Prevalence and factors associated with underweight children: a population-based subnational analysis from Pakistan

Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.

Predictors of under-weight among children younger than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan: a community-based cross sectional study

BACKGROUND

Underweight is a public health problem globally, and more severe in South Sudan with wide sub-regional differences. In Nimule border town, which represents other border towns in South Sudan, data on underweight among children below two years is unavailable. Thus, this study set out to assess predictors of underweight among children younger than 24 months in Nimule border town, Magwi County, Eastern Equatoria State, South Sudan.

METHODS

An analytical cross-sectional study was conducted in Nimule boarder town targeting 390 children younger than two years. Systematic sampling and simple random sampling methods were used. Data were collected through a researcher-administered questionnaire with both open and closed ended questions. Data was entered in EpiData and then exported into Statistical Package for Social Sciences research (SPSS) version 20 for analysis. Descriptive data analysis was conducted and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was conducted with the Chi-squared and Fisher's exact tests for categorical independent variables, and the student's t-test for numerical variables. Finally, multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%.

RESULTS

Out of the total 390 participants, 112 (28.7%) were under weight. The study showed primary (aOR, 0.38; 95% CI, 0.12-1.18; P = 0.095) and secondary (aOR, 0.37; 95% CI, 0.12-1.17; P = 0.091 levels of education were associated with underweight but not tertiary level of education (aOR, 0.76; 95% CI, 0.21-2.74; p = 0.671). Household income of 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10-0.68; P = 0.006) and above 10,000 (aOR, 0.11; 95% CI, 0.04-0.28; P < 0.001) South Sudanese pounds, supplementary feeding before 6 months (aOR; 0.01; 95% CI, 0.02-0.05; P < 0.001) were associated with underweight and irregular hand washing (aOR; 2.17; 95% CI, 1.14-4.11; P = 0.018) was associated with increased odds of underweight.

CONCLUSIONS

This study established a high prevalence of underweight. Maternal level of education particularly primary, secondary, higher household incomes in excess of 5,000 South Sudanese pounds reduced the risk of underweight. While irregular hand washing was a risk factor for underweight.

Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months

Background

Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia.

Methods

Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression.

Results

The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045).

Conclusion

Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.

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

INTRODUCTION

Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia.

METHODS

The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition.

RESULTS

The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted.

CONCLUSION

Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.

Prevalence and factors associated with undernutrition among children under the age of five years in Benin

BACKGROUND

Benin ranks as one of the countries in the world with an alarmingly high prevalence of stunting, wasting, and underweight in children under five years. However, limited studies have examined the factors associated with the prevalence of these undernutrition indicators among children under five years in the country. This study aimed to fill this research gap by examining the prevalence rates and factors associated with stunting, wasting, and underweight among this specific population of interest.

METHODS

This quantitative study utilised data from the most recent Benin Demographic and Health Survey (BDHS) conducted in 2017-18. The survey employed a nationally representative cross-sectional design and utilised a two-stage stratified cluster sampling technique to select participants. The study included a sample of 13,589 children under the age of five years. The main analytical approach employed was binary logistic regression, which was used to explore the associations between undernutrition (the combined outcome variable representing stunting, wasting, and underweight) and various socio-demographic factors.

RESULTS

The combined prevalence of stunting, wasting, and underweight among children under five years in Benin during the 2017-18 survey period was 14.95%. Several factors were significantly associated with these indicators of undernutrition, including female gender (AOR = 0.71, 95% CI = 0.59-0.85), birth weight of 4.1 kg and over (AOR = 0.26, 95% CI = 0.14-0.48), multiple births (AOR = 3.22, 95% CI = 2.11-4.91), and a child's experience of diarrhoea (AOR = 1.76, 95% CI = 1.40-2.20). Furthermore, the prevalence of these undernutrition indicators was higher among children whose mothers had lower levels of education (AOR = 0.82, 95% CI = 0.01-0.42) and were unmarried (AOR = 0.67, 95% CI = 0.49-0.93).

CONCLUSIONS

This present study confirms that undernutrition rates are elevated in Benin and are closely linked to perinatal factors such as birth weights and multiple births, postnatal health conditions including diarrheal episodes, and socio-demographic determinants such as a child's gender, maternal education level, and marital status. Therefore, there is the need to consider specific modifiable factors, such as low birth weight, episodes of child diarrhoea, and maternal education as priority targets for child nutrition interventions in Benin.

