Stunting associated with poor socioeconomic and maternal nutrition status and respiratory morbidity in Colombian schoolchildren

Children's sex composition and modern contraceptive use among mothers in Bangladesh

BACKGROUND

The stagnation and relatively low use of modern contraceptives are ongoing public health concerns in Bangladesh and other low- and middle-income countries. Although a cultural preference for sons may be linked to the current use of contraceptives, this linkage has not been adequately explored in the Bangladesh context. We investigated the effects of child sex composition on the current use of modern contraceptives.

METHODS

We extracted and analysed data from 17,333 women who participated in the 2017/18 Bangladesh Demographic and Health Survey. The outcome variable was the current use of modern contraceptive methods. The study factor was the parity and sex composition of the living children. We used multilevel logistic regressions to determine the association between the study factor and outcome variables, adjusting for potential covariates at the individual-, household-, and community-levels.

RESULTS

Women with relatively high parity had higher odds of currently using modern contraceptives. Among the individual parities, compared to women with no live sons, women with one or more live sons were more likely to report currently using modern contraceptives. However, this association is significant for women up to three children. When examining both parity and children's sex composition in a regression model, in each parity category, the likelihood of using modern contraceptives tend to rise with an increasing number of sons compared to women with just one daughter.

CONCLUSION

The findings of this study suggest that while the use of modern contraceptives by women increases with the increasing number of children and son preference is prevalent in Bangladesh, women also want to have a mixed composition of son and daughter. The study findings can be used in family planning programmes to customise contraceptive promotion and counselling messages.

Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: a synthesis of scoping reviews

OBJECTIVE

To summarise available evidence on the nutritional status of school-age children and adolescents (5-19 years) from seven global regions and on interventions implemented to improve malnutrition in this population.

SETTING

Global.

DESIGN

Findings were compiled from seven scoping literature reviews, including data from low- and middle-income countries within the following UNICEF-defined global regions: East Asia and Pacific; Europe and Central Asia; South Asia; West and Central Africa; Eastern and Southern Africa; Middle East and North Africa and Latin America and the Caribbean.

RESULTS

A double burden of malnutrition was evident across the world regions reviewed: stunting, thinness, anaemia and other micronutrient deficiencies persisted, alongside rising overweight and obesity prevalence. Transitions towards diets increasingly high in energy-dense, processed and micronutrient-poor foods were observed. Evidence from intervention studies was limited, but suggested that providing multiple micronutrient-fortified foods or beverages at school may effectively target micronutrient deficiencies and facilitate weight gain in undernourished populations. Interventions to prevent or manage overweight and obesity were even more limited. There was minimal evidence of using novel technological approaches to engage school-age children and adolescents, or of involving them in designing interventions.

CONCLUSION

The limited data available on nutrition of school-age children and adolescents are neither standardised nor comparable. Consensus on methods for assessing nutritional status and its determinants for this age group is urgently needed to set targets and monitor progress. Additionally, strategies are required to ensure that nutritious, safe and sustainable diets are available, affordable and appealing.

Food, water, and sanitation insecurities: Complex linkages and implications for achieving WASH security

Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security-one that addresses myriad transmission pathways and co-occurring diseases-that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

Background and objectives

Women’s nutritional status is important for their health and reproductive fitness. In a population where early marriage is common, we investigated how women’s nutritional status is associated with their age at marriage (marking a geographical transfer between households), and at first pregnancy.

Methodology

We used data from a cluster-randomized control trial from lowland Nepal (n = 4071). Outcomes including body mass index (BMI) were measured in early pregnancy and trial endpoint, after delivery. We fitted mixed-effects linear and logistic regression models to estimate associations of age at marriage and age at pregnancy with outcomes, and with odds of chronic energy deficiency (CED, BMI <18.5 kg/m²), at both timepoints.

Results

BMI in early pregnancy averaged 20.9 kg/m², with CED prevalence of 12.5%. In 750 women measured twice, BMI declined 1.2 (95% confidence interval 1.1, 1.3) kg/m² between early pregnancy and endpoint, when CED prevalence was 35.5%. Early pregnancy was associated in dose-response manner with poorer nutritional status. Early marriage was independently associated with poorer nutritional status among those pregnant ≤15 years, but with better nutritional status among those pregnant ≥19 years.

Conclusions and implications

The primary determinant of nutritional status was age at pregnancy, but this association also varied by marriage age. Our results suggest that natal households may marry their daughters earlier if food insecure, but that their nutritional status can improve in the marital household if pregnancy is delayed. Marriage age therefore determines which household funds adolescent weight gain, with implications for Darwinian fitness of the members of both households.

Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia

The prevalence of stunting in young Indonesian children is the highest among countries belonging to the Association of Southeast Asian Nations (ASEAN). Breastfed children are reported to grow better than non-breastfed. The present study examined the protective effect of exclusive breastfeeding against stunting in children under two years old (CU2) and its interaction with monthly household expenditure. Secondary analyses were conducted based on a 2012 cross-sectional study including 408 children aged 6-24 months and their caregivers from 14 villages in rural Eastern Indonesia. Data on breastfeeding history, childcare, and household expenditures were collected using structured questionnaires. Focus Group Discussions (FGDs) were conducted in each village (n = 14). Nearly two-thirds (61%) of caregivers who identified as the biological mother exclusively breastfed their child at 6 months. Exclusively-breastfed CU2 from poorer households were 20% less likely to be stunted than their non-exclusively-breastfed peers. Further, exclusively-breastfed CU2 from wealthier households were 50% less likely to be stunted than non-exclusively-breastfed CU2 from poorer households. FGDs revealed that some mothers were unaware of the importance of recommended breastfeeding practices. Exclusive breastfeeding may protect low-income children against stunting. Health promotion to improve caregiver motivation to exclusively breastfeed is critical in the present setting and beyond.

Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017-18

BACKGROUND

Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017-18.

METHODS

The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017-18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017-18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting.

RESULTS

The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017-18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother's characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father's characteristics, such as education explained 9% of this change.

