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Asebe HA, Asmare ZA, Mare KU, Kase BF, Tebeje TM, Asgedom YS, Shibeshi AH, Lombebo AA, Sabo KG, Fente BM, Bezie MM, Seifu BL. The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis. Front Nutr 2024; 11:1336864. [PMID: 38903623 PMCID: PMC11187342 DOI: 10.3389/fnut.2024.1336864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.
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Affiliation(s)
- Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanose Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Afewerk Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meklit Melaku Bezie
- Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia
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Kiguli S, Olupot-Olupot P, Hamaluba M, Giallongo E, Thomas K, Alaroker F, Opoka RO, Tagoola A, Oyella S, Nalwanga D, Nabawanuka E, Okiror W, Nakuya M, Amorut D, Muhindo R, Ayub Mpoya, Mnjalla H, Oguda E, Williams TN, Harrison DA, Rowan K, Briend A, Maitland K. Nutritional supplementation in children with severe pneumonia in Uganda and Kenya (COAST-Nutrition): a phase 2 randomised controlled trial. EClinicalMedicine 2024; 72:102640. [PMID: 38774673 PMCID: PMC11106534 DOI: 10.1016/j.eclinm.2024.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/24/2024] Open
Abstract
Background Severe pneumonia in African children results in poor long-term outcomes (deaths/readmissions) with undernutrition as a key risk factor. We hypothesised additional energy/protein-rich Ready-to-Use Therapeutic Foods (RUTF) would meet additional nutritional requirements and improve outcomes. Methods COAST-Nutrition was an open-label Phase 2 randomised controlled trial in children (aged 6 months-12 years) hospitalised with severe pneumonia (and hypoxaemia, SpO2 <92%) in Mbale, Soroti, Jinja, Masaka Regional Referral Hospitals, Uganda and Kilifi County Hospital, Kenya (ISRCTN10829073 (registered 6th June 2018) PACTR202106635355751 (registered 2nd June 2021)). Children were randomised (ratio 1:1) to enhanced nutritional supplementation with RUTF (plus usual diet) for 56 days vs usual diet (control). The primary outcome was change in mid-upper arm circumference (MUAC) at 90 days as a composite with mortality. Secondary outcomes include anthropometric status, mortality, and readmissions at Days 28, 90 and 180. Findings Between 12 August 2018 and 22 April 2022, 846 eligible children were randomised, 424 to RUTF and 422 to usual diet, and followed for 180-days [12 (1%) lost-to-follow-up]. RUTF supplement was initiated in 417/419 (>99%). By Day 90, there was no significant difference in the composite endpoint (probabilistic index 0.49, 95% CI 0.45-0.53, p = 0.74). Respective 90-day mortality (13/420 3.1% vs 14/421 3.3%) and MUAC increment (0.54 (SD 0.85) vs 0.55 (SD 0.81)) were similar between arms. There was no difference in any anthropometric secondary endpoints to Day 28, 90 or 180 except skinfold thickness at Day 28 and Day 90 was greater in the RUTF arm. Serious adverse events were higher in the RUTF arm (n = 164 vs 108), mainly due to hospital readmission for acute illness (54/387 (14%) vs 37/375 (10%). Interpretation Our study suggested that nutritional supplementation with RUTF did not improve outcomes to 180 days in children with severe pneumonia. Funding This trial is part of the EDCTP2 programme (grant number RIA-2016S-1636-COAST-Nutrition) supported by the European Union, and UK Joint Global Health Trials scheme: Medical Research Council, Department for International Development, Wellcome Trust (grant number MR/L004364/1, UK).
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Affiliation(s)
- Sarah Kiguli
- Department of Paediatrics, School of Medicine, Makerere University and Mulago Hospital Kampala, Uganda
| | - Peter Olupot-Olupot
- Busitema University Faculty of Health Sciences, Mbale Campus, Uganda
- Mbale Regional Referral Hospital Mbale, Uganda
| | - Mainga Hamaluba
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elisa Giallongo
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Karen Thomas
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | | | - Robert O. Opoka
- Department of Paediatrics, School of Medicine, Makerere University and Mulago Hospital Kampala, Uganda
- Jinja Regional Referral Hospital Jinja, Uganda
| | | | - Shela Oyella
- Masaka Regional Referral Hospital Masaka, Uganda
| | - Damalie Nalwanga
- Department of Paediatrics, School of Medicine, Makerere University and Mulago Hospital Kampala, Uganda
| | - Eva Nabawanuka
- Department of Paediatrics, School of Medicine, Makerere University and Mulago Hospital Kampala, Uganda
- Department of Radiology, School of Medicine, Makerere University, P.O Box 7072, Kampala, Uganda
| | - William Okiror
- Busitema University Faculty of Health Sciences, Mbale Campus, Uganda
- Mbale Regional Referral Hospital Mbale, Uganda
| | | | - Denis Amorut
- Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Ayub Mpoya
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Hellen Mnjalla
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emmanuel Oguda
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Thomas N. Williams
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
| | - David A. Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathy Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Andre Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Kathryn Maitland
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
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Ribeiro SA, Braga EL, Queiroga ML, Clementino MA, Fonseca XM, Belém MO, Magalhães LM, de Sousa JK, de Freitas TM, Veras HN, de Aquino CC, Santos AD, de Moura FR, Dos Santos AA, Havt A, Maciel BL, Lima AA. A New Murine Undernutrition Model Based on Complementary Feeding of Undernourished Children Causes Damage to the Morphofunctional Intestinal Epithelium Barrier. J Nutr 2024; 154:1232-1251. [PMID: 38346539 DOI: 10.1016/j.tjnut.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Complementary feeding is critical in establishing undernutrition. However, experimental undernourished diets do not represent the amount of nutrients in the complementary diets of undernourished children. OBJECTIVES To develop, validate, and evaluate the impact of a new murine model of undernutrition on the intestinal epithelium, based on the complementary diet of undernourished children from 7 countries with low-socioeconomic power belonging to the Malnutrition-Enteric Diseases (MAL-ED) cohort study. METHODS We used the difference in the percentage of energy, macronutrients, fiber and zinc in the complementary diet of children without undernutrition compared with stunting (height-for-age Z-score < -2) for the MAL-ED diet formulation. Subsequently, C57BL/6 mice were fed a control diet (AIN-93M diet) or MAL-ED diet for 28 d. Weight was measured daily; body composition was measured every 7 d; lactulose:mannitol ratio (LM) and morphometry were evaluated on days 7 and 28; the cotransport test and analysis of intestinal transporters and tight junctions were performed on day 7. RESULTS The MAL-ED diet presented -8.03% energy, -37.46% protein, -24.20% lipid, -10.83% zinc, +5.93% carbohydrate, and +45.17% fiber compared with the control diet. This diet rapidly reduced weight gain and compromised body growth and energy reserves during the chronic period (P < 0.05). In the intestinal epithelial barrier, this diet caused an increase in the LM (P < 0.001) and reduced (P < 0.001) the villous area associated with an increase in FAT/CD36 in the acute period and increased (P < 0.001) mannitol excretion in the chronic period. CONCLUSIONS The MAL-ED diet induced undernutrition in mice, resulting in acute damage to the integrity of the intestinal epithelial barrier and a subsequent increase in the intestinal area during the chronic period. This study introduces the first murine model of undernutrition for the complementary feeding phase, based on data from undernourished children in 7 different countries.
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Affiliation(s)
- Samilly A Ribeiro
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.
| | - Enock Lr Braga
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Marcus L Queiroga
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Marco A Clementino
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Xhaulla Mqc Fonseca
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Mônica O Belém
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Lyvia Mvc Magalhães
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - José K de Sousa
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Thiago M de Freitas
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Herlice N Veras
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Cristiane C de Aquino
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alan Dc Santos
- Núcleo de Estudos Químicos de Micromoléculas da Amazônia (NEQUIMA), Manaus, Brazil
| | - Flávio Rm de Moura
- Núcleo de Estudos Químicos de Micromoléculas da Amazônia (NEQUIMA), Manaus, Brazil
| | - Armênio A Dos Santos
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Havt
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Bruna Ll Maciel
- Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Aldo Am Lima
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Ariyo T, Jiang Q. Maternal autonomy and childhood undernutrition: Analysis of 2018 Nigeria demographic and health survey. J Child Health Care 2024; 28:150-165. [PMID: 35713878 DOI: 10.1177/13674935221108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Existing knowledge of how maternal autonomy relates to child undernutrition in Nigeria is few and limited to children under 24 months old. Nothing is known about how it affects older children. Therefore, this study investigated whether mothers' household autonomy affects children 24-59 months, as do children under 24 months old. We used data from 2018 Nigerian Demographic and Health Survey, which is a nationally representative survey. Samples include 3502 and 5463 children under 24 months and between 24 and 59 months old, respectively. Three anthropometry indexes were used to determine child undernutrition: weight-for-height, height-for-age, and weight-for-age, which indicate wasting, stunting, and underweight, respectively. Three domains of maternal autonomy: decision-making, financial-control, and mobility, were operationalized using responses from mothers. Results from logistic regression analysis show that in unadjusted models, maternal decision-making autonomy and mobility were associated with undernutrition in both samples. After adding covariates, only associations between maternal decision-making autonomy and underweight in children 24-59 months old retained statistical significance. Findings show that gendered social inequalities are linked to differences in child nutritional outcomes. Future studies could investigate how feeding practices mediate associations between maternal autonomy and childhood undernutrition.
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Affiliation(s)
- Tolulope Ariyo
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, China
| | - Quanbao Jiang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, China
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5
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Ngaboyeka G, Bisimwa G, Neven A, Mwene-Batu P, Kambale R, Ongezi E, Chimanuka C, Ntagerwa J, Balolebwami S, Mulume F, Battisti O, Dramaix M, Donnen P. Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo. BMC Public Health 2024; 24:587. [PMID: 38395784 PMCID: PMC10885520 DOI: 10.1186/s12889-024-18083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. METHODS We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. RESULTS Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. CONCLUSION Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.
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Affiliation(s)
- Gaylord Ngaboyeka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo.
- Institut Supérieur des Techniques Médicales Kanyamulande, Walungu, Democratic Republic of Congo.
