Seasonal variation of child under nutrition in Malawi: is seasonal food availability an important factor? Findings from a national level cross-sectional study

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Complexity of the Seasonality of Nutritional Status: Two Annul Peaks in Child Wasting in Eastern Chad

BACKGROUND

Understanding seasonal patterns in nutritional status is critical for achieving and tracking global nutrition goals. However, the majority of nutrition seasonality research design draws on 2 or 3 within-year time points based on existing assumptions of seasonality, missing a more nuanced pattern.

OBJECTIVE

We aimed to identify the intra-year variability of childhood wasting, severe wasting, and weight-for-height z-scores (WHZ) in a dryland single wet-season context and illustrate an analytical approach for improving analysis of the seasonality of nutritional status.

METHODS

To quantify the intra-year variability in nutritional status, we use data from a 23-month panel study (May 2018 to March 2020) following 231 children (6-59 months of age) in eastern Chad. We apply a mixed-effects harmonic regression with child- and village-level fixed effects on the odds of being wasted, severely wasted, and on WHZ, testing for multiple and nonsymmetrical seasonal peaks, adjusted for child sex and age. We triangulate our findings using climate data on temperature, vegetation, and precipitation.

RESULTS

We identify 2 annual peaks of wasting and severe wasting. Wasting peaks at 14.7% (confidence interval [CI], 11.8-18.2) at the end of the dry season, while the smaller peak corresponds to the start of the harvest period at 13.4% (CI, 10.7-16.6). The odds of being wasted decline during the rainy season to 11.8% (CI, 9.4-14.7), with the lowest prevalence of 8.8% (CI, 6.9-11.1) occurring during the start of the dry season. In addition, a 1°C monthly increase in temperature is significantly associated with a 5% (CI, 1.4-8.7) and 12% (CI, 3.0-20.3) increase in the odds that a child is wasted and severely wasted, respectively.

CONCLUSIONS

Intra-year variability of child wasting is far more complex and nuanced than identified by the literature, with 2 peaks, as opposed to 1, likely corresponding to different seasonal drivers, such as food insecurity, disease, water contamination, and care practices at different times of year. Better seasonality analysis can go a long way in improving the timing and content of programming with the goal of reducing child wasting.

Seasonality of Acute Malnutrition in African Drylands: Evidence From 15 Years of SMART Surveys

Reduction of wasting, or low weight-for-height, is a critical target for the Zero Hunger Sustainable Development Goal, yet robust evidence establishing continuous seasonal patterns of wasting is presently lacking. The current consensus of greatest hunger during the preharvest period is based on survey designs and analytical methods, which discretize time frame into preharvest/postharvest, dry/wet, or lean/plenty seasons. We present a spatiotemporally nuanced study of acute malnutrition seasonality in African drylands using a 15-year data set of Standardized Monitoring and Assessment of Relief and Transition surveys (n = 412,370). Climatological similarity was ensured by selecting subnational survey regions with 1 rainy season and by spatially matching each survey to aridity and livelihood zones. Harmonic logit regression models indicate 2 peaks of wasting during the calendar year. Greatest wasting prevalence is estimated in April to May, coincident with the primary peak of temperature. A secondary peak of wasting is observed in August to October, coinciding with the primary peak of rainfall and secondary peak of temperature. This pattern is retained across aridity and livelihood zones and is sensitive to temperature, precipitation, and vegetation. Improved subnational estimation of acute malnutrition seasonality can thus assist decision makers and practitioners in data-sparse settings and facilitate global progress toward Zero Hunger.

Hydrothermally-treated soybean-fortified maize-based nsima (stiff porridge) could contribute towards alleviating seasonal body weight loss in farming communities in sub-Saharan Africa

Objective

This study explored the use of hydrothermally-treated soybean-fortified maize-based stiff porridge (nsima) in managing body weight losses among the farming family community in Malawi during the labour-intensive cropping (growing) season. We hypothesized that soybean-fortified maize-based nsima could prevent seasonal body weight losses in farming communities during labour-intensive seasons better than conventional 100% maize nsima.

Research methods & procedures

A single-blind parallel dietary intervention 90-day study. During energy stress months, 42 farming households in Malawi were supplied with 15 kg of blind formulation of soybean-fortified maize flour (soybean: maize, 1:4, wt/wt) per person per month except for under-fives who were allotted half the quantity. Forty households were provided with equivalent quantities of 100% maize flour and served as control. Body weights of participants were taken at baseline and endpoint.

Results

After 3 months, the experimental group registered 3.7, 4.2, 2.9, and 5.2% statistically higher body weight compared to the controls for the under-five, the 5-9-year-olds, the 10-19-year-olds, and the >20-year-olds, respectively.

