Factors associated with nutritional status of infants and young children in Somali Region, Ethiopia: a cross- sectional study

Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia

To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.

Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Stunting is a major public health concern, particularly in low and middle-income countries. Globally, nearly 149 million under-five children are suffering from stunting. Despite it can occur in all age groups, the impact is more severe among children age less than 24 months as this period is critical time of very rapid growth and development. Therefore, this review aimed to determine the pooled prevalence and determinants of stunting among children during this critical period in Ethiopia.

METHODS

The literature search was conducted using international electronic data bases (pumed, Google scholar, CINHAL, Hinari, open Google) and the hand search of reference lists of eligible articles. The presence of heterogeneity between studies was evaluated using Cochrane Q-test and I2 test statistics and sensitivity analysis was also checked. Small study effect was checked through graphical and statistical test. Sub-group analysis was performed to handle heterogeneity.

RESULTS

This study included 14 studies with a total sample size of 8,056 children. The overall pooled estimate of stunting was 35.01(95% CI: 24.73-45.28, I2 = 98.98%) in the country with the highest prevalence in Amhara region. Increased Child's age (OR = 3.83; 95% CI: 2.47-5.18, I2 = 97.76%), no maternal education (OR = 2.90; 95%CI: 1.59-4.20, I2 = 89.73%), no maternal postnatal follow up (OR = 1.81; 95% CI:1.51-2.10) less than four food diversity of the child (OR = 2.24;95%CI; 1.94-2.55,I2 = 21.55%), low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were significant factors of stunting.

CONCLUSION AND RECOMMENDATIONS

The pooled prevalence of stunting among children during their critical time is high. Increased Child's age, no maternal education and no maternal postnatal follow up, less than four food diversity of the child, low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were determinants of stunting. Therefore, providing continuous maternal postnatal follow up, increase awareness of mothers on importance of colostrum and exclusive breast feeding, feeding of children the recommended variety of foods and at large to improve the wealth status of the households are crucial interventions to meet national and international targets of zero stunting in children less than 2 years.

Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa

Most children in South Africa attending public schools are predisposed to malnutrition due to poor infrastructure and social inequality. This is despite the implementation of the National School Nutrition Programme to address barriers to learning associated with hunger and malnutrition and the National Development Plan to reduce child malnutrition through provision of social grants. In view of this, we compared malnutrition indicators and associated socio-demographic factors among children in rural Mpumalanga and urban Gauteng in South African public primary schools selected using a multistage cluster random sampling. A validated researcher-administered questionnaire was used to collect socio-demographic data of caregivers, along with primary school children data collected on age, sex, learning grade, and anthropometric measures. Malnutrition indicators, which are stunting (low height-for-age z-scores), underweight (low weight-for-age z-scores), thinness (low body-mass-index-for-age z-scores), and overweight/obesity (high body mass index) were computed using WHO Anthro Plus 1.0.4 and data were analyzed using Stata 18. A total of 903 children (rural = 390 and urban = 513) with a mean age of 10 ± 2 years in the foundation phase (learning grades one to three) and the intermediate learning phase (learning grades four to seven) participated with their caregivers (mean age: 39 ± 8 years). Significant levels of poor socio-demographic status were observed among caregivers living in the rural setting compared to in the urban setting. Overall, thinness (18%), stunting (12%), underweight (10%), and overweight/obesity (24%) were observed among school children. Children in the rural schools had a significantly higher prevalence of stunting (20% vs. 3%; p < 0.0001), underweight (17% vs. 2%; p < 0.0001) and thinness (28% vs. 7%; p < 0.001) than their urban counterparts. In the urban, the odds of stunting, underweight and thinness were less among school children, while overweight/obesity was twice as likely in the urban setting. The multivariate final model showed lower odds of underweight [adjusted odds ratio (AOR) = 0.16; 95% confidence interval (CI): 0.06-0.42] and stunting [AOR = 0.33; 95% CI: 0.13-0.87] in the urban compared to the rural schools. The association of stunting with sex [AOR =0.53; 95% CI: 0.30-0.94] and the intermediate learning phase [AOR = 7.87; 95% CI: 4.48-13.82] was observed in the rural setting, while thinness was associated with living in households with an income of USD 52.51 to USD 262.60/month [AOR = 2.89; 95% CI: 1.01-8.24] and receiving the child social grant [AOR = 2.49; 0.90-6.86] in the urban setting. Overweight/obesity was associated with living in a household with an income of USD 52.51 to USD 262.60/month [AOR = 1.80; 95% CI: 1.02-3.10]. The findings suggest nutritional intervention approaches that are accustomed to the context of settings to effectively tackle malnutrition.

Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey

INTRODUCTION

Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia.

METHODS

The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition.

RESULTS

The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted.

CONCLUSION

Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.

Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan

Purpose

Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition.

Patients and Methods

A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients' records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p<0.05 taken as significant.

Results

One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35-0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21-4.68)].

Conclusion

This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.

Early initiation of breastfeeding, bottle feeding, and experiencing feeding challenges are associated with malnutrition

Malnutrition remains a public health concern amidst low proportions of the core infant and young child feeding (IYCF) practices, yet, data on specific child feeding practices that are associated with undernutrition are rare. Hence, this study sought to assess child feeding practices and their association with undernutrition among young children. An analytical cross-sectional design was used among mothers/caregivers with children aged 6-23 months, attending child welfare clinics in Techiman municipality, Ghana. Simple random sampling was used to select 8 health facilities, and 403 participants were selected from those facilities using proportional stratification. A 24-h dietary recall based on seven food groups was used to collect data on children's dietary intake and used to derive WHO child feeding indicators. The length, weight, and age of children were taken and used to compute anthropometric z-scores. The proportions of children who met their minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were 44%, 56%, and 36% respectively. Children 6-8 months [AOR=2.24, CI (1.037-4.841); p = .04] and 9-11 months [AOR=2.47, CI (1.096-5.573); p = .029], those who were not breastfed within the first hour of delivery [AOR = 3.56, CI (1.833-6.912), p < .001], and those who were bottle fed [AOR = 2.87, CI (1.374-5.973); p = .005] were more likely to be wasted. Children 6-8 months [AOR = 0.29, CI (0.126-0.672); p = .004] and 9-11 months [AOR = 0.24, CI (0.104-0.544); p = .001] and those who experienced feeding challenges [AOR = 0.52, CI (0.301-0.905); p = 0.021] were protected against stunting. The percentages of children who met their MDD, MMF, and MAD were low and not associated with undernutrition. Early initiation of breastfeeding and bottle feeding were associated with acute malnutrition and experiencing feeding challenges was associated with chronic malnutrition. Promoting appropriate child feeding practices can reduce the risk of undernutrition.

Effect of applying the health promotion model in stunting prevention and behavior control in Indonesia

BACKGROUND

Stunting is a condition of failure to thrive in children, due to chronic malnutrition and recurrent infections. This study aimed to evaluate the effectiveness of implementing the health promotion model in stunting prevention and control behavior.

MATERIALS AND METHODS

This cross-sectional quantitative analytic study was conducted using a survey method involving 228 mothers of stunted children in Indonesia. Cluster random sampling was used. Data were collected using a questionnaire with a Likert scale, and then, they were analyzed using univariate analysis, multiple linear regression, and pathway analysis to determine the direct and indirect effects.

RESULTS

All respondents were of non-risk age (20-45 years), most had height >150 cm (83.8%), moderate weight (93.4%), multigravida parity (87.3%), middle education (70.2%), unemployed (91.7%), monthly income of less than 1,800,000 rupiahs (89.9%), and exclusive breastfeeding (97.4%). Sanitation, self-efficacy, and social support had a significant effect on stunting prevention and control behavior (P < 0.05). Socioeconomic and sanitation effects through self-efficacy indirectly had a significant positive, while parenting through food or nutritional intake had a significant influence on the stunting incidence (P < 0.05). Variables that had a significant positive effect on stunting prevention and behavior directly were perceived vulnerability, perceived severity, perceived obstacles, self-efficacy, social support, community organizing, and facilitator (P < 0.05). Parenting through the health of diarrhea or acute respiratory infection (ARI) had no significant positive effect on the stunting incidence (P = 0.121).