CONCLUSION

The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children's height and weight, and aim to significantly reduce inter-household inequalities.

Mala nutrición en población escolar mexicana: factores geográficos y escolares asociados

OBJETIVOS

Determinar prevalencias de mala nutrición [sobrepeso u obesidad (Sp+O) y talla baja (TB)] en población mexicana de 6 a 12 años de edad de nivel básico de primaria, y su asociación con características geográficas (ámbito, marginación y región del país), y de la escuela (tipo, turno y grado).

MÉTODOS

Con información de 10 528 676 escolares, se estimaron prevalencias (e I.C. 95%), a nivel nacional y por características de interés, y su asociación mediante modelos de regresión logística.

RESULTADOS

La prevalencia nacional de Sp+O fue 34.4%, 36.5% en ámbito urbano y 40.2% en escuelas privadas. La prevalencia nacional de TB fue 8.7%; en área rural, 13.7% y 28.8% en escuelas tipo indígenas. El Sp+O y la TB se asociaron significativamente con características geográficas y de escuelas.

CONCLUSIONES

Existe una polarización nutricional en el contexto escolar del país. Es importante continuar con sistemas de monitoreo y vigilancia nutricional.

The Height of Children and Adolescents in Colombia. A Review of More than Sixty Years of Anthropometric Studies, 1957-2020

In this article, we present a review of the studies on the heights of children and teenagers in Colombia published since 1957. We focus on examining the geographic coverage, features of the population studied, height measurement techniques, authors’ profiles, and growth patterns in children. This relatively recent literature has been developed mainly by medical doctors who carried out rigorous measurements with highly specific time and space horizons. The first studies emphasized the differences among socioeconomic levels. Later, there was an interest in minority groups, such as indigenous people and Afro-descendants. Although most of the research lacked long-term vision, the overall balance shows that the country has been improving in anthropometric indicators over time, across territories, and in different socioeconomic groups.

Holistic-comprehensive approaches to improve nutritional status of children under five years

Background: Malnutrition has been identified as the leading cause of illness and death in almost half of children under 5 years. Hence, to prevent the impact of malnutrition on physical and psychological development, family physicians need to explore new approaches in the health care delivery models that go beyond the scope of practice. A holistic-comprehensive approach will help the physicians develop a more thorough assessment of nutritional status. This study aims to determine factors associated with the nutritional status of children under five years using holistic-comprehensive approaches.

Design and Methods: A case–control design was implemented, with emphasis on the identification of cases and control groups; 48 children confirmed malnutrition cases and 48 control without malnutrition were recruited from a Community Integrated Health Center in East Java, Indonesia. The characteristics of agent, host and environment between groups were compared and analyzed using correlation coefficients, odds ratio, logistic regression analysis, and Structural Equation Modeling-Partial Least Square (SEM-PLS).

Results: The SEM-PLS results showed that environmental factors have a greater influence on nutritional status (t-value >1.96), compared to the host factors. Furthermore, environmental factors having significant associations with nutritional status were poor socioeconomic status, low maternal educational level and not having exclusive breastfeeding. Also, the results of correlation coefficients and OR showed that birth weight (p=0.000, OR=33) and socioeconomic status (p=0.000, OR=22.3) had strong correlations with nutritional status.

Conclusions: Holistic-comprehensive approaches can be used as new ways to determine factors that may be associated with nutritional status of children under 5 years of age.

Engaging Mothers on the Growth of School-Age Children in a Rural South African Health and Demographic Site: A Qualitative Insight

A qualitative study was conducted to explore mothers' insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth.

Predictors of stunting among children age 6-59 months in Ethiopia using Bayesian multi-level analysis

In developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6-59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6-59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child's age (AOR = 1.022; 95% CrI 1.018-1.026), being a male child (AOR = 1.16; 95%CrI 1.05-1.29), a twin (AOR = 2.55; 95% CrI 1.78-3.56), having fever (AOR = 1.23; 95%CrI 1.02-1.46), having no formal education (AOR = 1.99; 95%CrI 1.28-2.96) and primary education (AOR = 83; 95%CrI 1.19-2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20-1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93-0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35-2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

Spatial heterogeneity and factors influencing stunting and severe stunting among under-5 children in Ethiopia: spatial and multilevel analysis

Stunting remains a major public health concern in Ethiopia. Government needs to reshape and redesign new interventions to reduce stunting among under-five children. Hence, this study identified the problem according to location and risk factor. This study is a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey. A total of 9588 children aged 0-59 months were included in the study. The spatial and multilevel logistic regression analyses were used to explore spatial heterogeneity and identify individual- and household-level factors associated with stunting and severe stunting. Spatial heterogeneity of stunting and severe stunting was seen across the study setting. Male children (AOR = 1.51, CI 1.16, 1.96); multiple births (AOR = 27.6, CI 10.73, 71.18); older children (AOR = 1.04, CI 1.01, 1.05) and anemic children (AOR = 3.21, CI 2.3, 4.49) were severely stunted at individual-level factors. Children from educated and malnourished mothers (respectively, AOR = 0.18, CI 0.05, 0.71; AOR = 5.35, CI 3.45, 8.32), and from less wealthier mothers (AOR = 5.95, CI 2.58, 13.69) were severely stunted at household-level factors. Giving priority to the hotspot areas of stunting and older and anemic children, multiple births, and maternal undernutrition is important to reduce stunting. Studies are recommended to fill the gaps of this study.

Priorities for intervention of childhood stunting in northeastern Ethiopia: A matched case-control study

Background

Stunting is a worldwide public health problem caused by factors that vary across regions, including in Ethiopia. Limited evidence to prevent stunting makes it difficult to design and prioritize appropriate interventions. Therefore, this study investigated the intervention priorities for the prevention of stunting among children 6–59 months old in Kemissie City Administration, northeastern Ethiopia.

