF was 11.3% (95% CI: 10.6-12.0) and it was highly prevalent among children of uneducated mothers (adjusted, 22%, 95% CI: 17.3-26.8). The key factors associated with SAF were children in the age group 24-35 months (OR: 2.43, 95% CI: 1.83-3.23), children born with low birth weight (OR: 3.14, 95% CI: 2.24-4.97), children of underweight mothers (OR: 1.82, 95% CI: 1.44-2.29), children of parents with no formal education (OR: 2.28, 95% CI: 1.56-3.31) and children from lower socio-economic status (OR: 2.25, 95% CI: 1.55-3.26). CONCLUSION Prioritizing and ensuring context-specific interventions addressing individual, community, public policy, and environment level risk factors from policy level to implementation to reduce structural and intermediary determinants of under-5 SAF.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hafiz T A Khan
- Health Promotion and Public Health, College of Nursing, Midwifery and Healthcare, University of West London, London, United Kingdom
| | - Mamunur Rashid
- Department of Public Health Science, Faculty of Occupational and Health Sciences, University of Gävle, Gävle, Sweden
| | - Md Nazrul Islam Mondal
- Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Farzana Akhter Bornee
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Baki Billah
- Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Karim MR, Al Mamun ASM, Rana MM, Mahumud RA, Shoma NN, Dutt D, Bharati P, Hossain MG. Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation. BMC Pediatr 2021; 21:573. [PMID: 34903193 PMCID: PMC8667456 DOI: 10.1186/s12887-021-03033-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh. Methods This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM. Result The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6–23 months (aOR = 2.29, 95% CI: 1.20–4.37; p < 0.05), (ii) early childbearing mothers’ (age < 20 years) children (aOR = 3.06, 95% CI: 1.08–8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11–8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52–5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19–0.92; p < 0.05). Conclusion The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.
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Affiliation(s)
- Md Reazul Karim
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | | | - Md Masud Rana
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Nurun Naher Shoma
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Dhiman Dutt
- Swiss Red Cross, House# 35, Road # 117, Gulshan-1, Dhaka, 1212, Bangladesh
| | - Premananda Bharati
- Biological Anthropology, Indian Statistical Institute, 203 BT Road, Kolkata, West Bengal, 700 108, India
| | - Md Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Das K, Das S, Mohapatra S, Swain A, Mohakud NK. Risk and Adverse Outcome Factors of Severe Acute Malnutrition in Children: A Hospital-Based Study in Odisha. Cureus 2021; 13:e18364. [PMID: 34737917 PMCID: PMC8557996 DOI: 10.7759/cureus.18364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Malnutrition is prevalent in 41% of children less than five years old in developing countries. Objective To determine the clinical spectrum, identify the risk factors, and find out the factors responsible for the adverse outcomes of severe acute malnutrition (SAM) in children. Methods In this prospective cohort, children aged one month to five years with SAM from October 2016 to September 2018 were enrolled. Clinical profile, contributing factors, treatment, and outcome of cases (n=198) were noted. Results SAM was diagnosed in 323 (1.6%) of admitted cases. The unimmunized children were 123 (62.1%). Common co-morbidities were acute gastroenteritis (n=89, 44.9%), respiratory tract infection (n=88, 44.4%), and septicemia (n=54, 26.7%). Children not on exclusive breastfeeding (n=157, 79.1%), early complementary feeding (<6 months) (n=157, 88.2%), bottle-feeding (n=138, 77.55%), low birth weight (157, 79.1%), living in kutcha houses (115, 58.2%), and unavailability of safe drinking water (131, 66.4%) were the significant risk factors. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes. One hundred and eighty-three (92.4%) children were cured and discharged and 15 (7.6%) children died. Conclusions Wrong feeding practices and unavailability of safe drinking water have an important bearing on the development of SAM children. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes.
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Affiliation(s)
- Kedarnath Das
- Paediatrics, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Swarnalata Das
- Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Arakhita Swain
- Paediatrics, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Nirmal K Mohakud
- Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Chanie ES, Dagne Z, Jimma MS, Eyayu T, Nebiyu S, Wondifraw EB, GebreEyesus FA, Yemata GA, Melkie A. The effect of timely initiation of complementary feeding and vitamin A supplementation on acute malnutrition among children aged 6-59 months attending Hamusit Health Centre, Northwest Ethiopia, 2021: A cross-sectional study. Heliyon 2021; 7:e08449. [PMID: 34901501 PMCID: PMC8637469 DOI: 10.1016/j.heliyon.2021.e08449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/03/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Acute malnutrition is a nutritional deficiency that results either from inadequate energy or protein intake. It is more prevalent in low- and middle-income countries. Even though efforts have been carried out at the global and national level, the burden is still intolerable and it attracts the attention of the government and researchers. Hence, this study aims to assess the magnitude of acute malnutrition and its associated factors among under-five children who attended Hamusit Health Centre from 1st September to 30th January 2021. MATERIALS AND METHODS This institution-based cross-sectional study was conducted from 1st September to 30th January on 404 randomly selected under-five children who visited the health centre. Samples were selected using a simple random sampling technique, and the data were obtained using a pre-tested standardized questionnaire. For data entry and analysis, Epi-info 7 and SPSS 21 applications were used, respectively. Bivariable and multivariable binary logistic regression were used to identify associated factors at a 95% confidence interval. Significance was considered at p-value<0.05. RESULTS The present research involved a total of 404 children aged 6-59 months. The magnitude of acute malnutrition in this study was 14.4%. Children aged 6-23 months [AOR: 2.92; 95%CI (1.46, 5.85)], vitamin A supplementation [AOR: 0.49; 95%CI (0.25, 0.95)], not timely initiation of complementary feeding [AOR: 2.02; 95%CI (1.06, 3.82)] and children with diarrhea prior to two weeks of the survey [AOR: 2.47; 95% CI (1.28, 4.87)] were significantly associated with acute malnutrition. CONCLUSION A significant number of children aged 6-59 months were affected by acute malnutrition. Younger children, vitamin A supplementation, not timely initiation of complementary feeding, and children with diarrhoea were other factors associated with acute malnutrition.
