Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia

Risk factors of child malnutrition under 5 years: Evidence from Pakistan using the Composite Index of Anthropometric Failure

OBJECTIVES

Child malnutrition is a very serious health issue globally, particularly in emerging countries. Among South Asian countries, Pakistan has been observed to have a high prevalence of child malnutrition. In spite of the implementation of many health strategies and preventive measures for vulnerable populations, this issue is still unresolved and needs further investigation. The purpose of this study was to investigate the role of various social-, maternal-, and child-level factors considered to be responsible for nutritional health disparities among children.

METHODS

An assessment method of malnutrition, i.e., Composite Index of Anthropometric Failure (CIAF), was used to detect the prevalence of malnutrition among children under 5 years of age in Pakistan in order to present a comprehensive view that was lacking conventional indices of malnutrition. A binary logistic regression model was fitted to assess the link between malnutrition and socioeconomic, maternal, and child attributes based on CIAF data compiled from weight-for-height, weight-for-age, and height-for-age Z-scores using data from the Pakistan Demographic Health Survey (2017-2018).

RESULTS

A total of 4224 children under 5 years of age were included in the analysis. Approximately half of the children (45.34%) comprised anthropometric failures for the overall prevalence of undernutrition based on CIAF. The results of this study revealed that the leading determinant associated with CIAF was the child's age in months, small birth size, lack of breastfeeding, lack of maternal education, poor economic status of the household, and poor-quality water sources. The factors associated with stunting comprised the child's age in months, small child birth size, underweight maternal body mass index, and uneducated mothers. Only one factor-low household economic profile-was significantly associated with waste. Sindh, Baluchistan, and Khyber Pakhtunkhwa provinces had a higher risk of having wasted children. On the other hand, children aged 25-36 months had higher, small child birth size, underweight maternal BMI, un-educated mother, un-educated father, low economic profile of household experiencing of being underweight.

CONCLUSIONS

The findings of this study reinforce the significance of maternal health, parental education, and household economic profile in the prevention of malnutrition within young children of adequate birth size, as well as better overall health care up to adolescence in Pakistan. Well-nourished individuals are a valuable human resource and a requirement for a nation's progress and prosperity. In emerging nations such evidence-based policies are crucial for fostering children's optimal physical and mental development to ensure a healthier future generation. Therefore, the execution of national health policies aimed at the improvement of maternal and societal factors could result in improved nutrition levels among children below 5 years of age in Pakistan.

Prevalence and correlates of malaria and undernutrition among acutely febrile children visiting temporary malaria screening sites in war-torn areas of Northeast Ethiopia

BACKGROUND

Malaria and undernutrition pose challenges for children in conflict-affected areas. Understanding the prevalence and risk factors for these issues in war-torn communities is important to effectively design aid efforts and select interventions. This study aimed to determine the prevalence and correlates of malaria and undernutrition among febrile children in northeast Ethiopia to help address these problems.

METHODS

A cross-sectional study was conducted from November 2022 to January 2023. Four hundred twenty-two children were enrolled using a systematic random sampling technique. Data on associated factor variables were collected via questionnaire. Capillary blood samples were collected from each child to prepare thick and thin blood films, which were stained with Giemsa and examined microscopically. Height and weight measurements were also taken using a meter and a standard calibrated balance. The data were analyzed in SPSS 26.0 using bivariable and multivariable logistic regression to determine associations between correlates, malaria infection, and undernutrition. Statistical significance was set at p < 0.05.

RESULTS

The overall malaria prevalence among screened children at temporary sites in the conflict-affected areas of Northeast Ethiopia was 65.9% (278/422). Plasmodium falciparum, P. vivax, and mixed infections accounted for 74.1%, 19.8%, and 6.1% of the cases, respectively. The presence of stagnant water (P<0.01), improper utilization of ITN, inadequate number of ITNs per family size (P<0.01), and absence of environmental management (P<0.01) were independent predictors of malaria. On the other hand, the overall undernutrition prevalence was 54.7% (231/422), including 26.5% underweight, 16.8% stunted, and 11.4% wasted. Dietary diversity score (P<0.01), meal frequency (P<0.01), and confirmed malaria infection (P<0.01) were significantly associated with underlnutrition.

CONCLUSION

Both malaria and undernutrition burdens were high among the children in this study. The findings suggest combined prevention measures for malaria and undernutrition should be strengthened in this region.

Undernutrition and its determinants among children aged 6-59 months in Southern Ethiopia

Malnutrition is responsible for over one-third of deaths among children under the age of five in low-and middle-income countries, including Ethiopia, and is largely preventable. The objective of this study was to determine the prevalence of undernutrition and its contributing factors among children aged 6-59 months in the Gedio zone of Southern Ethiopia. A community-based cross-sectional study design was used, and data were collected from 403 children and their mothers selected through random sampling technique. Anthropometric measures were converted to Z-scores using WHO-Anthro version 3.2.2 software. The prevalence of underweight, wasting, and stunting were 19.7% (95% CI 16-24%), 10% (95% CI 7-13%), and 49% (95% CI 44-54%) respectively. Low birth weight (AOR = 2.8, 95% CI (1.585-4.895), feeding non-diversified diet (AOR = 1.9, 95% CI (1.036-3.497), and being unvaccinated (AOR: 2.0; 95%CI (1.013-4.197) were significantly associated with being underweight. Family size of ≥ 5 (AOR = 4.4, CI (1.274-5.059), meal frequency of < 3 times per a day (AOR = 2.3, CI (1.037-5.024), and index birth interval of < 24 months (AOR = 2.2, CI (1.015-4.843) were significantly associated with wasting. Similarly, children aged ≥ 24 months (AOR = 2.8, CI (1.769-4.474), feeding non-diversified diet (AOR = 1.8, CI (1.153-2.894), total duration of breast-feeding < 12 months (AOR = 4.0, CI (2.547-6.429), and mothers BMI below 18.5 (AOR = 2.2, CI (1.328-3.718) were identified as a predictors of stunting. The study revealed significant levels of undernutrition, including underweight, wasting, and stunting, among children in the study area. Factors such as birth weight, dietary diversity score, and vaccine status were found to be strongly linked to underweight. Additionally, living in a large family, meal frequency, and birth interval were significantly associated with wasting. The age of the child, duration of breastfeeding, dietary diversity score, and maternal BMI status were also significantly linked to stunting. To address this issue, the study recommends promoting healthier feeding practices, dietary diversification, optimal breastfeeding, complete vaccination, wider birth intervals, and improving maternal nutrition to reduce undernutrition among children aged 6-59 months in the area. Implementing these measures could significantly improve the health of children in the study area.

Nutritional status and its associated factors among infants and young children aged 6-23 months in Addis Ababa, Central Ethiopia, 2021: a cross-sectional study

The aim of this study is to assess nutritional status and associated factors among infants and young children aged 6-23 months in Yeka sub-city, Ethiopia, 2021. An institution-based cross-sectional study was conducted in selected health centres found in the Yeka sub-city from May 2021 to July 2021. In total, 396 systematically selected infants and young children aged 6-23 months attended the selected health centres were included in the study. Data were collected by using a structured questionnaire and anthropometric measurements. A multinomial logistic regression model was used. The overall magnitude of undernutrition and overnutrition among infants and young children were 24.7% and 5.5%, respectively. Dietary diversity score (DDS) ((adjusted odd ratio (AOR) = 5.65; 95% CI = 2.301, 10.87; P value = 0.003), minimum meal frequency (MMF) (AOR = 5.435; 95% CI = 2.097, 11.09; P value = 0.0052), and diarrhoea (AOR = 2.52; 95% CI = 1.007, 6.310; P value = 0.002) were statistically significantly associated factors for nutritional status among infants and young children. Malnutrition (undernutrition and overnutrition) is a public health problem among infants and young children in Yeka sub-city, Ethiopia. DDS, MMF, and diarrhoeal disease were associated with higher odds of undernutrition.

Determinants of severe acute malnutrition among under-five children in Ethiopia: analysis using data from the 2016 Ethiopia Demographic and Health Survey

Objective

Malnutrition is a silent killer that is under-reported, under-addressed, and, as a result, emphasized. This study aimed to identify the determinants of severe acute malnutrition (SAM) among under-five children in Ethiopia.

Methods

Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 6,170 under-five children were included in the current analysis. The data were cleaned and analyzed using STATA 14. An adjusted odds ratio (AOR) and their 95% confidence intervals (CIs) were calculated to determine the association between factors and outcomes. A p-value of less than 0.05 was considered significant in multivariable logistic regression.