Conclusion

Soybean-fortified stiff porridge could feasibly be used to alleviate wasting among the resource-constraint populace in Malawi and many other parts of sub-Saharan Africa that rely on maize as a major staple.

Estimates and trends of zero vegetable or fruit consumption among children aged 6-23 months in 64 countries

Children require a diverse diet, that includes vegetables and fruits, to support growth and development and prevent non-communicable diseases. The WHO-UNICEF established a new infant and young child feeding (IYCF) indicator: zero vegetable or fruit (ZVF) consumption among children aged 6-23 months. We estimated the prevalence, trends, and factors associated with ZVF consumption using nationally representative, cross-sectional data on child health and nutrition in low-and-middle-income countries. We examined 125 Demographic and Health Surveys in 64 countries conducted between 2006-2020 with data on whether a child ate vegetables or fruits the previous day. Prevalence of ZVF consumption was calculated by country, region, and globally. Country trends were estimated and tested for statistical significance (p<0.05). Logistic regression analysis was used to examine the relationship between ZVF and child, mother, household, and survey cluster characteristics by world region and globally. Using a pooled estimate of the most recent survey available in each country, we estimate the global prevalence of ZVF consumption as 45.7%, with the highest prevalence in West and Central Africa (56.1%) and the lowest in Latin America and the Caribbean (34.5%). Recent trends in ZVF consumption varied by country (16 decreasing, eight increasing, 14 no change). Country trends in ZVF consumption represented diverse patterns of food consumption over time and may be affected by the timing of surveys. Children from wealthier households and children of mothers who are employed, more educated, and have access to media were less likely to consume ZVF. We find the prevalence of children aged 6-23 months who do not consume any vegetables or fruits is high and is associated with wealth and characteristics of the mother. Areas for future research include generating evidence from low-and-middle-income countries on effective interventions and translating strategies from other contexts to improve vegetable and fruit consumption among young children.

The burden of ocular morbidities among elderly patients visiting a district healthcare facility in Malawi: A retrospective study

Background

The population of older adults is growing dramatically. Sadly, this populace is highly prone to develop various ocular morbidities, which if left unattended can lead to blindness.

Aim

To determine the distribution of ocular morbidities among older adults at a secondary hospital in Malawi.

Methods

This was a retrospective cross-sectional study conducted at Mzimba North District Hospital in Malawi. We retrieved 314 patient records from the hospital's ophthalmic outpatient registry from August 2020 to July 2022 using a nonprobability census sampling technique. Data entry and analysis were done employing SPSS (v.26).

Results

More females 164 (52.2%) than males 150 (47.8%) had ocular morbidities. Cataract 108 (34.4%) was the most common ocular morbidity followed by allergic conjunctivitis 104 (33.1%), then pingueculae 44 (14%), and glaucoma 8 (2.5%) Cataract showed a statistically significant difference between males and females (p < 0.05). And Glaucoma portrayed a statistically significant variation according to age groups (p < 0.05). According to the time of the year, most cases were attended to in March compared to August.

Conclusion

The majority of blinding conditions among the elderly in Malawi are preventable similar to other geographical settings. Therefore, it is feasible to enhance the quality of life for senior Malawians and lessen the impact of blindness on individuals, families, and communities by addressing preventable causes of blindness through focused interventions.

Total trade, cereals trade and undernourishment: new empirical evidence for developing countries

While trade policies are considered strategic to shape national food systems and promote food security, the ultimate impact of trade openness on hunger is still highly debated. Using a sample of 81 developing over the period 2001–2016 and principally focusing on the prevalence of undernourishment, this study provides new empirical evidence. Firstly, it estimates the impact of total trade differentiating the effects that pass through changes in real per capita income—i.e. on the economic access to food—from the residual effects that it directly has on the other dimensions of food security. Subsequently, it concentrates on cereals trade, that usually is the most affected by trade restrictions and the most correlated to undernourishment. Finally, it explores the different effects of cereals trade in terms of imports and exports. Three main conclusions emerge: (a) trade openness contributes to lower the prevalence of undernourishment in developing countries and most of this effect is not income-mediated but, rather, passes through the impacts that it directly has on the other dimensions of food security; (b) such impacts are mostly driven by the trade openness of the cereals sector where (c) its import component turns out to play the main role.

Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi

Information on the concentration of body mass index and child death among females in Malawi, where the epidemics of weight gain have been disconcerting and preventable deaths among children linger, is limited. Therefore, the study examined the polarity of body mass index and the death of children among females. Using data from the Malawian Demographic and Health Survey from 2000 to 2015–2016, the study applied for the first time the index of concentration at the extremes and indirect demographic techniques to estimate the polarity of body mass index and child mortality among 65,499 females aged 15 to 49 years. The preponderance of obesity more than doubled from 2000 to 2015–2016 and was highest among females who were older (35–49 years), urban dwellers, rich, and located in districts within the central and southern regions. In addition, child survival was low among underweight, overweight, and obese females. While national-, regional-, and individual-level statistics are in development, these findings provide helpful information for health experts and other stakeholders to initiate appropriate age-region specific programs and interventions in Malawi, including targeting females in the high socio-economic bracket.

Children born during the hunger season are at a higher risk of severe acute malnutrition: Findings from a Guinea Sahelian ecological zone in Northern Ghana

Heightened food insecurity in the hunger season increases the risk of severe acute malnutrition (SAM) in childhood. This study examined the association of season of birth with SAM in a Guinean Sahelian ecological zone. We analyzed routine health and sociodemographic surveillance data from the Navrongo Health and Socio-demographic Surveillance System collected between 2011 and 2018. January-June, the period of highest food insecurity, was defined as the hunger season. We defined moderate acute malnutrition as child mid-upper arm circumference (MUAC) between 115 mm and 135 mm and SAM as MAUC ≤ 115 mm. We used adjusted logistic regression to quantify the association between the season of birth and SAM in children aged 6-35 months. From the 29,452 children studied, 24% had moderate acute malnutrition. Overall, 1.4% had SAM, with a higher prevalence (1.8%) in the hunger season of birth. Compared with those born October-December, adjusted odds ratios (aOR) and 95% confidence interval (95% CI) for SAM were increased for children born in the hunger season: January-March (1.77 [1.31-2.39]) and April-June (1.92 [1.44-2.56]). Low birth weight, age at an assessment of nutritional status, and ethno-linguistic group were also significantly associated with SAM in adjusted analyses. Our study established that being born in the hunger season is associated with a higher risk of severe acute malnutrition. The result implies improvement in the food supply to pregnant and lactating mothers through sustainable agriculture or food system change targeting the hunger season may reduce the burden of severe acute malnutrition.

Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review

OBJECTIVE

This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years.

DESIGN

This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

SETTING AND PARTICIPANTS

PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles.

MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS

Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight.

CONCLUSIONS AND IMPLICATIONS

The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.

Building climate-sensitive nutrition programmes

The food system and climate are closely interconnected. Although most research has focused on the need to adopt a plant-based diet to help mitigate climate change, there is also an urgent need to examine the effects of climate change on food systems to adapt to climate change. A systems approach can help identify the pathways through which climate influences food systems, thereby ensuring that programmes combating malnutrition take climate into account. Although little is known about how climate considerations are currently incorporated into nutrition programming, climate information services have the potential to help target the delivery of interventions for at-risk populations and reduce climate-related disruption during their implementation. To ensure climate services provide timely information relevant to nutrition programmes, it is important to fill gaps in our knowledge about the influence of climate variability on food supply chains. A proposed roadmap for developing climate-sensitive nutrition programmes recommends: (i) research aimed at achieving a better understanding of the pathways through which climate influences diet and nutrition, including any time lags; (ii) the identification of entry points for climate information into the decision-making process for nutrition programme delivery; and (iii) capacity-building and training programmes to better equip public health practitioners with the knowledge, confidence and motivation to incorporate climate resilience into nutrition programmes. With sustained investment in capacity-building, data collection and analysis, climate information services can be developed to provide the data, analyses and forecasts needed to ensure nutrition programmes target their interventions where and when they are most needed.

Effect Heterogeneity in Responding to Performance-Based Incentives: A Quasi-Experimental Comparison of Impacts on Health Service Indicators Between Hospitals and Health Centers in Malawi

Heterogeneity of effects produced by performance-based incentives (PBIs) at different levels of care provision is not well understood. This study analyzes effect heterogeneities between different facility types resulting from a PBI program in Malawi. Identical PBIs were applied to both district hospitals and health centers to improve the performance of essential health services provision. We conducted two complementary quasi-experiments comparing all 17 interventions with 17 matched independent control facilities (each 12 health centers, five hospitals). A pre- and post-test design with difference-in-differences analysis was used to estimate effects on 14 binary quality indicators; interrupted time series analysis of monthly routine data was used to estimate effects on 11 continuous quantity indicators. Effects were estimated separately for health centers and hospitals. Most quality indicators performed high at baseline, producing ceiling effects on further measurable improvements. Significant positive effects were observed for stocks of iron supplements (hospitals) and partographs (health centers). Four quantity indicators showed similar positive trend improvements across facility types (first-trimester antenatal visits, voluntary HIV-testing of couples, iron supplementation in pregnancy, vitamin A supplementation of children); two showed no change for either type of facility (skilled birth attendance, fully immunized one-year-olds); five indicators revealed different effect patterns for health centers and hospitals. In both health centers and hospitals, the largely positive PBI effects on antenatal care included resilience against interrupted supply chains and improvements in attendance rates. Observed heterogeneity might have been influenced by the availability of specific resources or the redistribution of service use.

