A survey of undernutrition in children under three years of age in rural Western China

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.

Social determinants of child malnutrition outcomes: Evidence from CHNS in China

China is committed to reduce child malnutrition outcomes (CMO) rates to less than 5 % by 2030 in order to meet the Sustainable Development Goal (SDG). Yet, this is still an enormous challenge for China, particularly in disadvantaged areas, due to regional and urban-rural disparities. Using China Health and Nutrition Survey (CHNS) data from 1991 to 2015 and fixed-effect models, this study investigates the social determinants of stunting (n = 4012) measured by height-for-age z score (HAZ) and wasting (n = 4229) measured by weight-for-height z score (WHZ) in children under the age of five. According to the empirical findings, the significant social determinants of child stunting encompassed whether the child is insured (p < 0.01), maternal education level (primary school (p < 0.01) low middle school (p < 0.01); vocational school (p < 0.01)), maternal employment status (p < 0.05), mother's average working days (p < 0.05), average household per capita income (p < 0.01), household asset index (p < 0.01), urbanization index living in a community (medium (p < 0.05); higher (p < 0.01); highest (p < 0.01)) and living regions (west (p < 0.01); northeast (p < 0.05)). Children's maternal employment status (p < 0.05), mother's average working days (p < 0.05), living areas (p < 0.05) and living regions (central (p < 0.01); west (p < 0.01); north-east (p < 0.05)) are the significant factors impacting child wasting. Furthermore, the interaction impact between maternal employment and have one additional working day per week is positive. To attain SDGs, the Chinese government should priorities lowering stunting and wasting among 5-year-olds in the western region, particularly in impoverished regions. Also, it is possible to develop tailored policies for the growth and development of children under the age of five by addressing pertinent socio-economic factors.

Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries

BACKGROUND

Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa.

METHODS

This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI).

RESULTS

The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206).

CONCLUSIONS

This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

Risk factors for wasting among hospitalised children in Nepal

Background

Malnutrition has various adverse effects in children. This study aimed to determine risk factors for malnutrition among hospitalised children, changes in nutritional status at admission and discharge and effects of use of systematic anthropometric measurement in identification of malnutrition.

Methods

We enrolled 426 children, aged between 6 months and 15 years, admitted to Siddhi Memorial Hospital, Bhaktapur, Nepal, from November 2016 to June 2017. Anthropometric measurements were performed at the time of admission and discharge. Risk factors were assessed by multivariable logistic regression models.

Results

Median age of children was 26 months (IQR: 13–49), and males were 58.7%. The prevalence of wasting was 9.2% (39/426) at admission and 8.5% (36/426) at discharge. Risk factors associated with wasting at admission were ethnic minority (aOR: 3.6, 95% CI 1.2–10.8), diarrhoeal diseases (aOR = 4.0; 95% CI 1.3–11.8), respiratory diseases (aOR: 3.4, 95% CI 1.4–8.1) and earthquake damage to house (aOR = 2.6; 95% CI 1.1–6.3). Clinical observation by care providers identified only 2 out of 112 malnutrition cases at admission and 4 out of 119 cases at discharge that were detected by the systematic anthropometric measurement.

Conclusions

Ethnic minority, diarrhoeal diseases, respiratory infections and house damage due to the earthquake were risk factors associated with wasting. Systematic anthropometric examination can identify significantly more malnourished children than simple observation of care providers.

Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates From Multiple Data Sources

BACKGROUND

Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations' Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources.

METHODS

Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008- 2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA).

RESULTS

Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P<.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%-60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%-42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%-33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF.

CONCLUSION

Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of Malnutrition and Associated Factors of Stunting among 6-23-Month-Old Infants in Central Rural China in 2019

This study aimed to evaluate the prevalence of malnutrition and to investigate the associated factors of stunting among 6-23-month-old infants in poor rural areas of central China. The China Nutrition Improvement Project on Children in Poor Areas was conducted in 56 national-level poor counties of seven provinces in 2019. We performed a multivariate binary logistic regression analysis to determine the associated factors of stunting. This cross-sectional study included 17,193 infants. The overall prevalence of stunting was the highest (3.9%), followed by overweight (3.0%), underweight (2.1%), wasting (2.0%), and obesity (0.5%). Girls [OR = 0.55, 95% CI (0.46, 0.65)], infants meeting requirements of minimum diversity diet [OR = 0.81, 95% CI (0.67, 0.98)], and mothers with middle-school or high-school education and above decreased the prevalence of stunting. Infants with diarrhea in two weeks [OR = 1.26,95% CI (0.98, 1.62)] were at higher odds of stunting. The malnutrition status in the study areas was improved, and vulnerable infants were found to need additional and earlier monitoring to detect and fundamentally prevent undernutrition.