Results

A multivariable logistic regression revealed that under-five children with the age of children in months 6-11 (AOR = 1.52, 95% CI: 1.25, 1.86), 12-23 (AOR = 1.98, 95% CI: 1.65, 2.37), and 24-59 months (AOR = 1.71, 95% CI: 1.40, 2.08), birth order between fourth and fifth (AOR = 1.24, 95% CI: 1.01, 1.54), having fever (AOR = 1.31, 95% CI: 1.09, 1.58), anemic children (AOR = 1.21, 95% CI: 1.07, 1.36), age of mothers in years 25-34 (AOR = 0.60, 95% CI: 0.51, 0.72) and 35-49 (AOR = 0.49, 95% CI: 0.39, 0.63), antenatal care (ANC) visits (AOR = 0.83, 95% CI: 0.71, 0.92), rural residence (AOR = 2.98, 95% CI: 2.54, 3.49), and solid fuels users (AOR = 2.46, 95% CI: 1.86, 3.26) were significant predictors.

Conclusion

Older age of children, those with higher birth order, those having fever, anemic children, those living in rural areas, and solid fuel users were more likely to suffer from SAM, while older mothers and those having ANC visits had reduced SAM as significant predictors.

Prevalence and associated factors of maternal depression among mothers of children with undernutrition at comprehensive specialized hospitals in Northwest Ethiopia in 2023: a cross-sectional study

Background

Malnutrition is one of the most significant child health problems in developing countries, accounting for an estimated 53% of child deaths per year. Depression is the leading cause of disease-related disability in women and adversely affects the health and well-being of mothers and their children. Studies have shown that maternal depression has an impact on infant growth and nutritional status. However, evidence is scarce regarding the relationship between maternal depression and child malnutrition.

Objectives

The general objective of this study was to assess the prevalence and associated factors of maternal depression among mothers of undernourished children at comprehensive specialized hospitals in Northwest Ethiopia in 2023.

Methods

An institution-based cross-sectional study was conducted among 465 participants. Outcome variables were assessed using a Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using SPSS-25. Bivariate and multivariable logistic regression analyses were conducted. Variables with a p-value less than 0.05 were considered statistically significant with a corresponding 95% confidence interval (CI).

Results

The prevalence of maternal depression among mothers of children with undernutrition was 36.4% (95% CI = 32%-41%). According to a multivariate analysis, lack of maternal education (adjusted odds ratio [AOR] = 2.872, 95% CI = 1.502-5.492), unemployment (AOR = 2.581, 95% CI = 1.497-4.451), poor social support (AOR = 2.209, 95% CI = 1.314-3.713), perceived stigma (AOR = 2.243, 95% CI = 1.414-3.560), and stunting (AOR = 1.913, 95% CI = 1.129-3.241) were factors significantly associated with maternal depression.

Conclusion

The overall prevalence of maternal depression was higher among mothers of children with undernutrition. This higher prevalence was associated with several factors, including lack of education, unemployment, poor social support, high perceived stigma, and stunted physical growth in the children themselves. To decrease maternal depression, we can address these factors by increasing the level of maternal education and employment opportunities, strengthening social support systems, reducing stigma, and providing interventions to reduce stunting.

Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review

Background and Aims

One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY.

Methods/Literature Search Strategy

Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review.

Results

The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY.

Conclusion

The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.

Anthropometric failures and its predictors among under five children in Ethiopia: multilevel logistic regression model using 2019 Ethiopian demographic and health survey data

BACKGROUND

Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess undernutrition status of children. There is no study on CIAF to identify the real and severe form of under nutrition among Ethiopian children that addressed community level factors. So, this study determined CIAF and identified important factors which helps to design appropriate intervention strategies by using multi-level advanced statistical model.

METHODS

The study included 5,530 under five children and utilized a secondary data (EMDHS 2019) which was collected through community-based and cross-sectionally from March 21 to June 28, 2019. Composite index of anthropometric failure among under five children was assessed and a two-stage sampling technique was used to select the study participants. Descriptive summary statistics was computed. A multi-level binary logistic regression model was employed to identify important predictors of CIAF in under five children. Adjusted odds ratio with its 95% CI was estimated and level of significance 0.05 was used to determine significant predictors of CIAF.

RESULTS

The prevalence of composite index of anthropometric failure (CIAF) was 40.69% (95% CI: 39.41, 42.00) in Ethiopia. Both individual and community level predictors were identified for CIAF in under five children. Among individual level predictors being male sex, older age, short birth interval, from mothers who have not formal education, and from poor household wealth quintile were associated with higher odds of CIAF among under five children. Low community women literacy and being from agriculturally based regions were the community level predictors that were associated with higher odds of CIAF in under five children in Ethiopia.

CONCLUSIONS

The burden of composite index of anthropometric failure in under five children was high in Ethiopia. Age of child, sex of child, preceding birth interval, mother's education, household wealth index, community women literacy and administrative regions of Ethiopia were identified as significant predictors of CIAF. Therefore, emphasis should be given for those factors to decrease the prevalence of CIAF in under five children in Ethiopia.

Association between short birth spacing and child malnutrition in Bangladesh: a propensity score matching approach

OBJECTIVES

This study aimed to explore the effects of short birth spacing (SBS), which is defined as a period of less than 33 months between two successive births, on multiple concurrent forms of child malnutrition (MCFCM) and at least one form of child malnutrition (ALOFCM) using propensity score matching (PSM).

METHODS

This study used data extracted from the 2017-18 Bangladesh Demographic and Health Survey. PSM with four different distance functions, including logistic regression, classification and regression tree, single hidden layer neural network and random forest, were performed to evaluate the effects of SBS on MCFCM and ALOFCM. We also explored how the effects were modified in different subsamples, including women's empowerment, education and economic status (women's 3E index)-constructed based on women's decision-making autonomy, education level, and wealth index, and age at marriage, and place of residence.

RESULTS

The prevalence of SBS was 22.16% among the 4652 complete cases. The matched samples of size 2062 generated by PSM showed higher odds of MCFCM (adjusted OR (AOR)=1.25, 95% CI=1.02 to 1.56, p=0.038) and ALOFCM (AOR=1.20, 95% CI=1.01 to 1.42, p=0.045) for the SBS children compared with their counterparts. In the subsample of women with 3E index≥50% coverage, the SBS children showed higher odds of MCFCM (AOR: 1.43, 95% CI=1.03 to 2.00, p=0.041] and ALOFCM (AOR: 1.33, 95% CI=1.02 to 1.74, p=0.036). Higher odds of MCFCM (AOR=1.27, 95% CI=1.02 to 1.58, p=0.036) and ALOFCM (AOR=1.23, 95% CI=1.02 to 1.51, p=0.032) for SBS children than normal children were also evident for the subsample of mothers married at age≤18 years.

CONCLUSION

SBS was significantly associated with child malnutrition, and the effect was modified by factors such as women's autonomy and age at marriage.

Anthropometric failure and associated factors among children aged 6-23 months in Ethiopia

Undernutrition in childhood is a crucial public health issue in Ethiopia. Yet, more than an assessment of undernutrition using conventional index is needed to conclude the overall prevalence of undernutrition among children aged 6-23 months. Therefore, this study aimed to assess the prevalence of undernutrition using composite index of anthropometric failure and its associated factors among children aged 6-23 months in Southwest Ethiopia. A community-based cross-sectional study was employed among 440 mother-child pairs selected using a two-stage cluster sampling method in the rural Kersa district, Jimma Zone, Southwest Ethiopia. A pretested structured questionnaire was used to collect data. Multivariable logistic regression analysis was employed to identify factors associated with undernutrition. Variables with a p-value of <.05 were considered statistically significant. The proportion of undernutrition using composite indexes of anthropometric failure was 57.3% among children aged 6-23 months. Children being male [AOR = 1.55; 95% CI (1.013, 2.373)], not met minimum acceptable diet (MAD) [AOR = 2.104; 95% CI (1.05, 4.214)], larger family size [AOR = 1.699; 95% CI (1.0791, 2.675)], having comorbidity [AOR = 3.31; 95% CI (2.068, 5.327)], and being in food insecurity household [AOR = 3.12; 95% CI (2.0, 4.868)] were more likely to be in anthropometric failure, whereas children from the mother who attended higher and above schooling [AOR = 0.244; 95% CI (0.093, 0.641)] were less likely to be in anthropometric failure. More than half of children aged 6-23 months were experienced anthropometric failure. Male children, those who have not received the MAD, come from larger families, have comorbidities, live in food-insecure households, and have mothers with higher education levels were found to be at higher risk of anthropometric failure.