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Affiliation(s)
| | | | | | - Tahir Eyayu
- Debre Tabor University, Debre Tabor, Ethiopia
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Caillaud S, Ginguené S, Maharjan SM, Koirala G, Tonon B, Le Roch K. Social representations of the undernourished child and health‐seeking behaviour in Nepal: From othering to different types of otherness. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Sujen Man Maharjan
- Mental Health and Care practices, Gender and Protection Action Against Hunger Kathmandu Nepal
| | - Gobinda Koirala
- Mental Health and Care practices, Gender and Protection Action Against Hunger Kathmandu Nepal
| | - Brigitte Tonon
- Mental Health and Care Practices, Gender and Protection Action Contre la Faim Paris France
| | - Karine Le Roch
- Mental Health and Care Practices, Gender and Protection Action Contre la Faim Paris France
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Tripoli FM, Accomando S, La Placa S, Pietravalle A, Putoto G, Corsello G, Giuffrè M. Analysis of risk and prognostic factors in a population of pediatric patients hospitalized for acute malnutrition at the Chiulo hospital, Angola. Ital J Pediatr 2021; 47:184. [PMID: 34507598 PMCID: PMC8434719 DOI: 10.1186/s13052-021-01140-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is a multifactorial pathology in which genetic, epigenetic, cultural, environmental, socio-economic factors interact with each other. The impact that this disease has on the health of children worldwide is dramatic. Severe acute malnutrition in particular is a disease affecting nearly 20 million preschool children worldwide, most of them in Africa and South East Asia. Objectives This work aims to investigate potential prognostic factors in the clinical evolution of acute malnutrition and potential risk factors for the development of the disease. Methods Our study was carried out at the “Hospital da Missão Catolica do Chiulo”, in Angola, where the NGO Doctors with Africa CUAMM has been operating since 2000. In the first part of the study we analyzed the characteristics and clinical evolution of 163 patients hospitalized for acute malnutrition at the UEN (Unidade Especial de Nutrição) of the Chiulo Hospital over a period of 6 months, in order to identify potential prognostic factors of the disease. The second part of our study was carried out by administering a questionnaire to a group of caregivers of malnourished children and to a group of caregivers of non-malnourished children admitted to Pediatrics for other causes, with the aim of identifying potential risk factors for the development of malnutrition. Results and conclusions The analysis of prognostic factors revealed that the most relevant are the WHZ (weight for height z-score) at the time of admission, the presence of Stunting and the presence of other pathologies or clinical conditions associated with severe acute malnutrition. The analysis of risk factors has shown that not only food shortages, but also errors in the timing of the suspension of breastfeeding and the timing of the introduction of complementary foods play an important role. Equally important were some family risk factors, including the size of the family unit and the presence of deceased children. It also emerged that the lack of knowledge of what a child needs to grow up healthy often affects the development of malnutrition. It follows that a useful and low-cost tool for preventing child malnutrition would be large-scale nutrition education campaigns.
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Affiliation(s)
- Federica Maria Tripoli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.,Doctors with Africa, CUAMM, Chiulo, Ombadja, Angola
| | - Salvatore Accomando
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Simona La Placa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | | | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
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Sarr M, Tidjani Alou M, Delerce J, Khelaifia S, Diagne N, Diallo A, Bassene H, Bréchard L, Bossi V, Mbaye B, Lagier JC, Levasseur A, Sokhna C, Million M, Raoult D. A Listeria monocytogenes clone in human breast milk associated with severe acute malnutrition in West Africa: A multicentric case-controlled study. PLoS Negl Trop Dis 2021; 15:e0009555. [PMID: 34185789 PMCID: PMC8291692 DOI: 10.1371/journal.pntd.0009555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/20/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Severe acute malnutrition (SAM) is a major public health problem affecting children under the age of five in many low- and middle-income countries, and its resolution would contribute towards achieving the several sustainable development goals. The etiology of SAM is pluri-factorial, including delayed maturation of the gut microbiota, suboptimal feeding practices and dysfunctional breastfeeding. The recent serendipitous detection of Listeria monocytogenes in the breast milk of Malian women, in contrast to French women, suggests a possible association with SAM. Methodology/ Principal findings To investigate the possible association of L. monocytogenes carriage in breast milk and SAM, a case-control study was performed in Senegal, with subjects recruited from two areas. Using 16S amplicon sequencing, a culture independent method, 100% (152/152) of the mothers were positive for L. monocytogenes in their breast milk while qPCR analysis gave lower recovery rates. Interestingly, after enrichment in Fraser broth and seeding on PALCALM agar, all 10 isolated strains were isolated from the milk of 10 mothers who had SAM children which also had a significantly increased relative abundance of L. monocytogenes (0.34 (SD 0.35) vs 0.05 (SD 0.07) in controls, p<0.0001). The high genomic similarity between these strains and Malian breast milk strains from a previous study supports the hypothesis of endemic clone carriage in West Africa. Moreover, the in vitro growth inhibition of L. monocytogenes using breast milk samples was obtained from only 50% of the milk of mothers who had SAM children, in contrast to control samples which systematically inhibited the growth of L. monocytogenes with a higher inhibition diameter (15.7 mm (SD 2.3) in controls versus 3.5 mm (SD 4.6) in SAM, p = 0.0001). Lactobacillus and Streptococcus isolated from the breast milk of controls inhibit L. monocytogenes in a species-dependent manner. Conclusions/Significance Our study reveals a previously unsuspected carriage of L. monocytogenes in the breast milk of West African women, which is associated with SAM. The inhibitory effect of human selected lactic acid bacterial species against L. monocytogenes might provide