The burden and correlates of childhood undernutrition in Tanzania according to composite index of anthropometric failure

Background

Undernutrition is a public health problem worldwide. Tanzania has made significant achievements in the reduction of childhood undernutrition over the past two decades. However, the exact burden of undernutrition was under-estimated when using conventional indices of stunting, wasting and underweight. The objective of this study was to determine the overall prevalence of undernutrition, describe the trends and examine the correlates associated with undernutrition among children under-five years using the composite index of anthropometric failure (CIAF). This study aims to understand the real burden and drivers of undernutrition to improve design, implementation and monitoring of appropriate interventions to ameliorate all form of childhood undernutrition in the country.

Methods

About 37,205 mother-child pairs were retrieved and analyzed from the Tanzania Demographic and Health Surveys (TDHS) conducted in various years from 1991, 1996, 1999, 2004–05, 2009–10, to 2015–16. The anthropometric data of children under-five years were used to determine the overall burden and trends of undernutrition using CIAF. The recent TDHS surveys from 2005 to 2015 were used to examine the correlates of CIAF. To determine the correlates, multivariate analysis was conducted to estimate the prevalence ratios (PR) with 95% confidence intervals (CI) using Poisson regression with robust variance.

Results

The prevalence of CIAF declined significantly from 50% in 1991 to 38.2% in 2015 (p < 0.001). The correlates of CIAF vary across surveys. The multivariate analysis of recent 2015 survey revealed that the prevalence of CIAF was significantly higher for older children (p < 0.001), children living in rural areas (p = 0.028), and those born with non-educated (p = 0.009) or single mothers (p = 0.008). The prevalence of CIAF was significantly lower for girls (p < 0.001), being born with overweight/obese mothers (p < 0.001), living with older head of the household (p < 0.001) or living in richest household (p < 0.001). Moreover, children who were born with low birth weight (p < 0.001), or having fever (p = 0.044) were most likely to have anthropometric failure. However, consumption of diversified diet was not found to be associated with anthropometric failure (p > 0.05).

Conclusion

About one in every three under-five years children are suffering from either one or multiple forms of anthropometric failure in Tanzania. There is a significant decline trends in overall burden of undernutrition in Tanzania from the past 25 years, as measured by CIAF. Multiple factors including those related to mothers, children and household socio-economic characteristics have the potential to influence childhood undernutrition. Efforts to reduce the burden of undernutrition should mainly focus on reducing poverty and raising people’s living standards.

Extended composite index of anthropometric failure in Argentinean preschool and school children

OBJECTIVE

The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces.

DESIGN

ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess.

SETTING

Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina).

PARTICIPANTS

10 879 children of both sexes aged between 3 and 13·99.

RESULTS

ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight.

CONCLUSIONS

The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.

METHODS

We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).

FINDINGS

Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).

INTERPRETATION

China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.

FUNDING

China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Association between intestinal worm infection and malnutrition among rural children aged 9-11 years old in Guizhou Province, China

BACKGROUND

Intestinal worm infection adversely impacted child health and was one of the China's largest health burdens. However, yet little was known about associations between intestinal worm infection and malnutrition in school-aged children in rural China. This study aimed to fill into the gap.

METHODS

Data were from a survey of children aged 9-11 years old in Guizhou Province, China conducted in June 2013. Considering anemia and low intelligent quotient (IQ) as mediating factors, binomial logistic regression was used to estimate the associations of intestinal worm infection with thinness, underweight, and stunting. Moreover, the associations between socio-demographic factors and malnutrition were also explored.

RESULTS

Among 2179 children, part of children was infected by intestinal worm (41.85%). Stunting (28%), low memory IQ (87.52%), and low process IQ (62.59%) were highly prevalent in the sample. Socio-demographic factors were associated with thinness, underweight, stunting, low memory IQ, low process IQ, anaemia, and intestinal worm infection. Intestinal worm infection was associated with low IQ, anemia, and stunting. In addition, anemia and low IQ could not confound the other expected associations.

CONCLUSION

This study demonstrated the association between intestinal worm infections and stunting appeared to be largely mediated via low IQ. The study highlighted the importance of deworming and improving nutrition in the surveyed areas.