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Anouk Neven
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Pacifique Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Faculté de Médecine, Université de Kaziba, Kaziba, Democratic Republic of Congo
| | - Richard Kambale
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Emmanuel Ongezi
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Christine Chimanuka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Joseph Ntagerwa
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Serge Balolebwami
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Francis Mulume
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Oreste Battisti
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Département de sciences cliniques, Faculté de médecine, Université de Liège, Liège, Belgique
| | - Michèle Dramaix
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Donnen
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Saleem J, Zakar R, Butt MS, Aadil RM, Ali Z, Bukhari GMJ, Ishaq M, Fischer F. Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan. BMC Public Health 2024; 24:167. [PMID: 38216908 PMCID: PMC10787446 DOI: 10.1186/s12889-024-17701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Malnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan. METHODS A multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children's anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio. RESULTS This study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five. CONCLUSION This study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Rana Muhammad Aadil
- National Institute of Food Sciences and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Zulfiqar Ali
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan
| | | | - Muhammad Ishaq
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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7
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Kangas ST, Ouédraogo CT, Tounkara M, Ouoluoguem B, Coulibaly IN, Haidara A, Diarra NH, Diassana K, Tausanovitch Z, Ritz C, Wells JC, Briend A, Myatt M, Radin E, Bailey J. Nutritional treatment of children 6-59 months with severely low weight-for-age z-score: a study protocol for a 3-arm randomized controlled trial. Trials 2024; 25:30. [PMID: 38191436 PMCID: PMC10773065 DOI: 10.1186/s13063-023-07890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Admission criteria that treat children with low mid-upper-arm circumference (MUAC), and low weight-for-height z-score (WHZ) are not aligned with the evidence on which children are at risk of mortality. An analysis of community-based cohort data from Senegal found that a combination of weight-for-age (WAZ) and MUAC criteria identified all children at risk of near-term death associated with severe anthropometric deficits. This study will address whether children with WAZ <-3 but MUAC ≥125 mm benefit from therapeutic feeding with ready-to-use therapeutic foods (RUTF) and whether a simplified protocol is non-inferior to the weight-based standard protocol. METHODS This is a prospective individually randomized controlled 3-arm trial conducted in the Nara health district in Mali. Children aged 6-59 months presenting with MUAC ≥125 mm and WAZ <-3 will be randomized to (1) control group receiving no treatment, (2) simplified treatment receiving 1 sachet of RUTF daily until WAZ ≥-3 for 2 visits, (3) standard treatment receiving RUTF according to WHZ category: (a) WHZ <-3 receive 200 kcal/kg/day until WHZ ≥-2 for 2 visits, (b) WHZ ≥-3 but <-2 receive 1 sachet daily until WHZ ≥-2 for 2 visits or (c) WHZ ≥-2 receive no treatment. All children will be followed up first fortnightly for 12 weeks and then monthly until 6 months post-enrolment. The primary endpoint will be measured at 2 months with the primary outcome being WAZ as a continuous measure. Other outcomes include other anthropometric measurements and a secondary endpoint will be observed at 6 months. A total of 1397 children will be recruited including 209 in the control and 594 in both the simplified and standard arms. The sample size should enable us to conclude on the superiority of the simplified treatment compared to no treatment and on the non-inferiority of the simplified treatment versus standard treatment with a margin of non-inferiority of 0.2 WAZ. DISCUSSION This trial aims to generate new evidence on the benefit of treating children with WAZ <-3 but MUAC ≥125 mm in order to guide the choice of admission criteria to malnutrition treatment and build evidence on the most efficient treatment protocol. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov: NCT05248516 on February 21, 2022.
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Affiliation(s)
| | | | - Moctar Tounkara
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Technics and Technologies of Bamako, Bamako, Mali
| | | | | | | | | | | | | | - Christian Ritz
- National Institute of Public Health, Copenhagen, Denmark
| | - Jonathan C Wells
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - André Briend
- Department of International Health, University of Tampere School of Medicine, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Myatt
- Brixton Health, Brixton, UK
- Emergency Nutrition Network, Kidlington, Oxforshire, UK
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Nandeep ER, Jaleel A, Reddy PB, Geddam JJB, Reddy SN, Hemalatha R. Developing and demonstrating an atomistic and holistic model of anthropometric failure among children under five years of age using the National Family Health Survey (NFHS)-5 data from India. Front Nutr 2024; 10:1280219. [PMID: 38260069 PMCID: PMC10800737 DOI: 10.3389/fnut.2023.1280219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Composite Index of Anthropometric Failure (CIAF) and its further modifications have not incorporated all the combinations of malnutrition. We propose a new model incorporating all the forms of malnutrition among children under five years of age. However, the current models might misclassify a growing child as malnourished. Our objective is to develop a comprehensive scoring system using the three anthropometric Z-scores [height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z-scores] and demonstrate the proposed CIAF model using the National Family Health Survey-5 (NFHS-5) data from India. Methods A new scoring system was developed using the WAZ, HAZ, and WHZ scores to determine the child's nutritional status. We also proposed a new CIAF model by including all possible categories of malnutrition and practically demonstrated it using the NFHS-5 dataset after applying the new scoring system. Under-five children with heights, weights, and ages available were included in the analysis. The groups of malnutrition are presented as weighted proportions before and after applying the new score to the proposed model. Results Our final analysis included individual-level data of 198,802 children under five years of age (weighted N = 195,197). After applying the new scoring system to the proposed model, the prevalence of stunting has reduced to 11.8% (95% CI 11.66-11.94) from 13.2% (95% CI 13.09-13.39) and wasting prevalence has reduced to 4.9% (95% CI 4.85-5.04) from 6.4% (95% CI 6.29-6.51). The most common forms of anthropometric failures among Indian children by using the newly developed CIAF model are: "Stunting and underweight" (30,127; 15.4%), Stunting only (23,035; 11.8%), and "wasting and underweight" (14,698; 7.5%). We found a new category called "Stunting, underweight, and overweight" (stunting = HAZ < -2SD, underweight = WAZ < -2SD, overweight = WHZ > +2SD). It constituted 0.1% (220 children) of the total sample. Conclusion When the new scoring system is applied to the proposed CIAF model, it captures all forms and combinations of malnutrition among under-five children without overlap and prevents misclassifying a growing child as malnourished. The newly identified category shows that stunting (HAZ < -2SD), overweight (WHZ > +2SD) and underweight (WAZ < -2SD) can co-exist in the same child.
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Affiliation(s)
- E. R. Nandeep
- Clinical Epidemiology Division, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Abdul Jaleel
- Public Health Nutrition Division, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
| | - P. Bhaskar Reddy
- Nutrition Information, Communication & Health Education (NICHE) Division, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
| | - J. J. Babu Geddam
- Clinical Epidemiology Division, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Samarasimha N. Reddy
- Clinical Epidemiology Division, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Rajkumar Hemalatha
- Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Hyderabad, Telangana, India
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Bwakura-Dangarembizi M, Dumbura C, Ngosa D, Majo FD, Piper JD, Sturgeon JP, Nathoo KJ, Amadi B, Norris S, Chasekwa B, Ntozini R, Wells JC, Kelly P, Prendergast AJ. Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia. Br J Nutr 2023; 130:1024-1033. [PMID: 36573378 PMCID: PMC10442795 DOI: 10.1017/s0007114522004056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference -1·49, 95 % CI (-2·01, -0·97)) and impedance index Z-scores (-0·13, 95 % CI (-0·24, -0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (-1·47, 95 % CI (-1·97, -0·97)) and impedance index Z-scores (-0·23, 95 % CI (-0·36, -0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.
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Affiliation(s)
- Mutsa Bwakura-Dangarembizi
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- University of Witwatersrand, Johannesburg, South Africa
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Joe D. Piper
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Jonathan P. Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Kusum J. Nathoo
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Shane Norris
- University of Witwatersrand, Johannesburg, South Africa
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan C. Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Blizard Institute, Queen Mary University of London, London, UK
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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Al-Taj MA, Al Serouri A, Al-Muradi AM, Al-Dharhani E, Al-faeq NN, Al-amodi FM, Abdulwahab MM, Nawfal AM, Alshemerry MH, Mujahed MA. Concurrent wasting and stunting among marginalised children in Sana'a city, Yemen: a cross-sectional study. J Nutr Sci 2023; 12:e91. [PMID: 37587974 PMCID: PMC10425760 DOI: 10.1017/jns.2023.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Concurrent wasting and stunting (WaSt) is a serious form of malnutrition among young children, particularly vulnerable groups affected by the conflict. Understanding the prevalence and risk factors of WaSt among vulnerable children is important to develop effective intervention measures to reduce the burden of WaSt. The present study aimed to identify the prevalence of and risk factors for WaSt among marginalised children aged 6-59 months in Sana'a city, Yemen. A community-based cross-sectional design was conducted on a total sample size of 450 marginalised children aged 6-59 months who lived at home with their mothers. Multivariable logistic regression analysis was performed and the prevalence of WaSt was found to be 10⋅7 %. Children aged 24-59 months were protected from WaSt (adjusted odds ratio (AOR) 0⋅40, 95 % confidence interval (CI) 0⋅21, 0⋅75). A higher prevalence of WaSt was associated with male sex (AOR 2⋅31, 95 % CI 1⋅13, 4⋅71), no history of being breastfed (AOR 3⋅57, 95 % CI 1⋅23, 10⋅39), acute diarrhoea (AOR 2⋅12, 95 % CI 1⋅12, 4⋅02) and family income sources of assistance from others (AOR 2⋅74, 95 % CI 1⋅08, 6⋅93) or salary work (AOR 2⋅22, 95 % CI 1⋅10, 4⋅47). Continued breast- and bottle-feeding were not associated with WaSt in children aged 6-23 months. Mothers' age, education and work status, family size and drinking water source were not associated with WaSt. Overall, we found that the prevalence of WaSt among marginalised children remained high. Interventions to improve household income, hygienic conditions and child feeding practices are necessary to promote child growth.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulwahed Al Serouri
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | - Nada Nabil Al-faeq
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Ali Mujahed Nawfal
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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11
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Sahiledengle B, Agho KE, Petrucka P, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Mwanri L. Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects modelling. MATERNAL & CHILD NUTRITION 2023; 19:e13483. [PMID: 36757269 PMCID: PMC10019057 DOI: 10.1111/mcn.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Kingsley E. Agho
- School of Health SciencesWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research Institute, School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- African Vision Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | | | - Abera Kumie
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Girma Beressa
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Daniel Atlaw
- Department of Human AnatomyMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Yohannes Tekalegn
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Demisu Zenbaba
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Fikreab Desta
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Lillian Mwanri
- Torrens University AustraliaAdelaideSouth AustraliaAustralia
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12
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Development of Food Multi-Mix Using a Linear Programming Approach to Fill the Nutrient Gap of Amino Acids and Micronutrients for Stunted Non-Wasted Children. Foods 2022; 12:foods12010064. [PMID: 36613280 PMCID: PMC9818143 DOI: 10.3390/foods12010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/10/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
Food-based approaches using locally available food escalates the feasibility and the sustainability of nutrition intervention. A complementary feeding recommendation (CFR) integrated with the food multi-mix (FMM) formulation was targeted to fulfill micronutrient and amino acid requirements for stunted non-wasted (SNW) children aged 12-23 months living in agricultural areas. A seven-day estimated food record (EFR) of 87 children was used to design the CFR and 4 identified underutilized foods were integrated as the FMM. A linear programming approach using Optifood was applied to optimize the CFR and FMM. CFR alone successfully fulfills the vitamin C, riboflavin, iron, and zinc, but it cannot fulfill calcium, thiamin, niacin, vitamin B6, folate, vitamin B12, and histidine. With the incorporation of the selected underutilized cowpea, buncis batik, wader fish, and cows' milk in the FMM development, the nutrients that are challenging in CFR development, can be fulfilled. Therefore, these findings present evidence that food multi-mix developed based on locally available nutrient-dense food sources can help to meet the nutrient gaps, which often remained even after a complementary feeding diet is optimized. Efficacy study using the developed CFR and FMM is recommended to assess effect in improving intake of micronutrients and amino acids and improving the linear growth of stunted, non-wasted children.