new therapeutic and inexpensive options to prevent and treat this neglected public health issue. Severe acute malnutrition is a global public health issue which greatly impacts childhood mortality rates. Although still not fully understood, the multi-factorial pathology of severe acute malnutrition has been associated, among other factors, with sub-optimal feeding practices (including dysfunctional breastfeeding) and an altered gut microbiota. The serendipitous detection of Listeria monocytogenes in the breast milk of Malian women has raised the possibility of its involvement in the pathogenesis of severe acute malnutrition. To investigate this possibility, the presence of L. monocytogenes was assessed in a cohort of lactating Senegalese women, both mothers of healthy children as well as those of severely malnourished children using culture-dependent and independent methods. Our study confirms the previously unsuspected presence of L. monocytogenes in the breast milk of Senegalese women, which is increased in the milk of mothers of severely malnourished children. Moreover, breast milk samples from the mothers of healthy children more frequently induced a potent inhibition of L. monocytogenes than those from the mothers of severely malnourished children. An inhibition was also achieved using potential probiotics, Lactobacillus and Streptococcus species, isolated from breast milk. Our study reveals the previously unsuspected carriage of L. monocytogenes in the breast milk of West African women, which is associated with severe acute malnutrition. The inhibitory effect of human selected lactic acid bacterial species against L. monocytogenes might provide new therapeutic and inexpensive options to prevent and treat this neglected public health issue.
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Affiliation(s)
- Marièma Sarr
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
- Campus Commun UCAD-IRD of Hann, Dakar, Senegal
| | - Maryam Tidjani Alou
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Jeremy Delerce
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Saber Khelaifia
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Nafissatou Diagne
- Campus Commun UCAD-IRD of Hann, Dakar, Senegal
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Aldiouma Diallo
- Campus Commun UCAD-IRD of Hann, Dakar, Senegal
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Hubert Bassene
- Campus Commun UCAD-IRD of Hann, Dakar, Senegal
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Ludivine Bréchard
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Vincent Bossi
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Babacar Mbaye
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Anthony Levasseur
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Cheikh Sokhna
- Campus Commun UCAD-IRD of Hann, Dakar, Senegal
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
- * E-mail:
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Rahman SMJ, Ahmed NAMF, Abedin MM, Ahammed B, Ali M, Rahman MJ, Maniruzzaman M. Investigate the risk factors of stunting, wasting, and underweight among under-five Bangladeshi children and its prediction based on machine learning approach. PLoS One 2021; 16:e0253172. [PMID: 34138925 PMCID: PMC8211236 DOI: 10.1371/journal.pone.0253172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Aims Malnutrition is a major health issue among Bangladeshi under-five (U5) children. Children are malnourished if the calories and proteins they take through their diet are not sufficient for their growth and maintenance. The goal of the research was to use machine learning (ML) algorithms to detect the risk factors of malnutrition (stunted, wasted, and underweight) as well as their prediction. Methods This work utilized malnutrition data that was derived from Bangladesh Demographic and Health Survey which was conducted in 2014. The selected dataset consisted of 7079 children with 13 factors. The potential risks of malnutrition have been identified by logistic regression (LR). Moreover, 3 ML classifiers (support vector machine (SVM), random forest (RF), and LR) have been implemented for predicting malnutrition and the performance of these ML algorithms were assessed on the basis of accuracy. Results The average prevalence of stunted, wasted, and underweight was 35.4%, 15.4%, and 32.8%, respectively. It was noted that LR identified five risk factors for stunting and underweight, as well as four factors for wasting. Results illustrated that RF can be accurately classified as stunted, wasted, and underweight children and obtained the highest accuracy of 88.3% for stunted, 87.7% for wasted, and 85.7% for underweight. Conclusion This research focused on the identification and prediction of major risk factors for stunting, wasting, and underweight using ML algorithms which will aid policymakers in reducing malnutrition among Bangladesh’s U5 children.
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Affiliation(s)
| | | | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Mohammad Ali
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Md. Maniruzzaman
- Statistics Discipline, Khulna University, Khulna, Bangladesh
- * E-mail:
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Ghosh PK, Das P, Goswam DR, Islam A, Chowdhury S, Mollah MM, Harun GD, Akhtar Z, Chowdhury F. Maternal Characteristics Mediating the Impact of Household Poverty on the Nutritional Status of Children Under 5 Years of Age in Bangladesh. Food Nutr Bull 2021; 42:389-398. [PMID: 34058896 DOI: 10.1177/0379572121999016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We explored the maternal characteristics that mediate the effect of household poverty on childhood undernutrition. METHODS We used the population-based Bangladesh Demographic Health Survey data from 2014 for demographic characteristics, child and maternal factors. RESULTS Of the 7173 under-5 children, 3456 (48.2%) had undernutrition. The prevalence of undernutrition was less common in wealthy households (poorest vs richest: adjusted prevalence ratio [aPR] = 1.37), mothers having history of antenatal care (ANC) visits (no visit vs ≥ 4 visits: aPR = 1.22), maternal higher education (no education vs higher education: aPR = 1.54), and mothers with good nutritional status (underweight vs healthy: aPR = 1.13). The risk of undernutrition (37.1%) was attributed to household wealth, mediated 55% by maternal factors; of which 20% by maternal education, 21% by ANC visits, and 14% by maternal nutritional status. CONCLUSIONS Our study findings outlined higher maternal education, ≥ 4 ANC visits and good maternal nutritional status in mediating the impact of household wealth on childhood nutrition.