CONCLUSION

Almost all variables have a significant direct and indirect effect on stunting prevention and control behavior, as well as the stunting incidence, except parenting through the health of diarrhea or ARI.

Factors associated with wasting and stunting among children aged 06-59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study

BACKGROUND

Child undernutrition is a major public health problem in Ethiopia despite different nutrition-specific and sensitive interventions implemented by the government. However, evidence regarding the burden and responsible factors is limited in the South Ari district. Hence, this study aimed to assess factors associated with wasting and stunting among children aged 06-59 months in the South Ari district, Southern Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted from March 11 to April 11, 2021, among 717 households with at least one child aged 06-59 months. Anthropometric measurements were taken using standard procedures and were converted to height for age Z score and weight-for-height using WHO Anthro software Version 3.2.2. Data were checked and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25.0. Binary logistic regression analysis was fitted to identify predictors of wasting and stunting. A p-value < 0.05 was used to declare statistical significance.

RESULT

The prevalence of wasting and stunting among children aged 06-59 months in the district was 9.1% (95% CI: 7.07%, 11.41%) and 59.97% (95% CI: 56.28%, 63.58%), respectively. Family size (8 and above) (AOR = 3.03, 95% CI: 1.31, 7.03), family size (5 to 7) (AOR = 2.05, 95% CI: 1.11, 3.81), poor and medium wealth index (AOR = 3.69, 95% CI: 1.65, 8.26) and (AOR = 2.29, 95% CI: 1.01, 5.16), insufficient maternal knowledge on child feeding practice (AOR = 2.58, 95% CI: 1.31, 5.07), presence of diarrhea in the past two weeks (AOR = 2.05, 95% CI: 1.10, 3.85), non-exclusive breastfeeding (AOR = 2.65, 95% CI: 1.51, 4.65), and birth interval of < 24 months (AOR = 4.49, 95% CI: 2.40, 8.37) were factors significantly associated with wasting. Whereas, children in the age group of 24-59 months (AOR = 2.24, 95% CI: 1.58, 3.16), non-exclusive breastfeeding (AOR = 1.81, 95% CI: 1.24, 2.65), birth interval of fewer than 24 months (AOR = 1.54, 95% CI: 1.11, 2.14), sub-optimal child dietary diversity score (AOR = 1.59, 95% CI: 1.14, 2.22), being a non-beneficiary of productive safety-net program (AOR = 1.91, 95% CI: 1.24, 2.95), and household food insecurity (AOR = 2.60, 95% CI: 1.86, 3.64) were factors significantly associated with stunting.

CONCLUSIONS

Wasting and stunting were found to be key public health problems in the South Ari District. Hence, further interventions should consider strategies to enhance household food security and integration of productive safety net programs with primary health care services. Rigorous work is required in advocating and strengthening the provision of family planning services, child care, and integrated management of common childhood illnesses. Moreover, behavioral change communication is highly demanded to improve child feeding practices.

Prevalence, correlates of undernutrition and intestinal parasitic infection among children below 5 years living in the forest community of Ndelele, East Region of Cameroon: A cross-sectional assessment

In low- and middle-income countries, undernutrition often co-exists with intestinal parasites, especially Soil Transmitted Helminth (STH) infections in children. The collective impact of both conditions result in undernutrition and can exacerbate the general poor health status of children. A cross-sectional survey of 422 mother-child (12-59 months old) pairs from 14 villages in the District of Ndelele, East Region of Cameroon, was carried out to assess the magnitude and correlates of undernutrition and intestinal parasites. Socio-demographic data were collected from mothers and anthropometric data were collected from children. Parasitological assessment was performed using a combination of direct microscopy flotation, sedimentation and centrifugation techniques. Correlates of undernutrition and intestinal parasites were identified using multinomial logistic regression at individual and household levels. 83.77% of the children assessed for undernutrition were undernourished and 66.82% were positive for one or more intestinal parasites. It was not uncommon for the study participants to be concurrently infected with two or more intestinal parasites. The most common intestinal parasitic infections detected in the study were A. lumbricoides, E. histolytica/dispar and Hookworm infection. Multinomial logistic regression using Nutritional status as outcome showed that, children who were not exclusively breastfed were 106% (RR = 2.06; C.I = 1.12-3.80) more likely to be underweight compared to those who were exclusively breastfed. The household size of 4 to 6 persons also significantly impacted wasting (p-value = 0.007) at 7% (RR = 1.07, C.I = 0.49-2.32). Analysis by a logistic regression model with STH infection as outcome revealed that, Fingernail cleanness (p-value = 0.044; AOR = 1.75; CI = 1.09-2.78) and household size (p-value = 0.038; AOR = 0.55; CI = 0.32-0.92) were positively associated with intestinal parasite infection at the 5% significant level. This study reveals that intestinal helminthic parasitic infections (STH) and undernutrition are serious health problems in children below five in the study area. To address this dire situation, concerted efforts are needed to improve sanitation, hygiene education access, community deworming programs, and improve diets.

Stunting and associated factors among children aged 6–59 months from productive safety net program beneficiary and non-beneficiary households in Meta District, East Hararghe zone, Eastern Ethiopia: a comparative cross-sectional study

Background

Undernutrition is one of the major public health problems affecting children in developing settings. Despite impressive interventions like productive safety net program (PSNP), there is limited information on the association between stunting and PSNP implementation in Ethiopia.

Methods

Community-based comparative cross-sectional study design was used among systematically selected 1555 children and their mothers/caregivers from households enrolled in PSNP and not, respectively, in Meta District east Ethiopia from 5th–20th of March 2017. Data were collected using pretested structured questionnaire. Measuring board was used to measure length/height of children. Length/height for age Z-score was generated using World Health Organization (WHO) Anthro version 3.2.2. Descriptive statistics was used to describe all relevant variables. Bivariable and multivariable logistic regression analyses were used to identify predictors of stunting. Odds ratio along with 95% confidence intervals were estimated to measure the strength of association. The statistical significance was declared at p value less than 0.05.

Results

The prevalence of stunting was 47.7%, 95% CI (44.1%, 51.5%) and 33.5%, 95% CI (29.9%, 36.9%) among children from households enrolled in PSNP and non-PSNP ones, respectively. Lack of maternal education [AOR = 3.39; 95% CI (1.12, 5.11)], women’s empowerment [AOR = 3.48; 95% CI (2.36, 5.12)] and fourth antenatal care visit [AOR = 4.2, 95% CI (2.5, 6.8)], practicing hand washing [AOR = 0.46; 95% CI (0.28, 0.76)], living in mid-land [AOR = 1.94, 95% CI (1.12, 3.35)] and low-land[AOR = 0.27: 95% CI (0.16, 0.45)] agro-ecological zones, PSNP membership [AOR = 1.82, 95% CI (1.14, 2.89)], childhood illness [AOR = 8.41; 95% CI (4.58, 12.76)], non-exclusive breastfeeding [AOR = 3.6; 95% CI (2.30, 4.80)], inadequate minimum dietary diversity [AOR = 4.7; 95% CI (3.0, 7.40)], child’s sex [AOR = 1.73, 95% CI (1.18, 2.53)] and age (24–59 months) [AOR = 3.2; 95% CI (1.6, 6.3)] were independent predictors of stunting.

Conclusions

The prevalence of stunting was high among children from households enrolled in PSNP. Stunting was significantly associated with maternal- and child-related factors. Therefore, women empowerment on household’s issues and improving infant and young child feeding practices could reduce the prevalence of stunting and its adverse consequences.

Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia

Background

Despite consistent efforts to reduce child undernutrition, severe acute malnutrition (SAM) continues to be a serious obstacle to child survival and development in Ethiopia. This study aimed to identify severe acute malnutrition and associated factors among children aged 6–59 months in Ethiopia.

Methods

A cross-sectional study was undertaken with 384 under-five children from February to March, 2020 in Ethiopia. A mid-upper arm circumference (MUAC) tape, weight scale, height board (standing) and recumbent length measurements (for children <24 months) were measured. To determine the variables associated with SAM, adjusted odds ratio was computed using multivariable analysis and p < 0.05 was declared as significant.