Association of low birth weight with undernutrition in preschool-aged children in Malawi

Background

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition is a broad term encompassing the three conditions namely undernutrition (micronutrient-related malnutrition), over-nutrition (overweight and obesity), and diet-related non-communicable diseases. Undernutrition is defined as the outcome of insufficient food intake and repeated infectious diseases. Low birth weight (LBW) is cited as a risk factor for mortality and morbidity in young children. However, its association with undernutrition has received little attention. Thus, the current study aimed to examine the relationship between LBW and undernutrition in Malawi.

Methods

A cross-sectional study was conducted using data from the Malawi Demographic and Health Survey (MDHS) 2015–16. Children whose Z-scores for each of the following indices height-for-age, weight-for-height, and weight-for-age were below the minus two standard deviations (−2SD) from the median of the World Health Organization’s (WHO) reference population were considered to be stunted, wasted and underweight, respectively. LBW was defined as babies whose birth weight was less than 2500 g. The multivariate logistic regression models were performed using surveylogistic while controlling various confounding factors in the six different models.

Results

The prevalence of stunted, underweight, wasted, and LBW were reported as follows, 39%. 11, 2, and 10% respectively. Compared to children with normal/average birth weight, those with LBW had significantly higher odds of being stunted [adjusted odds ratio (aOR): 1.72; 95% confidence interval (CI): 1.35–2.20), underweight (aOR: 2.30; 95% CI: 1.68–3.14) and wasted (aOR: 1.47; 95% CI: 1.38–4.25) respectively.

Conclusions

LBW was a strong predictor of all the three indices of undernutrition. Interventions that aim at improving the growth and development of children during the early years should consider addressing factors that trigger LBW.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0477-8) contains supplementary material, which is available to authorized users.

Relationship between malaria, anaemia, nutritional and socio-economic status amongst under-ten children, in the North Region of Cameroon: A cross-sectional assessment

Background

Despite malaria, malnutrition and anaemia being major public-health challenges in Cameroon, very little has been reported on the interaction between these interconnected health determinants. This study therefore sought to investigate the relationship between malaria, anaemia, nutritional and socio-economic status amongst under—ten children living in six localities within two health districts in the North Region of Cameroon.

Methods

Accordingly, a cross- sectional survey was conducted during the peak malaria season in November 2014, in Pitoa and Mayo-Oulo Health Districts. Three hundred and sixty eight children aged 6months—10 years were enrolled. Structured questionnaires were used to assess socio-economic status. Anthropometric indices were taken using standard methods and nutritional status assessed by calculating Height for Age (HA), Weight for Age (WA) and Weight for Height (WH) z-scores to determine stunting, underweight and wasting respectively. Finger-prick blood samples were used to prepare thin and thick blood smears for microscopy. Whole blood was collected to determine the PCV and blood spots on filter paper were used to extract plasmodium DNA for speciation by PCR.

Results

Overall prevalence rates of malaria, malnutrition and anaemia were 32.9%, 54.1% and 20.6% respectively. Stunting, underweight and wasting were detected in 56.9%, 63.5% and 34.8% of the children respectively. There was a significant association between malaria and malnutrition [OR = 1.89, (95% CI: 1.12–3.19); (p = 0.017)]. Malnutrition was also strongly associated with malaria status [OR = 2.07, (95% CI: 1.22–3.53); (p = 0.007)]. The prevalence rates of mild, moderate and severe anaemia were 8.1%, 9.2% and 3.3% respectively. Both malaria status and anaemia correlated with development index [OR = 0.75, (95% CI: 0.58–0.99); (p = 0.042)] and [OR = 1.45, (95% CI: 1.05–2.00); (p = 0.023)] respectively.

Conclusion

Our findings show a synergistic relationship between malaria and malnutrition. Effective collaboration between malaria control and nutrition intervention programmes is essential for proper case management and improved socio-economic status.

Factors Associated with Undernutrition in Children under the Age of Two Years: Secondary Data Analysis Based on the Pakistan Demographic and Health Survey 2012⁻2013

In Pakistan, 96% of the children under the age of two years do not receive an adequate diet. The main aim of this paper is to identify the sociodemographic, nutritional, and health-related factors associated with stunting, wasting, and underweight in children under the age of two years in Pakistan. Secondary data analysis was performed based on the Pakistan Demographic and Health Survey, 2012⁻2013. The analysis was limited to children under the age of two years (n = 984). Analysis was done using bivariate and multivariable binary logistic regression. The incidence of stunting, wasting, and underweight in children was 28.3%, 12.1%, and 27.9%, respectively. The odds of stunting, wasting, and underweight increased with the child's age. The odds of stunting and underweight increased with the mother's low body mass index, low access to information, high birth order of child, consanguineous marriages, father's low education, rural settlement, poor toilet facilities, and low vitamin A consumption. The odds of wasting increased in children who were not being breastfed, but no significant relation was seen with stunting and underweight. There is a need to improve child nutritional status in Pakistan by addressing issues such as poverty, low parental education, low micronutrient intake, and targeting provinces where undernutrition was found to be higher.