Prevalence and factors associated with severe undernutrition among under-5 children in Bangladesh, Pakistan, and Nepal: a comparative study using multilevel analysis

Despite economic growth and poverty reduction, under-5 child undernutrition is still rampant in South Asian countries. This study explored the prevalence and risk factors of severe undernutrition among under-5 children in Bangladesh, Pakistan, and Nepal for comparison using the Composite Index of Severe Anthropometric Failure. We utilised information on under-5 children from recent Demographic Health Surveys. We used multilevel logistic regression models for data analysis. The prevalence of severe undernutrition among under-5 children was around 11.5%, 19.8%, and 12.6% in Bangladesh, Pakistan, and Nepal, respectively. Children from the lowest socioeconomic quintile, and children born with low birth weight were key factors associated with severe undernutrition in these countries. The factors, parental education, maternal nutritional status, antenatal and postnatal care, and birth order were not homogeneous in explaining the determinants of child severe undernutrition across the countries. Our results suggest that the poorest households, and low birth weight of children have significant effects on severe undernutrition among under-5 children in these countries, which should be considered to formulate an evidence-based strategy to reduce severe undernutrition in South Asia.

Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study

BACKGROUND

Underweight is one of the important anthropometric components of malnutrition among under-five children and is a major public health concern in Bangladesh because it contributes to mortality as well as morbidity. In designing suitable health programs and policies with the goal of attaining UN SDG Goals, it is necessary to identify the critical risk factors of under-five malnutrition. It is evident that the quantile regression produces robust estimates in the presence of outliers. However, in the context of Bangladesh, no study has been conducted considering the sequential quantile regression on this topic. Therefore, the authors aimed to find the determinants of underweight among under-5 children in Bangladesh considering the latest country representative dataset.

METHODS AND MATERIALS

The paper considers a weighted sample of size 7762 children are used and data were extracted from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data. Multivariable simultaneous quantile regression models were used to fulfill the objectives of this study.

RESULTS

Findings depict that undernutrition affects the majority of children in the population as compared to the reference population. The WAZ-score of the child increases by 0.202 points at the 10th quantile of the conditional distribution, and by 0.565 points at the 90th quantile as we move from children of underweight to overweight women. Moreover, the WAZ scores of children from the richest families in the 10th, 50th, and 75th quantiles, respectively, are increased by 0.171, 0.016, and 0.084 points.

CONCLUSION

Quantile regression revealed the results of several socioeconomic and demographic factors acting differently across the WAZ distribution. Therefore, policymakers may consider the identified risk factors to lessen malnutrition among under-5 children in Bangladesh.

Prevalence and associated factors of stunting, wasting and underweight of children below five using quintile regression analysis (PDHS 2017-2018)

The objective of the current study is to identify the risk factors for malnutrition among the age of under-five children's in Pakistan. This is secondary data analysis for the data taken from Pakistan Demographic and Health Survey (PDHS 2017-18) and was analyzed by implementing quantile regression analysis. The sample size included 12,708 alive children in the study, for which the data collection period was from November 22, 2017, to April 30, 2018. The prevalence of malnutrition among boys is high (51.2%). Older age mother's children have more prevalence of malnutrition (20.7%). A child born with small body size (underweight: Q_0.25: - 0.625; Q_0.50: - 0.623; Q_0.75: - 0.426 and wasting: Q_0.50: - 0.513); having uneducated mother (underweight: Q_0.25: - 0.387; Q_0.50: - 0.247; Q_0.75: - 0.328), belonged to a poor household (underweight: Q_0.50: - 0.251),residing in rural areas (underweight: Q_0.25: - 0.443), not following properly breastfeeding practices (underweight: Q_0.50: - 0.439; Q_0.75: - 0.438) have negative effect on different measures of malnutrition and this effect is significantly raises across different quantiles of stunting , wasting and underweight (at p value < 0.01 and < 0.05). Older age mother (stunting: Q_0.50: 0.777; Q_0.75: 1.078; underweight Q_0.20: 0.568; Q_0.50: 0.429; Q_0.75: 0.524) and higher birth order number (stunting: Q_0.50: 0.415; Q_0.75: 0.535), have a positive effect on three measures of under-nutrition and this effect is gradual raises at different quantile of stunting, wasting and underweight. Elder and smoker mothers were proved associated risk factors of both stunting and being underweight in Pakistan. Moreover, Proper breastfeeding practices, better economic status, average or above the average birth weight of the child, and milk consumption are found protective factors against stunting, wasting, and underweight children in Pakistan.