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Affiliation(s)
- Probir Kumar Ghosh
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pritimoy Das
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Doli Rani Goswam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ausraful Islam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sukanta Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Zubair Akhtar
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Choedon T, Dinachandra K, Sethi V, Kumar P. Screening and Management of Maternal Malnutrition in Nutritional Rehabilitation Centers as a Routine Service: A Feasibility Study in Kalawati Saran Children Hospital, New Delhi. Indian J Community Med 2021; 46:241-246. [PMID: 34321734 PMCID: PMC8281876 DOI: 10.4103/ijcm.ijcm_491_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In India, Nutrition Rehabilitation Centers (NRCs) established at public health facilities provide residential medical nutrition therapy for severe acute malnutrition (SAM) children with complications. A large proportion of their mothers are also malnourished. NRCs do not provide services to such mothers as part of routine practice. However, technical algorithm for delivering Maternal Nutrition (MN) services in facility settings is available. Objectives: To test the practical feasibility of layering the MN services in NRC as a routine service. Methods: The MN services were delivered by a nutrition counselor using a triage approach (assess, classify, supplement/counsel/treat). All mothers received diet, micronutrients, and group counseling, those at nutritional risk received individual counseling and SAM mothers also received catch-up diet during their stay. Program data were collected from mothers during January 1 to August 31, 2019 at the NRC in Kalawati Saran Children Hospital. To gain operational insights, a structured interview with nutrition counselor was conducted. Results: Out of 168 mothers, 8% were found to be pregnant and 89% were at nutrition or medical risk. The prevalence of short stature was 18%, severe/thin 21%, overweight/obese 34%, and anemic 72%. Feedback from the nutrition counselor indicated no operational challenges, however, further efforts to ensure that mothers keep coming back for follow-up visits is needed. Conclusion: The findings indicated that existing staffs were able to deliver the MN services within the time, cost, and regime of the routine NRC. This paper provides four recommendations for layering the MN services in NRCs.
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Affiliation(s)
- Tashi Choedon
- National Centre of Excellence and Advanced Research on Diets, Lady Irwin College, New Delhi, India
| | - Konsam Dinachandra
- National Centre of Excellence and Advanced Research on Diets, Lady Irwin College, New Delhi, India
| | - Vani Sethi
- Nutrition Division, Kalawati Saran Children's Hospital, Associated Lady Hardinge Medical College, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Kalawati Saran Children's Hospital, Associated Lady Hardinge Medical College, New Delhi, India
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Menalu MM, Bayleyegn AD, Tizazu MA, Amare NS. Assessment of Prevalence and Factors Associated with Malnutrition Among Under-Five Children in Debre Berhan Town, Ethiopia. Int J Gen Med 2021; 14:1683-1697. [PMID: 33976568 PMCID: PMC8104975 DOI: 10.2147/ijgm.s307026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
Background Malnutrition is a deficiency or improper intake of energy and nutrients. It includes undernutrition (wasting, stunting, underweight, and mineral and vitamin-related malnutrition) and overnutrition. Purpose To estimate the prevalence and identify the risk factors for undernutrition among under-five children in Debre Berhan Town, North Shewa, Ethiopia. Methods A community-based cross-sectional study was conducted in Debre Berhan Town, from October 07, 2019 to January 24, 2020. Three hundred and eighty-five under-five children who were selected using systematic random sampling technique were included in this study. To collect data, a structured questionnaire and anthropometrical measurements were used. Data entry was done through Epi data 4.21, and for data analysis statistical package for social sciences version 20.0 was employed. Bivariate and multivariable logistic regression analysis was used to identify the factors associated with malnutrition. The statistical significance was stated at p value <0.05 with 95% confidence intervals. Results In the overall sample the total prevalence of undernutrition in below age-5 children was 61 (15.8%), the corresponding figures for underweight, stunted, and wasting were 26%, 41%, and 33%, respectively. Factors that contributed to under-five undernutrition were maternal illiteracy, not breastfeeding exclusively, preterm birth, absence of antenatal care, exposure to infectious diseases and diarrhea. Conclusion There was a higher prevalence of stunting (41%), wasting (33%), and being underweight (26%) in Debre Berhan town than the national (Ethiopia) or regional (Amhara) malnutrition prevalence. Mothers’ educational status should be improved by teaching them that proper nutrition is important for their child’s growth and development. Antenatal care for all pregnant women, education on child care, infection prevention, and child feeding should be provided and further strengthened.