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13
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Bangoura ST, Rabilloud M, Camara A, Campoy S, Condé M, Vanhems P, Kadio KJJO, Touré A, Khanafer N. Factors associated with the nutritional status of children under 5 years of age in Guinea between 2005 and 2018. Public Health Nutr 2022; 26:1-10. [PMID: 36539345 PMCID: PMC9989713 DOI: 10.1017/s1368980022002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the factors associated with the nutritional status of children under 5 years of age in Guinea between 2005 and 2018. DESIGN Data from the 2005, 2012 and 2018 Guinea Demographic and Health Surveys (DHS) were used for this study. Three anthropometric indicators (stunting, underweight and wasting) were assessed according to the 2006 WHO Child Growth Standards and analysed according to the year, the characteristics of the household, the child and the mother using multivariate logistic regression. SETTING Data were collected in the capital Conakry and in the seven administrative regions of Guinea. PARTICIPANTS The study included children under 5 years of age for whom height and weight were available: 2765 (DHS-2005), 3220 (DHS-2012) and 3551 (DHS-2018). RESULTS Analysis of the data from the three surveys showed that children living in rural areas were more likely to be stunted than children living in urban areas (OR = 1·32, 95 % CI (1·08, 1·62)). Similarly, the children from middle, poor and the poorest households were more likely to be stunted and underweight than children from richest households. The chance to stunting increased with age in the first 3 years. However, the chance to wasting decreased with age. Children in all age groups were more likely of being underweight. Children of thin mothers were more likely to be both wasted (OR = 2·0, 95 % CI (1·5, 2·6)) and underweight (OR = 1·9, 95 % CI (1·5, 2·3)). CONCLUSION The implementation of targeted interventions adapted to the observed disparities could considerably improve the nutritional status of children and mothers.
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Affiliation(s)
- Salifou Talassone Bangoura
- Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), Campus Universitaire Hadja Mafory Bangoura, Donka, Conakry, BP: 6629P, Guinée
- Chaire de Santé Publique, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
- Département des Sciences Pharmaceutiques et Biologiques, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Muriel Rabilloud
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Alioune Camara
- Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), Campus Universitaire Hadja Mafory Bangoura, Donka, Conakry, BP: 6629P, Guinée
- Chaire de Santé Publique, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Séphora Campoy
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Mamoudou Condé
- Chaire de Santé Publique, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Philippe Vanhems
- Santé publique, Epidémiologie et Ecologie Evolutive des Maladies Infectieuses, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111-UCBL 1-ENS, Lyon, France
- Department of Hygiene, Epidemiology, and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Kadio Jean-Jacques Olivier Kadio
- Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), Campus Universitaire Hadja Mafory Bangoura, Donka, Conakry, BP: 6629P, Guinée
- Chaire de Santé Publique, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
- Département des Sciences Pharmaceutiques et Biologiques, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Abdoulaye Touré
- Centre de Recherche et de Formation en Infectiologie de Guinée (CERFIG), Campus Universitaire Hadja Mafory Bangoura, Donka, Conakry, BP: 6629P, Guinée
- Chaire de Santé Publique, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
- Département des Sciences Pharmaceutiques et Biologiques, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Nagham Khanafer
- Santé publique, Epidémiologie et Ecologie Evolutive des Maladies Infectieuses, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111-UCBL 1-ENS, Lyon, France
- Department of Hygiene, Epidemiology, and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Saavedra JM, Prentice AM. Nutrition in school-age children: a rationale for revisiting priorities. Nutr Rev 2022:6811793. [PMID: 36346900 DOI: 10.1093/nutrit/nuac089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Middle childhood and early adolescence have received disproportionately low levels of scientific attention relative to other life stages, especially as related to nutrition and health. This is partly due to the justified emphasis on the first 1000 days of life, and the idea that early deficits and consequences may not be fully reversible. In addition, these stages of life may superficially appear less "eventful" than infancy or late adolescence. Finally, there has been historical ambiguity and inconsistency in terminology, depending on whether viewing "childhood" through physiologic, social, legal, or other lenses. Nevertheless, this age bracket, which encompasses most of the primary education and basic schooling years for most individuals, is marked by significant changes, inflection points, and sexually driven divergence in somatic and brain growth and development trajectories. These constitute transformative changes, and thus middle childhood and early adolescence represents a major and last opportunity to influence long-term health and productivity. This review highlights the specificities of growth and development in school age, with a focus on middle childhood and early adolescence (5 years-15 years of age, for the purposes of this review), the role of nutrition, the short- and long-term consequences of inadequate nutrition, and the current global status of nutrition in this age group. Adequate attention and emphasis on nutrition in the school-age years is critical: (a) for maintaining an adequate course of somatic and cognitive development, (b) for taking advantage of this last major opportunity to correct deficits of undernutrition and "catch-up" to normal life course development, and (c) for addressing the nutritional inadequacies and mitigating the longer-term consequences of overnutrition. This review summarizes and provides a rationale for prioritizing nutrition in school-age children, and for the need to revisit priorities and focus on this part of the life cycle to maximize individuals' potential and their contribution to society.
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Affiliation(s)
- Jose M Saavedra
- with the Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew M Prentice
- is with the MRC Unit, The Gambia and MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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Asmare AA, Agmas YA. Determinants of coexistence of stunting, wasting, and underweight among children under five years in the Gambia; evidence from 2019/20 Gambian demographic health survey: application of multivariate binary logistic regression model. BMC Public Health 2022; 22:1621. [PMID: 36028850 PMCID: PMC9414138 DOI: 10.1186/s12889-022-14000-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malnutrition happens when there are insufficient amounts of nutrients and energy consumed improperly. Included are both undernutrition and overnutrition. This study is aimed to evaluate the relationship among undernutrition indicators of stunting, underweight, and wasting among those under 5 years given other predictors. Methods The data were obtained from the measure of DHS program. A total of 2399 under-five children were involved in this study. A multivariate binary logistic regression model is used to assess the association between stunting, wasting, and being underweight given the effect of other predictors. Results Of the 2399 under-five children considered in this study, 13.5, 18.7, and 5.9% of them suffered from stunting, underweight, and wasting, respectively. The majority of children (40.1%) were obtained from the Brikama local government area of Gambia; more than half of the children (52.9%) were male, and 63.3% of children lived in urban areas. The association between stunting and underweight, underweight and wasting, and stunting and wasting was measured by the odds ratio (OR) of 15.87, 46.34, and 1.75, respectively, given the other predictors. The estimated odds ratio for children who had an average birth size to become stunted, underweight, and wasted were 0.965, 0.885, and 0.989 times the estimated odds ratio of children who had a small birth size, respectively. Conclusion The prevalence of stunting and wasting for under-five children in Gambia was lower than the world prevalence, but the prevalence of being underweight was higher. Children who are underweight have a significant association with both stunting and wasting. The age of the child, the child’s anemia level, and the birth type of the child are the common important determinants of stunting and underweight. The small birth size of a child was highly associated with a higher risk of stunting, underweight, and wasting among under five-year-olds.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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16
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Prevalence and Associated Factors of Stunting among School Age Children in Addis Ababa City, Ethiopia 2021. Ann Glob Health 2022; 88:57. [PMID: 35936231 PMCID: PMC9306670 DOI: 10.5334/aogh.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
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17
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Hoffman DJ, Posluszny HR. Navigating Linear and Ponderal Growth in Undernourished Children. J Nutr 2022; 152:1810-1811. [PMID: 35849077 PMCID: PMC9466570 DOI: 10.1093/jn/nxac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Hannah R Posluszny
- Department of International Health, Program in Human Nutrition, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Sinha RK, Kumar P, Daniel A, Shah H, Sriswan R, Kokane A, Mohapatra A, Kashyap V, Goel AK, Kumar V, Kiran A, Arlappa N, Joshi A, Nayak RR, Sayal S, de Wagt A. Association between anthropometric criteria and body composition among children aged 6-59 months with severe acute malnutrition: a cross-sectional assessment from India. BMC Nutr 2022; 8:56. [PMID: 35739560 PMCID: PMC9219132 DOI: 10.1186/s40795-022-00551-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
A multicentric study is being conducted in which children with severe acute malnutrition (SAM) aged 6–59 months are identified with only weight-for-height z-score (WHZ) < − 3 criteria. The present study aimed to assess associations of anthropometric parameters and body composition parameters, to improve treatment of SAM. We conducted a cross-section assessment using the enrolment data of children who participated in a multi-centric longitudinal controlled study from five Indian states. Fat-free mass (FFM) and fat mass (FM) were determined by bio-electrical impedance analysis (BIA). Six hundred fifty-nine children were enrolled in the study using WHZ < -3 criteria. Available data shows that WHZ, WAZ and BMIZ were significantly associated with FFMI while MUACZ was significantly associated with both FMI and FFMI. Children with both severe wasting and severe stunting had significantly lower FFMI compared to those who were only severely wasted. All forms of anthropometric deficits appear to adversely impact FFM and FM. Trial registration The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 dated 24/09/2020).
