Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya

Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.

Household food security, child dietary diversity and coping strategies among rural households. The case of Kole District in northern Uganda

Household food security, feeding practices, dietary diversity and coping strategies to household food insecurity are largely interconnected. Using a cross sectional study approach involving 162 mothers and care givers of children 0-36 months of age in Kole district of northern Uganda, this study examined the household food security status, child dietary diversity and household coping strategies. The study revealed that a slight majority of the households (55%) were food secure although with a low level of child dietary diversity experienced (68.1% for children 6-23 months age group and 55.3% for 24-36 months age group). We found that starch-based foods derived from cereals, roots and tubers were the most predominantly used food group in child feeding (82%), with limited consumption of other essential food groups, notably fruits, vegetables, meats and dairy products (18% combined). Additionally, only 57% of children 0 to 6 months old were receiving exclusive breastfeeding, and the introduction of complementary foods is often delayed and not well planned for those above 6 months of age. Results also showed that a wide range of coping strategies are employed however the major ones were, reliance on less preferred food (54.9%), limiting portions of meals (35.2%), reducing number of meals taken in a day (29%), and gathering wild fruits and harvesting immature crops (29.6%). It was observed that household food security is a strong determinant of child dietary diversity, may influence feeding practices and the range of coping strategies applicable to households when they experience food insecurity. Furthermore, nutritional education, household size and livelihood diversity play a significant role in determining household food security status, child dietary diversity and coping with food insecurity within rural households. In conclusion, addressing household food security, and coping strategies can play an important role in improving child feeding practices and dietary diversity in rural communities.

A systematic review of the relationship between household food insecurity and childhood undernutrition

BACKGROUND

This systematic review aims to investigate the association between household food insecurity (HFIS) and undernutrition in children under 5 years old, thereby informing policymakers on the vital factors needed to be considered in tailoring an effective strategy to tackle childhood undernutrition and ultimately HFIS.

METHODS

We performed a systematic review that examined household food insecurity among the undernourished under-five children. PubMed, Cochrane, EBSCO Host, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched from 1 January 2012 to 1 April 2022, for relevant articles. Outcome measures were stunting, underweight or wasting. Of the 2779 abstracts screened, 36 studies that fulfilled the inclusion and exclusion criteria were included. A range of tools had been used to measure HFIS, the most common being Household Food Insecurity Access Scale. HFIS has been found to be significantly associated with undernutrition, particularly stunting and underweight. This is observed proportionately across all national income levels.

CONCLUSIONS

Sustainable and inclusive economic growth, which aims to reduce income, education and gender inequality, should be a key policy goal in the minimizing food insecurity and childhood undernutrition. Multisectoral interventions are needed to address these issues.

Influence of HIV/AIDS Infection on Immunological and Nutritional Status in Adults and Older Adults: A Cross-Sectional Study in Kingdom of Bahrain

Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain, was carried out. Various biochemical markers were collected from patients' medical records, including CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine. A semi-structured questionnaire using a standardized food frequency questionnaire (FFQ) was used, from which total energy and total macronutrients were calculated. Results: The mean BMI of the participants was 27.20 kg/m2, and none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients' dietary intake of macronutrients and total calorie intake were either within or above the recommended RDA levels. The results also showed that all of the mean values of the nutritional and biochemical markers (CD4+ T cell count, albumin, Hb, HCT, MCV, WBCs, and creatinine) were within the normal reference ranges. A significant positive correlation between CD4+ T cell count, Hb, HCT, and albumin at the <0.05 level was found. There was no significant correlation between CD4+ T cell count and MCV, WBCs, and creatinine. A positive significant correlation was found between BMI, CD4+ T cell count, and WBCs at the <0.01 level. Conclusion: The BMI values were significantly correlated with the biochemical markers of AIDS progression. The dietary patterns of the participants were undiversified, with a high prevalence of obesity and overweight. Malnutrition among this study population was not present.