Spatial regression models to assess variations of composite index for anthropometric failure across the administrative zones in Ethiopia

BACKGROUND

There are a number of previous studies that investigated undernutrition and its determinants in Ethiopia. However, the national average in the level of undernutrition conceals large variation across administrative zones of Ethiopia. Hence, this study aimed to determine the geographic distribution of composite index for anthropometric failure (CIAF) and identify the influencing factors it' might be more appropriate.

METHODS

We used the zonal-level undernutrition data for the under-five children in Ethiopia from the Ethiopian Demographic and Health Survey (EDHS) dataset. Different spatial models were applied to explore the spatial distribution of the CIAF and the covariates.

RESULTS

The Univariate Moran's I statistics for CIAF showed spatial heterogeneity of undernutrition in Ethiopian administrative zones. The spatial autocorrelation model (SAC) was the best fit based on the AIC criteria. Results from the SAC model suggested that the CIAF was positively associated with mothers' illiteracy rate (0.61, pvalue 0.001), lower body mass index (0.92, pvalue = 0.023), and maximum temperature (0.2, pvalue = 0.0231) respectively. However, the CIAF was negatively associated with children without any comorbidity (-0.82, pvalue = 0.023), from families with accessibility of improved drinking water (-0.26, pvalue = 0.012), and minimum temperature (-0.16).

CONCLUSION

The CIAF across the administrative zones of Ethiopia is spatially clustered. Improving women's education, improving drinking water, and improving child breast feeding can reduce the prevalence of undernutrition (CIAF) across Ethiopian administrative zones. Moreover, targeted intervention in the geographical hotspots of CIAF can reduce the burden of CIAF across the administrative zones.

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

OBJECTIVES

Composite Index of Anthropometric Failure (CIAF) and Extended CIAF (ECIAF) allow for the identification of simultaneous presence of two or more types of malnutrition. The objective of this study was to analyze anthropometric failure in Argentinean children under 5 years old, taking into consideration regional and socioeconomic perspectives.

MATERIALS AND METHODS

Data from the National Survey of Children and Adolescents MICS 2019-2020 were used, which included 5473 children under 5 years old of both sexes residing in the six regions of Argentina. CIAF and ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting, and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. The data were analyzed according to region and wealth quintile.

RESULTS

In children aged 0-2.99 years, CIAF was 12.5% and ECIAF was 27.7%, with boys being more affected. In children aged 3-4.99 years, the rates were 9.7% and 22.3%, respectively, with girls showing a higher prevalence. The highest ECIAF was recorded in the Patagonia region (31.3%), while the highest ECIAF was observed in the poorest quintile.

DISCUSSION

The presence of double burden of malnutrition has been observed across all regions and household income levels. Additionally, overweight has shown a higher intensity in economically prosperous regions and households, while stunting has been more prevalent in economically disadvantaged areas.

Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6-59 months in Nigeria

Malnutrition has remained a global public health issue, particularly in low- and middle-income countries (LMICs). Researchers have committed to studying malnutrition (especially in children under the age of five) to address the nine malnutrition targets, set by the WHO to be achieved by 2025. This study seeks to evaluate the prevalence, the individual and contextual predictors of malnutrition among children aged 6-59 months across Nigeria and its states. Two separates, independently collected, nationally representative cross-sectional surveys, the National Human Development Report (NHDR 2018) and the 2018 Nigeria Demographic and Health Survey (2018 NDHS) were linked for this study. Spatial map was used to describe the prevalence of malnutrition, a 3-level multivariate multilevel logistic regression models were fitted where children/individuals (at level 1) were nested in communities/clusters (at level 2) and nested in states (at level 3). A weighted sample of 7,770 children 6-59 months were considered in this study. The results showed that an estimated 43.6% of children aged 6-59 months are poorly nourished in Nigeria. The proportions of poorly nourished children were generally highest in the Northern Nigeria. Child's gender, age, birth size, preceding birth order, anaemia status, maternal education, work status, body weight, household wealth status, number of bedrooms were among individual/household predictors of malnutrition. On the community level, being from community with high wealth index, distance to nearest health facilities is no big problem. Regional variations and gender inequality index were the state level predictors of malnutrition among children in Nigeria. This study has shown that two-third of children aged 6-59 months in Nigeria were poorly nourished, an indication of a growing concern of double burden of malnutrition in Nigeria.

Process Evaluation of Community-Based Nutrition Service for Under 2 Years Children in Degadamot District Using Qualitative Approach, Western Ethiopia, 2023

Malnutrition accounts for 45% of under-5 child morbidities in Ethiopia and is a more common issue in rural communities. In that regard, Ethiopia has implemented a CBN program at the community level to improve the nutrition status of children. Despite this, malnutrition still causes a significant rate of child morbidity and mortality. The implementation status of the CBN program is unknown. Thus, this evaluation aimed to evaluate the children under 2 years in Degadamot district health posts in northwest Ethiopia. A facility-based single-case study design with qualitative-method evaluation was employed from March 28 to April 28, 2023. The evaluation focused on the availability and compliance with multiple data sources. The qualitative data were transcribed, translated, and analyzed using thematic analysis with OPEN CODE version 4.02 software. Finally, the overall program implementation was determined based on predetermined judgmental criteria. According to the predetermined judgment parameter, the overall CBN program implementation level was 62.68%, measured by the availability of resources (71.36%) and compliance of service providers (54.0%). The overall community-based nutrition program implementation in the Degadamot district health post with 2 evaluation dimensions was judged as fair based on the presetting criteria. It is better to improve the service through training HEW and HDA, distributing nutritional supplies, providing regular support, and following up with HEWs for GMP performance in the Degadamot district.

Impact of malnutrition on the outcome and length of hospital stay in elective pediatric surgical patients: prospective cohort study at tertiary hospitals in Ethiopia

BACKGROUND

Pediatric surgical patients in low and middle-income countries suffer from malnutrition on top of the surgical pathology and post-operative stress which increases post-operative morbidity and mortality. Malnutrition is highly prevalent in Africa and is expected to impact the outcome of surgical patients. The study was aimed at determining the impact of malnutrition on the outcome and length of hospital stay in elective pediatric surgical patients.

METHODS

A prospective study was done on children, aged one month to fourteen years, who had undergone elective general surgery. Upon admission, nutritional assessment using an anthropometric indicator was undertaken and used to derive the WHO Anthro Z scores. Malnutrition was defined as a binary outcome: severely/moderately malnourished (Z < -2) versus well nourished (Z ≥ -2). After surgery, postoperative complications were documented. Chi-squared tests and t-tests were used to assess associations.

RESULTS

Of the 109 enrolled children, 49 (45%) had malnutrition preoperatively. Infants had a higher prevalence of malnutrition (65% versus 35%, p-value = 0·028) compared to older children. Postoperative infection was relatively more common in malnourished children (27·1% versus 20%). The mean post-operative stays were 5·69 days (SD 0.46) for well-nourished children and 6.89 days (SD 0·9) for malnourished patients but the difference was not statistically significant.

CONCLUSION

We observed neither significant long hospital stays nor a higher incidence of postoperative infection among children with malnutrition. Further investigations with a larger sample size are warranted.

Prevalence of Acute Malnutrition and Associated Factors among Children aged 6-59 months in South Wollo Zone, East Amhara, Northeast Ethiopia: a Community-based cross-sectional study

OBJECTIVE

The aim of this study is to determine the prevalence of acute malnutrition and associated factors in South Wollo zone, East Amhara, Northeast Ethiopia.

DESIGN

A community-based cross-sectional study was conducted among 504 children aged 6-59 months who were selected by using a multistage sampling technique. The mid-upper-arm-circumference and Z-scores for weight-for-height were used to determine the nutritional status of the participants. A semi-structured interview questionnaire was used to collect the data. Then data was entered into EpiData V.3.1 and exported to SPSS software V.25 for analysis. Binary logistic regression was used to identify factors associated with acute malnutrition and variables with p value<0.05 were declared as statistically significant.

SETTING

The study was conducted in South Wollo zone, Northeast Ethiopia from 1 August 2020 to 30 September 2020.

PARTICIPANTS

Children aged 6-59 months with their mothers were the study subjects.

RESULTS

The prevalence of acute malnutrition among children aged 6-59 months was 31.0%. Child aged 6-11 months (adjusted OR (AOR)=3.92; 95% CI: 1.74 to 8.82), illiterate mothers (AOR=3.01; 95% CI: 1.92 to 7.01), single mother (AOR=3.06; 95% CI: 1.32 to 7.07), lack of latrine (AOR=2.39; 95% CI: 1.12 to 5.11), diarrhoea (AOR=4.18; 95% CI: 2.02 to 8.65), respiratory tract infection (AOR=2.31; 95% CI: 1.08 to 4.94), family size (≥5) (AOR=3.29; 95% CI: 1.53 to 7.09) and cessation of breast feeding before 2 years (AOR=3.79; 95% CI: 1.71 to 8.23) were the independent predictors of acute malnutrition.

