1
|
Talukdar R, Ravel V, Barman D, Kumar V, Dutta S, Kanungo S. Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years. Diabetes Metab Syndr 2024; 18:102976. [PMID: 38508036 DOI: 10.1016/j.dsx.2024.102976] [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] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries. METHODS PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates. RESULTS Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates. CONCLUSIONS The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.
Collapse
Affiliation(s)
- Rounik Talukdar
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vanessa Ravel
- ICMR - National Institute of Epidemiology, Chennai, Tamil Nadu, India.
| | - Diplina Barman
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vivek Kumar
- Deepak Foundation, Katni, Madhya Pradesh, India.
| | - Shanta Dutta
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Suman Kanungo
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| |
Collapse
|
2
|
Widjaja NA, Hamidah A, Purnomo MT, Ardianah E. Effect of lactoferrin in oral nutrition supplement (ONS) towards IL-6 and IL-10 in failure to thrive children with infection. F1000Res 2023; 12:897. [PMID: 38434639 PMCID: PMC10904948 DOI: 10.12688/f1000research.130176.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/05/2024] Open
Abstract
Background Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which is able to upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. We conducted this study to investigate the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection. Methods We performed a quasi-experimental pre- and post-study in children aged 12-60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention. Results There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention. Conclusions In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio.ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.
Collapse
Affiliation(s)
| | - Azizah Hamidah
- Child Health, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | | | - Eva Ardianah
- Child Health, Airlangga University, Surabaya, East Java, 60286, Indonesia
| |
Collapse
|
3
|
Choudhary P, Padhi BK, Mital AK, Gandhi AP, Mishra SK, Suri N, Baral SS, Satapathy P, Shamim MA, Thangavelu L, Rustagi S, Sah R, Khatib MN, Gaidhane S, Zahiruddin QS, Abd-Alrazaq A, Abu Serhan H. Prevalence of stunting among under-five children in refugee and internally displaced communities: a systematic review and meta-analysis. Front Public Health 2023; 11:1278343. [PMID: 38094233 PMCID: PMC10716242 DOI: 10.3389/fpubh.2023.1278343] [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: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
Background A pooled estimate of stunting prevalence in refugee and internally displaced under-five children can help quantify the problem and focus on the nutritional needs of these marginalized groups. We aimed to assess the pooled prevalence of stunting in refugees and internally displaced under-five children from different parts of the globe. Methods In this systematic review and meta-analysis, seven databases (Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science) along with "preprint servers" were searched systematically from the earliest available date to 14 February 2023. Refugee and internally displaced (IDP) under-five children were included, and study quality was assessed using "National Heart, Lung, and Blood Institute (NHLBI)" tools. Results A total of 776 abstracts (PubMed = 208, Scopus = 192, Cochrane = 1, Web of Science = 27, Embase = 8, EBSCOHost = 123, ProQuest = 5, Google Scholar = 209, and Preprints = 3) were retrieved, duplicates removed, and screened, among which 30 studies were found eligible for qualitative and quantitative synthesis. The pooled prevalence of stunting was 26% [95% confidence interval (CI): 21-31]. Heterogeneity was high (I2 = 99%, p < 0.01). A subgroup analysis of the type of study subjects revealed a pooled stunting prevalence of 37% (95% CI: 23-53) in internally displaced populations and 22% (95% CI: 18-28) among refugee children. Based on geographical distribution, the stunting was 32% (95% CI: 24-40) in the African region, 34% (95% CI: 24-46) in the South-East Asian region, and 14% (95% CI: 11-19) in Eastern Mediterranean region. Conclusion The stunting rate is more in the internally displaced population than the refugee population and more in the South-East Asian and African regions. Our recommendation is to conduct further research to evaluate the determinants of undernutrition among under-five children of refugees and internally displaced populations from different regions so that international organizations and responsible stakeholders of that region can take effective remedial actions. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387156, PROSPERO [CRD42023387156].