Methods

A community-based individual matched case-control study was conducted from January to April 2017 including 107 cases and 214 controls. Controls were selected and matched with cases using the matching variable of child’s age. Data were collected by open data kit (ODK) software using a structured questionnaire. Data were analyzed using STATA version 13.0 and WHO (World Health Organization) Anthro 2005. A conditional logistic regression model was used for data analysis. From multivariable conditional logistic regression analysis, determinants of stunting were identified. A statistically significant level was declared by a conditional adjusted odds ratio (cAOR) with 95% confidence interval (CI) and p-value of less than 0.05.

Main findings

The wealth index 52 (48.6%) of the cases and 108 (50.5%) controls were categorized as poor. The mean height-for-age z-score (HAZ) for the cases and controls was -2.79±.67 and -0.55±.92, respectively. One-sixth (16.8%) of the cases and 29 (13.6%) of the controls were given prelacteal feeding. A majority 82 (86.9%) of the cases and 137 (69.1%) of the controls had undernourished mothers/care-givers. Slightly less than one-third 35 (32.7%) of cases and one-fourth 53 (24.8%) of controls were affected by repeated episodes of diarrhea. Mother’s body mass index (BMI) (conditional adjusted odds ratio [cAOR]) = 2.64; 95% CI: 1.28, 5.43), giving food priority to father (cAOR = 2.42; 95% CI: 1.23, 4.75), lack of exclusive breastfeeding for at least 6 months (cAOR = 2.44; 95% CI: 1.15, 5.17), no intake of meat by child (cAOR = 2.35; 95% CI: 1.21, 4.58) and child having repeated diarrheal episodes (cAOR = 2.0: 95% CI: 1.07, 3.86) were factors associated with childhood stunting.

Conclusion

Maternal nutritional status, food priority, duration of exclusive breastfeeding, no intake of meat and repeated episodes of diarrhea were the main determinants of stunting among children aged 6–59 months. Therefore, intervention measures to avert childhood stunting should include strengthening action on provision of essential nutrition, providing counseling to parents on giving food priority to children, promotion of optimal duration of breastfeeding and preventing diarrheal disease among children 6–59 months old.

Undernutrition and Associated Factors among Adolescent Girls in Damot Sore District, Southern Ethiopia

Background

Adolescent girls were given little health and nutrition attention. Focusing on adolescent girls' nutrition prior to conception is one way to break the intergenerational cycle of malnutrition. Therefore, the aim of this study was to assess the prevalence of undernutrition and associated factors among adolescent girls in rural Damot Sore District, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted from February to March 2017. Multistage sampling technique was used to select 729 adolescent girls. Structured interviewer-administered questionnaire was used to collect information on different variables. Weight and height were measured by using a well-calibrated digital Seca scale and portable stadiometer by trained data collectors. Height-for-age (HFA) and body mass index-for-age (BMIFA) z-scores were calculated using WHO AnthroPlus software as indicators of stunting and thinness, respectively. Wealth index was generated by using principal component analysis (PCA), and based on the results, household wealth index/status was converted into tertiles and categorized as higher/rich, medium, and lower/poor. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. Strength of association of variables was presented by odds ratio along with its 95% CI.

Results

The prevalence of stunting and thinness among adolescent girls was 29.6% (95% CI = 26.6%, 32.8%) and 19.5% (95% CI = 16.7%, 22.3%), respectively. Being in older adolescence (AOR = 2.06, 95% CI = 1.08, 3.92), mother occupation (farmer and government employee) ((AOR = 2.38, 95% CI = 1.31, 4.33) and (AOR = 3.05, 95% CI = 1.35, 6.92)), mother education (secondary and above) ((AOR = 0.53, 95% CI = 0.28, 0.98) and (AOR = 0.25, 95% CI = 0.09, 0.69)), and household wealth index (poor) (AOR = 1.94, 95% CI = 1.29, 2.92) were significantly associated with stunting. Father education (primary and secondary) ((AOR = 0.48, 95% CI = 0.31, 0.77) and (AOR = 0.45, 95% CI = 0.26, 0.78)), mother education (primary) (AOR = 0.56, 95% CI = 0.37, 0.87), and meal frequency (<2/day) (AOR = 1.87, 95% CI = 1.12, 3.13) were significantly associated with thinness.

Conclusion

The prevalence of stunting and thinness among adolescent girls was moderate, when compared to the prevalence reported in Sub-Saharan Africa. However, it was a major public health problem, when compared to the national nutrition baseline survey reports in Ethiopia. Parental education was a significant predictor of both stunting and thinness among adolescent girls. Thus, initiation of routine screening, promotion of education, and implementation of evidence based community nutrition programmes required to be improved.

Maternal stature, maternal education and child growth in Pakistan: a cross-sectional study

Pakistan has a significantly higher prevalence of stunted children under five years old compared with other countries with a similar income level. Given maternal education is a modifiable factor, we analyzed whether education has a larger marginal effect on improving children's growth for shorter stature mothers. Pakistan Demographic and Health Survey of 2012–13 was analyzed, with a total of 3,883 of children under five years of age (belonged to 2,327 mothers). The results showed that the overall prevalence of stunting, underweight, wasting, and overweight in our sample was 45%, 26.2%, 9.9%, and 9.5%, respectively. Short stature mothers have a higher number of malnourished children as compared to taller mothers. Compared to tall stature mothers, short stature mothers at all education levels have a higher number of stunted and underweight children. Maternal education has a significant positive effect on children's growth. However, we did not find significant differences in the marginal effect of maternal education among mothers with different statures. Policies providing specialized care to children born to short stature mothers are crucial, along with emphasizing mothers' education. Moreover, a poverty elevation program is necessary as a significant fraction of childhood malnutrition is attributed to the wealth index.

Prevalence and determinants of pre-adolescent (5-14 years) acute and chronic undernutrition in Lay Armachiho District, Ethiopia

Background

In Ethiopia it is documented that 16% of all grade repetitions in primary school and 33.9% childhood deaths are associated with undernutrition. School aged children are often omitted from public health research. Thus, the present study was carried out to find out the prevalence and determinants of pre-adolescent (5–14 years) acute and chronic undernutrition in Lay Armachiho District.