Mapping underweight in children using data from the five Ethiopia Demographic and Health Survey data conducted between 2000 and 2019: A geospatial analysis using the Bayesian framework

Background and aims

The Sustainable Development Goal is targeted to end all types of malnutrition including underweight by 2030. However, the reduction rate is not as expected to meet the target. Thus, we aimed to investigate the spatiotemporal distributions and drivers of underweight among children aged below 5 years in Ethiopia.

Methods

Geostatistical analysis using the Bayesian framework was conducted to map the spatial and Spatiotemporal distributions of underweight. Data for the primary outcome was obtained from the Ethiopian Demographic and Health Survey 2000–2019. Covariate data were accessed from different credible online sources at high resolutions. Spatial binomial regression was fitted to identify drivers of underweight using the Bayesian approach.

Results

The overall national prevalence of underweight was 44.7, 37.7, 35.4, 25.5, and 23.8% in 2000, 2005, 2011, 2016, and 2019, respectively, with a total reduction rate of 46.8%. Significant spatial clustering of underweight was observed in Northern, Northwestern, Southeastern, Eastern borders, and the border between Oromia and SNNPR regions. Mean annual temperature (mean regression coefficient (β): −0.39; 95% credible interval (95% CrI): −0.63, −0.14), altitude (β:−0.30; 95% CrI: 0.57, −0.05), population density (β:−0.03; 95% CrI: −0.03, −0.02), and distance to water bodies (β:−0.03; 95% CrI: −0.05, −0.004) were negatively associated with being underweight. However, travel time to the nearest cities in minutes (β: 0.09; 95% CrI: 0.03, 0.14) was positively associated with being underweight.

Conclusion

The national prevalence of underweight is reduced slower than expected in Ethiopia, with significant spatial variations across subnational and local levels. Temperature, altitude, population density, and distance to water bodies were negatively associated with underweight, whereas travel time to the nearest cities was positively associated with underweight in Ethiopia. Improving child nutrition through creating awareness and providing clean water should be strengthened.

Association between exposure to intimate partner violence and the nutritional status of women and children in Nigeria

Background

Globally, intimate partner violence (IPV) epitomizes a greater proportion of the violence experienced by women, with more than a third of women (41.3%) in sub-Saharan Africa reporting IPV during their lifetime. This study examined the association between exposure to IPV and the nutritional status of women and their children in Nigeria.

Methods

The study analyzed secondary data obtained from the 2018 Nigeria Demographic and Health Survey. Data on women’s lifetime experience of psychological, physical, and sexual IPV, as well as demographic and socioeconomic characteristics, were collected. We used regression models to determine the association between exposure to IPV and women and child nutrition indicators. A weighted sample of 4,391 women aged 15–49 years and 2,145 children 6–59 months were analyzed.

Results

The lifetime experience of IPV in the study was 35.31% (95% CI: 33.35, 37.33), 30.43% (95% CI: 28.54, 32.38) experienced psychological IPV, 19.43% (95% CI: 17.79, 21.19) experienced physical IPV, and 6.03% (95% CI: 5.12, 7.09) experienced sexual IPV. After adjusting for a range of characteristics, maternal lifetime exposure to IPV was associated with underweight (ARRR = 0.63; 95% CI: 0.44, 0.91) and overweight/obesity (ARRR = 1.28; 95% CI: 1.04, 1.58). We also found that, children whose mothers experienced IPV were less likely to be underweight compared to their counterparts (ARRR = 0.69; 95% CI: 0.50, 0.96).

Conclusions

Overall, IPV against women, particularly psychological, physical, and sexual IPV, is common in Nigeria and has an association with the nutritional status of affected women and their children. According to the study, women with a lifetime experience of IPV were more likely to be overweight. On the other hand, affected women’s children were less likely to be underweight. A far-reaching effort is required to curb IPV against women, particularly policies, programs, and laws are needed to protect women and children from the unfavourable effects of IPV to reduce the prevalence and impact of such violence.