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Affiliation(s)
- Mulat Mossie Menalu
- Department of Nursing, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Alebachew Demelash Bayleyegn
- Department of Nursing, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Michael Amera Tizazu
- Department of Midwifery, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Nakachew Sewnet Amare
- Department of Midwifery, College of Health Science, Institute of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Medialdea L, Bogin B, Thiam M, Vargas A, Marrodán MD, Dossou NI. Severe acute malnutrition morphological patterns in children under five. Sci Rep 2021; 11:4237. [PMID: 33608567 PMCID: PMC7895927 DOI: 10.1038/s41598-021-82727-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/24/2020] [Indexed: 01/14/2023] Open
Abstract
Current methods for infant and child nutritional assessment rely on anthropometric measurements, whose implementation faces technical challenges in low- and middle-income countries. Anthropometry is also limited to linear measurements, ignoring important body shape information related to health. This work proposes the use of 2D geometric morphometric techniques applied to a sample of Senegalese participants aged 6–59 months with an optimal nutritional condition or with severe acute malnutrition to address morphometric variations due to nutritional status. Significant differences in shape and size body changes were described according to nutritional status, resulting age, sex and allometric effect crucial factors to establish nutritional morphological patterns. The constructed discriminant functions exhibited the best classification rates in the left arm. A landmark-based template registering body shape could be useful to both assess acute malnutrition and better understand the morphological patterns that nutritional status promotes in children during their first 5 years of growth and development.
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Affiliation(s)
- Laura Medialdea
- Technical Department, Action Against Hunger (AAH) Foundation, Madrid, Spain. .,Laboratorio de Poblaciones del Pasado (LAPP), Departamento de Biología, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Barry Bogin
- UCSD/Salk Center for Academic Research and Training in Anthropogeny (CARTA), University of California San Diego, San Diego, USA.,School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Mbeugue Thiam
- Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Antonio Vargas
- Technical Department, Action Against Hunger (AAH) Foundation, Madrid, Spain
| | - María D Marrodán
- Grupo de Investigación EPINUT, Facultad de Medicina, Departamento de Biodiversidad, Ecología y Evolución, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Nicole I Dossou
- Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
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Dahal K, Yadav DK, Baral D, Yadav BK. Determinants of severe acute malnutrition among under 5 children in Satar community of Jhapa, Nepal. PLoS One 2021; 16:e0245151. [PMID: 33534789 PMCID: PMC7857586 DOI: 10.1371/journal.pone.0245151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal. Material & methods A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition. Results A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding <8 times/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding <8 times/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM. Conclusion Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.
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Affiliation(s)
- Kajol Dahal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
- * E-mail:
| | - Deepak Kumar Yadav
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dharanidhar Baral
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Birendra Kumar Yadav
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
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Amaha ND. Ethiopian progress towards achieving the global nutrition targets of 2025: analysis of sub-national trends and progress inequalities. BMC Res Notes 2020; 13:559. [PMID: 33298157 PMCID: PMC7726871 DOI: 10.1186/s13104-020-05408-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/28/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives The World Health Assembly (WHA) developed six global nutrition targets that focus on child and maternal nutrition. The progress made by individual countries is available as a yearly global nutrition report. However, reporting the national progress might mask important sub-national differences. This study aimed to measure the progress of the 11 regions of Ethiopia towards achieving the 2025 WHA targets using average annual reduction rates (AARR). Results Ethiopia is off-track in meeting the five global nutrition targets studied. The national AARR of stunting is 2.3 against a target of 5.3, for wasting the current AARR is 3.1 against a target of 5.3. The AARR of non-exclusive breastfeeding was 2.1 close to the target of 2.7. Anemia in women of reproductive age increased across all the regions of Ethiopia. The majority of Ethiopian regions were on track to achieving the overweight and exclusive breastfeeding targets by 2025. There is an urgent need to address anemia in Ethiopian women of reproductive age because its prevalence has been increasing. Secondly, the progress to reduce wasting and stunting in children under-5 has not been enough and more work needs to be done if Ethiopia is to achieve the 2025 targets.
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Affiliation(s)
- Nebyu Daniel Amaha
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, P.O Box: 1871, Mekele, Tigray, Ethiopia.
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Imam A, Hassan-Hanga F, Sallahdeen A, Farouk ZL. Socio-demographic and Household-Level Risk Factors for Severe Acute Malnutrition in Pre-school Children in North-Western Nigeria. J Trop Pediatr 2020; 66:589-597. [PMID: 32417915 DOI: 10.1093/tropej/fmaa018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Severe acute malnutrition (SAM) is associated with significant morbidity and mortality and is disproportionately distributed mainly in developing countries. In Nigeria, the prevalence of SAM in the North-Western region of the country is significantly higher than the national average. In this study, we identified risk factors for SAM in North-Western Nigeria. Identifying such risk factors would be helpful in developing local preventive strategies and providing insights for broader SAM control programs in other high-burden country settings. METHODS We performed post hoc data analysis, comparing baseline socio-demographic and household-level risk factors in a cohort of 1011 children aged between 6 and 59 months who either had SAM or were well-nourished children. We defined nutritional status using the World Health Organization (WHO) reference standards and investigated the association between SAM and our identified risk factors using multivariable logistic regression model. RESULTS Children aged between 12 and 23 months [adjusted odds ratio (AOR) 2.95, 95% confidence interval (CI) 1.99-4.38], household who reared domestic animals (AOR 1.94, 95% CI 1.40-2.69) and those from polygamous households (AOR 1.91, 95% CI 1.33-2.74) had significantly increased odds of developing SAM. Parental education and being on the household diet reduced the odds of having SAM. CONCLUSIONS Our findings suggest the need to develop optimal complementary feeding nutrition programs and promote adult and general education in our community. Cultural and feeding practices in local polygamous households also need further investigation to understand the association between polygamy with SAM.