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Affiliation(s)
- Rajesh Kumar Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India.
| | - Praveen Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Abner Daniel
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Hemang Shah
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Raja Sriswan
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Aditya Mohapatra
- Addl Director, Department of Health and Family Welfare, Government of Odisha Annex Building, SIHFW, Bira Maharana Ln, Nilakantha Nagar, Nayapalli, Bhubaneswar, Odisha-751012, India
| | - Vivek Kashyap
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - Anil Kumar Goel
- All India Institute of Medical Sciences, Raipur Gate No, 1, Great Eastern Rd, opposite Gurudwara, AIIMS Campus, Tatibandh, Raipur, Chhattisgarh-492099, India
| | - Virendra Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Asha Kiran
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - N Arlappa
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Ankur Joshi
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Rashmi Ranjan Nayak
- Joint Secretary, Department of Women and Child Development and Mission Shakti, Government of Odisha, Mission Shakti Bhawan, At-Gandamunda, PO-Baramunda, Bhubaneswar, Odisha, Pin-751030, India
| | - Shikha Sayal
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Arjan de Wagt
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
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19
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Sadler K, James PT, Bhutta ZA, Briend A, Isanaka S, Mertens A, Myatt M, O'Brien KS, Webb P, Khara T, Wells JC. How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project. J Nutr 2022; 152:2645-2651. [PMID: 35687496 PMCID: PMC9839990 DOI: 10.1093/jn/nxac091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023] Open
Abstract
Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.
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Affiliation(s)
| | | | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada,Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark,Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Epicentre, Paris, France
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | - Mark Myatt
- Emergency Nutrition Network, Kidlington, United Kingdom,Brixton Health, Llwyngwril, Gwynedd, Wales, United Kingdom
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, United Kingdom
| | - Jonathan C Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, United Kingdom
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20
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Guha S, Das S, Baffour B, Chandra H. Multivariate small area modelling of undernutrition prevalence among under-five children in Bangladesh. Int J Biostat 2022:ijb-2021-0130. [PMID: 35624076 DOI: 10.1515/ijb-2021-0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022]
Abstract
District-representative data are rarely collected in the surveys for identifying localised disparities in Bangladesh, and so district-level estimates of undernutrition indicators - stunting, wasting and underweight - have remained largely unexplored. This study aims to estimate district-level prevalence of these indicators by employing a multivariate Fay-Herriot (MFH) model which accounts for the underlying correlation among the undernutrition indicators. Direct estimates (DIR) of the target indicators and their variance-covariance matrices calculated from the 2019 Bangladesh Multiple Indicator Cluster Survey microdata have been used as input for developing univariate Fay-Herriot (UFH), bivariate Fay-Herriot (BFH) and MFH models. The comparison of the various model-based estimates and their relative standard errors with the corresponding direct estimates reveals that the MFH estimator provides unbiased estimates with more accuracy than the DIR, UFH and BFH estimators. The MFH model-based district level estimates of stunting, wasting and underweight range between 16 and 43%, 15 and 36%, and 6 and 13% respectively. District level bivariate maps of undernutrition indicators show that districts in north-eastern and south-eastern parts are highly exposed to either form of undernutrition, than the districts in south-western and central parts of the country. In terms of the number of undernourished children, millions of children affected by either form of undernutrition are living in densely populated districts like the capital district Dhaka, though undernutrition indicators (as a proportion) are comparatively lower. These findings can be used to target districts with a concurrence of multiple forms of undernutrition, and in the design of urgent intervention programs to reduce the inequality in child undernutrition at the localised district level.
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Affiliation(s)
- Saurav Guha
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India.,Health Analytics Network, Pittsburgh, PA, USA
| | - Sumonkanti Das
- School of Demography, Australian National University, Canberra, Australia
| | - Bernard Baffour
- School of Demography, Australian National University, Canberra, Australia
| | - Hukum Chandra
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
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21
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Ludwig C, Knoll-Pientka N, Mwanri A, Erfle C, Onywera V, Tremblay MS, Bühlmeier J, Luzak A, Ferland M, Schulz H, Libuda L, Hebebrand J. Low leptin levels are associated with elevated physical activity among lean school children in rural Tanzania. BMC Public Health 2022; 22:933. [PMID: 35538440 PMCID: PMC9087976 DOI: 10.1186/s12889-022-12949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Sub-Saharan African countries, rapid urbanization and increasing socio-economic status are associated with a transition to decreased physical activity (PA). A more sedentary lifestyle is linked to increased body fat leading to increments in leptin levels. Since rodent and human studies in high-income countries have shown that starvation-induced hypoleptinemia triggers high PA, efforts are warranted to pursue the hypothesis that low leptin levels in lean children of low- and middle-income countries (LMIC) are also associated with high PA. METHODS In this cross-sectional study, we assessed seven-day PA with triaxial accelerometry (ActiGraph GT3X) among 223 primary school children (9 to 12 years of age) in rural Tanzania. Moderate-to-vigorous PA (MVPA) and total accelerometer counts per day were outcome variables. Leptin was determined using enzyme linked immunosorbent assay tests from dried blood spots. Anthropometric assessments were conducted and food insecurity and socio-demographic data were gathered using semi-structured interviews. RESULTS In this sample of school children in rural Tanzania, leptin concentrations (median: 0.91 ng/mL, P25: 0.55, P75: 1.69), body mass index z-scores (median: -1.35, P25: -1.93, P75: -0.82), and height-for-age-z-scores (median: -1.16, P25: -1.96, P75: -0.61) were low. In contrast, PA levels were high with a median MVPA time of 119 min/day. Linear regression confirmed that leptin levels were negatively associated with MVPA (beta: -18.1; 95%CI: -29.7; -6.5; p = 0.002) and total accelerometer counts (beta: -90,256; 95%CI: -154,146; -26,365; p = 0.006). Children residing in areas with better infrastructure had lower MVPA levels (p < 0.001) and tended to have higher leptin levels (p = 0.062) than children residing in areas only reachable via dirt roads. CONCLUSION Our cross-sectional field study is the first that supports the hypothesis of low leptin levels as a potential endocrine trigger of high PA in lean children of a LMIC. We observed early signs of a PA transition towards a less active lifestyle in a subgroup residing in areas with better infrastructure that concomitantly tended to have higher leptin concentrations. Considering that area-dependent PA differences were more pronounced among girls than boys, whereas differences in leptin levels were less pronounced, not only biological, but also external factors explain PA transition.
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Affiliation(s)
- Christine Ludwig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburgstraße 21, 45147 Essen, Germany
| | - Nadja Knoll-Pientka
- LVR Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany
| | - Akwilina Mwanri
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, P.O. Box 3006, Morogoro, Tanzania
| | - Celina Erfle
- Department of Nutritional Sciences - Professorship of Nutrition in Prevention & Therapy, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Vincent Onywera
- Department of Physical Education, Exercise and Sports Science, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Judith Bühlmeier
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Paderborn, Germany
| | - Agnes Luzak
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Maike Ferland
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburgstraße 21, 45147 Essen, Germany
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Paderborn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburgstraße 21, 45147 Essen, Germany.
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22
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Michael H, Amimo JO, Rajashekara G, Saif LJ, Vlasova AN. Mechanisms of Kwashiorkor-Associated Immune Suppression: Insights From Human, Mouse, and Pig Studies. Front Immunol 2022; 13:826268. [PMID: 35585989 PMCID: PMC9108366 DOI: 10.3389/fimmu.2022.826268] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/31/2022] [Indexed: 12/11/2022] Open
Abstract
Malnutrition refers to inadequate energy and/or nutrient intake. Malnutrition exhibits a bidirectional relationship with infections whereby malnutrition increases risk of infections that further aggravates malnutrition. Severe malnutrition (SM) is the main cause of secondary immune deficiency and mortality among children in developing countries. SM can manifest as marasmus (non-edematous), observed most often (68.6% of all malnutrition cases), kwashiorkor (edematous), detected in 23.8% of cases, and marasmic kwashiorkor, identified in ~7.6% of SM cases. Marasmus and kwashiorkor occur due to calorie-energy and protein-calorie deficiency (PCD), respectively. Kwashiorkor and marasmic kwashiorkor present with reduced protein levels, protein catabolism rates, and altered levels of micronutrients leading to uncontrolled oxidative stress, exhaustion of anaerobic commensals, and proliferation of pathobionts. Due to these alterations, kwashiorkor children present with profoundly impaired immune function, compromised intestinal barrier, and secondary micronutrient deficiencies. Kwashiorkor-induced alterations contribute to growth stunting and reduced efficacy of oral vaccines. SM is treated with antibiotics and ready-to-use therapeutic foods with variable efficacy. Kwashiorkor has been extensively investigated in gnotobiotic (Gn) mice and piglet models to understand its multiple immediate and long-term effects on children health. Due to numerous physiological and immunological similarities between pigs and humans, pig represents a highly relevant model to study kwashiorkor pathophysiology and immunology. Here we summarize the impact of kwashiorkor on children's health, immunity, and gut functions and review the relevant findings from human and animal studies. We also discuss the reciprocal interactions between PCD and rotavirus-a highly prevalent enteric childhood pathogen due to which pathogenesis and immunity are affected by childhood SM.
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Affiliation(s)
- Husheem Michael
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, United States
| | - Joshua O. Amimo
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, United States
- Department of Animal Production, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Gireesh Rajashekara
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, United States
| | - Linda J. Saif
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, United States
| | - Anastasia N. Vlasova
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, OH, United States
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23
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Bwakura‐Dangarembizi M, Dumbura C, Amadi B, Chasekwa B, Ngosa D, Majo FD, Sturgeon JP, Chandwe K, Kapoma C, Bourke CD, Robertson RC, Nathoo KJ, Ntozini R, Norris SA, Kelly P, Prendergast AJ. Recovery of children following hospitalisation for complicated severe acute malnutrition. MATERNAL & CHILD NUTRITION 2022; 18:e13302. [PMID: 34939325 PMCID: PMC8932709 DOI: 10.1111/mcn.13302] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52‐weeks posthospitalization. Multivariable Fine‐Gray subdistribution hazard models, with death and loss to follow‐up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All‐cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height‐for‐age Z‐score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow‐up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high‐risk features should be prioritised for additional convalescent care to improve long‐term outcomes. One‐in‐six children managed for SAM were readmitted into hospital over the first year after discharge and one‐in‐eight remained undernourished by 52 weeks of follow‐up. Nonoedematous SAM, ongoing SAM at the time of discharge and underlying cerebral palsy were independent risk factors for hospital readmission and poor nutritional recovery. Low HAZ was a risk factor for hospital readmission and poor nutritional recovery. Postdischarge care should focus on children with disability, nonoedematous SAM at initial hospitalisation and have ongoing SAM at the time of discharge. Stunting should be considered in the management of children with SAM.