CONCLUSION

Acute malnutrition is highly prevalent in the study area which is more than the national figure. Thus, improving maternal education, access to the latrine, improved breastfeeding practice, improved family planning usage and early detection and treatment of diarrhoea and respiratory tract infections will enhance children's nutritional status. In addition, nutritional diversity education needs to be strengthened.

Determinants of Acute Malnutrition among Under-Five Children in Governmental Health Facilities in Sodo Town, Southern Ethiopia: Unmatched Case-Control Study

Background

Acute malnutrition is a major public health challenge among children globally. The burden is high in low-income countries like Ethiopia. Different reports and literatures revealed different risk factors of acute malnutrition in different geographical areas, but there were regional variations. So, the main aim of this study was to identify determinants of acute malnutrition among under-five children in governmental health facilities of Sodo town, Southern Ethiopia.

Methods

An institutional-based unmatched case-control study was conducted from February 1 to March 1, 2021. Consecutive sampling was used to select cases, and controls were selected using a systematic random sampling technique. An interviewer-administered structured questionnaire was used to collect data, and standardized anthropocentric measurement equipment was used to identify cases and controls. Data were analyzed using SPSS version 26. A logistic regression model was used to identify the determinants of acute malnutrition, and statistical significance was declared at P < 0.05.

Result

A total of 133 cases and 266 controls were included in the study making a response rate of 97.8%. Mothers with no formal education, birth interval less than 24 months, marital status (divorced widowed and separated), diarrhea in the past two weeks, using nonprotected water for drinking, exclusive breastfeeding less than 6 months, not taking sick children to health facility within 24 hours of the onset of any sickness, low birth weight, breastfeeding for less than 24 months, using nonimproved toilet, low dietary diversity, and food insecurity were significantly associated with acute malnutrition.

Conclusion

This study identified the major determinants of acute malnutrition among under-five children in the study area. Thus, ensuring safe water supply, empowering women, and improving knowledge and practices of mothers regarding exclusive breastfeeding and family planning are recommended.

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

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.

The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia

Background

The prevalence of stunting in Indonesia has decreased gradually. The strategy to reduce stunting is currently prioritized on improving socio-economic levels, fulfilling food intake, and sanitation conditions. This study aims to analyze the association between sociodemographics, nutrition, and sanitation on stunting in rural West Java Province in Indonesia.

Design and methods

A cross-sectional study was conducted in May-August 2022 among 247 mother-children pairs, selected by systematic random sampling from a rural area of West Java Province in Indonesia. The sociodemographic characteristics were measured using a structured questionnaire. The nutritional status of the children under five was assessed by length/height-for-age (HAZ), and was calculated using WHO Anthro software. Sanitation is assessed using observation and interviews with a structured questionnaire.

Results

The prevalence of stunting in children under five was 20.7% (5.3% severely stunted and 15.4% stunted). Binary logistic regression analysis using SPSS version 22.0 show that mother's height as the dominant factor associated with stunting in children under five (AOR = 3.45, 95% CI: 1.12-4.67, p = 0.008). In addition, children's age (AOR = 0.250, 95% CI: 0.104-0.598, p = 0.002); balanced diet practices (AOR = 1.57, 95% CI: 0.965-2.56, p = 0.069), and building materials (AOR = 1.869, 95% CI: 0.87-4.00, p = 0.108 are also related to stunting in children under five.

Conclusions

Efforts to improve maternal nutrition need to be carried out from the period before pregnancy to the first 1000 days of life. Education on healthy home indicators, especially the use of this type of building materials for houses, needs to be done to improve sanitation as an effort to prevent stunting in children under five.

Spatial distribution and associated factors of severe malnutrition among under-five children in Ethiopia: further analysis of 2019 mini EDHS

BACKGROUND

Malnutrition is both a significant cause and a result of poverty and deprivation. In developing nations, child malnutrition is still the main public health issue. Severe malnutrition affects every system of the body and leads to medical instability. The assessment of the burden of severe malnutrition is important for ready-to-use therapeutic foods and preparing therapy for these conditions. Therefore, this study aimed to assess the prevalence and spatial distribution of severe malnutrition and the factors associated with it.

METHODS

Data from the 2019 Mini-EDHS (Ethiopian Demographic and Health Surveys) with stratified sampling techniques were used. The data were weighted using sample weight to restore the data's representativeness and provide accurate statistical estimations. A total of 5,006 weighted samples of children under the age of five were used to analyze the study. A multilevel binary logistic regression model was built, and a cutoff P-value of 0.05 was used. The wag staff normalized concentration index and curve as well as spatial analysis were used.

RESULTS

The prevalence of severe malnutrition practice among under five years children in Ethiopia was 14.89% (95%CI: 13.93%, 15.91%), and ranges from 4.58% in Addis Ababa to 25.81% in the Afar region. Women with secondary and above education status as compared to uneducated [AOR = 0.17; 95%CI;[0.06, 0.48], high community women's education as compared to low [AOR = 0.54; 95%CI; 0.36, 0.78], women from richest household as compared to poorest [AOR = 0.63; 95%CI; 0.26, 0.94] and living in Oromia region as compared to Tigray [AOR = 0.33: 95%CI; 0.15, 0.74] were preventive factors. Whereas children 24-59 months of age as compared to under six months [AOR = 1.62; 95%CI; 1.50, 1.75], and being multiple births as compared to single [AOR = 5.34; 95%CI; 1.36,2 1.01] have significant risk factors for severe malnutrition. There was a pro-poor distribution of severe malnutrition among under-five children in Ethiopia with a concentration index of -0.23 [95%CI: -0.27, -0.19]. Severe malnutrition has significant spatial variation over regions in the country where the entire Afar, Eastern Amhara, Southern, and eastern Tigray regions were severely affected (RR = 1.72, P-value < 0.01).

CONCLUSION AND RECOMMENDATIONS

The prevalence of severe malnutrition in Ethiopia is relatively high as compared to other studies and most of them were severe chronic malnutrition. Having an educated mother/caregiver, and living in a cluster with high community women's education were preventive factors for severe malnutrition in children. Whereas having an unmarried mother/caregiver, old age of the child, plurality of birth, and having double children in the family have a positive association with it. Moreover, it was disproportionately concentrated in poor households (pro-poor distribution). The spatial distribution of childhood severe malnutrition was not random. Regions like Tigray, Afar, Eastern parts of Amhara, and Somalia regions should be considered priority areas for nutritional interventions for reducing severe malnutrition. Equity-focused nutritional interventions could be needed to curb the wealth-related inequalities of childhood severe malnutrition.

Determinants of nutritional status among primary school students in Dilla Town; Application of an ordinal logistic regression model

Background

One of the most frequent reasons for children's poor physical and mental development is malnutrition, becoming a more significant issue in most developing nations, including Ethiopia. Prior research used multiple anthropometric measurements separately to pinpoint undernutrition concerns in children. However, the impact of each explanatory variable on a single response category was not considered in these investigations. This study used a single composite index of anthropometric parameters to identify the factors affecting elementary school students' nutritional condition.

Methods

In Dilla, Ethiopia, 494 primary school students took part in a cross-sectional institutional survey during the 2021 academic year. Principal component analysis was used to create a single composite measure of nutritional status using z-scores for the anthropometric indices of height-for-age and body mass index-for-age. The relative effectiveness of a partial proportional odds model was compared with several other ordinal regression models to identify the important variables for children's nutritional status.

Results

27.94% of primary school students were undernourished (7.29% severely and 20.65% moderately). According to the fitted partial proportional odds model, the mother's education level (secondary or higher) was positively correlated with the nutritional status of primary school students, given that in this case the students ate three or more times per day and had a high dietary diversity score (OR = 5.94; CI: 2.2-16.0). Nevertheless, there was a negative correlation between larger family size (OR = 0.56; CI: 0.32-0.97), unprotected groundwater (OR = 0.76; CI: 0.6-0.96), and severely food insecure households (OR = 0.3; CI: 0.14-0.68).

Conclusion

In Dilla, Ethiopia, undernutrition among primary school students is a serious issue. It is essential to implement nutrition education and school feeding programs, improve drinking water sources, and boost the community's economy to alleviate the problems.

Exploring the risk factors of child malnutrition in Sub-Sahara Africa: A scoping review

Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub-Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.

Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis

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.