High Prevalence of Undernutrition among Children in Gondar Town, Northwest Ethiopia: A Community-Based Cross-Sectional Study

OBJECTIVE

To assess undernutrition and associated factors among children aged 6-59 months in Gondar Town, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted in 2014. Multistage sampling method was used to select study participants. Structured interviewer administered questionnaire and anthropometric measurements were used. Binary logistic regression was fitted to identify associated factors.

RESULTS

The prevalences of wasting and stunting were 6.8% and 45.7%, respectively. Higher odds of wasting were observed among children whose fathers were daily laborers (AOR = 2.63), children who had eating problem (AOR = 2.96), and those who were not exclusively breast-fed for the first six months (AOR = 5.63). Similarly, higher odds of stunting were found among female children (AOR = 1.65), children who lived in households having four to six families (AOR = 2.14), and children who did not start breast-feeding within one hour of birth (AOR = 0.67).

CONCLUSION

Childhood undernutrition was a significant problem. Child eating problem, paternal occupation, and exclusive breast-feeding were associated with wasting, whereas family size, child sex, and breast-feeding initiation time were associated with stunting. Therefore, strengthening of early initiation and exclusive breast-feeding, promoting healthcare seeking behavior, and designing social support programme for poor family are recommended to reduce undernutrition.

PREVALENCE AND DETERMINANTS OF STUNTING AMONG PRIMARY SCHOOL CHILDREN IN RURAL AND URBAN COMMUNITIES IN OBAFEMI OWODE LOCAL GOVERNMENT AREA, SOUTHWESTERN NIGERIA

BACKGROUND

Studies on stunting in children have largely focused on the underfive, establishing it as a strong predictor of mortality in these children. Few studies have documented the prevalence or determinants of stunting among school children in southwestern Nigeria. The aim of the study was to determine the prevalence and predictors of stunting among selected primary school children in rural and urban communities of Obafemi Owode Local Government Area, Ogun State.

METHOD

A cross-sectional study of rural and urban primary school children was conducted. An interviewer-administered questionnaire was used to collect information on respondents' and parents' socio-demographic characteristics. Stunting was defined as height-for-age less than two standard deviations from the median height-for-age of the standard World Health Organization reference population. Using EPI-INFO version 6.03, children were classified as stunted if z-scores of height-for-age were less than 2 standard deviations below the National Centre for Health statistics (NCHS)/WHO median. Height and weight were taken using a stadiometer and weighing scale respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 while predictors were determined using logistic regression at 95% level of significance.

RESULTS

A total of 1,160 primary school children were studied with 52.2% from rural schools. Males constituted 57.1% and 51.8% in the rural and urban school respectively. Prevalence of stunting among rural school children was 46.2%, and was significantly higher (p≤0.001) than among urban children at 33.8%. Younger children <10 years (OR: 0.088; 95CI: 0.052 - 0.150) and children between 11-12 years (OR: 0.534; 95CI: 0.322 - 0.886) were at a significantly lower risk of stunting both in rural schools compared to children >13 years.

CONCLUSION

The prevalence of stunting was high especially among pupils from schools in the rural communities. This underscores the need for urgent feasible and effective nutrition programs for primary school children especially those in rural schools within the study area.

Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia

BACKGROUND

Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0-59 months in rural Ethiopia.

METHODS

Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13.

RESULT

The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia.

CONCLUSION

The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished.

Patterns and Determinants of Double-Burden of Malnutrition among Rural Children: Evidence from China

Chinese children are facing dual burden of malnutrition—coexistence of under-and over-nutrition. Little systematic evidence exists for explaining the simultaneous presence of under-and over-nutrition. This study aims to explore underlying mechanisms of under-and over-nutrition among children in rural China. This study used a nationwide longitudinal dataset of children (N = 5,017) from 9 provinces across China, with four exclusively categories of nutritional outcomes including under-nutrition (stunting and underweight), over-nutrition (overweight only including obesity), paradox (stunted overweight), with normal nutrition as reference. Multinomial logit models (Level-1: occasions; Level-2: children; Level-3: villages) were fitted which corrected for non-independence of observations due to geographic clustering and repeated observations of individuals. A mixture of risk factors at the individual, household and neighbourhood levels predicted under-and over-nutrition among children in rural China. Improved socioeconomic status and living in more urbanised villages reduced the risk of stunted overweight among rural children in China. Young girls appeared to have higher risk of under-nutrition, and the risk decreased with age more markedly than for boys up to age 5. From age 5 onwards, boys tended to have higher risk of under-nutrition than girls. Girls aged around 12 and older were less likely to suffer from under-nutrition, while boys’ higher risk of under-nutrition persisted throughout adolescence. Children were less likely to suffer from over-nutrition compared to normal nutrition. Boys tended to have an even lower risk of over-nutrition than girls and the gender difference widened with age until adolescence. Our results have important policy implications that improving household economic status, in particular, maternal education and health insurance for children, and living environment are important to enhance rural children’s nutritional status in China. Investments in early years of childhood can be effective to reduce gender inequality in nutritional health in rural China.