Methods

In this community based cross-sectional study, anthropometrics, individual and household characteristics data were collected from December, 2016 to January, 2017. A total of 848 school aged children (5–14 years) were included in the study. Z-scores for height-for-age (HAZ) and body-mass-index-for-age (BAZ) were calculated to illustrate stunting (chronic undernutrition) and thinness (acute undernutrition), respectively with Anthro Plus software version 1.0.4 using the WHO 2007 growth reference standard. Finally, backward stepwise multivariable logistic regression analysis was carried out to identify factors associated with stunting and thinness, individually.

Results

The overall prevalence of stunting and thinness was 35.5 and 9.9%, respectively. The multivariable analysis showed that child age 10–14 years [AOR = 1.58, 95% CI: 1.17, 2.12] and lack of availability of a latrine at home [AOR = 1.60; 95% CI: 1.17, 2.20)] were associated with increased likelihood of stunting. Nevertheless, child’s hand washing practice before eating [AOR = 0.67; 95% CI: 0.49, 0.91] was protective against stunting. Children who consumed diversified foods [AOR = 0.64; 95% CI 0.39, 0.97] were protected from thinness.

Conclusion

In Lay Armachiho district, one-third and one in every ten of school aged children were stunted and thin, respectively. Children age 10–14 years, lack of availability of a latrine at home and hand washing practices before eating were associated with stunting, while only dietary diversity was associated with thinness. Ensuring consistent hand washing practices before eating and ensuring availability of latrine should be improved in the region, which can assist in effectively tackling undernutrition. Finally, dietary diversification should be enhanced to rectify burden of acute undernutrition.

Air pollution control and the occurrence of acute respiratory illness in school children of Quito, Ecuador

Because of air quality management and control, traffic-related air pollution has declined in Quito, Ecuador. We evaluated the effect of a city-wide 5-year air pollution control program on the occurrence of acute respiratory illness (ARI). We compared two studies conducted at the same location in Quito: in 2000, 2 years before the policy to control vehicle emission was introduced, and in 2007. Each study involved ~ 730 children aged 6-12 years, observed for 15 weeks. We examined associations between carboxyhemoglobin (COHb) serum concentration-an exposure proxy for carbon monoxide (CO)-ambient CO, and ARI in both cohorts. In 2007, we found a 48% reduction in the ARI incidence (RR 0.52; 95% CI 0.45-0.62, p < 0.0001), and 92% decrease in the percentage of children with COHb > 2.5% as compared to the 2000 study. We found no association between COHb concentrations above the safe level of 2.5% and the ARI incidence (p = 0.736). The decline in air pollution due to vehicle emissions control was associated with a lower incidence of respiratory illness in school children.

Childhood growth and neurocognition are associated with distinct sets of metabolites

Background

Undernutrition is a serious global problem that contributes to increased child morbidity and mortality, impaired neurocognitive development, and decreased educational and economic attainment. Current interventions are only marginally effective, and identification of associated metabolic pathways can offer new strategies for intervention.

Methods

Plasma samples were collected at 9 and 36 months from a subset of the PROVIDE child cohort (n = 130). Targeted metabolomics was performed on bile acids, acylcarnitines, amino acids, phosphatidylcholines, and sphingomyelins. Metabolic associations with linear growth and neurocognitive outcomes at four years were evaluated using correlation and penalized-linear regression analysis as well as conditional random forest modeling.

Findings

Different metabolites were associated with growth and neurocognitive outcomes. Improved growth outcomes were associated with higher concentrations of hydroxy-sphingomyelin and essential amino acids and lower levels of acylcarnitines and bile acid conjugation. Neurocognitive scores were largely associated with phosphatidylcholine species and early metabolic indicators of inflammation. All metabolites identified explain ~45% of growth and neurocognitive variation.

Interpretation

Growth outcomes were predominantly associated with metabolites measured early in life (9 months), many of which were biomarkers of insufficient diet, environmental enteric dysfunction, and microbiome disruption. Hydroxy-sphingomyelin was a significant predictor of improved growth. Neurocognitive outcome was predominantly associated with 36 month phosphatidylcholines and inflammatory metabolites, which may serve as important biomarkers of optimal neurodevelopment. The distinct sets of metabolites associated with growth and neurocognition suggest that intervention may require targeted approaches towards distinct metabolic pathways.

Fund

Bill & Melinda Gates Foundation (OP1173478); National Institutes of Health (AI043596, CA044579).

Examining the relationship between blood lead level and stunting, wasting and underweight- A cross-sectional study of children under 2 years-of-age in a Bangladeshi slum

Elevated blood lead level (BLL) is known to cause cardiac, immune, and cognitive damage but had not been thoroughly studied in relation to stunting among children under two years of age. We primarily aimed to assess the relationship between elevated BLL, the accumulation of concerned amount of the metal lead in blood and stunting and secondarily-wasting and underweight amongst Bangladeshi children less than two years of age. For this cross-sectional study, BLL measurements, anthropometric data, and socioeconomic indicator information were collected and analyzed for 729 children under two years of age upon enrollment in the MAL-ED study conducted in a Bangladeshi slum area. Univariate, bivariate and multivariate analyses were carried out to observe the proportion and mean and contribution of elevated BLL and other relevant variables in explaining the occurrence of stunting. Of the enrolled subjects, 39.0% were stunted [length-for-age z score (LAZ<-2)], 50.3% were male, and 86.6% had an elevated BLL (≥5μg/dL). Mean BLL of stunted children was 8.47 ± 3·37 μg/dL and 8.10 ± 3·80 μg/dL for non-stunted children. Proportion of children with elevated BLL was not significantly different between the stunted and non-stunted groups (p>0.05). When adjusted for other variables, elevated BLL was found to be a significant predictor of stunting and underweight (p<0.05) but not wasting (p>0.05). Elevated BLL (p<0·01), child's gender and weight (p<0·001), maternal body mass index (BMI) (p<0.05) and severe household food insecurity (p<0·05) were all significantly associated with stunting in the multivariate model. Increased odds of stunting was also observed for increased BLL. The findings suggest that chronic lead poisoning is significantly associated with high level of stunting among child slum dwellers in Bangladesh. These findings strengthen the argument for improved lead reduction efforts in Bangladesh, where lead poisoning and stunting are both highly prevalent.

Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children

BACKGROUND

Previous studies have shown maternal, inflammatory, and socioeconomic variables to be associated with growth and neurodevelopment in children from low-income countries. However, these outcomes are multifactorial and work describing which predictors most strongly influence them is lacking.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a longitudinal study of Bangladeshi children from birth to two years to assess oral vaccine efficacy. Variables pertaining to maternal and perinatal health, socioeconomic status, early childhood enteric and systemic inflammation, and anthropometry were collected. Bayley-III neurodevelopmental assessment was conducted at two years. As a secondary analysis, we employed hierarchical cluster and random forests techniques to identify and rank which variables predicted growth and neurodevelopment. Cluster analysis demonstrated three distinct groups of predictors. Mother's weight and length-for-age Z score (LAZ) at enrollment were the strongest predictors of LAZ at two years. Cognitive score on Bayley-III was strongly predicted by weight-for-age (WAZ) at enrollment, income, and LAZ at enrollment. Top predictors of language included Rotavirus vaccination, plasma IL 5, sCD14, TNFα, mother's weight, and male gender. Motor function was best predicted by fecal calprotectin, WAZ at enrollment, fecal neopterin, and plasma CRP index. The strongest predictors for social-emotional score included plasma sCD14, income, WAZ at enrollment, and LAZ at enrollment. Based on the random forests' predictions, the estimated percentage of variation explained was 35.4% for LAZ at two years, 34.3% for ΔLAZ, 42.7% for cognitive score, 28.1% for language, 40.8% for motor, and 37.9% for social-emotional score.

CONCLUSIONS/SIGNIFICANCE

Birth anthropometry and maternal weight were strong predictors of growth while enteric and systemic inflammation had stronger associations with neurodevelopment. Birth anthropometry was a powerful predictor for all outcomes. These data suggest that further study of stunting in low-income settings should include variables relating to maternal and prenatal health, while investigations focusing on neurodevelopmental outcomes should additionally target causes of systemic and enteric inflammation.

Multilevel correlates of household anthropometric typologies in Colombian mothers and their infants

Background

The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data.

Methods

Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained.

Results

This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology.

Conclusion

Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.

Impact of Childhood Malnutrition on Host Defense and Infection

The global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population.

Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996-2011

BACKGROUND

Nutritional transition (from under- to overnutrition) among women of reproductive age (15-49 y) is becoming increasingly common in many developing countries, including Bangladesh. However, the influence of this transition on the nutritional status of children <5 y of age (U5s) is unknown.

OBJECTIVES

The aim was to determine whether a nutritional transition has taken place in the past 15 y (1996-2011) among U5s and their mothers in Bangladesh and to examine how the association between maternal body mass index (BMI) and malnutrition in U5s has changed over time.

DESIGN

We analyzed data assembled from 5 Demographic and Health Surveys conducted between 1996 and 2011 in Bangladesh to describe the nutritional status of 28,941 U5s and their mothers. A Poisson regression model was used to examine the associations between maternal BMI and stunting, underweight, and wasting in U5s over time.

RESULTS

A nutritional transition among mothers of U5s was observed between 1996 and 2011. The height- or length-for-age and weight-for-age z score distributions of U5s showed consistent improvement; however, there was no indication of a nutritional transition. An interaction was found between maternal BMI categorized as underweight [BMI (kg/m²) <18.5], healthy BMI (BMI: 18.5-24.9), and overweight or obese (BMI ≥25) and year of survey on the risks of stunting and underweight in children. In 1996, children of underweight mothers had a 5% higher risk of being stunted than those born to healthy-BMI mothers (RR: 1.05; 95% CI: 1.00, 1.10); in 2011, children of underweight mothers had a 21% higher risk of being stunted (RR: 1.21; 95% CI: 1.13, 1.30). Maternal overweight or obesity was associated with a reduced risk of malnutrition in children.

CONCLUSIONS

A nutritional transition among U5s has yet to occur in Bangladesh. However, our results indicate that improvement in maternal BMI in the past 15 y was accompanied by a reduction in malnutrition in U5s.

SIBLING- AND FAMILY-LEVEL CLUSTERING OF UNDERWEIGHT CHILDREN IN NORTHERN INDIA

Child undernutrition remains a major child health and developmental issue in low- and middle-income countries. The concentration (clustering) of underweight children among siblings at the family level is known to exist in India. This study examined the extent and covariates of clustering of underweight children at the sibling and family level in Uttar Pradesh, the largest state of northern India. Clustering of underweight (low weight-for-age) children was assessed using data on 7533 under-five children from the National Family Health Survey (NFHS) conducted in 2005-06, analysed using binary logistic and binomial regression models. Related bio-demographic, socioeconomic and health care variables were used as covariates in the models. The odds of being underweight for the index child were about two times higher (OR=2.34, p<0.001) if any of the siblings within the household was malnourished or underweight. A longer birth interval increased the odds of a child being underweight. The odds of underweight were significantly lower (OR=0.69, p<0.001) for children born to normal-weight mothers compared with those born to underweight mothers. Similarly, the odds of underweight were significantly lower (OR=0.49, p=0.01) for children born to educated mothers (high school and above) compared with those born to illiterate mothers. The results of the binomial regression model suggested that the deviations between observed and expected number of children were positive (3.09, 3.78 and 2.71) for 1, 2 and 2+ underweight children within the households of underweight women, indicating the concentration of underweight children among underweight/malnourished mothers. Underweight children were found to be clustered among underweight mothers with multiple underweight siblings. The findings suggest that policy interventions need to focus on underweight mothers with multiple underweight children.