Prevalence and determinants of nutritional status among women and children in Pakistan

Background

Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalences of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.

Methods

The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012–13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.

Results

A higher proportion of children in rural areas were severely stunted (19.6% vs. 12.5%), severe wasted (2.4% vs. 2.2%), and severe underweight (9.4% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.5%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.3% vs. 19.0%) than rural women. The odds of severe stunting (OR = 0.24; C.I. = 0.15–0.37), severe underweight (OR = 0.11; C.I. = 0.05–0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR = 3.7; C.I. = 2.47–5.54) and Obese (RRR = 4.35; C.I. = 2.67–7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.

Conclusion

This study has highlighted determinants associated with maternal and child nutritional status, whereby the child’s nutritional status was measured by stunting, wasting, and underweight, and BMI measured the mother’s nutritional status. The main risk factors for a child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women’s age, educational status, rural residence, and household wealth. Poor households should be provided special attention to improve the nutritional status among women and children in poor households.

Determinants of underweight among children aged 0-23 months in Tanzania

Underweight is the most dependable growth indicator for overall child growth. Tanzania has the highest rate of underweight children in East Africa, with 1.27 million children under the age of five suffering from the condition. This study aimed to determine factors that influence underweight in Tanzanian children aged 0–23 months. We used data from the Tanzania Demographic and Health Survey (TDHS) 2015–2016 to conduct secondary analysis on a sample of 4,327 children aged 0–23 months. Descriptive and inferential statistics such as frequency, chi‐square, binary, and multivariate logistic regression were performed using the Statistical Package of Social Science (SPSS version 25). Statistical significance was defined as a p‐value of less than 0.05. Multivariate analysis found risk factors for underweight children were as follows: child's gender, age, birth weight, mothers' BMI, level of education, and type of toilet facility used by the households. Females had a significantly lower risk of being underweight (AOR = 0.62, 95% CI = 0.48–0.81, p < .05) compared with male children. The odds of being underweight increase with low birth weight (AOR = 2.92, 95% CI = 1.92–4.43, p < .05), low mother's BMI (AOR = 2.48, 95% CI = 1.34–4.58, p < .05), and low educational level (AOR = 1.78, 95% CI = 1.23–2.58, p < .05). Nutrition interventions such as growth monitoring, nutrition counseling, and nutrition education for parents/caregivers are critical to ensuring proper weight gain for all children under 2 years of age.

Trends and Determinants of Underweight among Children under Five Years in Ethiopia: Further Analysis with Ethiopian Demographic and Health Survey 2005-2016-Multivariate Decomposition Analysis

Background

Underweight is one of the paramount major worldwide health problems, and it traces a big number of populations from infancy to old age. This study aimed to analyze the trends and predictors of change in underweight among children under five years in Ethiopia.

Method

The data for this study were accessed from three Ethiopian Demographic and Health Survey data sets 2005, 2011, and 2016. The trend was examined separately for the periods 2005–2011, 2005–2016, and 2011–2016. Multivariate decomposition analysis of change in underweight was employed to answer the major research question of this study. The technique employed the output from the logistic regression model to parcel out the observed difference in underweight into components, and STATA 14 was utilized for data management and analysis.

Result

Perceiving the overall trend, the rate of underweight was decreased from 38% in 2005 to 24% in 2016. The decomposition analysis results revealed that, about 12.60% of declines in underweight have been explained by the difference in population characteristics or endowments (E) over the study period. The size of the child at birth, husband's education, women's education, and household wealth index contributed significantly to the compositional decline in underweight.

Conclusion

The magnitude of underweight among children under five years indicates a remarkable decline over the last ten years in Ethiopia. In this study, two-twelfth of the overall decrease in underweight among children under five years over the decade was due to the difference in characteristics between 2005 and 2016. Continuing to educate the population and boost the population's economy is needed on the government side in Ethiopia.

Prevalence and correlates of severe under-5 child anthropometric failure measured by the composite index of severe anthropometric failure in Bangladesh

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.

Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach

Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.