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Affiliation(s)
- Mutsa Bwakura‐Dangarembizi
- University of Zimbabwe College of Health Sciences Harare Zimbabwe
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
- University of Witwatersrand Johannesburg South Africa
| | - Cherlynn Dumbura
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia Lusaka Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
| | - Deophine Ngosa
- Tropical Gastroenterology and Nutrition Group, University of Zambia Lusaka Zambia
| | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
| | - Jonathan P. Sturgeon
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
- Blizard Institute, Queen Mary University of London London UK
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, University of Zambia Lusaka Zambia
| | - Chanda Kapoma
- Tropical Gastroenterology and Nutrition Group, University of Zambia Lusaka Zambia
| | - Claire D. Bourke
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
- Blizard Institute, Queen Mary University of London London UK
| | - Ruairi C. Robertson
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
- Blizard Institute, Queen Mary University of London London UK
| | - Kusum J. Nathoo
- University of Zimbabwe College of Health Sciences Harare Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
| | | | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia Lusaka Zambia
- Blizard Institute, Queen Mary University of London London UK
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe
- Blizard Institute, Queen Mary University of London London UK
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24
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Cliffer IR, Perumal N, Masters WA, Naumova EN, Ouedraogo LN, Garanet F, Rogers BL. Linear Growth Spurts are Preceded by Higher Weight Gain Velocity and Followed by Weight Slowdowns Among Rural Children in Burkina Faso: A Longitudinal Study. J Nutr 2022; 152:1963-1973. [PMID: 35325187 PMCID: PMC9361740 DOI: 10.1093/jn/nxac071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The temporal relationship between length (linear) and weight (ponderal) growth in early life is important to support optimal nutrition program design. Studies based on measures of attained size have established that wasting often precedes stunting, but such studies do not capture responsiveness of growth to previous compared with current conditions. As a result, the temporality of linear and ponderal growth relationships remain unclear. OBJECTIVES We used growth velocity indicators to assess the temporal bidirectional relationships between linear and ponderal growth in children. METHODS Using monthly anthropometric measurements from 5039 Burkinabè children enrolled at 6 months of age and followed until 28 months from August 2014 to December 2016, we employed multilevel mixed-effects models to investigate concurrent and lagged associations between linear and ponderal growth velocity, controlling for time trends, seasonality, and morbidity. RESULTS Faster ponderal growth is associated with faster concurrent and subsequent linear growth (0.21-0.72 increase in length velocity z-score per unit increase in weight velocity z-score), while faster linear growth is associated with slower future weight gain (0.009-0.02 decrease in weight velocity z-score per unit increase in length velocity z-score), especially among children 9-14 months. Ponderal growth slows around the same time as peaks in morbidity, followed roughly a month later by slower linear growth. CONCLUSIONS Use of velocity measures to assess temporal dependencies between linear and ponderal growth demonstrate that the same growth-limiting conditions likely affect both length and weight velocity, that slow ponderal growth likely limits subsequent linear growth, and that linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid slowdowns in weight gain.
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Affiliation(s)
| | - Nandita Perumal
- Global Health and Population Department, Harvard T.H. Chan School of Public
Health, Harvard University, Boston, MA, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
| | - Laetitia Nikiema Ouedraogo
- Institut de Recherche en Sciences de la Santé, Centre National de la
Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Franck Garanet
- Institut de Recherche en Sciences de la Santé, Centre National de la
Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
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25
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Gausman J, Kim R, Li Z, Tu L, Rajpal S, Joe W, Subramanian SV. Comparison of Child Undernutrition Anthropometric Indicators Across 56 Low- and Middle-Income Countries. JAMA Netw Open 2022; 5:e221223. [PMID: 35275168 PMCID: PMC8917428 DOI: 10.1001/jamanetworkopen.2022.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The United Nations' Sustainable Development Goal Target 2.2 seeks to end all forms of malnutrition by 2030 by meeting targets, including the elimination of stunting and wasting in all children younger than 5 years. Such indicators are used to monitor childhood undernutrition but may not provide a complete picture at a population level. OBJECTIVE To compare global estimates of the prevalence of undernutrition using conventional indicators of anthropometric failure (AF; stunting, underweight, and wasting); the Composite Index of Anthropometric Failure (CIAF); and a proposed classification system called Categories of Anthropometric Failure (CAF) as well as to investigate the association of the conventional indicators, CIAF, and CAF with diarrheal disease as an assessment of the validity of each measure. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the prevalence of undernutrition among children in 56 low- and middle-income countries using data from the nationally representative Demographic and Health Surveys. The study included 530 906 children younger than 5 years. Data were collected from June 2005 to December 2018 and analyzed from September 27, 2020, to February 4, 2021. MAIN OUTCOMES AND MEASURES Undernutrition identified according to conventional indicators (stunting, underweight, and wasting), the CIAF, and the proposed CAF classification system was estimated and compared. Six logistic regression models were used to examine the association between different classifications of anthropometric failure (AF) and morbidity. RESULTS A total of 530 906 children (mean [SD] age, 29.0 [17.2] months; 272 355 [51.3%] boys and 258 551 [48.7%] girls) from 56 low- and middle-income countries were included in the analysis. Estimates of undernutrition generated using the conventional indicators of stunting, underweight, and wasting were lower than estimates generated using the CIAF in all countries. The CAF classification system pointed to considerable variation across countries in children with multiple AFs, which does not correspond to the overall prevalence of undernutrition. For example, 7.5% of children in Niger and 7.1% of children in Timor-Leste were stunted, underweight, and wasted, while 56.0% of children in Niger and 71.1% of children in Timor-Leste were undernourished according to the CIAF. In addition, children who had stunting, underweight, and wasting had 1.52 (95% CI, 1.45-1.61) times the odds of diarrhea compared with children who exhibited no AFs. CONCLUSIONS AND RELEVANCE The results of this study highlight the importance of using different approaches to aid understanding of the entire spectrum of AF with regard to research and development of policies and programs to address AF. The use of the CIAF and the CAF classification system may be useful for treatment to prevent AFs and could accelerate progress in meeting targets for the Sustainable Development Goal.
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Affiliation(s)
- Jewel Gausman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Zhihui Li
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lucia Tu
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Sunil Rajpal
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Department of Economics, FLAME University, New Delhi, India
| | - William Joe
- Population Research Centre, Institute of Economic Growth, Delhi University Enclave, North Campus, Delhi, India
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zaba T, Conkle J, Nyawo M, Foote D, Myatt M. Concurrent wasting and stunting among children 6-59 months: an analysis using district-level survey data in Mozambique. BMC Nutr 2022; 8:15. [PMID: 35180886 PMCID: PMC8855563 DOI: 10.1186/s40795-022-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the past it was believed that wasting and stunting were independent of each other. Recent work has shown that they can occur concurrently in a child and that increases considerably the risk of mortality. Concurrent wasting and stunting (WaSt) is currently defined as WHZ < -2 AND HAZ < -2. Wasting is measured by WHZ and MUAC and evidence shows that they tend to identify different sets of children. Our study aimed to look at the effect of adding MUAC on the prevalence and burden of WaSt, and to assess diagnosis of WaSt with a single measurement. Methods We analyzed population-based anthropometric surveys from 37 districts in Mozambique conducted by the Government of Mozambique between 2017 and 2019. We proposed a new case-definition for WaSt that includes MUAC in acknowledgement of the different children with wasting diagnosed by WHZ and MUAC. We estimated how many WaSt cases are eligible to be included in the existing treatment program in Mozambique by calculating the True Positive and False Positive Values of WaSt using our proposed case-definition against the wasting admission criteria. AUC of ROC curves used for MUAC and WAZ and optimal cut-offs were determined using Youden’s Index. Results Including MUAC in the concurrent WaSt case-definition identified more children with WaSt compared to the original case-definition and more younger children and girls were identified. Using both MUAC and WHZ and enrolling severe and moderate wasting is already picking up most of the WaSt cases: 100% in health facilities and 79.40% with MUAC mass screenings at community level. Cut-off values from the ROC curve for the proposed case-definition were MUAC ≤133 mm and WAZ ≤ 2.145 Z-scores, however, they yielded many false positive values. Conclusion WaSt case-definition should include MUAC. WaSt should commence to be reported in surveys and Mozambique should also start monitoring and treating children with WaSt. A cost-effective approach to identify all children with WaSt without adding too many false positive is needed, as well as understanding how to achieve optimal treatment outcomes within existing programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00508-9.
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Affiliation(s)
- Tomás Zaba
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique.
| | - Joel Conkle
- United Nations Children's Fund, 1st Floor UN House, 38-44 Stein St, Klein Windhoek, Namibia
| | - Mara Nyawo
- United Nations Children's Fund, Eastern and Southern Africa Regional Office, PO Box 44145-00100, Nairobi, Kenya
| | - Dorothy Foote
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique
| | - Mark Myatt
- Brixton Health, Cilfach Greigiog, Llwyngwril, Gwynedd, Wales, LL37 2JD 5RJ, UK
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Anato A. Predictors of wasting among children under-five years in largely food insecure area of north Wollo, Ethiopia: a cross-sectional study. J Nutr Sci 2022; 11:e8. [PMID: 35291271 PMCID: PMC8889084 DOI: 10.1017/jns.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Child undernutrition is widespread in low- and middle-income countries and is linked with weakened immunity and increased risks of morbidity and mortality. Ethiopia has made a marked reduction in stunting, but there has, however, been little progress in wasting reduction and limited evidence in food insecure areas may hamper the design of effective interventions. Therefore, the aim of the present study was to determine the contributing factors to persistent high prevalence of wasting among 6-59-month-old children. A community-based cross-sectional study was employed in February to March 2020, and included 384 mother-child pairs. Data were collected using a structured interviewer-administered questionnaire. Bivariate and multivariable logistic regression analyses were conducted. The overall prevalence of wasting was 12⋅8 % (95 % CI 9⋅1, 16⋅1); with 5⋅8 % severely wasted. Factors significantly associated with wasting were child age 6-23 (v. 24-59 months), delayed initiation of breast-feeding, diarrhoeal illness in the last 2 weeks, poor dietary diversity and low socioeconomic status. The present findings support that aligning poverty reduction interventions and healthcare services is important to accelerate wasting reduction more equitably and achieve the World Health Assembly's target and SDG goal #2 in the coming years. Improving accessibility and affordability of nutritious foods and early diagnosis and treatment of childhood morbidity are critical to address childhood wasting in the context of food insecure areas.