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Affiliation(s)
- Abdulazeez Imam
- Department of Vaccines and Immunity, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 452, Fajara, Gambia
| | - Fatimah Hassan-Hanga
- Department of Paediatrics, Bayero University, Kano, Nigeria.,Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Azeezat Sallahdeen
- Department of Vaccines and Immunity, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 452, Fajara, Gambia
| | - Zubaida L Farouk
- Department of Paediatrics, Bayero University, Kano, Nigeria.,Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
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Laillou A, Gauthier L, Wieringa F, Berger J, Chea S, Poirot E. Reducing malnutrition in Cambodia. A modeling exercise to prioritize multisectoral interventions. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 2:e12770. [PMID: 32835454 PMCID: PMC7591311 DOI: 10.1111/mcn.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022]
Abstract
Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6-23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north-eastern provinces and the capital and used as cross-sectional. Socio-demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low-household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north-eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity-focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
| | | | - Frank Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Samnang Chea
- Council of Agriculture and Development (CARD), Office of the Council of MinistersPhnom PenhCambodia
| | - Etienne Poirot
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
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Socio-demographic risk factors for severe malnutrition in children aged under five among various birth cohorts in Bangladesh. J Biosoc Sci 2020; 53:590-605. [PMID: 32787991 DOI: 10.1017/s0021932020000425] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were 'only one form' and 'multiple forms' of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother's education, father's occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.
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Bitew ZW, Alebel A, Worku T, Alemu A. Recovery rate and its predictors among children with severe acute malnutrition in Addis Ababa, Ethiopia: A retrospective cohort study. PLoS One 2020; 15:e0235259. [PMID: 32701985 PMCID: PMC7377431 DOI: 10.1371/journal.pone.0235259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Malnutrition is a public health problem in under-five children in several parts of the world even after decades of the implementation of management protocols. An estimated 17 million children under the age of five years are living with severe acute malnutrition and the majorities are found in Asia and Africa, including Ethiopia. OBJECTIVE The main objective of this study was to determine the recovery rate and its predictors among under-five children who were admitted to St. Paul's Hospital Millennium Medical College from 2012 to 2019. METHODS An institution based retrospective cohort study was employed at St. Paul's Hospital Millennium Medical College from May 20, 2019 to June 28, 2019. Data were collected by reviewing children's' medical records using a structured checklist. A total of 534 charts were selected using a simple random sampling method and 515 of them were used for the final analysis. Ep-info version 7 software was used for data entry and STATA Version 15 for analysis. The Kaplan Meier failure estimate with Log-rank test was used to determine the survival estimates. Bi-variable and multivariable Cox proportional hazards regression model were fitted to identify predictors of mortality. Finally, variables with p-values less than 0.05 in the multivariable Cox regression were considered as independent predictors. The proportional hazards assumption was checked using the Schoenfeld residuals test and the final model fitness was checked using the Cox-Snail residual test. RESULT In this study, a total of 515 subjects were followed for 8672 child-days and 79% of the subjects recovered from SAM with the median time of 17 days. The incidence density rate of recovery was 46 per 1000 child-days. Tuberculosis (AHR(Adjusted Hazard Ratio) 0.44 & 95% CI: 0.32, 0.62), pale conjunctiva (AHR,0.67 & 95% CI: 0.52, 0.88), IV fluid infusion (AHR, 0.71 & 95 CI: 0.51, 0.98), feeding F100 (AHR, 1.63 & 95% CI:1.04,2.54), Vitamin A supplementation (AHR, 1.3 & 95% CI:1.07, 1.59) and bottle feeding (AHR, 0.79 & 95CI%: 0.64-0.98) were the independent predictors of time to recovery from SAM. CONCLUSION In conclusion, the recovery rate was relatively higher than the Sphere standard and the national SAM management protocol. Co-morbidities and the treatments given were the main determinants of recovery of children. Co-morbidities must be managed as early as possible and the treatments given during the SAM management process need to be given with precaution.
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Affiliation(s)
- Zebenay Workneh Bitew
- Department of Pediatric Nursing, School of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ayinalem Alemu
- Department of Medical Microbiology, Ethipian Public Health Institute, Addis Ababa, Ethiopia
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Ghimire U, Aryal BK, Gupta AK, Sapkota S. Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study. BMC Pediatr 2020; 20:249. [PMID: 32456624 PMCID: PMC7249365 DOI: 10.1186/s12887-020-02154-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/19/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal. METHODS We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant. RESULTS Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23-12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06-71.09) children (0-12 vs. 24-59 months). CONCLUSIONS The findings of this study indicated that household size, household food access, and the child's age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.