Dietary Diversity and Undernutrition in Children Aged 6-23 Months in Sub-Saharan Africa

Dietary diversity plays a major role in the health status of children. However, evidence on its crucial role on children's health status remains inconclusive in sub-Saharan Africa (SSA). In this study, we examined the association between dietary diversity and undernutrition among children aged 6-23 months in SSA. We pooled data from the most recent Demographic and Health Surveys of 32 countries in SSA from 2010 to 2020. A sample of 48,968 mother-child pairs of children within the ages of 6-23 months and mothers aged 15-49 years were included in this study. Multilevel logistic regression analysis was carried out to examine the association between dietary diversity and stunting, wasting, and underweight. The results were presented as crude odds ratios (cOR) and adjusted odds ratios (aOR) with their 95% confidence intervals. Statistical significance was set at p < 0.05. The overall prevalence of minimum dietary diversity was 25.1%, with South Africa recording the highest prevalence (43.9%) and Burkina Faso recording the lowest prevalence (5.6%). The highest prevalence of stunting was recorded by Burundi (51.8%) while the lowest prevalence was found in Ghana (13.6%), with an overall regional prevalence of 28.6%. For wasting, prevalence from all countries was found to be 9.4%. South Africa recorded the lowest prevalence of wasting (2.1%) while Niger recorded the highest prevalence (27.3%). Lastly, the prevalence of underweight ranged from 5.3% in South Africa to 41.8% in Niger, with an all-country prevalence of 16.4%. Children who had adequate minimum dietary diversity had 12% less likelihood of being stunted (aOR = 0.88, 95% CI = 0.83, 0.94), compared to those who had inadequate minimum dietary diversity. Having an adequate minimum dietary diversity significantly lowered the risk of underweight among children by 17% (aOR = 0.83, 95% CI = 0.77, 0.91). Having an adequate minimum dietary diversity was associated with 13% reduced odds of wasting among children (aOR = 0.87, 95% CI = 0.78, 0.97), compared to those who had inadequate minimum dietary diversity. This study highlights the significant association between minimum dietary diversity and stunting, wasting, and underweight among 6-23 month-old children in SSA. There is an urgent need for additional nutrition-specific interventions and strengthening of existing interventions aimed at improving infant and young child feeding practices, including complementary feeding practices among children aged 6-23 months in the 32 countries in SSA. Such interventions should focus more on countries where the prevalence of adequate minimum dietary diversity was low and undernutrition was high.

Frequency and assessment of Nutritional Status of school going children in rural areas of Islamabad

Background and Objectives:

Nutritional status is considered a significant and positive health indicator. It determines anthropometric measurements of preschool children, the height of children at the time of school entry and prevalence of low birth weight. The objective of the study was to determine the frequency of nutritional status and socio-demographic factors influencing under nutrition among school children of rural Islamabad.

Methods:

A cross-sectional study was conducted among school children of the age (4-16 years) from January 2017 to September 2019. The Sample size was 1710. Schools were selected through convenient sampling technique. Frequency and percentages were calculated and inferential statistics were computed to analyze the association of health status with categorical variables by using chi-square by keeping the level of significance <0.05 through SPSS version 20.

Results:

The mean age of the sample was 9.38 ± 4.14 with the maximum number of children (49.1%) in the age bracket of 5-9. Out of 1710 children, 54.4% had normal weight for age, 25.3% were underweight, 7.5% overweight and 12.8% were found to be obese. Stunting was found to be 26%. Prevalence of being underweight was higher than overweight /obesity particularly in younger and higher age groups as indicated by p-value of 0.000. Comparing with females, male students had significantly higher frequency of being underweight and stunted as reflected by p-value of 0.004 and 0.000 respectively. Univariate analysis also showed a strong association between age and nutritional status as mean weight increased from 39.22 ±5.21 to 63.50± 4.66 and height from 35.67±5.76 to 113.73± 29.22 with advancing age.

Conclusions:

Undernutrition remains an ongoing health problem in school going children of rural Islamabad; particularly in male students of younger age groups. School health programs and nutritional interventions need to be strengthened particularly in rural areas of Islamabad.