Collapse
Affiliation(s)
- Priyanka Choudhary
- Department of Community Medicine, Shri Atal Bihari Vajpayee Government Medical College, Faridabad, India
| | - Bijaya K. Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar Mital
- Department of Paediatrics, Shri Atal Bihari Vajpayee Government Medical College, Faridabad, India
| | - Aravind P. Gandhi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Sanjeeb Kumar Mishra
- Department of Community Medicine, Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Sambalpur, Odisha, India
| | - Neha Suri
- Department of Physical Medicine and Rehabilitation, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudhansu Sekhar Baral
- Department of Physical Medicine and Rehabilitation, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakasini Satapathy
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
- Evidence Synthesis Lab, Kolkata, India
| | | | - Lakshmi Thangavelu
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine, Doha, Qatar
| | | |
Collapse
|
4
|
Ghanim M, Mosleh R, Hamdan A, Amer J, Alqub M, Jarrar Y, Dwikat M. Assessment of Perceptions and Predictors Towards Consanguinity: A Cross-Sectional Study from Palestine. J Multidiscip Healthc 2023; 16:3443-3453. [PMID: 38024133 PMCID: PMC10656848 DOI: 10.2147/jmdh.s433506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background/Aim Consanguinity represents a biological relationship between two individuals. In clinical genetics, it specifically refers to the marriage between individuals who are second cousins or closer. The aim of the study is to assess perceptions and their predictors among the Palestinian population towards consanguinity. Methods A survey-based cross-sectional study was conducted. The sample was collected using convenience and snowball sampling methods, yielding a sample of 1008 participants. The perceptions towards consanguinity and its predictors were assessed using Chi-square test. Results The prevalence of consanguinity among married participants was 18.7% (N = 81/432), while it was 28.8% among their parents. Consanguinity rate was significantly low among the young age group (ie, <47 years old) and among participants whose mothers have undergraduate educational levels (P < 0.05). Other factors like parental consanguinity, educational level of participants, their father's educational level, and residency place showed no significant associations (P > 0.05). Rejection of consanguinity was significantly noted among young age participants, absence of parental consanguinity, the presence of children or family members with genetic disorders and female gender (P < 0.001). Furthermore, participants who indicated that they are governmental employees, those with 2000-5000 ILS monthly income, those who are married (P < 0.01), and those who indicated that their mothers are holders of postgraduate degree were significantly more likely to reject the idea of consanguinity (P < 0.05). Also, medical and/or scientific reasons were significantly associated with rejecting the idea of consanguinity (P < 0.001). Conclusion Consanguinity prevalence has decreased among recent generations in Palestine, but it remains a significant challenge in Palestine. Therefore, educational and awareness programs about consanguinity and its health effects are effective strategies for reducing the consanguinity rate, especially for persons who are at the age of marriage.
Collapse
Affiliation(s)
- Mustafa Ghanim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rami Mosleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anas Hamdan
- Department of Anesthesia and Resuscitation Technology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Johnny Amer
- Department of Allied and Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Malik Alqub
- Department of Allied and Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazun Jarrar
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Majdi Dwikat
- Department of Allied and Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|
5
|
A. Assaf E, Al Sabbah H, Al-Jawadleh A. Analysis of the nutritional status in the Palestinian territory: a review study. Front Nutr 2023; 10:1206090. [PMID: 37533576 PMCID: PMC10391640 DOI: 10.3389/fnut.2023.1206090] [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: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023. Method Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Results Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children. Conclusion This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.
Collapse
Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Haleama Al Sabbah
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ayoub Al-Jawadleh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| |
Collapse
|
6
|
Roy TB, Das T, Das P, Das P. Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context. BMC Nutr 2023; 9:69. [PMID: 37328887 DOI: 10.1186/s40795-023-00725-w] [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: 01/22/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023] Open
Abstract
Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India's Demography and Health Survey (DHS) conducted in 2019-2021. A total of 1, 46,521 children aged 0-59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons.
Collapse
Affiliation(s)
- Tamal Basu Roy
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
| | - Tanu Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134.
| | - Partha Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
| | - Priya Das
- Department of Geography, Raiganj University, Uttar Dinajpur, West Bengal, Raiganj, India, 733134
| |
Collapse
|
7
|
Skinner A, Tester-Jones MC, Carrieri D. Undernutrition among children living in refugee camps: a systematic review of prevalence. BMJ Open 2023; 13:e070246. [PMID: 37321810 PMCID: PMC10277121 DOI: 10.1136/bmjopen-2022-070246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This review aimed to provide an overview of the prevalence of undernutrition in children under 5 years old in refugee camps according to the different indicators. In addition, we aimed to evaluate the quality and quantity of relevant epidemiological data available. DESIGN We used a systematic review of prevalence study design to achieve the above aims. We sought eligible observational studies through database searching of OVID Medline, CAB Global Health, Scopus and PubMed; citation chasing; and grey literature searching. SETTING The setting of interest was refugee camps across the globe. PARTICIPANTS Participants in the studies included in the review were children under 5 years old. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome measures of interest were the prevalence of wasting, global acute malnutrition, stunting and underweight. RESULTS The review included 33 cross-sectional studies in 86 sites and a total of 36 750 participants. Overall, the quality of the studies was moderate to high, but some reports lacked clarity around data collection or outcome definitions. The results showed a wide variation in prevalence estimates across the different indicators and between different refugee camps. The median prevalence estimates of global acute malnutrition based on weight-for-height z-score, stunting and underweight were 7.1%, 23.8% and 16.7%, respectively. Using weight-for-height z-score identified a higher prevalence of acute malnutrition than using mid-upper arm circumference in the majority of studies. CONCLUSIONS Acute malnutrition remains a public health problem in many refugee camps, but chronic malnutrition has a high prevalence in more locations. Research and policy must, therefore, focus not only on nutrition but also on the wider determinants of both acute and chronic undernutrition. The difference in prevalence of global acute malnutrition depending on the measure used has implications for screening and diagnosis.
Collapse
Affiliation(s)
- Annabel Skinner
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
8
|
Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape. Nutrients 2022; 14:nu14194201. [PMID: 36235853 PMCID: PMC9572091 DOI: 10.3390/nu14194201] [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: 08/03/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition. METHODOLOGY PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR. RESULTS The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time. CONCLUSIONS In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.