Latent Classes of Anthropometric Growth in Early Childhood Using Uni- and Multivariate approaches in a South African Birth Cohort

Background

Conventional methods for modelling longitudinal growth data focus on the analysis of mean longitudinal trends or the identification of abnormal growth based on cross-sectional standardized z-scores. Latent Class Mixed Modelling (LCMM) considers the underlying heterogeneity in growth profiles and allows for the identification of groups of subjects that follow similar longitudinal trends.

Methods

LCMM was used to identify underlying latent profiles of growth for univariate responses of standardized height, standardized weight, standardized body mass index and standardized weight-for-length/height measurements and multivariate response of joint standardized height and standardized weight measurements from birth to five years for a sample of 1143 children from a South African birth cohort, the Drakenstein Child Health Study (DCHS). Allocations across latent growth classes were compared to better understand the differences and similarities across the classes identified given different composite measures of height and weight as input.

Results

Four classes of growth within standardized height (n1=516, n2=112, n3=187, n4=321) and standardized weight (n1=263, n2=150, n3=584, n4=142), three latent growth classes within Body Mass Index (BMI) (n1=481, n2=485, n3=149) and Weight for length/height (WFH) (n1=321, n2=710, n3=84) and five latent growth classes within the multivariate response of standardized height and standardized weight (n1=318, n2=205, n3=75, n4=296, n5=242) were identified, each with distinct trajectories over childhood. A strong association was found between various growth classes and abnormal growth features such as rapid weight gain, stunting, underweight and overweight.

Conclusions

With the identification of these classes, a better understanding of distinct childhood growth trajectories and their predictors may be gained, informing interventions to promote optimal childhood growth.

Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study

Background

Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018.

Methods

We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome.

Findings

Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation.

Interpretation

This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation.

Funding

Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).

Household Food Insecurity and Associated Factors among Iranian Patients with Esophageal and Gastric Cancers

Background: Household food insecurity (HFI) which has still been one of the major global public health issues is related to adverse health outcomes in individuals. Therefore, this study aimed to determine the prevalence of HFI and its associated factors in Iranian patients with esophageal and gastric cancers. Methods: The data of this cross-sectional study was obtained from 315 patients with esophageal and gastric cancers who were selected from a gastrointestinal cancer-based cohort study conducted in Firoozgar hospital, in Tehran. Food insecurity (FI) was measured using the Iranian version of the HFI questionnaire that was completed by a trained interviewer. The multivariable logistic regression model was used to determine the independent association of each factor with HFI. A P value lower than 0.05 was considered statistically significant. Results: The mean±SD of participants' age was 63.2±12.6 years and 65.4% were men. Most of the patients (75.8%) suffered from gastric cancer and 24.2% from esophageal cancer. The overall prevalence of FI among participants' households was 35.2%. There was an independent significant association between wealth index (WI) and HFI after the use of the multivariable logistic regression model, in such a way that the odds of FI in the poorest, poor, moderate, and rich patients' households were respectively, 6.41, 5.05, 2.74 and 2.04 times higher compared with the richest households. Conclusion: More than a third of participants' households struggled with FI, which was found to have a higher prevalence in loweconomic households. Therefore, health policymakers should intervene in food-insecure households by developing, establishing, and implementing strategies and control programs to improve affordable food access.

Socioeconomic inequalities in food purchasing practices and expenditure patterns: Results from a cross-sectional household survey in western Kenya

Introduction

Socioeconomic inequalities contribute to poor health. Inequitable access to diverse and healthy foods can be a risk factor for non-communicable diseases, especially in individuals of low socioeconomic status. We examined the extent of socioeconomic inequalities in food purchasing practices, expenditure, and consumption in a resource-poor setting in Kenya.

Methods

We conducted a secondary analysis of baseline cross-sectional data from a natural experimental study with a sample size of 512 individuals from 376 households in western Kenya. Data were collected on household food sources, expenditure and food consumption. Household socioeconomic status (SES) was assessed using the multiple correspondence analysis (MCA) model. Concentration indices (Ci) and multivariable linear regression models were used to establish socioeconomic inequalities.