Sanitation ladder and undernutrition among under-five children in Pakistan

While the state of sanitation in Pakistan has improved in the last decade, a significant proportion of its population is still using inadequate sanitation or no toilet facility at all. Open defecation has decreased over the years; however, it has been replaced by poor quality sanitation in rural areas that might still cause diarrhoea and undernutrition. The research regarding inadequate sanitation in Pakistan, especially in terms of the sanitation ladder, remains limited. The present research thus fills this research gap by assessing the impact of different types of sanitation on the prevalence of stunting and underweight (moderate as well as severe) among under-five children in Pakistan using the nationally representative micro survey, Pakistan Demographic and Health Survey (2017-18). The sanitation ladder comprises of piped to sewer (highest level, base) followed by flush to septic tank, flush to pit latrine, other improved, unimproved sanitation, and open defecation. In order to estimate the adjusted and unadjusted odds ratios of the determinants, this research uses logistic regressions are used to estimate adjusted and unadjusted odds ratios of the determinants. We show that toilets connected to piped sewerage network are rare in the rural areas of Pakistan and a large segment of the rural population is still practicing open defecation. The logistic regressions show that piped sewerage network and flush to septic tanks are associated with lowest odds (both adjusted and unadjusted) of stunting and underweight among under-five children. In multivariate regressions, pit latrines are associated with even higher adjusted odds of severe and moderate and severe stunting as well as underweight among under-five children, showing that poor quality pit latrines may bring the source of faecal contamination to the doorstep of the households. Therefore, interventions targeting reduction in open defecation should promote good quality toilets for sustainable long-term improvements in child health.

Infant and Child Feeding Index and nutritional status of children aged 6 to 24 months in a Metropolitan city

Background:

The nutritional status of children is influenced by feeding practices. Infant and Child Feeding Index (ICFI) is an age-specific composite index to assess the feeding practices of children.

Objectives:

To determine the association between ICFI and the nutritional status of children aged 6 to 24 months. To find whether ICFI has value as a tool for detecting poor nutritional status. To determine the association of ICFI and nutritional status with sociodemographic and other factors.

Methods:

A cross-sectional study was conducted in the urban field practice area of a tertiary care institute among 149 children aged 6 to 24 months and their mothers. Data on feeding practices were obtained and ICFI scores were calculated. The weight and length of the children were measured and Z scores (WAZ, LAZ, and WLZ) were calculated. A Chi-square test was used to find the association between the categorical variables.

Results:

We found no association between ICFI and any of the three nutritional indicators such as WAZ, LAZ, and WLZ. The sensitivity of the ICFI was low for detecting underweight (10.0%), stunting (29.4%), and wasting (11.1%). ICFI was significantly associated with the growth monitoring of children and mothers' education. WAZ was significantly associated with mother's education and socioeconomic class.

Conclusions:

There is no association between ICFI and the nutritional status of children. ICFI has limited value in detecting the poor nutritional status of children in this urban setting. Maternal education and growth monitoring of children play an important role in infant and child feeding practices.

Assessment of Prevalence and Factors Associated with Malnutrition Among Under-Five Children in Debre Berhan Town, Ethiopia

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.

Determinants of Under-Five Children Body Mass Index in Sudan; Application of Quantile Regression: A Systematic Review

Background:

One of the health challenges in Sub-Saharan countries is child malnutrition. Body Mass Index (BMI) can be defined as a measure of nutritional status. Examining the determinants of under-five children’s BMI is a significant subject that needs to be studied. For this study, quantile regression was used to identify the determinants of under-five children’s BMI in Sudan.

Methods:

We used the 2014 Sudan Multiple Indicator Cluster Survey (MICS) conducted by the Central Bureau of Statistics. Quantile regression was used.

Results:

Place of residence, state, mother’s educational level, gender, age of the child, and wealth index were an important effect significantly affecting under-five children’s BMI at different quantile levels.

Conclusion:

Taking measures on the nutritional status of mothers will accordingly resolve the nutritional status of their children. Therefore, the focus of policymakers should be on the influential significant factors which were found across all quantile levels to plan and develop strategies to enhance the normal or healthy weight status of under-five children in Sudan.

Why under five children are stunted in Pakistan? A multilevel analysis of Punjab Multiple indicator Cluster Survey (MICS-2014)

BACKGROUND

Pakistan is facing a serious problem of child under-nutrition as about 38% of children in Pakistan are stunted. Punjab, the largest province by population and contributes high gross domestic product (GDP) share in economy has reported 27% moderately and 10% severely stunted children of less than 5 years. Thus, this study aims at examining the determinants of stunting (moderate and severe) at different level of hierarchy empirically in Punjab province of Pakistan.