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Affiliation(s)
- Umesh Ghimire
- New ERA, Kalopul, Rudramati Marga, Kathmandu, 44600 Nepal
| | | | | | - Suman Sapkota
- Partnership for Social Development, Kathmandu, 446006 Nepal
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Hossain A, Niroula B, Duwal S, Ahmed S, Kibria MG. Maternal profiles and social determinants of severe acute malnutrition among children under-five years of age: A case-control study in Nepal. Heliyon 2020; 6:e03849. [PMID: 32420471 PMCID: PMC7218020 DOI: 10.1016/j.heliyon.2020.e03849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/09/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022] Open
Abstract
Background Addressing the determinants of severe acute malnutrition (SAM) among children remains a challenge in Nepal. This study investigated the effect of maternal and social determinants of SAM among under-five children of Nepal. Methods We conducted a hospital-based unmatched case-control study with 256 under-five children (128 cases and 128 controls). The children aged 6–59 months were taken, and the cases and controls were defined based on mid-upper arm circumference (MUAC). Results Backward Stepwise logistic regression analysis of 6–59 months children showed that the odds of SAM were lower among male children (AOR = 0.50, 95% CI = 0.27–0.92), mothers from high socioeconomic status (AOR = 0.469, 95% CI = 0.26–0.83), breastfeeding 6–12 months (AOR = 0.21, 95% CI = 0.05–0.68), breastfeeding ≥13 months (AOR = 0.18, 95% CI = 0.05–0.54) and optimal complementary feeding (AOR = 0.40, 95% CI = 0.22–0.70). SAM was significantly higher among children of the age group 6–24 months (AOR = 2.57, 95% CI = 1.30–5.22) and children with a history of diarrhea (AOR = 1.75, 95% CI = 0.92–3.39). Conclusions In order to reduce the children's SAM, it is necessary to scale up services to improve the socioeconomic status which includes the education, occupation, and monthly income of the mother. Girls of age group 6–24 months were more likely to develop SAM. Two contributing factors to decrease SAM are the importance of exclusive breastfeeding practices and the availability and usage of soap in hand washing, which are ideal for low cost interventions. To reduce SAM in Nepal, a focus on enhancing complementary feeding through increased affordability of nutritious foods is also needed.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Centre for Development Action, Dhaka 1216, Bangladesh
| | - Bhupendra Niroula
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Kathmandu University, Dhulikhel, Kathmandu 45200, Nepal
| | - Sangita Duwal
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Kathmandu University, Dhulikhel, Kathmandu 45200, Nepal
| | - Shakil Ahmed
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh
| | - Md Golam Kibria
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Centre for Development Action, Dhaka 1216, Bangladesh
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Abitew DB, Yalew AW, Bezabih AM, Bazzano AN. Predictors of relapse of acute malnutrition following exit from community-based management program in Amhara region, Northwest Ethiopia: An unmatched case-control study. PLoS One 2020; 15:e0231524. [PMID: 32320426 PMCID: PMC7176369 DOI: 10.1371/journal.pone.0231524] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 03/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community-based management of acute malnutrition (CMAM) is an effective program to manage children with acute malnutrition, including both severe and moderate acute malnutrition. However, little is known about continued child nutritional status after discharge from community based management of acute malnutrition programs in Ethiopia. OBJECTIVE The study aimed to identify factors associated with relapse of acute malnutrition among children 6-59 months after been discharged recovered from community based management program in South Gondar Zone, Northwest Ethiopia. METHODS A case-control study was conducted in three districts of South Gondar Zone by tracing children age 6-59 months who were reported as recovered from the community based management program. Sample size calculated for the first objective of assessing prevalence of severe acute malnutrition among children following discharge as recovery using Epi- Info version 7.1.3.3 StatCalc taking 95% CL, 17.8% post discharge relapse (Ashraf H, et al. (2012), 3% margin of error, design effect of 2 and adding 5% non-response rate was the largest sample size and used to this study. Children with Mid Upper Arm Circumference (MUAC) <12.5cm constituted cases and children with > = 12.5cm served as controls. Data were collected from 10 November 2017 to 30 January 2018 using a survey questionnaire and families were asked to bring children to a health facility for anthropometric measurements, following which data were entered and analyzed. Bivariate and multivariable logistic regression models were utilized to measure association between the risk factors and acute malnutrition. RESULTS Overall, 1,273 participants were interviewed. The mean age in months of children was 23.1 (±9.1 SD) for cases and 23.1 (±8.9 SD) for controls. About 40% of the cases and 50% of the controls were female children. The factors associated with acute malnutrition were: male children (AOR = 1.84, 95% CI: 1.42-2.39), living in a food insecure household (AOR = 1.67, 95% CI:1.15-2.44), non-receipt of Vitamin A supplement (AOR = 1.76, 95% CI: 1.28-2.41), prelacteal feeding (AOR = 2.81 (95%CI, 1.57-5.05), distance to water source more than 15 walk (AOR = 1.88, 95% CI:1.32-2.71), less frequent self-reported hand washing (AOR = 1.35, 95% CI:1.05-1.75), mother not having consumed extra food during this pregnancy/lactation (AOR = 1.36, 95% CI: 1.03-1.78), and respondent age above 30 years (AOR = 1.43, 95% CI:1.10-1.87). CONCLUSION The key factors contributing to relapse of acute malnutrition were related to childcare and feeding practices. Social and behavior change communication strategies targeting families at risk of undernutrition, along with improved food security and integrated programming are recommended to prevent relapse of acute malnutrition.