Collapse
|
9
|
Baraquoni NA, Qouta SR, Vänskä M, Diab SY, Punamäki RL, Manduca P. It Takes Time to Unravel the Ecology of War in Gaza, Palestine: Long-Term Changes in Maternal, Newborn and Toddlers' Heavy Metal Loads, and Infant and Toddler Developmental Milestones in the Aftermath of the 2014 Military Attacks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186698. [PMID: 32938007 PMCID: PMC7558099 DOI: 10.3390/ijerph17186698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
Toxicant, teratogen and carcinogen metal war remnants negatively affect human health. The current study analyzes, first, the persistence of heavy metal contamination in newborn hair in four cohorts across time in Gaza Palestine; second, the change in mothers’ and infants’ heavy metal contamination from birth to toddlerhood; and third, the impact of heavy metal contamination on infants’ and toddlers’ growth and development. The hair of newborns was analyzed for twelve heavy metals by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) in cohorts recruited at delivery in 2011, 2015, 2016, and 2018–2019. In the 2015 cohort, mothers’ hair samples were taken at delivery, and toddlers and mothers hair were also analyzed 18 months later. Growth levels of infants at six months and toddlers at 18 months were assessed according to World Health Organization (WHO) standards according to a mother report and pediatric check-up, respectively. 1. The level of metal contamination in utero was persistently high across 8 years, 2011, 2015, 2016, 2019, following three major military attacks (2009, 2012, 2014). 2. The 2015 cohort babies exposed in utero to attacks in 2014 at six months showed association of high load at birth in mother of arsenic and in newborn of barium with underweight, of barium and molybdenum in newborn with stunting. 3. Eighteen months after birth, toddlers had a higher level of metals in hairs than when they were born, while, in their mothers, such levels were similar to those at delivery, confirming persistence in the environment of war remnants. Underweight and stunting, both in infants and toddlers, were higher than reported for previous years, as well as being progressive within the cohort. Severe environmental factors, metal contamination and food insecurity put Gaza’s infant health at risk.
Collapse
Affiliation(s)
| | - Samir R. Qouta
- Doha Institute for Graduate Studies, School of Social Sciences and Humanities, Al Tarfa Street, Zone 70, Doha, P.O. Box 200592, Qatar;
| | - Mervi Vänskä
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Safwat Y. Diab
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Raija-Leena Punamäki
- Department of Psychology, Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland; (M.V.); (S.Y.D.); (R.-L.P.)
| | - Paola Manduca
- Association for Scientific Research, Nwrg-onlus, 16123 Genova, Italy
- Correspondence:
| |
Collapse
|
10
|
Binagwaho A, Rukundo A, Powers S, Donahoe KB, Agbonyitor M, Ngabo F, Karema C, Scott KW, Smith Fawzi MC. Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications. BMC Public Health 2020; 20:83. [PMID: 31959142 PMCID: PMC6971879 DOI: 10.1186/s12889-020-8164-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda. Methods Data for this study come from the 2000 to 2015 Rwanda’s Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting. Results The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight. Conclusions Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.
Collapse
Affiliation(s)
- Agnes Binagwaho
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda. .,Harvard Medical School, Boston, MA, USA. .,Dartmouth Geisel School of Medicine, Hanover, NH, USA.
| | | | - Samuel Powers
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda.,University of Virginia, Charlottesville, VA, USA
| | - Kateri B Donahoe
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda
| | | | - Fidel Ngabo
- School of Public Health, Universite libre de Bruxelles, Brussels, Belgium
| | - Corine Karema
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th Floor, PO Box 6955, Kigali, Rwanda
| | | | | |
Collapse
|
11
|
Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review. Disaster Med Public Health Prep 2019; 14:601-619. [PMID: 31818343 DOI: 10.1017/dmp.2019.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The worst rates of preventable mortality and morbidity among women and children occur in humanitarian settings. Reliable, easy-to-use, standardized, and efficient tools for data collection are needed to enable different organizations to plan and act in the most effective way. In 2015, the World Health Organization (WHO) commissioned a review of tools for data collection on the health of women and children in humanitarian emergencies. An update of this review was conducted to investigate whether the recommendations made were taken forward and to identify newly developed tools. Fifty-three studies and 5 new tools were identified. Only 1 study used 1 of the tools identified in our search. Little has been done in terms of the previous recommendations. Authors may not be aware of the availability of such tools and of the importance of documenting their data using the same methods as other researchers. Currently used tools may not be suitable for use in humanitarian settings or may not include the domains of the authors' interests. The development of standardized instruments should be done with all key workers in the area and could be coordinated by the WHO.
Collapse
|
12
|
Modjadji P, Madiba S. Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3021. [PMID: 31438531 PMCID: PMC6747220 DOI: 10.3390/ijerph16173021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa. METHODS A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren. RESULTS Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight. CONCLUSIONS The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.
Collapse
Affiliation(s)
- Perpetua Modjadji
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa.
| | - Sphiwe Madiba
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa
| |
Collapse
|