Mother's education and nutritional status as correlates of child stunting, wasting, underweight, and overweight in Nigeria: Evidence from 2018 Demographic and Health Survey

Aim: This study examined the nexus between mother's education and nutritional status and their relationships with child stunting, wasting, underweight, and overweight. Methods: The data of 34,193 under-five (U-5) children from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed using descriptive statistics, and binary and complementary log-logistic regression models. Results: The prevalence of child stunting, wasting, underweight, and overweight were 36.51%, 6.92%, 21.73%, and 2.05%, respectively. Compared to children born to mothers with at least secondary education, uneducated women's children (odds ratio (OR) = 1.55; 95% confidence interval (CI) = 1.32-1.82) and those of women with primary education (OR = 1.49; 95% CI = 1.28-1.72) were more likely to be stunted. Similarly, children born to uneducated women (OR = 1.51; 95% CI = 1.24-1.83) were more likely to be underweight than women with at least secondary education. The likelihood of child underweight (OR = 1.71; 95% CI = 1.45-2.01) and wasting (rate ratio (RR) = 1.82; 95% CI = 1.47-2.26) were higher among underweight mothers, respectively, than those with normal body mass index (BMI). The likelihood of child stunting (OR = 0.75; 95% CI = 0.67-0.84) and underweight (OR = 0.66; 95% CI = 0.57-0.77) were lower among obese/overweight mothers compared to those with normal BMI, but their children were more likely to be overweight (RR = 1.77; 95% CI = 1.27-2.48). Conclusion: Attainment of higher education by mothers should be promoted to prevent childhood nutritional imbalances, and sensitization on healthy dietary habits and lifestyles should be promoted among women, especially the overweight/obese, to reduce their risk of having overweight children.

Determinants of Child Stunting, Wasting, and Underweight: Evidence from 2017 to 2018 Pakistan Demographic and Health Survey

Child malnutrition persists in low-resource countries such as Pakistan, indicating an urgent need for interventions and policies aimed to address this critical population health issue. The World Health Organization Global Target 2025 includes the reduction of malnourishment in the form of stunting, wasting, and low weight. This study aims to examine the prevalence of factors associated with three measures of child malnutrition, i.e., stunting, wasting, and low weight in Pakistan. This study uses a secondary data analysis design based on data from Pakistan Demographic and Health Survey (2017-18) that used a two-stage cluster sampling approach. National level data covering urban and rural areas were used for this study consisting of 4,226 children less than 5 years of age. Univariate and multivariable analyses using logistic regression models were conducted. Over 23% of the children were underweight, 8.0% suffered wasting, and 37.7% were stunted. Children with small size at birth (<45.7 cm), those who were average in size (45.7 to 60 cm) at birth were less likely to be stunted (AOR, 0.4890) and underweight (AOR, 0.538). Children with large size at birth (>60 cm) were also less likely to be stunted (AOR, 0.288) and underweight (AOR, 0.538). Children who consumed fresh milk were less likely to be classified as wasted (AOR, 0.524) than those children who did not consume fresh milk. The children in high- and middle-economic status families were less likely to be stunted, underweight, or wasted. Children of mothers who had secondary and higher education were less likely to be stunted (AOR, 0.584) and were less likely to be underweight (AOR, 0.668) than illiterate mothers' children. Children of working mothers were less likely to be wasted compared to children of nonworking mothers (AOR, 0.287). Maternal BMI is also inversely associated with being underweight because overweight and obese mothers were less likely to have underweight children (AOR, 0.585). Our findings reflect a need to design targeted public health policies and community-based education that emphasize the mother's education on nutrition health and provide socioeconomic resources that enable mothers to provide dietary needs that prevent malnutrition.

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.

Assessment of undernutrition using the composite index of anthropometric failure (CIAF) and its determinants: A cross-sectional study in the rural area of the Bogor District in Indonesia

Background

The Composite Index of Anthropometric Failure (CIAF) can comprehensively identify undernutrition by combining several indicators of nutritional status – namely, weight-for-age, length/height-for-age and weight-for-length/height – to determine the nutritional status of children under five years of age. This study aims to assess undernutrition using the CIAF and its determinants on children under five years of age in the Bogor District, Indonesia.

Methods

A cross-sectional study was conducted during February–May 2019 among 330 mother-children pairs (with children under five), selected by systematic random sampling from four villages as undernutrition pockets in the rural area of Bogor District, Indonesia. The nutritional status of the children was assessed by measuring weight and length/height. Z-score was calculated using WHO Anthro software and was categorized based on conventional indices, including weight-for-age (WAZ), length/height-for-age (HAZ) and weight-for-length/height (WHZ). The CIAF is measured based on a combination of conventional index measurements. In addition, mothers’ and childrens’ characteristics and clean living behaviour are assessed via structured questionnaires. Environmental sanitation is assessed using the environment meter. Binary logistic regression analysis with SPSS version 22.0 is used to analyse the dominant factors associated with undernutrition.

Results

Among children under five, 42.1% experienced anthropometric failure (overall prevalence of undernutrition based on the CIAF), 2.4% experienced wasting only, 5.8% were classified as both wasting and underweight, 2.1% as wasting, underweight and stunting, 16.4% as underweight and stunting, 11.5% as stunting only, and 3.9% as underweight only. Assessment of nutritional status using a conventional anthropometric index shows that respective prevalences of underweight, stunted and wasted were 27.8, 29.7, and 10.6%. The mother’s height is the most dominant factor associated with anthropometric failure [p = 0.008; AOR = 1.95; 95% CI: 2.19–3.19]. The most dominant factors associated with the conventional undernutrition indices of underweight, stunted and wasted are, respectively, family income [p = 0.018; AOR = 5.44; 95% CI: 1.34–22.11], mother’s height [p = < 0.001; AOR = 3.29; 95% CI:1.83–5.91] and child’s age [p = 0.013; AOR = 2.59; 95% CI: 1.22–5.47].

Conclusion

Nearly half of children under five experience anthropometric failure. Specific nutrition improvement interventions and specific nutrition interventions during pregnancy and lactation are needed, especially for malnourished mothers, to prevent malnutrition in infant.

Thinness among children aged 5–17 years living in Nakivale refugee settlement, South Western Uganda: a cross-sectional study

Background

Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5–17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda.

Methods

This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance.

Results

A total of 420 children aged 5–17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8–11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63–24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27–8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15–8.83, p = 0.025).

Conclusion

Five in every 100 children aged 5–17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children.

Understanding the rural-urban disparity in acute respiratory infection symptoms among under-five children in Sub-Saharan Africa: a multivariate decomposition analysis

Background

Acute Respiratory Infections (ARIs) account for more than 6% of the worldwide disease burden in children under the age of five, with the majority occurring in Sub-Saharan Africa. Rural children are more vulnerable to and disproportionately affected by ARIs. As a result, we examined the rural–urban disparity in the prevalence of ARI symptoms and associated factors among children under the age of five in Sub-Saharan Africa.

Methods

We used the most recent Demographic and Health Survey (DHS) data from 36 countries in Sub-Saharan Africa. The study included 199,130 weighted samples in total. To identify variables associated with ARIs symptoms, a multilevel binary logistic regression model was fitted. The Adjusted Odds Ratio (AOR) with a 95% CI was used to determine the statistical significance and strength of the association. To explain the rural–urban disparity in ARI prevalence, a logit-based multivariate decomposition analysis was used.

Results

Being female, ever breastfeeding, belonging to a poorer, better wealth status, and having better maternal educational status were significantly associated with lower odds of ARIs among under-five children. Whereas, small size or large size at birth, not taking vitamin A supplementation, being severely underweight, having diarrhea, didn’t have media exposure, never had the vaccination, being aged 36–47 months, and being aged 48–59 months were significantly associated with higher odds of ARIs among under-five children. The multivariate decomposition analysis revealed that the difference in characteristics (endowment) across residences explained 64.7% of the overall rural–urban difference in the prevalence of ARIs, while the difference in the effect of characteristics (change in coefficient) explained 35.3%.

Conclusion

This study found that rural children were highly affected by ARIs in SSA. To reduce the excess ARIs in rural children, public health interventions aimed at impoverished households, home births, and unvaccinated and malnourished children are crucial.

Under-nutrition and its determinants among school-aged children in northwest Ethiopia

Background

Malnutrition among children has lifelong implications, its outcomes not only cover the whole life but also transfer from one generation to another generation. Most studies conducted before focused on undernutrition in pregnant mothers and children less than 5 years of age, whereas school-age children are often omitted from health and nutrition surveys or surveillance. In Northwest Ethiopia, particularly in the study area, the community levels nutritional status of school-age is not well studied and documented. Therefore, this study aimed to assess the prevalence and determinants of the under-nutritional status of school-age children in Gondar Zuria District, Northwest Ethiopia.