Results

About half (47.9%) of individuals achieved a minimum level of dietary diversity with the majority coming from wealthier households. The two most consumed food groups were grains and roots (97.5%, n = 499) and dark green leafy vegetables (73.8%, n = 378), but these did not vary by SES. The consumption of dark green leafy vegetables was similar across wealth quantiles (Ci = 0.014, p = 0.314). Overall, the wealthier households spent significantly more money on food purchases with a median of USD 50 (IQR = 60) in a month compared to the poorest who spent a median of USD 40 (IQR = 40). Of all the sources of food, the highest amount was spent at open-air markets median of USD 20 (IQR = 30) and the expenditure did not vary significantly by SES (Ci = 0.4, p = 0.684). The higher the socioeconomic status the higher the total amount spent on food purchases. In multivariable regression analysis, household SES was a significant determinant of food expenditure [Adjusted coefficient = 6.09 (95%confidence interval CI = 2.19, 9.99)].

Conclusion

Wealthier households spent more money on food compared to the poorest households, especially on buying food at supermarkets. Individuals from the poorest households were dominant in eating grains and roots and less likely to consume a variety of food groups, including pulses, dairy, eggs and fruits, and vegetables. Individuals from the poorest households were also less likely to achieve adequate dietary diversity. Deliberate policies on diet and nutrition are required to address socioeconomic inequalities in food purchasing practices.

Dietary Diversity, Household Food Insecurity and Stunting among Children Aged 12 to 59 Months in N'Djamena-Chad

BACKGROUND

Household food insecurity is increasingly recognized as a global health problem, particularly in sub-Saharan Africa. This study aimed to contextualize the associations between household food insecurity, dietary diversity and stunting in N'Djamena.

METHODS

This study is a community-based cross-sectional study, and the SMART (Standardized Monitoring and Assessment of Relief and Transitions) methodology was used to calculate the sample size. A total of 881 households were selected for the survey. A 24-h recall evaluated the dietary diversity score (DDS), the Household Food Insecurity Access Scale (HFIAS) made it possible to assess household food insecurity (HFI), and stunting among children aged 12 to 59 months was assessed by anthropometric measurements. Logistic regression was constructed to determine the association between household food insecurity, dietary diversity, and stunting. The study was conducted from January to March 2022.

RESULTS

The prevalence of severe food insecurity was 16.6%, and that of stunting was 25.3%. The mean DDS was 6.5 ± 1.6. Severe food insecurity (OR 2.505, CI: 1.670-3.756) was significantly associated with stunting. The association between DDS and stunting was not significant.

CONCLUSIONS

This study's prevalence of household food insecurity and stunting was very high. Household food insecurity and household size were significantly associated with stunting.

Comparing level of food insecurity between households with and without home gardening practices in Zege, Amhara region, North West Ethiopia: Community based study

BACKGROUND

Globally, close to 1 billion people suffer from hunger and food insecurity. Evidence showed that prevalence of household food insecurity in Ethiopia is ranged from 25.5%-75.8%. Home gardening is one way to alleviate food insecurity. Hence, the study aimed to determine level of food insecurity and its associated factors between home gardening and non-home gardening household in Zegie, North west Ethiopia.

METHODS

Community-based study was conducted from February 10th-March 10th/2020. A total of 648 samples were included. First, 2142 total households who have 6-59 months of age children in the area identified and registered. Then, households categorized in to home garden practicing (1433) and non-home garden practicing (709). The calculated sample size, 324 for each group were selected using simple random sampling technique.