Results

The prevalence of acute undernutrition was 26%; 18% and 8% of the children were moderately and severely undernourished, respectively. Family size (≥5 members) (AOR: 3.71, 95% CI: 1.55–8.89), younger age group (6–11 months) (AOR: 4.80, 95% CI: 1.61–14.31) and history of diarrhea in the two weeks prior to the survey (AOR: 5.36, 95% CI: 1.97–14.61) were independently associated with SAM in the study population.

Conclusion

Large family size, child age, diarrheal and household insecurity were important determinants of SAM among children. Therefore, aligning social protection programmes and improving health related interventions along with improving optimal breastfeeding, prevention and control of child morbidity, and strengthening family planning services are recommended to reduce child SAM.

Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study

Background

Undernutrition accounts for nearly half of under-five child mortality in developing countries where household nutrition is largely dependent on agriculture. Despite the strong influence of agroecology on agriculture in those countries, limited information exists on whether undernutrition in children under five varies with agro-ecological location.

Methods

Using Karamoja sub-region of Uganda, one of the most food insecure parts of Eastern Africa as a case area, and applying a multi-stage sampling procedure, and a structured questionnaire, this study examined in a comparative manner, the prevalence and predictors of undernutrition in children under five among the agricultural, pastoral, and agro-pastoral ecological zones. Chi-square test and Kruskal-Wallis test were used to establish the disparity in prevalence of undernutrition and household contextual characteristics, respectively. Binary logistic regression was used to determine the predictors of undernutrition in children under five among the three agro-ecological zones. The level of statistical significance was set at p ≤ 0.05.

Results

The prevalence of underweight, stunting, and wasting ranged from 36 to 58% but varied with agroecology in terms of the peak age ranging from 6 to 37 months. Child characteristics, feeding practices, household economic factors, sanitation factors, and caregiver characteristics that predict undernutrition among children under five were identified (p ≤ 0.05). Caregiver handwashing after using latrine (p = 0.005) and diarrhoea in a fortnight (p < 0.001) increased the likelihood of stunting in pastoral agroecology only whereas cereal storage in both sacks and granary in agro-pastoral zone was associated with reduced likelihood of both underweight (p < 0.001 and p = 0.014) and stunting (p = 0.011 and p = 0.018), respectively. A male child was more likely to be underweight and stunted in pastoral (p = 0.002 and p = 0.011) and agro-pastoral (p = 0.017 and p = 0.002) agroecology, respectively. Household expenses reduced the likelihood of both underweight and wasting in pastoral (p = 0.013 and p = 0.005) and agricultural (p = 0.011 and p = 0.021) agroecology, respectively. Flour storage duration increased the stunting likelihood in pastoral (p = 0.032) and agro-pastoral (p = 0.006) agroecologies.

Conclusion

This study has revealed that, in a food insecure developing country setting such as Karamoja sub-region of Uganda, undernutrition among children under five varies with agroecology. Thus, nutritional interventions in such locations should be agroecology specific.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03363-6.

Factors Related to Underweight Prevalence among 33,776 Children Below 60 Months Old Living in Northern Geopolitical Zones, Nigeria (2008–2018)

The prevalence of underweight among children below 60 months old in Nigeria remains a significant public health challenge, especially in northern geopolitical zones (NGZ), ranging from 15% to 35%. This study investigates time-based trends in underweight prevalence and its related characteristics among NGZ children below 60 months old. Extracted NGZ representative dataset of 33,776 live births from the Nigeria Demographic and Health Survey between 2008 and 2018 was used to assess the characteristics related to underweight prevalence in children aged 0–23, 24–59, and 0–59 months using multilevel logistics regression. Findings showed that 11,313 NGZ children below 60 months old were underweight, and 24–59-month-old children recorded the highest prevalence (34.8%; 95% confidence interval: 33.5–36.2). Four factors were consistently significantly related to underweight prevalence in children across the three age groups: poor or average-income households, maternal height, children who had diarrhoea episodes, and children living in the northeast or northwest. Intervention initiatives that include poverty alleviation through cash transfer, timely health checks of offspring of short mothers, and adequate clean water and sanitation infrastructure to reduce the incidence of diarrhoea can substantially reduce underweight prevalence among children in NGZ in Nigeria.

Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis

Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.

Factors Associated With Pre-Lacteal Feeding Practices Among Mothers Having Children Aged 0-36 Months in Bangladesh: Evidence From Bangladesh Demographic and Health Survey 2017-18

Despite being a known barrier to optimal breast-feeding indicators, the practice of Pre-lacteal Feeding (PLF) remains a key challenge in Bangladesh. This study examines the prevalence and underlying factors associated with PLF, for which data from a weighted sample of 4982 Bangladeshi mothers with children aged 0 to 36 months from the 2017-18 Bangladesh Demographic and Health Survey was used. Step-by-step multivariate logistic regression was performed to identify the association of significant determinants of PLF practices. Nearly 29% newborns received PLF before breastmilk and timely initiation of breastfeeding did not happen in case of 20.5% babies. The odds of PLF were significantly higher among the inhabitants of Dhaka division compared to other regions. In addition, birth-related factors such as optimal ANC visits (P < .01), home delivery (P < .01) and delivered by cesarean section (P < .01) showed significantly higher odds of introducing PLF to the newborns. Our results demonstrated the need for developing targeted policies and actions to prevent such practices of PLF in order to improve optimal breastfeeding behavior in Bangladesh.

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.

Prevalence of Undernutrition and Its Associated Factors Among Lactating Women in the Shebedino District, Sidama Regional State, Ethiopia

Background: Ensuring the nutritional status of lactating women is crucial to prevent maternal morbidity and mortality in poor countries like Ethiopia. Hence, this study aimed to assess the prevalence of undernutrition and its associated factors among lactating women in Shebedino district, Sidama Regional State, Ethiopia.

Methods: A community-based cross-sectional study was conducted among randomly selected 612 lactating women from February to March 2020. Data were collected by using an interviewer-administered, structured, and pretested questionnaire. Also, physical measurements (weight, height, and body mass index) were measured by using standardized and calibrated instruments. Data entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were done. A P-value of ≤.05 was used to consider the statistical significance.

Result: The prevalence of undernutrition was 25.9% (95% CI: 22.5, 29.5). Having polygamous husband (AOR = 3.47, 95% CI: 1.13, 10.68), belonged to households with less than 5 members (AOR = 1.81, 95% CI: 1.16, 2.83), abortion history in the last 6 months (AOR = 3.09, 95% CI: 1.73, 5.51), poor household wealth status (AOR = 3.85, 95% CI: 1.89, 7.81), and medium wealth status (AOR = 2.07, 95% CI: 1.06, 4.03) were factors positively associated with undernutrition.

Conclusion: Undernutrition among lactating women was high in the study area. Attention should be given to the economic status of the women, family planning services, abortion prevention, and habits of marrying more than 1 wife (polygamy).

Undernutrition and Associated Factors Among Children Aged 6-23 Months in Dessie Town, Northeastern Ethiopia, 2021: A Community Based Cross-Sectional Study

BACKGROUND

Globally about 159, 101, and 52 million children are stunted, underweight, and wasted, respectively. According to the 2016 Ethiopian Demographic and Health Survey, about 38% of Ethiopian children are stunted and 46, 28.4, and 9.8% of children in Amhara Region are stunted, underweight and wasted, respectively. This study aimed to assess undernutrition and associated factors among children aged 6-23 months old at Dessie town, 2021.

METHOD

A community-based cross-sectional study was conducted from October - November 2021 in Dessie Town. A total of 421 Mothers/caregivers with children aged 6-23 months old were selected by a systematic sampling method from the health extension registration book. Epi-data 3.01 was used for data entry, SPSS version 20 for statistical analysis, and WHO Anthro version 3.2.2 software for calculating the z scores. Binary logistic regression and multivariate logistic regression were used to analyze the data. AOR with 95% CI and P-values less than 0.05 were considered to see the statistical significance.