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Affiliation(s)
- Anchamo Anato
- Department of Human Nutrition, School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
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Hjellbakk VK, Hailemariam H, Reta F, Engebretsen IMS. Diet and nutritional status among hospitalised children in Hawassa, Southern Ethiopia. BMC Pediatr 2022; 22:57. [PMID: 35062911 PMCID: PMC8781358 DOI: 10.1186/s12887-022-03107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Undernutrition constitutes a major problem among children in Hawassa, Ethiopia, and the literature on nutritional status in hospitalised children is scarce. The aim of this study was to investigate dietary diversity, nutritional practices, and the frequencies of undernutrition and the factors associated with severe acute malnutrition (SAM) in a hospitalised paediatric population in Hawassa, Southern Ethiopia. Methods A hospital-based cross-sectional study was carried out among hospitalised children in Hawassa, Southern Ethiopia. Children aged 6 to 59 months and their caregivers admitted for >24 hours from two public hospitals in Hawassa between November 2019 and January 2020 were included. Dietary diversity was assessed using World Health Organization (WHO) guidelines. Weight and height/length of the children were measured, and z-scores were calculated using the WHO growth standards. The definition of SAM was a weight-for-height z-score (WHZ) less than –3 or a clinically confirmed SAM diagnosis with higher WHZ. Results A total of 188 caregiver-child pairs were assessed in the two public hospitals. The majority of the patients were admitted with SAM (N = 70/188, 37%) or respiratory tract infections (N = 44/188, 23%). There was a similar number of boys and girls with SAM. Of all the children, 59% reported to have consumed foods from fewer than four food groups, while 40% reported eating foods from four or more food groups. The rate of malnutrition was high, and 35.8% of the children were classified as wasted (WHZ < –2) and 41% were stunted (height-for-age z-score < –2). Nearly 30% of the SAM patients were also stunted. Conclusion This study revealed that hospitalised children in this setting had poor dietary diversity and nutritional status, a high degree of morbidity, and extreme poverty. There is thus a need to focus on nutrition patterns in clinical settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03107-6.
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Thurstans S, Sessions N, Dolan C, Sadler K, Cichon B, Isanaka S, Roberfroid D, Stobaugh H, Webb P, Khara T. The relationship between wasting and stunting in young children: A systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13246. [PMID: 34486229 PMCID: PMC8710094 DOI: 10.1111/mcn.13246] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near-term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z score might effectively identify children at most risk of near-term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.
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Affiliation(s)
- Susan Thurstans
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited KingdomUK
- Emergency Nutrition NetworkOxfordUK
| | | | | | | | | | - Sheila Isanaka
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of ResearchEpicentreParisFrance
| | - Dominique Roberfroid
- Faculty of MedicineUniversity of NamurNamurBelgium
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
| | - Heather Stobaugh
- Action Against Hunger USANew YorkNew YorkUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Patrick Webb
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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Chowdhury MRK, Khan HTA, Rashid M, Kabir R, Islam S, Shariful Islam M, Kader M. 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. BMJ Open 2021; 11:e052814. [PMID: 34903543 PMCID: PMC8672009 DOI: 10.1136/bmjopen-2021-052814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
| | - Hafiz T A Khan
- College of Nursing, Midwifery and Healthcare, University of West London, Brentford, London, UK
| | - Mamunur Rashid
- Department of Public Health and Sports Sciences, University of Gävle, Gavle, Gävleborg, Sweden
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, London, UK
| | - Sazin Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Manzur Kader
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Community-Level Impacts of Climate-Smart Agriculture Interventions on Food Security and Dietary Diversity in Climate-Smart Villages in Myanmar. CLIMATE 2021. [DOI: 10.3390/cli9110166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diversification of production to strengthen resilience is a key tenet of climate-smart agriculture (CSA), which can help to address the complex vulnerabilities of agriculture-dependent rural communities. In this study, we investigated the relationship between the promotion of different CSA practices across four climate-smart villages (CSVs) in Myanmar. To determine the impact of the CSA practices on livelihoods and health, survey data were collected from agricultural households (n = 527) over three years. Within the time period studied, the results indicate that some the CSA practices and technologies adopted were significantly associated with changes in household dietary diversity scores (HDDS), but, in the short-term, these were not associated with improvements in the households’ food insecurity scores (HFIAS). Based on the survey responses, we examined how pathways of CSA practice adoption tailored to different contexts of Myanmar’s four agroecologies could contribute to the observed changes, including possible resulting trade-offs. We highlight that understanding the impacts of CSA adoption on household food security in CSVs will require longer-term monitoring, as most CSA options are medium- to long-cycle interventions. Our further analysis of knowledge, attitudes and practices (KAPs) amongst the households indicated a poor understanding of the household knowledge, attitudes and practices in relation to nutrition, food choices, food preparation, sanitation and hygiene. Our KAP findings indicate that current nutrition education interventions in the Myanmar CSVs are inadequate and will need further improvement for health and nutrition outcomes from the portfolio of CSA interventions.
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
- * E-mail:
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Neherta M, Nurdin Y. Primary Prevention of Neglect in Children through Health Education for Adolescent Girls in West Sumatra, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: High cases of stunting in toddlers require an effective and efficient primary prevention model. One of the efforts that can be done is to increase the knowledge of female adolescents to prevent anemia.
AIM: The aim of the study was to produce a model that can be used as primary prevention of stunting in children.
METHODS: Pre-test-Post-test Group Design. This research was conducted from March to November 2019 in Talamau District, West Pasaman Regency, involving 370 female adolescents as respondents. The intervention was carried out 3 times, followed by four separate evaluations. The intervention consists of engaging the respondents with various learning activities such as interactive lectures, group discussions, video screenings, messages through WhatsApp, and demonstrations. Data analysis was performed using GLM repeated measure.
RESULTS: Health education interventions on anemia prevention can improve knowledge and attitudes among female adolescents; anemia prevention got a p-value of 0.00.
CONCLUSION: The primary prevention model of stunting can increase knowledge and attitudes in female adolescents. It is recommended that parents, teachers, and health workers jointly provide health education regularly to prevent anemia so that stunting cases in toddlers no longer exist.
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Boamah-Kaali E, Jack DW, Ae-Ngibise KA, Quinn A, Kaali S, Dubowski K, Oppong FB, Wylie BJ, Mujtaba MN, Gould CF, Gyaase S, Chillrud S, Owusu-Agyei S, Kinney PL, Asante KP, Lee AG. Prenatal and Postnatal Household Air Pollution Exposure and Infant Growth Trajectories: Evidence from a Rural Ghanaian Pregnancy Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:117009. [PMID: 34842444 PMCID: PMC8629028 DOI: 10.1289/ehp8109] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND The exposure-response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown. OBJECTIVES To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life. METHODS The Ghana Randomized Air Pollution and Health Study enrolled n=1,414 pregnant women at ≤24wk gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length z (WLZ)-scores were calculated. For each anthropometric measure, we employed latent class growth analysis to generate growth trajectories over the first year of life and assigned each child to a trajectory group. We then employed ordinal logistic regression to determine associations between HAP exposures and growth trajectory assignments. Associations with stove intervention arm were also considered. RESULTS Of the 1,306 live births, 1,144 had valid CO data and anthropometric variables measured at least once. Prenatal HAP exposure increased risk for lower length [CO odds ratio (OR)= 1.17, 95% CI: 1.01, 1.35 per 1-ppm increase; PM2.5 OR= 1.07, 95% CI: 1.02, 1.13 per 10-μg/m3 increase], lower LAZ z-score (CO OR= 1.15, 95% CI: 1.01, 1.32 per 1-ppm increase) and stunting (CO OR= 1.25, 95% CI: 1.08, 1.45) trajectories. Postnatal HAP exposure increased risk for smaller HC (CO OR= 1.09, 95% CI: 1.04, 1.13 per 1-ppm increase), smaller MUAC and lower WLZ-score (PM2.5 OR= 1.07, 95% CI: 1.00, 1.14 and OR= 1.09, 95% CI: 1.01, 1.19 per 10-μg/m3 increase, respectively) trajectories. Infants in the LPG arm had decreased odds of having smaller HC and MUAC trajectories as compared with those in the open fire stove arm (OR= 0.58, 95% CI: 0.37, 0.92 and OR= 0.45, 95% CI: 0.22, 0.90, respectively). DISCUSSION Higher early life HAP exposure (during pregnancy and through the first year of life) was associated with poorer infant growth trajectories among children in rural Ghana. A cleaner-burning stove intervention may have improved some growth trajectories. https://doi.org/10.1289/EHP8109.
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Affiliation(s)
- Ellen Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Darby W. Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Kenneth A. Ae-Ngibise
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda Maryland, USA
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Kathryn Dubowski
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Felix B. Oppong
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohammed N. Mujtaba
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Carlos F. Gould
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, New York, USA
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, New York, USA
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Alison G. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ickes SB, Craig C, Heidkamp R. Design Factors for Food Supplementation and Nutrition Education Interventions That Limit Conclusions about Effectiveness for Wasting Prevention: A Scoping Review of Peer-Reviewed Literature. Adv Nutr 2021; 13:328-341. [PMID: 34666351 PMCID: PMC8803494 DOI: 10.1093/advances/nmab107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/04/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
We conducted a scoping review to characterize the evidence base for the effectiveness of food supplementation (FS), nutrition education (NE), or FS/NE interventions to prevent wasting among children aged 6 to 59 mo. We aimed to identify gaps in peer-reviewed literature and to develop recommendations for strengthening study designs. We identified 56 unique studies (FS = 21, NE = 19, FS/NE = 16) for which we assessed intervention design factors, implementation context, evaluation methods, and wasting impact. Compared with studies focused on stunting, fewer wasting-focused studies reported weight-for-height z score (WHZ). Midupper arm circumference (MUAC) was more commonly reported in wasting-focused studies (71.4%) than those focused on stunting (36.8%) or wasting and stunting (30.4%). FS studies measured anthropometry (mean, 95% CI) more frequently at every 11.3 (7.8, 14.8) wk than NE interventions at 36.3 (8.8, 62.1) wk (P = 0.036), but not FS/NE interventions at 25.8 (5.6, 49.1) wk (P = 0.138). NE interventions tended to be of longer duration than FS or FS/NE interventions. Only 6 studies followed and measured children after the intervention period ended. Across all studies, 45% reported a significant effect on wasting; these included FS, NE, and FS/NE interventions. The lack of comparability across studies limits conclusions about the effectiveness of specific types of interventions. To build a more unified evidence base for wasting prevention we recommend that future studies 1) report on a consistent set of metrics, including MUAC; 2) attempt to measure change in wasting incidence using more frequent measures; 3) measure wasting prevalence among the general population; 4) follow children postintervention to assess relapse; 5) measure food insecurity and diet quality; and 6) use harmonized protocols across multiple settings. Such efforts to improve study comparability will strengthen the evidence base, may help unite divergent professional communities, and ultimately accelerate progress toward eliminating child undernutrition.