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Affiliation(s)
| | | | | | - Alessandra N. Bazzano
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
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Hossain FB, Shawon MSR, Al-Abid MSU, Mahmood S, Adhikary G, Bulbul MMI. Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five South Asian countries: evidence from demographic and health surveys. BMJ Open 2020; 10:e032866. [PMID: 32184304 PMCID: PMC7076246 DOI: 10.1136/bmjopen-2019-032866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We aimed to investigate the socioeconomic inequalities in the burden of underweight and overweight among children in South Asia. We also examined other factors that were associated with these outcomes independently of household's socioeconomic status. DESIGN Nationally-representative surveys. SETTINGS Demographic and Health Surveys from Bangladesh, India, Pakistan, Maldives and Nepal, which were conducted between 2009 and 2016. PARTICIPANTS Children aged 24 to 59 months with valid measurement for height and weight (n=146 996). PRIMARY EXPOSURE AND OUTCOME MEASURES Primary exposures were household's wealth index and level of education. Underweight and overweight were defined according to the WHO and International Obesity Task Force definitions, respectively. RESULTS Underweight prevalence was 37% in Bangladesh, 38% in India, 19% in Maldives, 29% in Nepal and 28% in Pakistan. Bangladesh, India and Nepal had similar overweight prevalence (between 2% and 4%) whereas Pakistan (7%) and Maldives (9%) had higher prevalence. Households with higher wealth index or education had lower odds of having underweight children. Adjusted ORs of underweight for richest versus poorest households were 0.4 (95% CI: 0.3 to 0.5), 0.5 (95% CI: 0.5 to 0.6), 0.5 (95% CI: 0.2 to 1.4), 0.5 (95% CI: 0.3 to 0.8) and 0.7 (95% CI: 0.5 to 1.1) for Bangladesh, India, Maldives, Nepal and Pakistan, respectively. Compared with poorest households, richest households were more likely to have overweight children in all countries except Pakistan, but such associations were not significant after adjustment for other factors. There were higher odds of having overweight children in households with higher education in Bangladesh (OR 2.1 (95% CI: 1.3 to 3.5)), India (OR 1.2 (95% CI: 1.2 to 1.3)) and Pakistan (OR 1.8 (95% CI: 1.1 to 2.9)) when compared with households with no education. Maternal nutritional status was consistently associated with children's nutritional outcomes after adjustments for socioeconomic status. CONCLUSIONS Our study provides evidence for socioeconomic inequalities for childhood underweight and overweight in South Asian countries, although the directions of associations for underweight and overweight might be different.
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Affiliation(s)
| | | | - Md Shehab Uddin Al-Abid
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Gourab Adhikary
- Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
| | - Md M Islam Bulbul
- National Nutrition Services, Institute of Public Health Nutrition, Dhaka, Bangladesh
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Lamichhane DK, Leem JH, Kim HC. Household air pollution and caste-ethnic differences in undernutrition among children in Nepal. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:435-444. [PMID: 31830862 DOI: 10.1080/19338244.2019.1699771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigated whether the association between household air pollution (HAP) and nutritional status (stunting, underweight, or wasting) among children differ by caste/ethnicity. Child anthropometry data for 9,914 children aged 0-59 months were analyzed linearly as Z scores and as dichotomous categories. Exposure to HAP was significantly associated with a decrease in child height-for-age and child weight-for-age, as well as with stunting and underweight. Children in low caste (Dalits) had higher prevalence of stunting (odds ratio [OR] = 1.21; 95% confidence intervals [CI] = 1.01, 1.44), underweight (OR = 1.47; 95% CI = 1.24, 1.75), and wasting (OR = 1.53; 95% CI = 1.21, 1.92) than those children in upper caste group. This association was modestly attenuated with adjustment for HAP. Exposure to HAP partly explained the caste-ethnic difference in undernutrition among children in Nepal.
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Affiliation(s)
- Dirga Kumar Lamichhane
- Department of Social and Preventive Medicine, School of Medicine, Inha University, Incheon, South Korea
| | - Jong Han Leem
- Department of Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon, South Korea
| | - Hwan Cheol Kim
- Department of Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon, South Korea
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Abstract
Child undernutrition is a major public health problem throughout the world, particularly in developing countries. The main objective of this study was to identify the risk factors for acute undernutrition among under-5 children in Bangladesh. Data were taken from the nationally representative Bangladesh Demographic Health and Survey conducted in 2014. The study sample comprised 7131 under-5 children. Of these, 4.6% were found to be severely wasted (Z-score < -3.0), 11.1% moderately wasted (-3.0≤Z-score < -2.0) and 84.3% adequately nourished (Z-score ≥-2.0). Chi-squared analysis was used to investigate the association between child nutrition status and selected covariates. Multinomial logistic regression was applied to identify the risk factors for acute undernutrition. The selected factors division, place of residence, sex of child, place of delivery, child age, respiratory illness, size at birth, measles vaccination, fever, diarrhoea, maternal BMI, maternal education, paternal occupation, wealth index and household toilet facilities were found to be highly significant (p < 0.05) in the analysis. Multinomial regression analysis revealed that residence in Barisal and Chittagong divisions, a smaller than average size at birth and low maternal BMI (≤18.50 kg/m2) were significant determinants of both moderate and severe acute undernutrition among under-5 children in Bangladesh.
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Caffarelli C, Santamaria F, Mastrorilli C, Santoro A, Iovane B, Petraroli M, Gaeta V, Di Pinto R, Borrelli M, Bernasconi S, Corsello G. Report on advances for pediatricians in 2018: allergy, cardiology, critical care, endocrinology, hereditary metabolic diseases, gastroenterology, infectious diseases, neonatology, nutrition, respiratory tract disorders and surgery. Ital J Pediatr 2019; 45:126. [PMID: 31619283 PMCID: PMC6796402 DOI: 10.1186/s13052-019-0727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022] Open
Abstract
This review reported notable advances in pediatrics that have been published in 2018. We have highlighted progresses in allergy, cardiology, critical care, endocrinology, hereditary metabolic diseases, gastroenterology, infectious diseases, neonatology, nutrition, respiratory tract disorders and surgery. Many studies have informed on epidemiologic observations. Promising outcomes in prevention, diagnosis and treatment have been reported. We think that advances realized in 2018 can now be utilized to ameliorate patient care.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carla Mastrorilli
- UO Pediatria e Pronto Soccorso, Azienda Ospedaliero-Universitaria Consorziale Policlinico Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Brunella Iovane
- UOC Pediatria Generale e d'Urgenza, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Valeria Gaeta
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Rosita Di Pinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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