A Critical Analysis of the Drivers of Human Migration Patterns in the Presence of Climate Change: A New Conceptual Model

Both climate change and migration present key concerns for global health progress. Despite this, a transparent method for identifying and understanding the relationship between climate change, migration and other contextual factors remains a knowledge gap. Existing conceptual models are useful in understanding the complexities of climate migration, but provide varying degrees of applicability to quantitative studies, resulting in non-homogenous transferability of knowledge in this important area. This paper attempts to provide a critical review of climate migration literature, as well as presenting a new conceptual model for the identification of the drivers of migration in the context of climate change. It focuses on the interactions and the dynamics of drivers over time, space and society. Through systematic, pan-disciplinary and homogenous application of theory to different geographical contexts, we aim to improve understanding of the impacts of climate change on migration. A brief case study of Malawi is provided to demonstrate how this global conceptual model can be applied into local contextual scenarios. In doing so, we hope to provide insights that help in the more homogenous applications of conceptual frameworks for this area and more generally.

Climate and location as determinants of childhood stunting, wasting, and overweight: An application of semiparametric multivariate probit model

OBJECTIVE

The aim of this study was to investigate the effects of climate and location while using the multivariate model of malnutrition.

METHODS

The joint semiparametric model of stunting, wasting, and overweight was fitted to 2015 child Malawi demographic health survey data with 5149 records. The MDHS was a cross-sectional study. The smooth functions for the non-parametric terms were the regression splines and the effect of location was smoothed by the Markov random field (MRF).

RESULTS

Rainfall had a positive effect on stunting (β = 0.076, P = 0.044) and overweight (β = 0.854, P = 0.039). Mean temperature (β = 1.220, P = 0.031) and distance to water body (β = 0.009, P = 0.049) also had a positive effect on wasting. Increased length of rainy season was associated with reduced overweight (β = -0.163, P = 0.042). Location was not a significant predictor of all malnutrition indicators, although there was observable spatial variation regarding overweight and wasting. There was significant positive correlation between stunting and overweight (ρ = 0.234; 95% confidence interval, 0.135-0.324). The findings on socioeconomic determinants are consistent with the literature.

CONCLUSION

Nutrition interventions may target hot spot areas that have shown increased risk for overweight and wasting. The strategies to minimize malnutrition should focus on consequences of climate change like high rainfall, length of season, and temperature.

Growing and Learning When Consumption Is Seasonal: Long-Term Evidence From Tanzania

This article shows that the seasonality of food consumption during childhood, conditional on average consumption, affects long-run human capital development. We develop a model that distinguishes differences in average consumption levels, seasonal fluctuations, and idiosyncratic shocks, and estimate the model using panel data from early 1990s Tanzania. We then test whether the mean and seasonality of a child's consumption profile affect height and educational attainment in 2010. Results show that the negative effects of greater seasonality are 30 % to 60 % of the magnitudes of the positive effects of greater average consumption. Put differently, children expected to have identical human capital based on annualized consumption measures will have substantially different outcomes if one child's consumption is more seasonal. We discuss implications for measurement and policy.

Monitoring and evaluation design of Malawi's Right Foods at the Right Time nutrition program

Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6-23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program's M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up.

Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi

OBJECTIVE

To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0-9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.

DESIGN

Cross-sectional study.

SETTING

Two rural districts in Central Malawi.

SUBJECTS

Pregnant (n 589) and lactating (n 641) women.

RESULTS

Of surveyed pregnant and lactating women, 66·7 and 68·6 %, respectively, experienced moderate or severe food insecurity and only 32·4 and 28·1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0·36 lower DDS (P&lt;0·05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3·19; CI 1·68, 6·03). The risk of not consuming eggs (3·77; 1·04, 13·7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0·36, 0·44 and 0·62 lower DDS, respectively (all P&lt;0·05). The risk of not achieving MDD was higher among moderately (1·95; 1·06, 3·59) and severely (2·82; 1·53, 5·22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose-response manner among lactating women experiencing mild (1·75; 1·01, 3·03 and 2·81; 1·09, 7·25), moderate (2·66; 1·47, 4·82 and 3·75; 1·40, 10·0) and severe (5·33; 2·63, 10·8 and 3·47; 1·19, 10·1) food insecurity.