RESULTS

A total of 421 mothers or care givers paired with 6-23 months old children participated in the study. The prevalence of stunting, underweight, wasting were 36.8% (95% CI: 32%, 41.6%), 27.6% (95% CI: 23.6%, 32.2%), and 11.5% (95% CI: 8.4%, 14.7%) respectively. Sex of the child (AOR = 1.55; 95% CI: 1.02, 2.34), handwashing practice (AOR = 2.32; 95% CI: 1.05, 5.11) and maternal family planning use (AOR = 0.39; 95% CI: 0.19, 0.77) were significantly associated with stunting. Age of child 12-17 months (AOR = 4.62; 95% CI: 2.65, 8.06) and sex of the child (AOR = 1.93; 95% CI: 1.21, 3.07) were associated with underweight. Age of child 12-17 months (AOR = 2.25; 95% CI: 1.06, 4.78) and treatment of drinking water (AOR = 0.21; 95% CI: 0.07, 0.59) were associated with wasting.

CONCLUSION AND RECOMMENDATION

In this study, the prevalence of undernutrition among children aged 6-23 months was higher for stunting (36.8%), underweight (27.6%) and wasting (11.5%) compared to WHO classification. Improved access to water, hygiene and sanitation, family planning services, avoiding gender discrimination during child feeding, and age-appropriate feeding practices are recommended. Moreover, implementation of public policies on food and nutrition is required for children 6-23 months of age.

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.

Prenatal and Postnatal Household Air Pollution Exposure and Infant Growth Trajectories: Evidence from a Rural Ghanaian Pregnancy Cohort

BACKGROUND

The exposure-response association between prenatal and postnatal household air pollution (HAP) and infant growth trajectories is unknown.

OBJECTIVES

To evaluate associations between prenatal and postnatal HAP exposure and stove interventions on growth trajectories over the first year of life.

METHODS

The Ghana Randomized Air Pollution and Health Study enrolled n=1,414 pregnant women at ≤24wk gestation from Kintampo, Ghana, and randomized them to liquefied petroleum gas (LPG), improved biomass, or open fire (control) stoves. We quantified HAP exposure by repeated, personal prenatal and postnatal carbon monoxide (CO) and, in a subset, fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] assessments. Length, weight, mid-upper arm circumference (MUAC) and head circumference (HC) were measured at birth, 3, 6, 9, and 12 months; weight-for-age, length-for-age (LAZ), and weight-for-length z (WLZ)-scores were calculated. For each anthropometric measure, we employed latent class growth analysis to generate growth trajectories over the first year of life and assigned each child to a trajectory group. We then employed ordinal logistic regression to determine associations between HAP exposures and growth trajectory assignments. Associations with stove intervention arm were also considered.

RESULTS

Of the 1,306 live births, 1,144 had valid CO data and anthropometric variables measured at least once. Prenatal HAP exposure increased risk for lower length [CO odds ratio (OR)= 1.17, 95% CI: 1.01, 1.35 per 1-ppm increase; PM2.5 OR= 1.07, 95% CI: 1.02, 1.13 per 10-μg/m3 increase], lower LAZ z-score (CO OR= 1.15, 95% CI: 1.01, 1.32 per 1-ppm increase) and stunting (CO OR= 1.25, 95% CI: 1.08, 1.45) trajectories. Postnatal HAP exposure increased risk for smaller HC (CO OR= 1.09, 95% CI: 1.04, 1.13 per 1-ppm increase), smaller MUAC and lower WLZ-score (PM2.5 OR= 1.07, 95% CI: 1.00, 1.14 and OR= 1.09, 95% CI: 1.01, 1.19 per 10-μg/m3 increase, respectively) trajectories. Infants in the LPG arm had decreased odds of having smaller HC and MUAC trajectories as compared with those in the open fire stove arm (OR= 0.58, 95% CI: 0.37, 0.92 and OR= 0.45, 95% CI: 0.22, 0.90, respectively).

DISCUSSION

Higher early life HAP exposure (during pregnancy and through the first year of life) was associated with poorer infant growth trajectories among children in rural Ghana. A cleaner-burning stove intervention may have improved some growth trajectories. https://doi.org/10.1289/EHP8109.

EVALUATION OF PROTEIN AND IRON ABSORPTION OF MOCAF-BASED WEANING FOOD

Weaning food biscuit based on mocaf (modified cassava flour) with substitution of soybean, mung bean and red kidney bean flour is expected increasing protein of the product. However, in the legumes flour there are anti-nutritional agent that can affect the absorption of other nutrient such as protein and iron. The purpose of this study was to evaluate the absorption of protein and iron from mocaf based-weaning food. Protein and iron absorption were determined from weaning food (biscuit) using Sprague-Dawley rats, 3 weeks old, weight 70-80 g for 0, 30, 60, 90, and 120 minutes. The treatments of this study were mocaf biscuits (as a control), biscuits with substitution of soybean flour (MSF), mung bean flour (MMF), red kidney bean flour (MRF) and commercial biscuits (CB). The highest protein absorption of control, MSF and MRF were at 120 minutes with absorption percentages 27.76, 38.94, and 9.35%, respectively. Samples MMF and CB had the highest protein absorption at 60 and 90 minutes, with absorption percentages 15.58 and 37.57%. Meanwhile, the highest iron absorption of control, MSF and MMF were at 90 minutes with absorption percentages 53.86, 4.71, and 54.29%. Samples MRF and CB had highest iron absorption at 60 minutes with absorption percentages 7.97 and 69.76%, respectively. The MSF sample had highest protein absorption than other samples. Meanwhile, the MMF sample had an iron absorption value that approached to commercial biscuit.

The Magnitude of Wasting and Associated Factors among Children Aged 2-5 Years in Southern Ethiopia: A Cross-Sectional Study

Background

Malnutrition accounts for almost half of the global under-five child mortality. Worm infections are one of the immediate and commonest causes that affect the nutritional status of children. There is limited data related to the magnitude of wasting and associated factors among children. Therefore, this study was aimed at assessing the magnitude of wasting and associated factors among children aged 2 to 5 years in the Wonago district of Gedeo Zone, southern Ethiopia.

Methods

Community-based cross-sectional study design was conducted. A total of 3324 children aged 2-5 years were included in the study. A pretested semistructured questionnaire was used for data collection, and anthropometric measurements were computed using the World Health Organization Anthro-nutritional software. The multivariate logistic regression analyses with adjusted odds ratio, 95% confidence interval, and P value less than 0.05 were used to identify the factors significantly associated with wasting.

Results

A total of 3273 children aged 2-5 years participated with a 98.5% response rate. The magnitude of wasting was 13%. The factors like government-employed fathers [AOR = 1.93; 95% CI (1.08, 3.46)], child's age range between 48 and 59 months [AOR = 1.46; 95% CI (1.01, 2.09)], being a male child [AOR = 1.42; 95% CI (1.07, 1.88)], having diarrheal disease in the past two weeks [AOR = 0.39; 95% CI (0.17, 0.90)], and bathing less than two times per week [AOR = 1.42; 95% CI (1.03, 1.96)] were factors significantly associated with wasting.

Conclusion

Undernutrition in children is still a problem, and the proportion of wasting was 13%. Government-employed fathers, child's age range between 48 and 59 months, being a male child, having diarrheal disease in the past two weeks, and bathing below two times per week were significantly associated with children's nutritional status warranting close attention by policymakers and stakeholders. For researchers, a further longitudinal study is recommended to get strong evidence.

Assessment of Prevalence and Factors Associated with Malnutrition Among Under-Five Children in Debre Berhan Town, Ethiopia

Background

Malnutrition is a deficiency or improper intake of energy and nutrients. It includes undernutrition (wasting, stunting, underweight, and mineral and vitamin-related malnutrition) and overnutrition.

Purpose

To estimate the prevalence and identify the risk factors for undernutrition among under-five children in Debre Berhan Town, North Shewa, Ethiopia.

Methods

A community-based cross-sectional study was conducted in Debre Berhan Town, from October 07, 2019 to January 24, 2020. Three hundred and eighty-five under-five children who were selected using systematic random sampling technique were included in this study. To collect data, a structured questionnaire and anthropometrical measurements were used. Data entry was done through Epi data 4.21, and for data analysis statistical package for social sciences version 20.0 was employed. Bivariate and multivariable logistic regression analysis was used to identify the factors associated with malnutrition. The statistical significance was stated at p value <0.05 with 95% confidence intervals.