Methods

A community-based cross-sectional study design was employed with 364 respondents from January to April 2020. Data entered using Epi Data software version 3.1. Standard deviation scores were obtained by the world health organization Anthro Plus software to determine the nutritional status of children, and further analysis was done by using STATA version 14 software. Adjusted odds ratio with its corresponding 95 % confidence interval was used to declare statistically significant variables.

Results

The prevalence of overall under-nutrition was 71.98% (95%, CI: 67%–76%) from which, 43.13% (95%, CI: 38%–48%) were stunted, 40.93% (95%, CI: 35%–46%) were under-weight, and 35.44% (95%, CI: 30%–40%) were wasted. Child age [AOR = 0.30, 95% CI (0.13–0.68)], food insecurity [AOR = 2.24, 95% CI (1.03–4.83)], good knowledge of mother/care giver [AOR = 0.40, 95% CI (0.17–0.92)], having larger family size (Tzioumis and Adair, 2014; Wolde et al., 2015; Mohammed et al., 2019) [6-8] [AOR = 2.92, 95% CI (1.29–6.58)], and unprotected drinking water sources [AOR = 2.84, 95% CI (1.00–8.06)] were the predictors of under-nutrition.

Conclusion

According to the world health organization cut-offs, the prevalence of overall under-nutrition in the study area was very high. Child age, food insecurity, knowledge of mother/caregiver, having a larger family size, and unprotected drinking water sources were the predictors of under-nutrition. The district offices should give attention to the improvement of the food security status of the community, and give priority to the availability and accessibility of drinking water sources, particularly pipe water sources. Special attention to older age groups of children is important to control the prevalence of under-nutrition.

Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet

OBJECTIVE

To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old.

DESIGN

A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination.

SETTING

Tibet, China.

PARTICIPANTS

Children under 5 years old in Tibet.

RESULTS

Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (β = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05).

CONCLUSIONS

High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.

Space-time dynamics regression models to assess variations of composite index for anthropometric failure across the administrative zones in Ethiopia

BACKGROUND

A single anthropometric index such as stunting, wasting, or underweight does not show the holistic picture of under-five children's undernutrition status. To alleviate this problem, we adopted a multifaceted single index known as the composite index for anthropometric failure (CIAF). Using this undernutrition index, we investigated the disparities of Ethiopian under-five children's undernutrition status in space and time.

METHODS

Data for analysis were extracted from the Ethiopian Demographic and Health Surveys (EDHSs). The space-time dynamics models were formulated to explore the effects of different covariates on undernutrition among children under five in 72 administrative zones in Ethiopia.

RESULTS

The general nested spatial-temporal dynamic model with spatial and temporal lags autoregressive components was found to be the most adequate (AIC = -409.33, R2 = 96.01) model. According to the model results, the increase in the percentage of breastfeeding mothers in the zone decreases the CIAF rates of children in the zone. Similarly, the increase in the percentages of parental education, and mothers' nutritional status in the zones decreases the CIAF rate in the zone. On the hand, increased percentages of households with unimproved water access, unimproved sanitation facilities, deprivation of women's autonomy, unemployment of women, and lower wealth index contributed to the increased CIAF rate in the zone.

CONCLUSION

The CIAF risk factors are spatially and temporally correlated across 72 administrative zones in Ethiopia. There exist geographical differences in CIAF among the zones, which are influenced by spatial neighborhoods of the zone and temporal lags within the zone. Hence these findings emphasize the need to take the spatial neighborhood and historical/temporal contexts into account when planning CIAF prevention.

Associated Factors of Wasting among Infants and Young Children (IYC) in Kuyu District, Northern Oromia, Ethiopia

Wasting among infants and young children in underdeveloped countries including Ethiopia is one of the most serious public health issues. Therefore, this study was designed to assess the magnitude of wasting and the variables that associate with it among infants and young children in the Kuyu district of Northern Oromia, Ethiopia. A community-based cross-sectional study of 612 infants and young children aged 6-23 months was conducted. To select eligible infants and young children from each family in the Kuyu district, a multilevel sampling approach was used. The amount and determinants related to wasting were investigated using the Statistical Package for Social Sciences (SPSS) version 20.0. In the study area, 14.1% of infants and young children were found to be wasting. Maternal educational status (AOR = 1.8, 95% CI; 1.01, 4.32), diarrhoea (AOR = 2.3, 95% CI; 1.98, 4.56), exclusive breastfeeding (AOR = 2.46, 95% CI, 1.4, 4.58), antenatal care visits (AOR = 2.21; 95% CI, 1.32, 3.48), and wealth index (AOR = 1.66, 95% CI; 1.07, 4.47) were significantly associated with wasting. According to the findings of this study, mother educational status, the occurrence of diarrhoea, exclusive breastfeeding, antenatal care visits, and wealth index have an impact on infants and young children's wasting. Therefore, to lower the burden of wasting among infants and young children in the study, community-based schooling and nutritional interventions are urgently needed.

Maternal Underweight and Its Association with Composite Index of Anthropometric Failure among Children under Two Years of Age with Diarrhea in Bangladesh

Malnutrition in women has been a long-standing public health concern, with serious effects on child survival and development. Maternal body mass index (BMI) is an important maternal nutritional indicator. There are few published studies although child anthropometric failures do not occur in isolation and identifying children with single versus several co-occurring failures can better capture cases of growth failure in combination: stunting, wasting, and underweight. In the context of multiple anthropometric failures, traditional markers used to assess children's nutritional status tend to underestimate overall undernutrition. Using the composite index of anthropometric failure (CIAF), we aimed to assess the association between maternal undernutrition and child undernutrition among children with diarrhea under the age of two and to investigate the correlates. Using 1431 mother-child dyads from the Antibiotic for Children with Diarrhea (ABCD) trial, we extracted children's data at enrollment and on day 90 and day 180 follow-ups. ABCD was a randomized, multi-country, multi-site, double-blind, placebo-controlled clinical trial. The Bangladesh site collected data from July 2017 to July 2019. The outcome variable, CIAF, allows combinations of height-for-age, height-for-weight, and weight-for-age to determine the overall prevalence of undernutrition. The generalized estimating equation was used to explore the correlates of CIAF. After adjusting all the potential covariates, maternal undernutrition status was found to be strongly associated with child undernutrition using the CIAF [aOR: 1.4 (95% CI: 1.0, 1.9), p-value = 0.043] among the children with diarrhea under 2 years old. Maternal higher education had a protective effect on CIAF [aOR: 0.7 (95% CI: 0.5, 0.9), p-value = 0.033]. Our study findings highlight the importance of an integrated approach focusing on maternal nutrition and maternal education could affect a reduction in child undernutrition based on CIAF.

Using traditional healers to treat child malnutrition: a qualitative study of health-seeking behaviour in eastern Ethiopia

Background

Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children’s malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents’ treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people’s health-seeking behaviour.

Methods

The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers’ assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory.

Results

Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition.

Conclusions

Through an exploration of people’s own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres.

Nutritional status of 6-59 months of age children is not significantly varied between households with and without home gardening practices in Zege, North West Ethiopia, 2020: community based comparative study

BACKGROUND

Malnutrition is a critical public health issue that has been related to a significant increase in mortality and morbidity rates. Despite the fact that children are expected to benefit from home gardening products, their nutritional condition in Ethiopia, particularly in the planned study region, is not thoroughly monitored. Therefore the purpose of this is to determine the nutritional status of 6-59 months of age children between households with and without home gardening practices at Zege.

METHODS

A community based comparative cross-sectional study was conducted among paired mothers with 6-59 month children from February to March 2020. Data were collected using questionnaire and anthropometric measurement tools. Binary logistic regression models were used. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.

RESULT

Stunting and wasting among children aged 6-59 months was high and did not show significant variation between households practicing home gardening (stunting 46.1%, at 95%, CI: 40.6-51.3 and wasting 9.1%, at 95% CI: 6.2-12.7) and not practiced home gardening (stunting 50.3%, at 95% CI: 44.5-55.8 and wasting 10.1%, 95% CI: 6.8-13.8). Having low dietary diversity (AOR = 2.7; 95% CI: 1.9-3.9), Being male (AOR = 2.1; 95% CI: 1.4-3), feeding frequency < 3/day (AOR = 1.7; 95% CI: 1.1-2.4), and presence of diarrhea (AOR = 2.6; 95% CI: 1.4-4.6) were predictors of stunting. Unprotected-drinking water (AOR = 2.1; 95% CI: 1.0-4.2), not fully-immunized (AOR = 2.6; 95% CI: 1.3-5.1) and being female (AOR = 2.4; 95% CI: 1.3-4.6) were predictors for child wasting.