RESULTS

The overall prevalence of food insecurity was 38.1% (95% CI: 34.29-42.11%). Food insecurity was significantly higher in non-home gardening groups than their counter parts 45.5% (95% CI: 39.80-51.20%). Having primary education and above (AO = 1.89, 95% CI: 1.25-2.86%), wealth index; 2nd quantile (AOR = 0.44, 95% CI: 0.25-0.85%), 3rd quantile (AOR = 0.32, 95% CI: 0.17-0.62%) and 4th quantile (AOR = 0.27, 95% CI: 0.15-0.54%), dietary diversity (AOR = 1.83, 95% CI: 1.15-2.92%) and home garden practices (AOR = 1.57, 95% CI: 1.06-2.32%) were variables significantly associated with food insecurity.

CONCLUSION

Food insecurity in non-home garden practicing households is higher than practicing households. The local agriculture sector needs to emphasis and empowered households on home gardening practices to realize food security.

Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: A repeated cross-sectional assessment

The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (β = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (β = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress.

Predictors of the amount of intake of Ready-To-Use-Therapeutic foods among children in outpatient therapeutic programs in Nairobi, Kenya

Ready‐to‐use Therapeutic Food (RUTF) therapy is a standard protocol for treating children with severe acute malnutrition (SAM) admitted in Out‐Patient Therapeutic Programmes (OTP). The amount of RUTF to be consumed by a child is based on weight (200 kcal/kg body weight/day) as stipulated in the Kenya Integrated Management of Acute Malnutrition (IMAM) protocol for timely weight gain. There is limited information on the determinants of consumption of the correct amount of RUTF. This study sought to fill this gap by establishing the associations between the caregivers' and the child's characteristics and the amount of RUTF the child ate within a 24‐h recall period. We used a cross‐sectional study design and interviewed 200 caregivers of children 6–23 months of age admitted in four OTP centers in Nairobi Kenya. We used a researcher‐administered questionnaire to collect information from the caregivers. Seventy‐three percent of the children ate the recommended amount of RUTF. A smaller proportion (54.4%) of younger children (6–11 months of age) ate the recommended amount of RUTF compared to older children (12–17 months old and 18–23 months old at 89.1% and 82.8%, respectively). The predictors of consumption of the correct amount of RUTF were child's birth order—firstborn (AOR 29.92; 95% CI: 5.67–157.93) and children's age; 12–17 months old (AOR 5.19; 95% CI: 2.18–12.36) and 18–23 months (AOR 6.19 95% CI: 2.62), indicating that firstborn and older children were more likely to consume the correct amounts of RUTF. Caregivers' knowledge and correct practices in feeding a child with RUTF also predicted the consumption of the correct amount of RUTF. In conclusion, maternal and child characteristics are determinants of the consumption of the correct amount of RUTF by children in OTP.

Household food insecurity during pregnancy as a predictor of anthropometric indices failures in infants aged less than 6 months: a retrospective longitudinal study

OBJECTIVE

To investigate the impact of household food insecurity during the third trimester of pregnancy on the growth indicators of infants aged less than 6 months.

DESIGN

Retrospective longitudinal study.

SETTING

137 healthcare centres (15 cities) in Khorasan Razavi province, Iran. Data were extracted from the Sina Electronic Health Record System (SinaEHR®).

PARTICIPANTS

This study was conducted on 2481 mother and infant dyads during November 2016-March 2019. The Household Food Insecurity Access Scale (nine-item version) was used to measure food insecurity in the third trimester of pregnancy. Women who delivered singleton infants were included in the study, and anthropometric indices of infants were measured throughout the first 6 months of life.

RESULTS

Approximately 67 % of the participants were food secure, while 33 % had varying degrees of food insecurity. The children born to the mothers in the food-insecure households were, respectively, 2·01, 3·03, and 3·83 times more likely to be stunted at birth (95 % CI 1·17, 3·46), 4 months (95 % CI 1·21, 7·61) and 6 months of age (95 % CI 1·37, 10·68) compared to their counterparts in the food-secure households. However, there were no significant differences in mean birth weight, birth height and head circumference at birth between the two groups.

CONCLUSIONS

Household food insecurity during pregnancy is a risk factor for stunting in infants aged less than 6 months. Therefore, national nutrition programs could considerably support women in food-insecure households during and before pregnancy.