Results

In the overall sample the total prevalence of undernutrition in below age-5 children was 61 (15.8%), the corresponding figures for underweight, stunted, and wasting were 26%, 41%, and 33%, respectively. Factors that contributed to under-five undernutrition were maternal illiteracy, not breastfeeding exclusively, preterm birth, absence of antenatal care, exposure to infectious diseases and diarrhea.

Conclusion

There was a higher prevalence of stunting (41%), wasting (33%), and being underweight (26%) in Debre Berhan town than the national (Ethiopia) or regional (Amhara) malnutrition prevalence. Mothers’ educational status should be improved by teaching them that proper nutrition is important for their child’s growth and development. Antenatal care for all pregnant women, education on child care, infection prevention, and child feeding should be provided and further strengthened.

Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study

BACKGROUND

Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user.

OBJECTIVE

To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia.

METHODS

A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.

RESULTS

The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever.

CONCLUSION

The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.

Level of hemoglobin among cow milk and camel milk consuming young children: A comparative study

BACKGROUND

Cow milk is an important source of macro-and micronutrients. However, it has low iron content but high content of casein and calcium thus could negatively influence hemoglobin synthesis. On the other hand, camel milk contains higher iron concentration than cow milk. In addition, the majority of iron in camel milk is associated with the lower molecular fraction of casein suggesting better bioavailability. Furthermore, vitamin C concentration, a useful iron absorption enhancer, is more than three-fold greater in camel milk than cow milk. This study compared hemoglobin concentration among young children consuming consistently cow milk or camel milk.

METHODS

Hemoglobin concentration of young children (aged 6-59 mo) from settled pastoralist communities of the Somali region, Ethiopia, consistently consuming cow milk (n = 166) or camel milk (n = 166) was determined. In addition, socio-demographic and water, sanitation, and hygienic (WASH) conditions of study participants' households were captured. Furthermore, dietary intake and anthropometric characteristics of participating children were assessed.

RESULTS

Among the participating children, 38.6% were underweight, 33.4% were stunted, and 34.5% were wasted. In addition, 77.4% of children were anemic. The present study households had poor WASH conditions. Only 0.6% of children had the minimum acceptable dietary diversity. There was small but significant mean hemoglobin difference among camel milk and cow milk consuming children (9.6±1.8 g/dl vs 9.1±2.2 g/dl; p = 0.012). In addition, the odds of low hemoglobin concentration was greater among cow milk consuming children than camel milk consuming children [AOR 2.17; 95 CI; 1.39, 3.37; p = 0.001]. However, the overall anemia prevalence among the two groups was similar.

CONCLUSION

Camel milk consumption is associated with better hemoglobin concentration but may not be sufficient to prevent anemia in populations from resource poor settings. The etiology of anemia is multifactorial thus further studies on the link between milk consumption and hemoglobin concentration are important.

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia

BACKGROUND

Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices.

METHODS

A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used.

RESULTS

A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition.

CONCLUSIONS

Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Associated risk factors of underweight among under-five children in Ethiopia using multilevel ordinal logistic regression model

Background

Malnutrition is associated with both under nutrition and over nutrition which causes the body to get improper amount of nutrients to maintain tissues and organ function. Under nutrition is the result of insufficient intake of food, poor utilization of nutrients due to illnesses, or a combination of these factors. The purpose of this study was to identify associated risk factors and assess the variation of underweight among under-five children of different regions in Ethiopia.

Methods

Ethiopian Demography and Health Survey (EDHS-2016) weight-to-age data for under-five children is used. In order to achieve the objective of this study; descriptive, single level and multilevel ordinal logistic regression analysis were used.

Results

From a total of 8935 children about 8.1% were severely underweight, 17.1% were moderately underweight and 74.8% were normal. The test of heterogeneity suggested that underweight varies among region and multilevel ordinal model fit data better than single level ordinal model.

Conclusion

Educational level of mother, religion, birth order, type of birth, sex of child, mother body mass index, birth size of child, existence of diarrhea for last two weeks before survey, existence of fever for last two weeks before survey, duration of breast feeding, age child and wealth index had significant effect on underweight among under-five children in Ethiopia. The finding revealed that among the fitted multilevel partial proportional odds model, the random intercept model with fixed coefficients is appropriate to assess the risk factors of underweight among under-five children in Ethiopia. The findings of this study have important policy implications. The government should work closely with both the private sector and civil society to teach women to have sufficient knowledge, awareness and mechanisms of improving under-five underweight for children's wellbeing.

Changes in socio-economic inequality in nutritional status among children in EAG states, India

OBJECTIVE

The primary purpose of this study is to examine changes in socio-economic inequality in nutritional status (stunting and underweight) among children in Empowered Action Group (EAG) states.

DESIGN

The study is based on the most recent two wave's cross-sectional data from the National Family Health Survey (NFHS) conducted in 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4). The study used height-for-age (stunting) and weight-for-age (underweight) of children as anthropometric indicators.

SETTING

EAG states including Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh in India.

PARTICIPANTS

The study includes a total of 11 858 (NFHS-3) and 92 630 (NFHS-4) children under 5 years of age.

RESULT

The socio-economic inequality in stunting remained unchanged in all EAG states. At the same time, the inequality in underweight decreased during 2005-2016. On decomposing, the factors contributing to socio-economic inequality revealed that household wealth index, mother's education and mother's nutritional status were the largest contributors to stunting (47 %, 24 % and 8 %) and underweight (51 %, 21 % and 16 %), respectively, in 2015-2016.

CONCLUSION

The study concluded the socio-economic inequality in underweight among children under 5 years of age increased over the years in EAG states in India. Altogether, household wealth index, mother's education and mother's nutritional status contributed to nearly 80 % to inequality in stunting and 90 % to inequality in underweight in 2015-2016. Hence, efforts should be made to minimise the socio-economic inequality in the nutritional status of children, particularly in EAG states in India.

Low Economic Class Might Predispose Children under Five Years of Age to Stunting in Ethiopia: Updates of Systematic Review and Meta-Analysis

Background

Malnutrition is major public health problem worldwide, particularly in developing countries including Ethiopia. In 2016, out of 667 million children under five years of age, 159 million were stunted worldwide. The prevalence of stunting has been decreasing greatly from 58% in 2000 to 44% in 2011 and 38% in 2016 in Ethiopia. However, the prevalence of stunting is still high and considered as public health problem for the country. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among children under five years of age in Ethiopia. Methodology. The databases searched were MEDLINE, Scopus, HINARI, and grey literature studies. The studies' qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist. The JBI checklist was used in assessing the risk of bias and method of measurement for both outcome and independent variables. Especially, the study design, study participants, definition of stunting, statistical methods used to identify the associations, results/data presentations, and odds ratios (ORs) with confidence intervals (CIs) were assessed. In the statistical analysis, the funnel plot, Egger's test, and Begg's test were used to assess publication bias. The I² statistic, forest plot, and Cochran's Q-test were used to deal with heterogeneity.

Results

In this review, 35 studies were included to assess the pooled prevalence of stunting. Similarly, 16 studies were used to assess the estimated effect sizes of wealth index on stunting. In this meta-analysis, the pooled prevalence of stunting was 41.5% among children under five years of age, despite its considerable heterogeneity (I² = 97.6%, p < 0.001, Q = 1461.93). However, no publication bias was detected (Egger's test p=0.26 and Begg's test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR: 1.33, 95% CI 1.07, 1.65 or AOR: 1.92, 95% CI 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Both of the estimated effect sizes of low and medium wealth indexes had substantial heterogeneity (I² = 63.8%, p < 0.001, Q = 44.21 and I² = 78.3%, p < 0.001, Q = 73.73) respectively). In estimating the effect, there was no publication bias (small-studies effect) (Egger and Begg's test, p > 0.05).

Conclusions

The pooled prevalence of stunting was great. In the subgroup analysis, the Amhara region had the highest prevalence of stunting, followed by the Oromia and Tigray regions, respectively. Low economic status was associated with stunting in Ethiopia. This relationship was found to be statistically more accurate in Oromia and Amhara regions. The government should emphasize community-based nutrition programs by scaling up more in these regions, just like the Seqota Declaration.

Dietary condition and feeding practices of children aged 6-23 months in Ethiopia: analysis of 2005-2016 demographic and health survey

BACKGROUND

Childhood malnutrition is well estimated as the major underlying risk factor for morbidity and mortality in children under 5 years. Feeding practices greatly influence the dietary condition of children aged 6-23 months in developing countries. Therefore, this study was performed to determine the association between infant young children feeding (IYCF) practices and the dietary conditions of children aged 6-23 months in Ethiopia.