Determinants and morbidities of multiple anthropometric deficits in southwest rural Ethiopia

OBJECTIVE

The aim of this study was to compare undernutrition with child morbidity and their determinants according to a composite index of anthropometrical failures and conventional indices.

METHODS

We used data generated from three rounds of a longitudinal panel survey conducted in nine districts in Oromiya Region and the Southern Nations, Nationality and Peoples Region of Ethiopia. We estimated undernutrition using conventional indices and composite index of anthropometrical failures. Included in this analysis were 579, 674, and 674 children age <5 y in rounds 1, 2, and 3, respectively. The households were recruited using the expanded program on immunization sampling method. The hierarchical nature of the data Applied nutritional investigation was taken into account during the statistical analysis using a two-level mixed-effects logistic regression model.

RESULTS

A composite index of anthropological failure, estimated 45.1%, 42.4%, and 46.4% of the children were undernourished in round 1, 2, and 3, respectively. The conventional indices estimated 24.4%, 24.2%, and 30.4% underweight in round 1, 2, and 3, respectively. Being female (odds ratio [OR], 7.4; 95% confidence interval [CI], 3.9-14.0); low dietary diversity (OR, 3.1; 95% CI, 1.6-5.9); medium dietary diversity (OR, 1.9; 95% CI, 1.1-3.3), and no special foods during illness (OR, 1.8; 95% CI, 1.2-2.8) were determinant of multiple anthropometrical failures. Children with multiple anthropometric failures were 2.6 times more likely to report child morbidities (OR, 2.6; 95% CI, 1.1-5.9). However, none of the conventional indices were associated with any of the reported child morbidities, such as stunting (OR, 1.1; 95% CI, 0.8-1.4), wasting (OR, 0.9; 95% CI, 0.5-1.6), or underweight (OR, 1.4; 95% CI, 1.0-2.0).

CONCLUSION

The conventional indices underestimated the prevalence of undernutrition by 20.7%. Children with multiple anthropometric failures are at high risk for developing child morbidities and should benefit from nutrition intervention to reduce child morbidities.

Magnitude of undernutrition in children aged 2 to 4 years using CIAF and conventional indices in the slums of Mumbai city

Conventional indicators - weight-for-age, height-for-age, weight-for-height and mid-upper arm circumference (MUAC) reflect different facets of the nutritional status. Weight-for-age is the most commonly used indicator. When used individually or in combination, conventional indices fail to depict the overall magnitude of undernutrition in the population. Composite Index of Anthropometric Failure (CIAF) is an alternative classification system which attempts to fill this lacuna. Thus, we undertook this study with the objective to compare the prevalence of undernutrition using CIAF and the conventional indices. We included 634 children aged between 2 to 4 years from anganwadis located in three areas of Mumbai. Weight, height and MUAC measurements were taken. Z scores were computed for weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) using WHO Anthro software. Children were classified as per the conventional indices and CIAF. The prevalence of underweight, stunting and wasting was 35.7%, 33.8% and 18.5% respectively. None of the children had MUAC < 11.5 cm. About 1% of the children were moderately wasted according to MUAC. As per CIAF, 47.8% children were undernourished. According to CIAF, one-third of the undernourished children had single anthropometric failure while half of them had dual failure and 17.1% had multiple failures. When compared with the conventional indices, CIAF could recognize 12.1%, 14.0%, 29.3% and 46.7% more undernourished children than WAZ, HAZ, WHZ and MUAC respectively. In conclusion, CIAF is seen to have many advantages over the conventional indices. CIAF is useful in assessing the overall magnitude of undernutrition and identifying children with multiple anthropometric failures. It also recognizes more undernourished children than all the conventional indices. Therefore, CIAF should be used more widely as a tool for nutritional assessment particularly in developing countries where the burden of undernutrition is high.