CONCLUSION

stunting and wasting are highly prevalent in both home gardening and non- home gardening households' children of the community. Promoting diversified diet, protected water source, vaccinating children, access to a healthy environment and integrated with the access of nutrition education programs are vital interventions to improve nutrition.

Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: a cross-sectional study

Background

Malnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children.

Methods

This is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated.

Results

Ninety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017).

Conclusion

The PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00525-8.

Risk Factors of Stunting and Wasting among Children Aged 6–59 Months in Household Food Insecurity of Jima Geneti District, Western Oromia, Ethiopia: An Observational Study

Undernutrition is the most difficult and widespread public health concern in low-income nations including Ethiopia. Therefore, this study aimed to investigate the associated risk factors of stunting and wasting among children aged 6–59 months in Jima Geneti district, Western Oromia, Ethiopia. A community-based cross-sectional study was conducted on 500 children from December 1 to 28, 2020. A multiple-stage sampling method was performed to select children from each kebele. Anthropometric measurements were taken, and the nutritional status was generated using WHO Anthro v. 3.2.1. Data analysis was performed using the SPSS version 20.0. Bivariate and multivariate logistic regression analyses were carried out to identify the associated risk factors of stunting and wasting among children in the study area. Statistical significance was set at p < 0.05. The study results showed that the prevalence of stunting and wasting among children was 27% and 11.8%, respectively. The findings of this study also revealed that the prevalence of household food insecurity and poor dietary diets was 19.6% and 52.2%, respectively. Low wealth status (AOR = 2.5; 95% CI: 1.1, 5.55) and poor dietary diets (AOR = 4.7; 95% CI: 2.5, 8.83) were associated risk factors for stunting. However, child meal frequency (AOR = 3.9; 95% CI: 1.23, 12.6), and children who did feed leftover food (AOR = 2.75; 95% CI: 1.02, 7.44) were associated risk factors for wasting. Poor dietary diets (AOR = 2.65; 95% CI: 1.06, 6.66) were also associated risk factors for wasting. The findings of this study concluded that the prevalence of stunting and wasting was high in the study area. Therefore, addressing family-level risk factors which are major drivers of children's nutritional status is crucial to ensure the nutritional status of children.

Applied nutritional investigation Determinants of undernutrition among private and public primary school children: A comparative cross-sectional study toward nutritional transition in northwest Ethiopia

OBJECTIVES

Undernutrition is a major public health concern, particularly in children. The burden is higher in developing countries. Undernutrition is considered when there is one or more of the following: stunting, underweight, or wasting. Childhood undernutrition can have numerous long-term effects: a lower physical capacity for work, lower intellectual quotients, greater risk for morbidity and mortality, and cognitive impairment. Undernourished children also can have poor cognitive scores, a high absenteeism rate, and high class repetition compared with non-undernourished children. The aim of this study was to assess undernutrition and its associated factors among public and private primary school children in Gondar town, northwest Ethiopia.

METHODS

A school-based, cross-sectional study was conducted from March 5 to April 9, 2019. A multistage sampling technique was applied to select study participants. A simple random (lottery) sampling method was used to select seven public schools and five private schools. Systematic random sampling was used to select 774 study participants. The data were collected through face-to-face interviews. Multivariable logistic regressions were conducted to identify factors associated with undernutrition. The World Health Organization (WHO) AnthroPlus software was used to determine the status of undernutrition. Participants with a Z-score less than -2 were considered to be undernourished. Statistical significance was declared at P < 0.05 and odds ratios (ORs) were reported with a 95% confidence interval (CI).

RESULTS

The prevalence of undernutrition was higher among public school children (37.1%) than those attending private schools (28.3%). Not having family car (adjusted OR [aOR], 0.28; 95% CI, 0.09-0.84), snack frequency no more than twice a day (aOR, 5.29; 95% CI, 1.37-20.37), and vigorous intensity sports (aOR, 0.53; 95% CI, 0.32-0.91) were significantly associated with undernutrition among public primary school students. Family income below the median (aOR, 2.12; 95% CI, 1.23-3.53), no preference for sweets (aOR, 0.59; 95% CI, 0.36-0.97), and not habits while reading (aOR, 0.42; 95% CI, 0.19-0.89) were the factors significantly associated with undernutrition among private primary school students.

CONCLUSION

The prevalence of undernutrition was high. Children in public schools were highly vulnerable to undernutrition compared with those in private schools. Not having a family car, snack frequency no more than twice daily, and vigorous intensity sports increase the risk for undernutrition among public school children. Family income below the median, not preferring sweets, and not having a habit of eating while reading increase the risk for undernutrition among private school children. It is better to give attention to healthy dietary habits and healthy lifestyles to reduce childhood undernutrition.

Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth

The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting or underweight) among children under 5 in Bangladesh: a nationally representative cross-sectional study

OBJECTIVES

The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh.

DESIGN

A nationally representative cross-sectional study.

SETTING

Bangladesh.

RESPONDENTS

Children age under 5 years of age.

OUTCOME MEASURE

This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition.

STATISTICAL ANALYSIS

Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis.

RESULTS

Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24-35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24-35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father's occupation, children's age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition.

CONCLUSION

One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father's occupation, children's age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children.

Prevalence and Potential Determinants of Aggregate Anthropometric Failure among Pakistani Children: Findings from a Community Health Survey

Malnutrition among children is an important public health problem in Pakistan. Conventional indicators (stunting, wasting and underweight) are well known. However, there is a need for aggregate indicators in this perspective. The goal of this study is to assess the prevalence and trends of malnutrition among Pakistani children under the age of five using the so-called composite index of anthropometric failure (CIAF), a tool for calculating the whole aggregate burden of malnutrition. The data were extracted from the Pakistan Demographic and Health Survey 2012-2013. Mothers' education and socioeconomic statuses (SES) were assessed as important factors in malnutrition. Chi-squared analysis was used to check the bivariate association, and multiple logistic regression was used to identify the significant correlates of child malnutrition. Moreover, multiple correspondence analysis (MCA) was applied to strengthen the use of CIAF as an outcome variable. The study looked at 3071 children under the age of five, with 52.2% of them falling into the CIAF. Children of educated mothers had 43% fewer odds of being malnourished (OR (Odd Ratio) = 0.57, 95% CI (Confidence Interval) = 0.44-0.73). Additionally, a decreasing trend in malnutrition was found with increasing SES. There is a need to improve maternal education. Such programs focusing on increasing women's autonomy in making home decisions should be established. Furthermore, long-term interventions for improving home SES and effective nutritional methods should be examined. For policymakers, the use of CIAF is suggested since it provides an estimate of the entire burden of undernutrition.

Spatial data analysis of malnutrition among children under-five years in Ethiopia

Background

Childhood malnutrition is a major cause of child mortality under the age of 5 in the sub-Saharan Africa region. This study sought to identify the risk factors and spatial distribution of the composite index of anthropometric failure (CIAF).

Methods

Secondary data from 2000, 2005, 2011, and 2016 Ethiopian Health and Demographic Survey (EDHS) were used. The generalized geo-additive mixed model was adopted via the Integrated Nested Laplace Approximation (INLA) with a binomial family and logit link function.

Results

The CIAF status of children was found to be positively associated with the male gender, the potency of contracting a disease, and multiple births. However, it was negatively associated with family wealth quartiles, parental level of education, place of residence, unemployment status of mothers, improved sanitation, media exposure, and survey years. Moreover, the study revealed significant spatial variations on the level of CIAF among administrative zones.

Conclusions

The generalized geo-additive mixed-effects model results identified gender of the child, presence of comorbidity, size of child at birth, dietary diversity, birth type, place of residence, age of the child, parental level of education, wealth index, sanitation facilities, and media exposure as main drivers of CIAF. The results would help decision-makers to develop and carry out target-oriented programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01391-x.

Prevalence of undernutrition and potential risk factors among children below five years of age in Somali region, Ethiopia: evidence from 2016 Ethiopian demographic and health survey

BACKGROUND

Childhood under-nutrition is far-reaching in low and middle-income nations. Undernutrition is one of the major open wellbeing concerns among newborn children and youthful children in Ethiopia. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Somali Region, Ethiopia.

METHODS

The data for this study was extricated from the Ethiopian Demographic and Health Survey (EDHS) 2016. The data collected from 1339 children born 5 years before was considered within the analysis. A multivariable binary logistic regression analysis was utilized at a 5% level of significance to decide the individual and community-level variables related to childhood malnutrition.