Economic Benefits of Investing in Women's Health: A Systematic Review

BACKGROUND

Globally, the status of women's health falls short of its potential. In addition to the deleterious ethical and human rights implications of this deficit, the negative economic impact may also be consequential, but these mechanisms are poorly understood. Building on the literature that highlights health as a driver of economic growth and poverty alleviation, we aim to systematically investigate the broader economic benefits of investing in women's health.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed health, gender, and economic literature to identify studies that investigate the impact of women's health on micro- and macroeconomic outcomes. We developed an extensive search algorithm and conducted searches using 10 unique databases spanning the timeframe 01/01/1970 to 01/04/2013. Articles were included if they reported on economic impacts stemming from changes in women's health (table of outcome measures included in full review, Table 1). In total, the two lead investigators independently screened 20,832 abstracts and extracted 438 records for full text review. The final review reflects the inclusion of 124 articles.

RESULTS

The existing literature indicates that healthier women and their children contribute to more productive and better-educated societies. This study documents an extensive literature confirming that women's health is tied to long-term productivity: the development and economic performance of nations depends, in part, upon how each country protects and promotes the health of women. Providing opportunities for deliberate family planning; healthy mothers before, during, and after childbirth, and the health and productivity of subsequent generations can catalyze a cycle of positive societal development.

CONCLUSIONS

This review highlights the untapped potential of initiatives that aim to address women's health. Societies that prioritize women's health will likely have better population health overall, and will remain more productive for generations to come.

[Relationship between nutritional status and school absenteeism among students in rural schools]

Objective To determine the nutritional status and prevalence of malnutrition and overweight in students in rural schools and their relationship with school absence rates. Methods Descriptive study carried out in 34 rural schools in Anapoima and La Mesa in 2013. A sample of 785 (82.4 %) students was selected by convenience sampling. The inclusion criteria were students registered for the period 2013 in grades 0-5 (ages 5-16) with parental consent and student assent. Weight and height of all subjects were taken. Overall absence rates and illness-related absence rates were recorded. Results 422 pupils were male (53.8 %) and 524 (66.8 %) had between 5-9 years old. A lower than average height for age occurred in 10.1 %(n=79) of the students. The thinness was recorded at 1.75 %(n=13), the overweight at 14.3 %(n=112) and the obesity at 4.5 %(n=45) of the students. The number of absence episodes per child per year due to any reason and due to disease was 5.7 and 1.4, respectively. Stunted growth and overweight students had a significantly higher number of absence days compared to students with adequate nutritional status (p <0.01). Stunted growth had the highest absence rates. Conclusions Malnutrition and obesity coexist in the study area. There is a significant relationship between school absence days (both general and illness-related) and stunting and overweight in students.

Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey

Background

Stunting is one of the main public health problems in Tanzania. It is caused mainly by malnutrition among children aged less than 5 years. Identifying the determinants of stunting and severe stunting among such children would help public health planners to reshape and redesign new interventions to reduce this health hazard. This study aimed to identify factors associated with stunting and severe stunting among children aged less than five years in Tanzania.

Methods

The sample is made up of 7324 children aged 0-59 months, from the Tanzania Demographic and Health Surveys 2010. Analysis in this study was restricted to children who lived with the respondent (women aged 15-49 years). Stunting and severe stunting were examined against a set of individual-, household- and community-level factors using simple and multiple logistic regression analyses.

Results

The prevalence of stunting and severe stunting were 35.5 % [95 % Confidence interval (CI): 33.3-37.7] and 14.4 % (95 % CI: 12.9-16.1) for children aged 0-23 months and 41.6 % (95 % CI: 39.8-43.3) and 16.1 % (95 % CI: 14.8-17.5) for children aged 0-59 months, respectively. Multivariable analyses showed that the most consistent significant risk factors for stunted and severely-stunted children aged 0-23 and 0-59 months were: mothers with no schooling, male children, babies perceived to be of small or average size at birth by their mothers and unsafe sources of drinking water [adjusted odds ratio (AOR) for stunted children aged 0-23 months = 1.37; 95 % CI: (1.07, 1.75)]; [AOR for severely stunted children aged 0-23 months = 1.50; 95 % CI: (1.05, 2.14)], [AOR for stunted children aged 0-59 months = 1.42; 95 % CI: (1.13, 1.79)] and [AOR for severely stunted children aged 0-59 months = 1.26; 95 % CI: (1.09, 1.46)].

Conclusions

Community-based interventions are needed to reduce the occurrence of stunting and severe stunting in Tanzania. These interventions should target mothers with low levels of education, male children, small- or average-size babies and households with unsafe drinking water.

Longitudinal study of thinness from birth to early childhood: the association with parental thinness

AIM

Epidemiological research on thinness, particularly in early childhood, is limited. This study tracked thin children aged 5 years back to birth, compared them with normal-weight children and investigated the relationship with parental thinness.

METHODS

We enrolled 2678 children (50.5% boys) aged 5 years and attending kindergarten or nursery in the Nara Prefecture of Japan. The children's height and weight at birth, 1.5 years and 3.5 years, were obtained from mother-child health records. Child thinness was defined as having a body mass index (BMI) of less than the fifth percentile of the reference values for Japanese children, and parental thinness was defined as a BMI of <18.5.

RESULTS

The overall prevalence of thinness at 5 years of age was 4%, with no significant difference between genders. At every age, weight z-scores and BMI percentiles were significantly lower in thin children than normal-weight children. The increment in weight z-scores between birth and the age of 1.5 years was significantly lower in thin children. The only parental link was paternal thinness and thinness in boys.

CONCLUSION

Careful observation of body weight from birth is important to reduce thinness at 5 years of age. Paternal thinness may be a risk factor for thinness in boys.

Somatic growth of lean children: the potential role of sleep

BACKGROUND

Despite the current obesity pandemic, childhood malnutrition remains an urgent, public health concern. Similar to the obesity pandemic, childhood malnutrition is influenced by genetic and a number of social, environmental and biological factors. In this study, we investigated the association between sleep duration and somatic growth in lean children.