METHODOLOGY

Data for this study is coming from Punjab Multiple Indicators Cluster Survey (MICS-2014), used two-stage, stratified cluster sampling approach. Sub-national level data covering urban and rural areas were used for this study consists of 25,067 children less than 5 year's ages, from nine administrative divisions and 36 districts of Punjab province of Pakistan. Descriptive statistics and multilevel hierarchical models were estimated. Multilevel data analyses have an advantage because it provides robust standard error estimates and helps in finding variation in the data at various levels.

RESULTS

Punjab has a stunting prevalence of about 27% moderately and 10% severely stunted children of less than 5 years. The results depict that increasing the age of the child, increasing birth order, illiterate mothers and fathers, lack of sanitation facilities and being poor are associated significantly with the likelihood of moderate and severe stunting. Surprisingly, there is a gender bias in stunting in Punjab, Pakistan and being a girl child is more likely associated with moderate and severe stunting, which shows the patriarchal nature of the society and a substantial prevalence of gender bias in household resource allocations.

CONCLUSION

This outcome of our analysis points towards targeting not only households (focus on girls) but also their families and communities.

Child Nutrition Trends Over the Past Two Decades and Challenges for Achieving Nutrition SDGs and National Targets in China

Background: The objectives of the current study were to identify the trends in child nutrition, the gaps in achieving child nutrition-related goals, and implications for program and policy options for the Chinese government. Methods: Eight child nutrition-related indicators from the Sustainable Development Goals (SDGs) and China’s national nutrition plans, and two datasets, Global Burden of Disease 2016 and Chinese National Nutrition and Health Surveillance, were used in our analysis. Results: Over the past 26 years, the prevalence of stunting, wasting, and underweight for children under 5 years was reduced by 58.7%, 53.4%, and 69.2%, respectively. Overweight for children aged 1–4 years increased 88.9% and obesity increased 2.14 times. Exclusive breastfeeding of newborns (7–28 days) was stable, at about 30%. We estimated child wasting would be 3.0% lower than the target of 5.0% based on predictive values for meeting the SDGs in 2025. The number of stunted children under five years would be reduced by 39.7%, while overweight would increase 2.2% throughout China. Conclusion: These results highlight the urgent need for targeted policies and interventions to reduce child stunting and overweight and increase exclusive breastfeeding to improve child health and meet the SDG targets and China’s national goals.

Nutritional status of tuberculosis patients, a comparative cross-sectional study

Background

Each year, more than 13.7 million people became an active case of tuberculosis and more than 1.5 million cases of TB patient will die. The association between TB and malnutrition is bi-directional, TB leads the patient to malnutrition, and malnutrition increases the risk of developing active TB by 6 to 10 times. Improving the nutrition of individual greatly reduces tuberculosis. The aims of this study were to assess the nutritional status and determinants of underweight among TB patients.

Methods

A comparative cross-sectional study design was implemented. The sample size was calculated using 95% CI, 90% power, the prevalence of malnutrition in TB patients 50%,

TB patients to TB free resident ratio of 3, the design effect of 2 and a 5% non-response rate. Systematic random sampling was used to select TB patients and simple random sampling technique was used to select TB free residents. The data were collected from July 2015–May 2018. The data were collected by interviewing the patient, measuring anthropometric indicators and collecting the stool and blood samples. The data were entered into the computer using Epi-info software and analyzed using SPSS software. Descriptive statistics were used to find the proportion of malnutrition. Binary logistic regression was used to identify the determinants of malnutrition.

Results

A total of 5045 study participants (1681 TB patients and 3364 TB free residents) were included giving for the response rate of 93.1%. The prevalence of underweight among TB patients was 57.17% (95% CI: 54.80, − 59.54%) and 88.52% of TB patients were anemic. The prevalence of malnutrition (underweight) among TB free residents was 23.37% (95% CI: 21.93–24.80). The nutritional status of TB patients was determined by site of infection AOR: 0.68 [0.49–0.94], sex of the patient AOR: 0.39 [0.25–0.56], residence AOR: 3.84 [2.74–5.54], intestinal parasite infection AOR: 7 [5.2–9.95], problematic alcohol use AOR: 1.52 [1.17–2.13].

Conclusion

High proportions of TB patients were malnourished. TB patients were highly susceptible to malnutrition and even a very distal reason for malnutrition in the community became a proximal cause for TB patients.