RESULTS

The prevalence of stunting, underweight and wasting were 27.4, 28.7 and 22.7%, respectively. About 16.1% of children were both stunted and underweight; the extent of both being underweight and wasted was 11.7%, the prevalence of both stunted and wasted children was 5.5%, and all three malnutrition conditions were 4.7% children. Among the variables considered in this study, age of the child in months, type of birth, anemia level, size of child at birth, sex of the child, mothers' BMI and sources of drinking water were significantly related to stunting, underweight and wasting in Somali Region.

CONCLUSIONS

The prevalence of stunting, underweight and wasting was relatively high. Undernutrition is one of the major open wellbeing concerns among children in Somali region. The impact of these variables ought to be considered to develop strategies for decreasing the lack of healthy sustenance due to undernutrition in the study areas. Hence, intercession should be centered on making strides for the under-nutrition determinant variables of the children to be solid, to improve the child's wholesome status, and decrease child mortality quickly.

Disparities in childhood composite index of anthropometric failure prevalence and determinants across Ethiopian administrative zones

BACKGROUND

The prevalence of under-five children's undernutrition in Ethiopia is among the highest in the world. This study aimed at exploring the prevalence and risk factors of the composite index for anthropometric failure (CIAF) of under-five children in Ethiopia by incorporating the zonal (district) effects.

METHODS

The data was drawn from Ethiopian Demographic and Health Surveys (EDHSs), a population-based cross-sectional study of 29,599 under-five year children from 72 Zones in the years 2000, 2005, 2011, and 2016. Fixed effect variables related to child and maternal-household were included in the model. We adopted a generalized mixed model with CIAF as outcome variable and Zones as random effects.

RESULTS

The prevalence of CIAF in Ethiopia was 53.78% with the highest prevalence of 61.30% in 2000 and the lowest prevalence of 46.58% in 2016. The model result revealed that being a female child, absence of comorbidity, singleton births, and the first order of birth showed significantly lower CIAF prevalence than their counterparts. Among the household characteristics, children from mothers of underweight body mass index, uneducated parents, poor household sanitation, and rural residents were more likely to be undernourished than their counterparts. Based on the best linear unbiased prediction for the zonal-level random effect, significant variations of CIAF among zones were observed.

CONCLUSION

The generalized linear mixed-effects model results identified gender of the child, size of child at birth, dietary diversity, birth type, place of residence, age of the child, parental level of education, wealth index, sanitation facilities, and media exposure as main drivers of CIAF. Disparities of CIAF were observed between and within the Ethiopian administrative Zones over time.

Development and storage stability of chickpea, mung bean, and peanut-based ready-to-use therapeutic food to tackle protein-energy malnutrition

Protein-energy malnutrition (PEM) is most prevalent and affecting a large number of children in Pakistan. Ready-to-use therapeutic food (RUTF) is a tackling strategy to overcome the PEM in Pakistan. The present research was designed to formulate RUTF from different indigenous sources. After conducting some preliminary trials, 14 RUTF formulations were developed by mixing peanut, mung bean, and chickpea alone as well as in various combinations with the addition of sugar, powdered milk, oil, and vitamin-mineral premix. Freshly prepared RUTF was stored at room temperature (20 ± 5°C) and packed in aluminum foil for 90 days to investigate the microbiological analysis (total plate count and mold count), water activity (Aw), peroxide value, and thiobarbituric acid (TBA) value. All the parameters showed significant (p < .05) differences among peanut, chickpea, and mung bean-based RUTF except water activity. The storage days and interaction between treatments and storage days also showed a significant (p < .05) effect on water activity, total plate count, mold count, peroxide value, and TBA of RUTF formulations. The present study revealed that the peanut, chickpea, and mung bean can be used in the formulation of RUTF due to their shelf stability and help to mitigate the PEM in Pakistan.

Complex Multilevel Modelling of the Individual, Household and Regional Level Variability in Predictors of Undernutrition among Children Aged 6-59 Months in Ethiopia

Worldwide, ten and a half million children under five die every year, with 98% of these deaths in low- and middle-income countries, including Ethiopia. Undernutrition is a serious public health problem in Ethiopia and children are the most affected segments of the population. This study, therefore, sought to investigate the socio-economic, demographic, health and environmental factors associated with undernutrition among children aged 6-59 months in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey. In this study, anthropometric data (height and weight) and other variables of 9461 children were measured. Descriptive statistics and multilevel logistic regression models were fitted. The descriptive results revealed that about 27.5% of the children aged between 6-59 months were undernourished. Place of residence, employment status of the mother, educational status of the mother, the mother's nutritional status, age of the child, birth order of children, source of drinking water, diarrhea and fever among children in the two weeks before the survey were the most important factors associated with undernutrition among children aged 6-59 months in Ethiopia. The findings indicate that it is useful to support health care and food security programs in rural areas to directly address food insecurity and undernutrition problems of the poor and exposed communities in rural parts of the country. The education sector must increase mothers' access to education in all areas to help identify the quality of healthcare and the required attention needed for their children. The health sector should increase their health education programs on the importance of exclusive breastfeeding.

Differences in the socio-demographic determinants of undernutrition in children aged <5 years in urban and rural areas of Bangladesh measured by the Composite Index of Anthropometric Failure

OBJECTIVES

This study investigates the prevalence and determinants of undernutrition among children <5 years living in Bangladesh using the Composite Index of Anthropometric Failure (CIAF) and highlights the differences between urban and rural areas.

STUDY DESIGN

Data are drawn from three cross-sectional Bangladesh Demographic Health Surveys conducted from 2007 to 2014.

METHODS

A Chi-square test was used to assess the prevalence of <5 years child undernutrition. Logistic regression analysis was performed to identify various sociodemographic risk factors.

RESULTS

The prevalence of undernutrition based on the CIAF was 52% among children <5 years in Bangladesh. The prevalence of undernutrition in children living in urban areas and rural areas were found to be 45% and 54%, respectively. As per the CIAF, undernutrition was highly prevalent among children in the older age group, children of uneducated and currently working mothers, those of underweight mothers, children of fourth and above in the birth order, children of fathers who were manual labourers, children of households who had no access to television and those in the poorest households whether in urban or rural areas. Children in the older age group, children of uneducated mothers, those with underweight mothers and those from the poorest households provided common key risk factors for undernutrition in both urban and rural areas. Children of fourth and above birth order and not watching television at all were additional risk factors of child undernutrition in rural areas.

CONCLUSION

Half of the children in rural areas and two-fifths of them in urban areas are suffering undernutrition in Bangladesh, and several sociodemographic factors heighten the risks. Also, birth order and watching television were identified as the differential risk factors. This study therefore concludes that evidence-based interventions are needed to reduce the burden of undernutrition in children in the country.

Socio-economic inequality in anthropometric failure among children aged under 5 years in India: evidence from the Comprehensive National Nutrition Survey 2016-18

BACKGROUND

Conventional indicators used to access the nutritional status of children tend to underestimate the overall undernutrition in the presence of multiple anthropometric failures. Further, factors contributing to the rich-poor gap in the composite index of anthropometric failure (CIAF) have not been explored. This study aims to estimate the prevalence of CIAF and quantify the contribution of factors that explain the rich-poor gap in CIAF.

METHODS

The present study used data of 38,060 children under the age of five years and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey of children and adolescents aged 0-19 years in India. The CIAF outcome variable in this study provide an overall prevalence of undernutrition, with six mutually exclusive anthropometric measurements of height-for-age, height-for-weight, and weight-for-age, calculated using the World Health Organization (WHO) Multicenter Growth Reference Study. Multivariate regression and decomposition analysis were used to examine the association between covariates with CIAF and to estimate the contribution of different covariates in the existing rich-poor gap.

RESULTS

An overall CIAF prevalence of 48.2% among children aged aged under 5 years of age was found in this study. 6.0% children had all three forms of anthropometric failures. The odds of CIAF were more likely among children belonging to poorest households (AOR: 2.41, 95% CI: 2.12-2.75) and those residing in urban area (AOR: 1.06, 95% CI 1.00-1.11). Children of underweight mothers and those with high parity were at higher risk of CIAF (AOR: 1.51, 95% CI: 1.42-1.61) and (AOR: 1.15, 95% CI: 1.08-1.22), respectively. Children of mother exposed to mass media were at lower risk of CIAF (AOR: 0.87, 95% CI: 0.81-0.93).

CONCLUSION

This study estimated a composite index to assess the overall anthropometric failure, which also provides a broader understanding of the extent and pattern of undernutrition among children. Findings show that maternal covariates contribute the most to the rich-poor gap. As well, the findings suggest that intervention programs with a targeted approach are crucial to reach the most vulnerable groups and to reduce the overall burden of undernutrition.