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.

Dietary diversity and associated factors among children aged 6 to 23 months in Chelia District, Ethiopia

BACKGROUND

Although minimum dietary diversity (MDD) is one of the core indicators of a high-quality diet for infants and young children, meeting this dietary diversity standard remains a challenge in Ethiopia. Therefore, adequate information on the status and factors affecting minimum dietary diversity is essential to identify potential strategic interventions. This study to study is to assess DD and associated factors among children aged 6 to 23 months in Chelia District, Ethiopia.

METHODS

A community-based cross-sectional study was conducted in the seven kebeles of Chelia District from 12th April to April 30th, 2020. Kebele is the smallest administrative unit in Ethiopia. Multistage sampling was used to select 631 participants who had a child aged 6 to 23 months. Data was entered into the Epi data version 3.1 and analyzed using Statistical Package for Social Science (SPSS) version 24. A binary logistic regression was fitted to identify significant factors associated with met MDD at 95% CI and a p-value < 0.05.

RESULTS

Less than one-quarter (17.32%) of infants and young children aged 6 to 23 months had met MDD. The dominant group of foods consumed was composed of grains, roots, and tubers. Children aged18-23 months (AOR = 3.26, 1.36-7.79), mothers aged 35-44 years (AOR = 3.25, 1.38-7.45), housewives as household heads (AOR = 3.41, 1.56-2.37), children of smaller family size (AOR = 3.89, 1.18-12.78), and caregivers who studied grade 9-12 (AOR = 9.98, 5.66-17.10), who received information about food diversity during ANC (AOR = 1.48, 2.21-11.23) and PNC (AOR = 3.94, 2.04-7.63) visit, who travels less than one hour to reach the market (AOR = 2.94, 1.24-6.91) and who had high family income (AOR = 4.12, 1.90-8.19) were significantly associated with meeting MDD.

CONCLUSION

Dietary diversity among children aged 6 to 23 months in Chelia District is low. It is proposed that caregivers on MDD be educated/trained and encouraged to share information during health service in order to increase the diverse diet and achieve a better dietary diversity score for infants and younger children.

Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review

BACKGROUND

The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting.

METHODS

This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020.

RESULTS

Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity.

CONCLUSIONS

This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

Assessing Food Insecurity and Its Drivers among Smallholder Farming Households in Rural Oyo State, Nigeria: The HFIAS Approach

Hunger and food insecurity take center stage in most debates in Africa, and in recent times with serious concerns about Nigeria. This study assessed food insecurity among farming households in rural Oyo State, Nigeria, using cross-sectional datasets from 211 farming households through a multi-stage sampling procedure. The Household Food Insecurity Access Scale (HFIAS) module was employed in assessing food insecurity status of farming households, and the ordered logit model (OLM) was used to analyze factors influencing food insecurity among farming households. The results revealed that 12.8% of the farming households were food secure while 87.2% had varying levels of food insecurity. The OLM results indicated that age, household head’s years of schooling, gender, farm size, farm experience, non-farm income, food expenditure, and access to extension service significantly influenced food insecurity among farming households. Based on the findings, efforts should be geared towards promoting households’ education-related intervention programs in order to improve their nutrition-related knowledge that can enhance their food security status. Additionally, there should be provision of rural infrastructural facilities such as piped water, rural electrification, and healthcare service that promote healthy living and enhance households’ agricultural productivity.