METHODS

A stratified, randomly clustered sampling design was used to select fifth grade students from 10 primary schools in Shanghai. Based on a body mass index below the 15th percentile a subsample of 143 lean children aged 10-11 years old was defined. Sleep duration and other potential confounders were surveyed through parental or self-report questionnaires. Body measurements were collected and used to calculate the Z score of weight, height, body mass index as well as body fat percentage.

RESULTS

Compared with children who slept <9 hours, those who slept for ≥10 hours grew taller and gained more weight after adjusting for confounding factors. When children slept 9-10 hours, they had significantly higher Z score of weight and body mass index.

CONCLUSIONS

Prolonged sleep not only benefits weight gain but also improves height in lean children. Our findings might provide important public health advice such that prolonged sleep may be an effective modifier of nutritional problems in childhood.

Prenatal nutrient supplementation and postnatal growth in a developing nation: an RCT

BACKGROUND AND OBJECTIVES

Prenatal lipid-based nutrient supplements (LNS) have been shown to improve birth anthropometry. However, little is known about the effects of such supplements on infant health. We hypothesized that prenatal LNS compared with multiple micronutrient supplement for pregnant and lactating women would improve survival, growth, and morbidity during infancy.

METHODS

Infants' weight, length, head, chest, and mid-upper arm circumferences were measured during monthly home visits from birth to 12 months of age in the Micronutriments et Santé de la Mère et de l'Enfant--2 trial. Differences in stunting and wasting episodes between study arms were assessed by Cox regression for recurrent event models. Morbidity signs during the 2 weeks before the visits and death cases were also assessed by multilevel analysis accounting for repeated individual measurements.

RESULTS

Infant length-for-age growth (-0.033 z score/month; 95% confidence interval: -0.601 to -0.006; P = .018) for the LNS group was inferior to that of the control group. We did not find evidence of significant difference in mortality or morbidity between groups.

CONCLUSIONS

The previously reported positive effect of prenatal LNS on birth length was not sustained during the postnatal phase. Prenatal LNS does not appear to make a long-lasting difference in child linear growth.

Understanding child stunting in India: a comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression

Background

Most attempts to address undernutrition, responsible for one third of global child deaths, have fallen behind expectations. This suggests that the assumptions underlying current modelling and intervention practices should be revisited.

Objective

We undertook a comprehensive analysis of the determinants of child stunting in India, and explored whether the established focus on linear effects of single risks is appropriate.

Design

Using cross-sectional data for children aged 0–24 months from the Indian National Family Health Survey for 2005/2006, we populated an evidence-based diagram of immediate, intermediate and underlying determinants of stunting. We modelled linear, non-linear, spatial and age-varying effects of these determinants using additive quantile regression for four quantiles of the Z-score of standardized height-for-age and logistic regression for stunting and severe stunting.

Results

At least one variable within each of eleven groups of determinants was significantly associated with height-for-age in the 35% Z-score quantile regression. The non-modifiable risk factors child age and sex, and the protective factors household wealth, maternal education and BMI showed the largest effects. Being a twin or multiple birth was associated with dramatically decreased height-for-age. Maternal age, maternal BMI, birth order and number of antenatal visits influenced child stunting in non-linear ways. Findings across the four quantile and two logistic regression models were largely comparable.

Conclusions

Our analysis confirms the multifactorial nature of child stunting. It emphasizes the need to pursue a systems-based approach and to consider non-linear effects, and suggests that differential effects across the height-for-age distribution do not play a major role.

Does Having a Migrant Parent Reduce the Risk of Undernutrition for Children Who Stay Behind in South-East Asia?

Many parents from South-East Asia who go overseas to work are motivated by a desire to secure a better future for their children, yet the health consequences for children who stay behind are poorly understood. This study is the first cross-country comparison to explore the relationships between parental migration and the risk of undernutrition (stunting) for primary school-aged children. The analysis uses data from the CHAMPSEA Project for children aged 9 to 11 years in the Philippines (N = 480) and Vietnam (N = 482). A series of logistic regression models compares outcomes for children living in transnational households and children living with both parents in non-migrant households in the same communities. We find no general advantage of having a migrant parent. Rather there is a reduced risk of stunting only for some left-behind children in the Philippines, whereas having a caregiver with low educational attainment is a major risk factor for all children. The findings point to a complex set of relationships between parental migration and child nutrition, possibly reflecting differential opportunities for accumulating household wealth through overseas earnings. Moreover, differences between the two countries caution against generalizing across national or cultural groups. We conclude by considering the implications of the findings for theories of transnationalism and for the UN Millennium Development Goal of reducing childhood undernutrition.

Parental height in relation to offspring coronary heart disease: examining transgenerational influences on health using the west of Scotland Midspan Family Study

Background Adult height is known to be inversely related to coronary heart disease (CHD) risk. We sought to investigate transgenerational influence of parental height on offspring’s CHD risk.

Methods Parents took part in a cardiorespiratory disease survey in two Scottish towns during the 1970s, in which their physical stature was measured. In 1996, their offspring were invited to participate in a similar survey, which included an electrocardiogram recording and risk factor assessment.

Results A total of 2306 natural offspring aged 30–59 years from 1456 couples were subsequently flagged for notification of mortality and followed for CHD-related hospitalizations. Taller paternal and/or maternal height was associated with socio-economic advantage, heavier birthweight and increased high-density lipoprotein cholesterol in offspring. Increased height in fathers, but more strongly in mothers (risk ratio for 1 SD change in maternal height = 0.85; 95% confidence interval: 0.76 to 0.95), was associated with a lower risk of offspring CHD, adjusting for age, sex, other parental height and CHD risk factors.

Conclusion There is evidence of an association between taller parental, particularly maternal, height and lower offspring CHD risk. This may reflect an influence of early maternal growth on the intrauterine environment provided for her offspring.