METHOD

A cross-sectional study was conducted based on data on 5638 children aged 6-23 months from three Ethiopia Demographic and Health Surveys (EDHS) (2005, 2011, 2016). Multivariable logistic regression was performed to estimate the odd ratios (ORs) and 95% confidence intervals (CIs) of stunting and anaemia with IYCF practices.

RESULT

The prevalence of stunting among children aged 6-23 months in Ethiopia decreased greatly from 49% in 2005 to 32% in 2016. Among the IYCF practices, consumption of iron-rich foods, minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were significant predictors of stunting. In addition, the prevalence of anaemia declined significantly from 26% in 2005 to 16% in 2011, but increased to 29% in 2016. Among the IYCF practices, breastfeeding and minimum meal frequency (MMF) had lower odds of childhood anaemia.

CONCLUSIONS

The present study showed that anaemia and stunting among children aged 6-23 months in Ethiopia is critical public health problems that need urgent attention.

A Community-Based School Nutrition Intervention Improves Diet Diversity and School Attendance in Palestinian Refugee Schoolchildren in Lebanon

BACKGROUND

School feeding programs have the potential to supply children with healthy school food, alleviate short-term hunger, and improve children's educational outcomes.

OBJECTIVES

We linked community kitchens to a subsidized school snack intervention and assessed the impact of this intervention on nutritional (diet diversity, hemoglobin, and anthropometry) and educational (attendance and academic performance) outcomes of Palestinian refugee schoolchildren.

METHODS

We collected data from 1362 students (aged 5-15 y) and their parents at baseline, and at an 8-mo follow-up in 2 control and 2 intervention schools. We conducted linear, logistic, and negative binomial regression analyses to assess changes in outcomes of children participating in the intervention schools compared with children in control schools (intention-to-treat). We also assessed the impact of the snack intervention in children who participated ≥50% of the time (HP, high-participation) compared with those who participated <50% (LP, low-participation), or who only received nutrition education (control) (per protocol). All the analyses were adjusted for child age and gender, maternal education, household expenditure, and school-level clustering effect.

RESULTS

At endline, there were 648 children in the control group, and within the intervention group, 260 children were LP and 454 were HP. There was a significantly greater increase in overall diet diversity score and dairy consumption in the HP group compared with controls. Both LP and HP groups were more likely to consume proteins, and less likely to consume desserts than controls. Furthermore, the HP group had a significant increase in hemoglobin, and both LP and HP groups had a significant decrease in school absenteeism compared with controls.

CONCLUSIONS

This community-based school nutrition intervention had a positive impact on diet diversity, hemoglobin, and school attendance of children.

Towards identifying malnutrition among infants under 6 months: a mixed-methods study of South-Sudanese refugees in Ethiopia

OBJECTIVES

To determine (i) whether distinct groups of infants under 6 months old (U6M) were identifiable as malnourished based on anthropometric measures and if so to determine the probability of admittance to GOAL Ethiopia's Management of At Risk Mothers and Infants (MAMI) programme based on group membership; (ii) whether there were discrepancies in admission using recognised anthropometric criteria, compared with group membership and (iii) the barriers and potential solutions to identifying malnutrition within U6M.

DESIGN

Mixed-methods approaches were used, whereby data collected by GOAL Ethiopia underwent: factor mixture modelling, χ2 analysis and logistic regression analysis. Qualitative analysis was performed through coding of key informant interviews.

SETTING

Data were collected in two refugee camps in Ethiopia. Key informant interviews were conducted remotely with international MAMI programmers and nutrition experts.

PARTICIPANTS

Participants were 3444 South-Sudanese U6M and eleven key informants experienced in MAMI programming.

RESULTS

Well-nourished and malnourished groups were identified, with notable discrepancies between group membership and MAMI programme admittance. Despite weight for age z-scores (WAZ) emerging as the most discriminant measure to identify malnutrition, admittance was most strongly associated with mid-upper arm circumference (MUAC). Misconceptions surrounding malnutrition, a dearth of evidence and issues with the current identification protocol emerged as barriers to identifying malnutrition among U6M.

CONCLUSIONS

Our model suggests that WAZ is the most discriminating anthropometric measure for malnutrition in this population. However, the challenges of using WAZ should be weighed up against the more scalable, but potentially overly sensitive and less accurate use of MUAC among U6M.

Drivers of stunting reduction in Ethiopia: a country case study

BACKGROUND

Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y.

OBJECTIVES

The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level.

METHODS

This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000-2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken.

RESULTS

National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls' education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls' education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction.

CONCLUSIONS

Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.

Feeding practices for toddlers with stunting in Jakarta: A case study

Stunting represents a child's failure to thrive. On the basis of the World Health Organization child growth standards, stunting is a height of <-2 SD of the z-score for the child's age. There are several major causes of stunting. One is the inability to optimize child feeding practices. The aim of this study was to explore the feeding practices that lead to stunting in toddlers in Jakarta. The participants in this study were 15 mothers. Content analysis was the method that was chosen for this study. The data analysis revealed four themes that describe the feeding practices for toddlers with stunting in Jakarta: i) mothers providing instant porridge and ready-to-serve steamed chicken rice; ii) a feeding frequency of small portions only 2-3 times per day; iii) a lack of diet diversity; and iv) the suboptimal intake of iron-rich foods. The provision of effective education about appropriate feeding practices to pregnant women and mothers with toddlers is expected to reduce the incidence of stunting in Indonesia.

Environmental enteric dysfunction and child stunting

In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.

An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria

Introduction

Good nutritional status is pertinent to the optimal outcome of effective ART among children. Against this backdrop, the objective of the current study is to assess the nutritional indices of children receiving ART in South-West Nigeria.

Methods

The study was cross-sectional in design. We randomly selected three urban and six rural ART sites from the ones offering ART services in Oyo state. All consented children receiving ART treatments in the aforementioned sites participated in the study. A total of 390 HIV-positive children and adolescents aged 6–18 years were interviewed using a semi-structured interviewer-administered questionnaire. Children were assessed and growth curves were constructed using the 2007 World Health Organisation (WHO) growth reference standard for children as well as adolescents. Data were presented using descriptive statistics.

Results

About 52% of the children are male, 136 (34.9%) have lost at least one parent, 52 (13.3%) have lost either parent to HIV/AIDS. Among the males, 19%, 27%, and 27% were underweight, stunted and thin, respectively when compared with 17%, 23% and 23%, respectively, among females. The male and female weight-for-age average z-score were (-0.98 vs -1.04), height-for-age (-1.12 vs -1.07), and BMI-for-age (-1.19 vs -1.18). Irrespective of age, sex, parental survival, and residence, weight-for-age and BMI-for-age analysis revealed substantial underweight, with the worst outcomes being among those orphaned by HIV/AIDS.

Conclusion

All nutritional indices considered in this study fell short of the WHO standard. HIV positive children in the ART sites included in this study are faced with a high burden of undernourishment despite been placed on daily ART regimens. In addition to efficient ART, interventions to ameliorate poor nutritional status is needed.

Determinants of underweight among 6-59 months old children in Berahle, Afar, North East Ethiopia: a case control study 2016

OBJECTIVE

The objective of this study was to identify determinants of underweight among 6-59 months old children in Berahle Woreda, Afar, North East Ethiopia, in 2016.

RESULT

The median age (IQR) of cases and controls were 24 (34) and 18 (23) months respectively and 51.6% of the children were not exclusively breast-fed but 64.8% controls were exclusively breastfed. Age group of 48-59 months (AOR = 11.93; 95% CI 3.88-36.67), illiterate mothers (AOR = 2.32; 95% CI 1.19-4.55), low dietary diversity (AOR = 4.57; 95% CI 2.40-8.69), diarrhea in the past of 2 weeks (AOR = 2.93; 95% CI 1.46-5.85), birth interval (AOR = 5.17; 95% CI 2.37-11.26) and unprotected source of water (AOR = 2.62; 95% CI 1.42-4.85) were determinant factors of underweight.

Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa

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.