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Affiliation(s)
| | | | - Rebecca Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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36
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Kiguli S, Olopot-Olupot P, Alaroker F, Engoru C, Opoka RO, Tagoola A, Hamaluba M, Mnjalla H, Mpoya A, Mogaka C, Nalwanga D, Nabawanuka E, Nokes J, Nyaigoti C, Briend A, van Woensel JBM, Grieve R, Sadique Z, Williams TN, Thomas K, Harrison DA, Rowan K, Maitland K. Children's Oxygen Administration Strategies And Nutrition Trial (COAST-Nutrition): a protocol for a phase II randomised controlled trial. Wellcome Open Res 2021; 6:221. [PMID: 34734123 PMCID: PMC8529399 DOI: 10.12688/wellcomeopenres.17123.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To prevent poor long-term outcomes (deaths and readmissions) the integrated global action plan for pneumonia and diarrhoea recommends under the 'Treat' element of Protect, Prevent and Treat interventions the importance of continued feeding but gives no specific recommendations for nutritional support. Early nutritional support has been practiced in a wide variety of critically ill patients to provide vital cell substrates, antioxidants, vitamins, and minerals essential for normal cell function and decreasing hypermetabolism. We hypothesise that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery. We suggest that providing additional energy-rich, protein, fat and micronutrient ready-to-use therapeutic feeds (RUTF) to help meet additional nutritional requirements may improve outcome. Methods: COAST-Nutrition is an open, multicentre, Phase II randomised controlled trial in children aged 6 months to 12 years hospitalised with suspected severe pneumonia (and hypoxaemia, SpO 2 <92%) to establish whether supplementary feeds with RUTF given in addition to usual diet for 56-days (experimental) improves outcomes at 90-days compared to usual diet alone (control). Primary endpoint is change in mid-upper arm circumference (MUAC) at 90 days and/or as a composite with 90-day mortality. Secondary outcomes include anthropometric status, mortality, readmission at days 28 and 180. The trial will be conducted in four sites in two countries (Uganda and Kenya) enrolling 840 children followed up to 180 days. Ancillary studies include cost-economic analysis, molecular characterisation of bacterial and viral pathogens, evaluation of putative biomarkers of pneumonia, assessment of muscle and fat mass and host genetic studies. Discussion: This study is the first step in providing an option for nutritional support following severe pneumonia and will help in the design of a large Phase III trial. Registration: ISRCTN10829073 (6 th June 2018) PACTR202106635355751 (2 nd June 2021).
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Affiliation(s)
- Sarah Kiguli
- Paediatrics, Makerere University, Kampala, Uganda
| | | | | | - Charles Engoru
- Paediatrics, Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Abner Tagoola
- Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Mainga Hamaluba
- Paediatrics, Kilifi County Hospital, Kilifi, Kilifi, POBox230, Kenya
| | - Hellen Mnjalla
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Ayub Mpoya
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Christabel Mogaka
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | | | | | - James Nokes
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Charles Nyaigoti
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - André Briend
- School of Medicine, University of Tampere, Tampere, Finland
| | - Job B. M. van Woensel
- Paediatric Intensive Care Unit, Emma Children’s Hospital and Academic Medical Center, Amsterdam, The Netherlands
| | - Richard Grieve
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Zia Sadique
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
| | - Karen Thomas
- Intensive Care National Audit, London, WC1V 6AZ, UK
| | | | | | - Kathryn Maitland
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
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Kohlmann K, Sudfeld CR, Garba S, Guindo O, Grais RF, Isanaka S. Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger. BMC Public Health 2021; 21:1713. [PMID: 34548050 PMCID: PMC8454021 DOI: 10.1186/s12889-021-11689-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger. METHODS From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < - 2 and stunted if they had a length-for-age Z-score < - 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations. RESULTS Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age. CONCLUSIONS These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02145000 .
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Affiliation(s)
- Kristin Kohlmann
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | | | | | | | - Sheila Isanaka
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA.
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
- Epicentre, 14-34 Avenue Jean Jaurès, 75019, Paris, France.
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Changing sex differences in undernutrition of African children: findings from Demographic and Health Surveys. J Biosoc Sci 2021; 54:847-857. [PMID: 34488914 DOI: 10.1017/s0021932021000468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <-2.0); 1.01 for wasting (weight-for-height Z-score <-2.0); 1.05 for underweight (weight-for-age Z-score <-2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <-2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0-23 months and lower values for children age 24-59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-2006), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.
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Kiguli S, Olopot-Olupot P, Alaroker F, Engoru C, Opoka RO, Tagoola A, Hamaluba M, Mnjalla H, Mpoya A, Mogaka C, Nalwanga D, Nabawanuka E, Nokes J, Nyaigoti C, Briend A, van Woensel JBM, Grieve R, Sadique Z, Williams TN, Thomas K, Harrison DA, Rowan K, Maitland K. Children's Oxygen Administration Strategies And Nutrition Trial (COAST-Nutrition): a protocol for a phase II randomised controlled trial. Wellcome Open Res 2021; 6:221. [PMID: 34734123 PMCID: PMC8529399 DOI: 10.12688/wellcomeopenres.17123.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 09/22/2023] Open
Abstract
Background: To prevent poor long-term outcomes (deaths and readmissions) the integrated global action plan for pneumonia and diarrhoea recommends under the 'Treat' element of Protect, Prevent and Treat interventions the importance of continued feeding but gives no specific recommendations for nutritional support. Early nutritional support has been practiced in a wide variety of critically ill patients to provide vital cell substrates, antioxidants, vitamins, and minerals essential for normal cell function and decreasing hypermetabolism. We hypothesise that the excess post-discharge mortality associated with pneumonia may relate to the catabolic response and muscle wasting induced by severe infection and inadequacy of the diet to aid recovery. We suggest that providing additional energy-rich, protein, fat and micronutrient ready-to-use therapeutic feeds (RUTF) to help meet additional nutritional requirements may improve outcome. Methods: COAST-Nutrition is an open, multicentre, Phase II randomised controlled trial in children aged 6 months to 12 years hospitalised with suspected severe pneumonia (and hypoxaemia, SpO 2 <92%) to establish whether supplementary feeds with RUTF given in addition to usual diet for 56-days (experimental) improves outcomes at 90-days compared to usual diet alone (control). Primary endpoint is change in mid-upper arm circumference (MUAC) at 90 days and/or as a composite with 90-day mortality. Secondary outcomes include anthropometric status, mortality, readmission at days 28 and 180. The trial will be conducted in four sites in two countries (Uganda and Kenya) enrolling 840 children followed up to 180 days. Ancillary studies include cost-economic analysis, molecular characterisation of bacterial and viral pathogens, evaluation of putative biomarkers of pneumonia, assessment of muscle and fat mass and host genetic studies. Discussion: This study is the first step in providing an option for nutritional support following severe pneumonia and will help in the design of a large Phase III trial. Registration: ISRCTN10829073 (6 th June 2018) PACTR202106635355751 (2 nd June 2021).
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Affiliation(s)
- Sarah Kiguli
- Paediatrics, Makerere University, Kampala, Uganda
| | | | | | - Charles Engoru
- Paediatrics, Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Abner Tagoola
- Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Mainga Hamaluba
- Paediatrics, Kilifi County Hospital, Kilifi, Kilifi, POBox230, Kenya
| | - Hellen Mnjalla
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Ayub Mpoya
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Christabel Mogaka
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | | | | | - James Nokes
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - Charles Nyaigoti
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
| | - André Briend
- School of Medicine, University of Tampere, Tampere, Finland
| | - Job B. M. van Woensel
- Paediatric Intensive Care Unit, Emma Children’s Hospital and Academic Medical Center, Amsterdam, The Netherlands
| | - Richard Grieve
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Zia Sadique
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
| | - Karen Thomas
- Intensive Care National Audit, London, WC1V 6AZ, UK
| | | | | | - Kathryn Maitland
- KEMRI Wellcome TRust Research Programme, Kilifi, Kilifi, POBox230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, UK
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Alaaraj N, Soliman A, Rogol AD. Growth of malnourished infants and children: how is inflammation involved? Expert Rev Endocrinol Metab 2021; 16:213-216. [PMID: 34289758 DOI: 10.1080/17446651.2021.1956903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Ad Dawhah, Qatar
| | - Ashraf Soliman
- Alexandria University, Department of Pediatrics, Division of Endocrinology, Alexandria, Egypt
| | - Alan D Rogol
- University of Virginia, Department of Pediatrics, Charlottesville, VA, USA
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Zhang Z, Li F, Hannon BA, Hustead DS, Aw MM, Liu Z, Chuah KA, Low YL, Huynh DTT. Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13093036. [PMID: 34578914 PMCID: PMC8468927 DOI: 10.3390/nu13093036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).
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Affiliation(s)
- Zhiying Zhang
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Fei Li
- Abbott Nutrition China Research and Development Center, Building 14, No. 1036 Tianlin Road, Shanghai 200233, China;
| | - Bridget A. Hannon
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Deborah S. Hustead
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Marion M. Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore;
| | - Zhongyuan Liu
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Khun Aik Chuah
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
| | - Yen Ling Low
- Abbott Nutrition Research and Development, 3300 Stelzer Road, Columbus, OH 43219, USA; (B.A.H.); (D.S.H.); (Y.L.L.)
| | - Dieu T. T. Huynh
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore 138668, Singapore; (Z.Z.); (Z.L.); (K.A.C.)
- Correspondence: ; Tel.: +65-8322-9798
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42
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Singh P, Shah M, Bruckner TA. Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India. J Nutr 2021; 151:2455-2464. [PMID: 34143878 PMCID: PMC8436001 DOI: 10.1093/jn/nxab150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition. OBJECTIVES We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India. METHODS In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates. RESULTS Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM. CONCLUSIONS An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.
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Affiliation(s)
- Parvati Singh
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
| | - Manisha Shah
- Department of Public Policy, Luskin School of Public Affairs,
University of California, Los Angeles, Los
Angeles, CA, USA
| | - Tim A Bruckner
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
- Center for Population, Inequality and Policy, University of
California, Irvine, Irvine, CA,
USA
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43
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Wright CM, Macpherson J, Bland R, Ashorn P, Zaman S, Ho FK. Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan. J Nutr 2021; 151:2022-2028. [PMID: 33830247 PMCID: PMC8245889 DOI: 10.1093/jn/nxab054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have had sufficient longitudinal data to track how different malnourished states relate to mortality at different ages and interrelate over time. OBJECTIVES This study aims to describe the RRs and proportions of mortality associated with wasting and stunting and the pathways into and out of these nutritional states. METHODS Longitudinal growth data sets collected for children ages 0-24 months from Malawi, South Africa, and Pakistan were combined (n = 5088). Children were classified as deceased, wasted (weight for height < -2 SD; 1-4%), stunted (length < -2SD; 20-47%), or wasted and stunted (WaSt; 2-5%) at ages 3, 6, 9, 12, 18, and 24 months. Mixed-effects Cox models were used to study the association between nutritional status and mortality. RESULTS By age 3 months, 20% of children were already stunted, rising to 49% by 24 months, while wasting (4.2% and 2.2% at 3 months, respectively) and WaSt (0.9% and 3.7% at 24 months, respectively) were less common. The HR for mortality in WaSt was 9.5 (95% CI, 5.9-15), but 60% of WaSt-associated mortality occurred at 3-6 months. Wasting or WaSt was associated with 10-23% of deaths beyond 6 months, but in the second year over half of deaths occurred in stunted, nonwasted children. Stunting persisted in 82% of children and wasting persisted in 44%. Wasted children were more likely than nonwasted, nonstunted children to become stunted (RR, 1.93; 95% CI, 1.7-2.2), but 94% of children who progressed to stunting had not been wasted in the prior period. CONCLUSIONS WaSt greatly increased the risk of death, particularly in very young infants, but more deaths overall were associated with stunting. Most stunting appeared to be either intrauterine in origin or arose in children without prior wasting. Either stunting and wasting represent alternative responses to restricted nutrition, or stunting also has other, nonnutritional causes.