Determinants of linear growth from infancy to school-aged years: a population-based follow-up study in urban Amazonian children

BACKGROUND

Although linear growth during childhood may be affected by early-life exposures, few studies have examined whether the effects of these exposures linger on during school age, particularly in low- and middle-income countries.

METHODS

We conducted a population-based longitudinal study of 256 children living in the Brazilian Amazon, aged 0.1 y to 5.5 y in 2003. Data regarding socioeconomic and maternal characteristics, infant feeding practices, morbidities, and birth weight and length were collected at baseline of the study (2003). Child body length/height was measured at baseline and at follow-up visits (in 2007 and 2009). Restricted cubic splines were used to construct average height-for-age Z score (HAZ) growth curves, yielding estimated HAZ differences among exposure categories at ages 0.5 y, 1 y, 2 y, 5 y, 7 y, and 10 y.

RESULTS

At baseline, median age was 2.6 y (interquartile range, 1.4 y-3.8 y), and mean HAZ was -0.53 (standard deviation, 1.15); 10.2% of children were stunted. In multivariable analysis, children in households above the household wealth index median were 0.30 Z taller at age 5 y (P = 0.017), and children whose families owned land were 0.34 Z taller by age 10 y (P = 0.023), when compared with poorer children. Mothers in the highest tertile for height had children whose HAZ were significantly higher compared with those of children from mothers in the lowest height tertile at all ages. Birth weight and length were positively related to linear growth throughout childhood; by age 10 y, children weighing >3500 g at birth were 0.31 Z taller than those weighing 2501 g to 3500 g (P = 0.022) at birth, and children measuring ≥51 cm at birth were 0.51 Z taller than those measuring ≤48 cm (P = 0.005).

CONCLUSIONS

Results suggest socioeconomic background is a potentially modifiable predictor of linear growth during the school-aged years. Maternal height and child's anthropometric characteristics at birth are positively associated with HAZ up until child age 10 y.

Maternal education inequalities in height growth rates in early childhood: 2004 Pelotas birth cohort study

Socio-economic inequalities in attained height have been reported in many countries. The aim of this study was to explore the age at which maternal education inequalities in child height emerge among children from a middle-income country. Using data from the 2004 Pelotas cohort study from Brazil we modelled individual height growth trajectories in 2106 boys and 1947 girls from birth to 4 years using a linear spline mixed-effects model. We examined the associations of maternal education with birth length and trajectories of growth in length/height, and explored the effect of adjusting for a number of potential confounder or mediator factors. We showed linear and positive associations of maternal education with birth length and length/height growth rates at 0-3 months and 12-29/32 months with very little association at 3-12 months, particularly in boys. By age 4 years the mean height of boys was 101.06 cm (SE = 0.28) in the lowest and 104.20 cm (SE = 0.15) in the highest education category (mean difference 3.14 cm, SE = 0.32, P < 0.001). Among girls the mean height was 100.02 cm (SE = 0.27) and 103.03 cm (SE = 0.15) in the lowest and highest education categories, respectively (mean difference 3.01 cm, SE = 0.31, P < 0.001). For both boys and girls there was on average a 3-cm difference between the extreme education categories. Adjusting for maternal height reduced the observed birth length differences across maternal education categories, but differences in postnatal growth rates persisted. Our data demonstrate an increase in the absolute and relative inequality in height after birth; inequality increases from approximately 0.2 standard deviations of birth length to approximately 0.7 standard deviations of height at age 4, indicating that height inequality, which was already present at birth, widened through differential growth rates to age 2 years.

Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries

PURPOSE OF REVIEW

This review highlights recent progress toward understanding complex interactions between diarrhea, pneumonia, and undernutrition among children in low-income and middle-income countries.

RECENT FINDINGS

New studies parallel earlier reports that diarrhea and pneumonia impair children's growth and that underlying malnutrition is a major risk factor for these conditions. Episodes of diarrhea may predispose to pneumonia in undernourished children. Additional studies support breastfeeding and micronutrient supplementation for the prevention and control of diarrhea and pneumonia. Malnutrition may partially account for the reduced efficacy of oral rotavirus vaccines in low-income countries. Immunization of pregnant women against influenza also appears to reduce intrauterine growth retardation. Immunization of infants against Streptococcus pneumoniae may improve their growth. New genetic studies indicate that polymorphisms in apolipoprotein E or the leptin receptor modulate children's risk for diarrhea and Entamoeba histolytica infection, respectively, thereby linking two genes important for lipid metabolism to enteric infections.

SUMMARY

Significant advances have been made in understanding the vicious cycle of malnutrition, diarrhea, and pneumonia in developing countries. Future challenges will be to translate this progress into effective and widely accessible public health measures.

Micronutrient and anthropometric status indicators are associated with physical fitness in Colombian schoolchildren

Poor physical fitness is associated with increased health-related risks in children. The association of nutritional status indicators and physical fitness in children residing in developing countries is not well characterised. We conducted a cross-sectional study among 1945 children of age 5-12 years in Bogotá, Colombia, to assess whether anthropometric and micronutrient status indicators were associated with performance in the shuttle run and standing long jump tests. Stunted children scored significantly lower in the run (0·4 s; P = 0·0002) and jump (6 cm; boys only; P = 0·003) tests than non-stunted children, after adjustment for age and other factors. Children who were thin, overweight or obese ran slower than normal-weight children (P < 0·01). Lower jump scores were associated with overweight or obesity and greater arm fat area in boys only (P < 0·0001). Girls with low ferritin concentrations ran 0·6 s slower than girls with normal ferritin concentrations (P = 0·02). Erythrocyte folate concentrations were linearly related to higher run (P < 0·0001) and long jump scores (P = 0·0001). Boys with marginal or low vitamin B12 status had 4 cm lower long jump scores than children with normal status (P = 0·01). Suboptimal anthropometric and micronutrient status are related to poorer performance in fitness tests. The effects of improving nutritional status on physical fitness of children warrant investigation.