Methodology for developing and evaluating food-based dietary guidelines and a Healthy Eating Index for Ethiopia: a study protocol

INTRODUCTION

Food-based dietary guidelines (FBDGs) are used to promote and maintain healthy eating in a population, by providing country-specific guidance. However, many African countries like Ethiopia do not have FBDGs. This paper describes the methodology for the development of Ethiopian FBDGs and for creating and evaluating a Healthy Eating Index and a scoring tool that can be used to monitor the adherence of the population to FBDGs.

METHODS AND ANALYSIS

A multidisciplinary technical working group will be tasked to develop FBDGs for the general population above 2 years of age based on identification of priority diet-related public health problems and risk factors, and a systematic review of dietary patterns in relation to the identified priority health outcomes, following a multistep process. FBDGs will be translated into daily food choices for specific subpopulations by applying linear programming using data from the National Food Consumption Survey (NFCS) of 2011. FBDGs will be evaluated for cultural appropriateness, acceptability, consumer understanding and practicality. A dietary gap assessment will be conducted by comparing the national food supply with the country's food demand. In addition an Ethiopian Healthy Eating Index (EHEI) will be developed based on the FBDGs using the NFCS data. The EHEI will be evaluated by comparing the EHEI Score based on 24 hours diet recall with that of the EHEI Score based on a Food Frequency Questionnaire, by analysing the association of the EHEI Score with population characteristics and micronutrient intake with or without additional adjustment for energy intake. Finally, a brief Food Quality Screening tool scoring for the important EHEI components will be developed to enable evaluation for counselling.

ETHICS AND DISSEMINATION

Ethical approval is received from the Scientific and Ethical Review Office of the Ethiopian Public Health Institute. The findings will be disseminated through peer-reviewed publications.A dissemination workshop will be organised with key implementing sectors of the food system for a healthier diet (http://a4nh.cgiar.org/our-research/research-flagships/) and with key public and private partners. The findings from this study will be translated into FBDGs and shared through conferences, reports and the mass media (TV and radio).

TRIAL REGISTRATION NUMBER

NCT03394963; Pre-results.

Determinants of none-exclusive breast feeding practice among HIV positive women at selected Health Institutions in Ethiopia: case control study

OBJECTIVE

Exclusive breast feeding (EBF) has been practiced all over the world as the best way of cost effective feeding practice, particularly in the developing countries. This practice is associated with a lower risk of human immunodeficiency virus transmission than mixed feeding. 'Studies focusing on determinants of EBF among women living with HIV are limited. Hence, the current study is aimed at identifying those determinants.

RESULT

This study showed that being employed (AOR = 4.363, 95% CI 2.324 to 8.191), home delivery (AOR = 0.029, 95% CI 0.004 to 0.235) and secondary education (AOR = 10.351, 95% CI 1.297 to 82.628) are significantly associated with non-EBF. In this study none EBF practice was significantly associated with women who are employed, delivered at home and educational status.

Prevalence of Malnutrition and Associated Factors among Under-Five Children in Pastoral Communities of Afar Regional State, Northeast Ethiopia: A Community-Based Cross-Sectional Study

BACKGROUND

Malnutrition among children remains one of the most important causes of morbidity and mortality in the world. In Ethiopia, malnutrition is one of the most serious public health problem and the biggest in the world. This study aimed to assess the prevalence of malnutrition and associated factors among under-five children in pastoral communities of Afar Regional state, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was conducted on 840 children aged 6-59 months from March 01-25, 2017. A multistage cluster sampling method was used to select the study participants. A structured questionnaire was used and anthropometric measurements were taken to collect data. EPI Data 3.1 and SPSS version 20.0 were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression analysis was used to identify the factors associated with malnutrition. The statistical significance was declared at p value < 0.05 with 95% confidence intervals in the final model.

RESULT

The study found the prevalence of wasting, stunting, and underweight was 16.2% (95% CI: 13.8-18.8%), 43.1% (95% CI: 39.8-46.5%), and 24.8% (95% CI: 21.9-27.8%), respectively. Family size (AOR = 2.72, 95% CI: 1.62-4.55), prelacteal feeding (AOR = 3.81, 95% CI: 1.79-5.42), and diarrhoea in the past two weeks (AOR = 4.57, 95% CI: 2.56-8.16) were associated with wasting. And sex of child (AOR = 1.98, 95% CI: 1.46-2.72), age of child ((12-23 months: AOR = 3.44, 95% CI: 2.24-5.29); (24-35 months: AOR = 3.58, 95% CI: 2.25-5.69); and (36-59 months: AOR = 4.42, 95% CI: 2.79-6.94)), and immunization status of child (AOR = 3.34, 95% CI: 1.31-4.81) were predictors for stunting. Moreover, mother's education (AOR = 4.06, 95% CI: 2.01-8.19), sex of child (AOR = 1.83, 95% CI: 1.29-2.94), prelacteal feeding (AOR = 2.81, 95% CI: 1.64-3.72), and immunization status of child (AOR = 3.17, 95% CI: 2.14-4.99) were significantly associated with underweight.

CONCLUSIONS

This study indicated that child malnutrition was high among under-five children. Family size of five and above, receiving prelacteal feeding, and diarrhoea in the past two weeks were positively associated with wasting. Male child, increasing age of child, and not fully immunized child were positive predictors for increasing stunting. Maternal illiteracy, male child, prelacteal feeding, and not fully immunized child were factors affecting underweight. Promoting use of family planning, preventing diarrhoeal diseases, and vaccinating children integrated with the access of nutrition education programs are vital interventions to improve nutritional status of the children.

Predictors of inappropriate complementary feeding practice among children aged 6 to 23 months in Wonago District, South Ethiopia, 2017; case control study

Background

Inappropriate complementary feeding practice could result in child illness, sub-optimal growth and development. Evidence shows a huge burden of inappropriate complementary feeding practice from global to national level. But studies regarding predictors of inappropriate complementary feeding practices were scarce especially in the study area. Therefore, the aim of this study was to determine predictors and community level factors associated with inappropriate complementary feeding practice among children age 6 to 23 months in Wonago district, South Ethiopia.

Methods

A community based unmatched case-control study design complemented by a qualitative and dietary data was employed among children in Wonago district from April- 07 to June- 06, 2017. A total of 372 study subjects were enrolled to the study by stratified sampling technique. Data were checked, coded and entered to Epi data and exported to SPSS for analysis. Univariate, bivariable and multivariable logistic regressions analyses were applied. A p- value < 0.05 was considered as statistical significant level.

Results

Paternal household decision making on feeding(AOR = 4.65, 95% CI = (1.69, 12.81)), family priority to elders during feeding(AOR = 2.35, 95% CI = (1.08, 5.14)), absence of nearby health facility(AOR = 4.15, 95% CI = (1.63, 10.55)), unplanned pregnancy (AOR = 3.45, 95% CI = (1.21, 9.85)), missing ANC(AOR = 2.71, 95% CI = (1.48, 4.96)) and missing EPI service utilization (AOR = 2.43, 95% CI = (1.34, 4.38)) were independent predictors of inappropriate complementary feeding practices. Whereas; lack of awareness, short birth spacing practice, poverty and feeding culture were community related factors. The nutrient density of complementary foods were below WHO desired density level except for energy, protein and vitamin C.

Conclusions

Inappropriate complementary feeding practice was related to household feeding cultures, health service access and utilization and community related factors like awareness, poverty and low birth spacing. Complementary foods were found to have lower nutrient density than desired by WHO. Promoting community’s health service utilization and increasing awareness regarding complementary feeding were recommended.