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, School of Medicine, Nursing and Dentistry, University of Glasgow, Glasgow, United Kingdom
| | - John Macpherson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Bland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Public Health, University of Witwatersrand, Witwatersrand, South Africa
| | - Per Ashorn
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences, Lahore, Pakistan
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Imam A, Hassan-Hanga F, Sallahdeen A, Farouk ZL. A cross-sectional study of prevalence and risk factors for stunting among under-fives attending acute malnutrition treatment programmes in north-western Nigeria: Should these programmes be adapted to also manage stunting? Int Health 2021; 13:262-271. [PMID: 32780808 PMCID: PMC8079315 DOI: 10.1093/inthealth/ihaa043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background Stunting and severe wasting can co-occur in under-fives, predisposing them to increased risks for morbidity and mortality. The Community Management of Acute Malnutrition (CMAM) programme, which provides outpatient malnutrition care for severely wasted children, has been successful at managing severe wasting, but there are limited data on stunting among entrants into these programmes. Methods We performed secondary analysis of data collected from attendees of two CMAM centres in north-western Nigeria. Using WHO reference standards, we determined the prevalence of concurrent stunting (height/length-for-age <-2 SD) among severely wasted children (weight-for-height z-scores <-3 SD). We identified individual and household-level risk factors for concurrent stunting using multivariable logistic regression analysis. Results Our cohort comprised 472 severely wasted children and the majority (82.8%) were stunted. Age groups of 12–23 mo (adjusted OR [AOR]=2.38, 95% CI 1.26 to 4.48) and 24–35 mo (AOR=7.81, 95% CI 1.99 to 30.67), male gender (AOR=2.51, 95% CI 1.43 to 4.39) and attending the rural malnutrition clinic (AOR=3.08, 95% CI 1.64 to 5.79) were associated with a significantly increased probability of stunting. Conclusions Stunting prevalence is high among severely wasted children attending CMAM programmes in north-western Nigeria. Policymakers need to adapt these treatment programmes to also cater for stunting, taking into account practical programmatic realities such as available expertise and scarce resource allocation.
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Affiliation(s)
- Abdulazeez Imam
- Department of Vaccines and Immunity, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 452, Fajara, Gambia
| | - Fatimah Hassan-Hanga
- Department of Paediatrics, Bayero University Kano, Department of Paediatrics, Aminu Kano Teaching Hospital, P.M.B 3452, Kano, Nigeria
| | - Azeezat Sallahdeen
- Department of Vaccines and Immunity, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, P.O. Box 452, Fajara, Gambia
| | - Zubaida L Farouk
- Department of Paediatrics, Bayero University Kano, Department of Paediatrics, Aminu Kano Teaching Hospital, P.M.B 3452, Kano, Nigeria
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Fenn B, Myatt M, Mates E, Black RE, Wilkinson C, Khara T. Effects on child growth of a reduction in the general food distribution ration and provision of small-quantity lipid-based nutrient supplements in refugee camps in eastern Chad. BMJ Nutr Prev Health 2021; 4:235-242. [PMID: 34308131 PMCID: PMC8258085 DOI: 10.1136/bmjnph-2021-000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background We used the United Nations High Commissioner for Refugees Standardised Expanded Nutrition Survey data to evaluate the effect of a change in food ration on child growth in refugee camps in eastern Chad. Methods We compared trends of wasting and stunting prevalence over time and the association between the coexistence of being both stunted and wasted using Pearson’s χ2 test. We analysed the effect of an approximate 50% reduction in the general food distribution, with the introduction of a 20 g daily ration of small quantity lipid-based nutrient supplements given to all children aged 6–23 months, on child growth. This was done using interrupted time-series analysis to observe differences in levels and trends in mean height-for-age z-score (HAZ) and weight-for-height z-score (WHZ) over time and by age group (6–24 months and 24–59 months). Results Overall the prevalence of stunting and wasting decreased significantly over time. The odds of being both stunted and wasted was 1.38 higher than having one or the other condition separately (p<0.001, 95% CI=1.29 to 1.47). Trends in mean HAZ and WHZ before and after a ration change in 2014 indicate that growth had either slowed down or worsened. In the period following the ration change, children 24–59 months saw a significant decrease in mean HAZ of 0.04 per year (p=0.02, 95% CI=−0.07 to –0.01) and for the younger age group, there was a significant decrease in mean WHZ of 0.06 per year (p=0.03, 95% CI=−0.12 to –0.01). Conclusions The dual burden of stunting and wasting is a considerable challenge in refugee camp settings. Changes to the food distribution had adverse effects on child growth for both age groups. Broadening the scope of interventions aimed at children in camps is essential when tackling malnutrition with increased efforts essential during periods of wider food assistance shortages.
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Affiliation(s)
| | | | | | - Robert E Black
- Institute of International Programs, Johns Hopkins, Baltimore, Maryland, USA
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Raiten DJ, Combs GF, Steiber AL, Bremer AA. Perspective: Nutritional Status as a Biological Variable (NABV): Integrating Nutrition Science into Basic and Clinical Research and Care. Adv Nutr 2021; 12:1599-1609. [PMID: 34009250 PMCID: PMC8483963 DOI: 10.1093/advances/nmab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/26/2021] [Accepted: 03/18/2021] [Indexed: 01/02/2023] Open
Abstract
The field of nutrition has evolved from one focused primarily on discovery of the identities, metabolic functions, and requirements for essential nutrients to one focused on the application of that knowledge to the development and implementation of dietary recommendations to promote health and prevent disease. This evolution has produced a deeper appreciation of not only the roles of nutrients, but also factors affecting their functions in increasingly complex global health contexts. The intersection of nutrition with an increasingly more complex global health context necessitates a view of nutritional status as a biological variable (NABV), the study of which includes an appreciation that nutritional status is: 1) not limited to dietary exposure; 2) intimately and inextricably involved in all aspects of human health promotion, disease prevention, and treatment; and 3) both an input and an outcome of health and disease. This expanded view of nutrition will inform future research by facilitating considerations of the contexts and variability associated with the many interacting factors affecting and affected by nutritional status. It will also demand new tools to study multifactorial relations to the end of increasing precision and the development of evidence-based, safe, and effective standards of health care, dietary interventions, and public health programs.
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Affiliation(s)
| | - Gerald F Combs
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA,
USA
| | | | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Tesfaw LM, Fenta HM. Multivariate logistic regression analysis on the association between anthropometric indicators of under-five children in Nigeria: NDHS 2018. BMC Pediatr 2021; 21:193. [PMID: 33888079 PMCID: PMC8061068 DOI: 10.1186/s12887-021-02657-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Child malnutrition is a huge health problem having multifaceted consequences for child survival and long-term well-being. Although, several studies investigated stunting, underweight, and wasting in low- and middle-income countries, in Nigeria, the link between them received little attention. The aim of this study is, therefore, to assess the association between anthropometric indicators of under-five children such as stunting, underweight and wasting given that of other characteristics of children and households. Methods The data for this study was obtained from Nigerian Demographic and health survey (NDHS) in 2018. A total of 11,314 under-five children were involved. Multivariate logistic regression model was used to determine the association between stunting, underweight and wasting given that of the estimated effect of other determinants. Results From 11,314 under-five children the study considered 36.2, 21.4 and 6.7% of them suffered from stunting, underweight and wasting, respectively. About half (50.7%) of the children were male, 24.1% was obtained from North West region of Nigeria, and 37.8% of them were from households having unimproved drinking water. The pairwise dependency between stunting and underweight; underweight and wasting was measured using odds ratio (OR) of 15.796, and 16.750 respectively. The estimated odds of children from richest household to become stunted, underweight, and wasted was respectively 0.392, 0.540, 0.786 times that of the estimated odds of children from poorest households. Conclusion The prevalence of under-five children with stunting, underweight and/or wasting in Nigeria was very high. The important determinants of stunting, underweight, and wasting for under five children were household wealth index, women body mass index, sex of the child, anemia, mothers’ age at first birth, and a diarrhea two weeks prior to the survey. Whereas, region, religion, multiple birth, women’s educational level significantly associated with both stunting and underweight. Both stunting and wasting significantly associated with underweight.
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Suri DJ, Potani I, Singh A, Griswold S, Wong WW, Langlois B, Shen Y, Chui KHK, Rosenberg IH, Webb P, Rogers BL. Body Composition Changes in Children during Treatment for Moderate Acute Malnutrition: Findings from a 4-Arm Cluster-Randomized Trial in Sierra Leone. J Nutr 2021; 151:2043-2050. [PMID: 33880554 PMCID: PMC8245884 DOI: 10.1093/jn/nxab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed. OBJECTIVES We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes. METHODS The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk. RESULTS Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different. CONCLUSIONS Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897.
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Affiliation(s)
- Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Isabel Potani
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Akriti Singh
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Stacy Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - William W Wong
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Breanne Langlois
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Ye Shen
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
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Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6-59 Months in the ComPAS Cluster Randomized Controlled Trial. Nutrients 2021; 13:nu13041054. [PMID: 33805040 PMCID: PMC8064102 DOI: 10.3390/nu13041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.
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Madzorera I, Ghosh S, Wang M, Fawzi W, Isanaka S, Hertzmark E, Namirembe G, Bashaasha B, Agaba E, Turyashemererwa F, Webb P, Duggan C. Prenatal dietary diversity may influence underweight in infants in a Ugandan birth-cohort. MATERNAL AND CHILD NUTRITION 2021; 17:e13127. [PMID: 33595899 PMCID: PMC8189249 DOI: 10.1111/mcn.13127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.
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Affiliation(s)
- Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Shibani Ghosh
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Molin Wang
- Departments of Epidemiology and Biostatistics, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Sheila Isanaka
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Grace Namirembe
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Edgar Agaba
- USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Florence Turyashemererwa
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Patrick Webb
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,USAID Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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