CONCLUSIONS

Addressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.

Analysis of individual-level and community-level effects on childhood undernutrition in Malawi

BACKGROUND

Undernutrition is a major global public health problem among children under the age of 5 years. We aimed to untangle the effects of a wide range of individual- and community-level socioeconomic factors on the risks of childhood undernutrition in Malawi.

METHODS

We analyzed 6384 women-infant pairs from the 2004 and 2010 Malawi Demographic and Health Surveys (MDHSs). The undernutrition status was assessed by three domains of stunted (height-for-age), wasted (weight-for-height), and underweight (weight-for-age). We constructed generalized estimating equation logistic models to analyze associations of individual- and community-level characteristics with childhood undernutrition.

RESULTS

About 48.4% of the children were stunted, 4.5% were wasted, and 14.4% were underweight. At the individual level, the risk of childhood undernutrition was significantly higher in males, children with a small birth size, children with a diarrheal episode in the last 2 weeks, children that were a product of multiple births, children born to mothers with either a low socioeconomic status, or a poor education, or who were underweight, and children born in the year 2004. At community level, children born in communities with low and medium wealth, and in communities with low and medium female educational attainment were more likely to be undernourished. Unexpectedly, the maternal HIV status was not associated with childhood undernutrition at either the individual or community level.

CONCLUSION

This study provides evidence of the importance of both individual- and community-level factors in determining childhood undernutrition. Interventions against childhood undernutrition should consider the various predictors discussed in this study in order to reduce undernutrition in children and contribute to their well-being.

FRAGILE ENVIRONMENT, SEASONALITY AND MATERNAL AND CHILDHOOD UNDERNUTRITION IN BANGLADESH

This study assessed whether agricultural and household incomes were the same across different agro-ecological environments in Bangladesh. An in-depth analysis of the effect of unfavourable ecologies on maternal and child malnutrition was carried out. Data were from a longitudinal data set comprising a nationally representative data sample collected in 2014 and the Food Security Nutrition Surveillance Project (FSNSP) conducted in 2011 and 2012. Anthropometric indices were used to assess the nutritional status of mothers and under-five children. The key variables of interest were food seasonality and geographical location. Data were analysed using the General Linear Model and multinomial and binary logistic regression analysis. Panel data analysis showed that household income was not equal across agro-ecological zones, indicating that the fragility of the environment affects a household's ability to access food, and thus the nutritional status of mothers and children. Coastal areas of Bangladesh were found to be less dependent on agriculture, particularly cultivation, which had diminished during last few decades. Per capita income has been increasing in coastal areas of Bangladesh, led by remittance (money sent home by migrant workers) growing at 8% per year against 6% in other areas. Regression analysis showed that a household in a coastal zone earned 19% less than one in more favourable zones. Although the income from farm practices was found to be lower in unfavourable areas, the deficiency was compensated by increased non-farm incomes. The results from the FSNSP data showed that overall the rates of stunting and wasting among under-five children were 37% and 11.7%, respectively, and nearly 28% of mothers suffered from undernutrition. A highly significant regional heterogeneity in undernutrition was found, with alarmingly high levels in the Haor Basin and coastal belt areas. There were significantly higher rates of underweight and wasting in the monsoon season compared with the two harvest seasons among children under the age of five. The findings stress the importance of bringing geographical location and seasonality thinking into debates on hunger and nutrition in Bangladesh.

Nutritional status, feeding practices and state of other related indicators at onset of a multi-model community nutrition intervention program in Mpigi District, Uganda

INTRODUCTION

In Uganda, malnutrition level has persistently remained high among the under-fives and this has led NGOs like World Vision, Uganda into finding innovative ways for intervention. This paper presents an assessment of nutrition status and values of related indicators at onset of a community intervention program in four sub-counties of Mpigi district in Central Uganda.

METHODS

This was a cross-sectional study to provide baseline information for a nutrition intervention. The study units were index children aged 6-59 months from 818 households. Face to face interviews were conducted using semi-structured questionnaires. Values of key indicators were computed and compared between designated control and intervention areas.

RESULTS

Stunting level was 32% while wasting was 3% and underweight at 10%. Most of the index children (78%) started breastfeeding within the first hour of birth. Nearly a third of the households visited had a kitchen garden and this did not differ by intervention status.

CONCLUSION

Like at regional level, nutrition status and feeding practices in the study area were poor. The values of these indicators did not significantly change by designated intervention status. Much effort was needed to realize a difference in nutrition and feeding practices in designated intervention areas.