"Wasting away": Diabetes, food insecurity, and medical insecurity in the Somali Region of Ethiopia

Most research on diabetes has taken place in cities or in high-income countries, even though most diabetes deaths occur in low and middle-income countries, and diabetes disproportionately affects the poor. This research, by contrast, investigates rising concerns about diabetes among Somalis in eastern Ethiopia--in communities where obesity is rare and people face chronic food insecurity, forced displacement, recurrent humanitarian crises, and lack of access to medical care. Findings presented in this article build on ethnographic research with Somalis in eastern Ethiopia since 2007, and include anthropometric and demographic data collection with Somali diabetes patients and select adult siblings of these patients (n = 108) plus in-depth ethnographic interviews with a subset of the diabetes patients, their siblings, and medical providers serving Somali communities (n = 29) in July-August 2018. Most Somali patients we spoke with shared symptoms of progressive weight loss, weakness, and loss of teeth--or what people called "wasting away"--even when complying with prescribed pharmaceutical regimens and/or insulin. Diabetes and "wasting away" were characterized by Somalis as humoral pathologies; but rather than a consequence of obesity or pathological weight gain, these were perceived to be a consequence of stress, trauma, anger, displacement, loss of healthy fatness, and lack of access to fresh and healthy food over their lifetimes. Somalis' simultaneous experiences of progressive nutritional wasting and adult-onset diabetes echo how "tropical diabetes" was defined and experienced for thousands of years prior to the development of effective early diagnostics and biomedical treatments. This analysis therefore suggests heterogeneity and overlaps within and between categories of "type 1" and "type 2 diabetes" in populations with differential exposures to stress, crisis, and poverty. Exposures to food insecurity and medical insecurity, in particular, are pathogenic, and shape diabetes patients' clinical presentations and prognoses, as well as local etiologies and patterns of disease.

Dietary diversity and nutritional status among children in rural Burkina Faso

Background

Burkina Faso has a seasonal malnutrition pattern, with higher malnutrition prevalence during the rainy season when crop yields are low. We investigated the association between dietary diversity and nutritional status among children aged 6-59 mo during the low crop yield season in rural Burkina Faso to assess the role of dietary diversity during the lean season on childhood nutritional status.

Methods

Caregivers reported the dietary diversity of the past 7 d, consisting of 11 food groups, summed into a scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores were calculated based on 2006 WHO standards. Stunting, wasting and underweight were defined as HAZ, WHZ and WAZ <-2 SD, respectively. Multivariable regression models adjusting for potential confounders including household food insecurity and animal ownership were used to assess the relationship between anthropometric indices and dietary diversity.

Results

Of 251 children enrolled in the study, 20.6% were stunted, 10.0% wasted and 13.9% underweight. Greater dietary diversity was associated with greater HAZ (SD 0.14, 95% CI 0.04 to 0.25) among all children. There was no association between dietary diversity and wasting or mid-upper arm circumference in this study.

Conclusions

Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.

Prevalence and associated factors of underweight among children 6-59 months of age in Takusa district, Northwest Ethiopia

BACKGROUND

Most of the nearly 104 million underweight children in the world lived in South East Asia and sub-Saharan Africa in 2010. According to the 2014 Ethiopian Demographic and Health Survey (EDHS) report, 24 and 7% of children aged 6-59 months were underweight and severely underweight, respectively. Although appropriate child feeding and nutritional interventions reduce child illness and death, malnutrition remains a leading public health problem in Ethiopia. As literature on the issue is scarce in northwest Ethiopia, this study aimed at determining the prevalence of under-weight and associated factors in children 6-59 months of age in Takusa district, northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted from January to February, 2017, at Takusa district, northwest Ethiopia. A total of 645 subjects were selected using the multi-stage sampling technique. Anthro software version 2.02 was used to determine the nutritional status of the children. A multivariable logistic regression analysis was used to investigate factors associated with underweight. Adjusted Odds Ratios (AOR) with the corresponding 95% Confidence Interval (CI) were used to show the strength of associations, and variables with P-values of < 0.05 were considered statistically significant.

RESULTS

In this study, the overall prevalence of underweight was 19.5% (95% CI: 16.4-22.8). According to the multivariate analysis, urban residence (AOR = 0.60; 95% CI: 0.38-0.95), no antenatal care (ANC) follow up (AOR = 1.59; 95% CI 1.01-2.52), and mothers age (over 35 years) (AOR = 0.62; 95% CI: 0.38-0.99) were significantly associated with lower odds of underweight.

CONCLUSION

In the study community, the prevalence of underweight was lower than the findings of different studies in Ethiopia. Advanced maternal age (> 35 years), no antenatal follow up during pregnancy, and rural residence were significantly associated with underweight. Therefore, interventions targeting community management of acute malnutrition might be appropriate to manage the problem of underweight; efforts should also be intensified to reduce under-weight by focusing on identified determinants.

Prevalence of stunting and associated factors among preschool children: A community based comparative cross sectional study in Ethiopia

BACKGROUND

The prevalence of under nutrition is very high in developing countries especially in women and under five children. Stunting alone affected an estimated 154.8 million (22.9%) under five children globally in 2016. It is one of the main undernutrition and health problems facing children in Ethiopia. Hence, the aim of the current study was to assess the prevalence and associated factors of stunting among preschool children from food secure and food insecure households in Albuko district, northeast Ethiopia.

METHODS

This study was addressed by a community based comparative cross sectional study design which was conducted among preschool children in Albuko district from March to April 2017. Simple random sampling was used to select the five representative kebeles. To reach study participants, systematic sampling technique was utilized. Pretested and structured questionnaire was used to collect data. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using current WHO growth standards. Adjusted odds ratio (AOR) with its 95 % confidence interval (CI) was computed to assess the strength of the association. To identify the associated factors of stunting, multivariable logistic regression models were built. In the multivariable analysis, variables with a P-value of <0.05 were considered statistically significant.

RESULTS

The overall combined prevalence of stunting among preschool children in the study area was 39.3% [95%CI; 36.3, 42.3%]. A higher stunting prevalence was observed among preschool children from food insecure households [42.8%, 95%CI; 38.4, 47.2%] than food secure ones [35.9%, 95%CI; 31.7, 40.1%]. Having uneducated mothers, large family size, and male sex were common factors significantly associated with stunting in both food secure and insecure households. While child birth order and the amount of water (<40 litters) for use were significantly associated with stunting among preschool children living in food secure households, and lesser child age, lack of extra food during pregnancy/lactation, and low dietary diversity score (DDS below four food groups) were significantly associated with stunting among preschool children from food insecure households.

CONCLUSION

The present study showed that stunting is an important public health problem among preschool children from both food secure and insecure households in Albuko district. Though productive safety net program (PSNP) is a proven strategy in reducing the burden of childhood undernutrition/stunting, this study showed that there is no significant variation in the magnitude of stunting. However, it does not mean that PSNP interventions are not important in reducing the prevalence of stunting. Therefore, strengthening maternal nutrition, family planning utilization, and maternal education and enhancing dietary diversity, water sanitation and hygiene are critical interventions to reduce the level of stunting among under five children.

Predictors of poor nutritional status among children aged 6-24 months in agricultural regions of Mali: a cross-sectional study

BACKGROUND

The right nutrition during the first 2 years of life can positively impact a child's ability to develop, grow, and learn. Malnutrition remains a public health problem in Mali and little is known about the factors affecting the nutritional status of children. This study aims to assess the magnitude and the predictors of undernutrition in children aged 6-24 months in the poor rural regions of Mali.

METHODS

A community-based cross-sectional study was conducted in the villages in the Sikasso and Mopti regions in Mali from January to March 2016, comprising of 959 boys and 856 girls aged 6-24 months. A structured interviewer administered a questionnaire that was used to collect data from the mothers living in 1764 households. Anthropometric measurements were performed using standardized methods in order to identify the factors associated with children suffering from undernutrition (stunting and wasting). Bivariate and multivariate logistic regression analyses were conducted.

RESULTS

The results of our study indicated that 23.9 and 28.4% children were underweight and stunted; the prevalence of wasting was 13.9% using the W/H measurement and 16.5% with the MUAC. Overall, the presence of diarrhea in the past 2 weeks (p < 0.001), higher child age (p < 0.001), male sex (p < 0.001), households with the lowest household amenity score (p < 0.002), and households with a low dietary diversity score (p < 001) were significantly associated with chronic malnutrition. The factors significantly associated with acute malnutrition were male sex (p < 0.01), preterm birth (p < 0.03), lower child age (0.001), a high number of siblings (p < 0.03), and living in a household with more months of inadequate food provisioning (p < 0.03).

CONCLUSION

Child undernutrition is a critical public health problem in the agricultural regions of Mali. Future efforts should be directed at addressing the food insecurity and at improving the yearlong household availability and accessibility of nutritious food, as well as taking diseases prevention into account.