Household Food Insecurity, Level of Nutritional Adequacy, and Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency

BACKGROUND: The food security and livestock service office of North Sumatra Province (2020) noted that almost a third of the area or 35% of the subdistricts in Central Tapanuli Regency are food-insecure areas. AIM: This study aims to determine the level of family food insecurity, the level of nutritional adequacy, and the nutritional status of children under 5 in the coastal area of Central Tapanuli Regency. METHODS: This research is part of a dissertation study entitled Positive Deviance in Household Food Insecure in Improving the Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency. The steps in this research are to identify the level of household food insecurity, level of nutritional adequacy, and nutritional status of children under 5. The research was conducted by interviewing respondents (mothers of toddlers) and taking anthropometric measurements of 59 children under 5 purposively in the coastal area of Central Tapanuli Regency. RESULTS: Most of the occupations of the head of the family are fishers (78.0%) and the household food insecurity status as much as 81.4% is food insecure. The nutritional status of children under 5 in the less category is 50.8%, the nutritional status of stunting is 35.6%, and wasting is 10.2%. There is a significant relationship between family food insecurity and the level of adequacy of nutrients: Energy (p = 0.000; odds ratio [OR] = 38.000) and protein (p = 0.002; OR = 10.929). There is a significant relationship between household food insecurity and nutritional status of weight for age (p = 0.0039; OR = 6.300). CONCLUSION: Household food insecurity is related to the level of nutritional adequacy (energy and protein) and nutritional status of weight for age.

Household Food Security Access and Nutritional Status among Early Adolescents in a Poor Neighborhood of Sinamangal, Nepal

BACKGROUND

Early adolescence is an important period of the life cycle wherein the food system plays a critical role in protecting food security as well as the nutritional needs essential for a healthy transition from childhood to adulthood. Despite the surging concerns regarding the food and nutrition security of adolescents throughout the nation, people in a poor neighborhood are often neglected and considered the most vulnerable.

OBJECTIVES

This research aims to assess the status of household food security and nutritional status among early adolescents living in a poor neighborhood of Kathmandu, Nepal.

METHODS

Using a cross-sectional study design, data was collected with the Household Food Insecurity Access Scale (HFIAS) tool. Nutritional status was measured using the WHO Child Growth Standard Reference 2007 Statistical Software for Social Science (SPSS) macro package based on BMI-for-age z-score, height-for-age z-score, and weight-for-age z-score, respectively. Data were entered in a predetermined format of SPSS version 20.0 and imported into STATA version 13.1 for univariate and bivariate analyses. Ethical approval was sought from the Ethical Review Board of Nepal Health Research Council (NHRC) prior to the study.

RESULTS

More than one-fifth (21%) of the households were food insecure. Based on BMI-for-age, 5.5% of the adolescents were found to be moderately undernourished and 2.6% were severely undernourished. The percentage of moderately and severely stunted adolescents were 8.4% and 5.8%, respectively, based on height-for-age. Based on weight-for-age, moderately and severely underweight adolescents accounted for 13.0% and 1.3% of the total.

CONCLUSION

The prevalence of underweight, stunting, and wasting among early adolescents was high. The households in a poor neighborhood were also experiencing some form of food insecurity. This calls for targeted efforts to address malnutrition and improve the nutritional status of early adolescents, particularly in poor neighborhoods.

Food Insecurity, Nutritional Inequality, and Maternal–Child Health: A Role for Biocultural Scholarship in Filling Knowledge Gaps

Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security's four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children's nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.

Prevalence and overlap of known undernutrition risk factors in children in Nairobi Kenya

We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.

Interventions on Food Security and Water Uses for Improving Nutritional Status of Pregnant Women and Children Younger Than Five Years in Low-Middle Income Countries: A Systematic Review

Malnutrition is a global health issue concerning children and pregnant women in low- and middle-income countries (LMICs). The aim of this review was to assess the health-impact outcomes of interventions addressing food security, water quality and hygiene in order to address the improvement of the nutritional status in children below five years and pregnant women in LMICs. Using PRISMA procedures, a systematic review was conducted by searching in biomedical databases clinical trials and interventions for children and pregnant women. Full articles were screened (n_f = 252) and critically appraised. The review included 27 randomized and non-randomized trials and interventions. Based on the analysis, three agents concerning nutritional status were identified. First, exclusive breastfeeding and complementary feeding were fundamental elements in preventing malnutrition. Second, provision of sanitation facilities and the promotion of hygienic practices were also essential to prevent infections spread and the consequent deterioration of nutritional status. Finally, seasonality was also seen to be a relevant factor to consider while planning and implementing interventions in the populations under study. In spite of the efforts conducted over last decades, the improvement in food insecurity rates has remained insufficient. Therefore, the development of global health programs is fundamental to guide future actions.

Mothers' Perspectives of Complementary Feeding Practices in an Urban Informal Settlement in Kisumu County, Western Kenya

BACKGROUND

In informal settlements, the benefits of urban dwelling are diminished by conditions of poverty that exacerbate child undernutrition. The Child Health and Mortality Prevention Surveillance (CHAMPS) project has identified malnutrition as the leading underlying cause of death in children under 5 in the Manyatta urban informal settlement in Kisumu County, Kenya.

OBJECTIVE

This qualitative study, nested within the CHAMPS project, aimed to understand community perspectives on complementary feeding practices in this settlement.

METHODS

In-depth interviews were conducted with 20 mothers who lived in the urban informal settlement and had a child 6-23 months old. Two focus group discussions were conducted, 1 with mothers and 1 with community health workers (CHWs), to further explore themes related to complementary feeding.

RESULTS

Mothers were knowledgeable about globally recommended feeding practices, but such practices were often not implemented due to 1) the community/household water and sanitation environment, 2) the community/household food environment, 3) a lack of income and employment opportunities for women, and 4) sociocultural factors. Together, these create an environment that is not conducive to optimal child feeding practices.

CONCLUSIONS

To improve complementary feeding practices and child nutritional outcomes in Kenya's informal urban settings, both community- and individual-level factors should be addressed. Possible interventions include investment in water infrastructure and social protection programs, such as cash transfers.

Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird's random-effect model at 95% confidence intervals (CIs). The I² statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results' stability. The Mixed Methods Appraisal Tool (MMAT) - Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I² = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.

Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

BACKGROUND

There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition.

OBJECTIVES

This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.'s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis.

RESULTS

Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition.

CONCLUSIONS

This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the "urban advantage". A conceptual framework emerging from the existing literature is proposed to guide future studies and policies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration number: CRD42018089788 .

Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia

OBJECTIVE

To investigate the relation of child dietary diversity and household food insecurity along with other socio-demographic with child anthropometric indices in north-central Ethiopia, an area with a high level of food insecurity and inadequate diet quality.

DESIGN

A community-based cross-sectional study was used.

SETTINGS

The study was conducted in Dessie and Combolcha towns of north-central Ethiopia from April to May 2018.

PARTICIPANTS

Randomly selected 512 mother-child pairs with child's age range of 6-59 months.

RESULTS

The mean (± SD) scores of weight-for-height/length, height/length-for-age, weight-for-age, and BMI-for-age Z-scores were 1.35 (± 2.03), - 1.89 (± 1.79), 0.05 (± 1.54), and 1.39 (± 2.06), respectively. From all anthropometric indicators, stunting and overweight/obesity remained the severe public issues hitting 43% and 42% of the children, respectively. In the model, mothers' age and education and child's age, sex, and dietary diversity were significantly related with child height-for-age Z-score while place of residence, sex of household head, child's age, and dietary diversity score were the predictors of child BMI-for-age Z-score in the urban contexts of the study area. Nevertheless, food insecurity was not related to any of the child anthropometric indices.

CONCLUSION

The double burden of malnutrition epidemics (stunting and obesity) coexisted as severe public health concerns in urban settings. Anthropometric statuses of children were affected by multidimensional factors and seek strong integration and immediate intervention of multiple sectors.

Inequities in child survival in Nigerian communities during the Sustainable Development Goal era: insights from analysis of 2016/2017 Multiple Indicator Cluster Survey

BACKGROUND

Child survival is a major concern in Nigeria, as it contributes 13% of the global under-five mortalities. Although studies have examined the determinants of under-five mortality in Nigeria, the comparative roles of social determinants of health at the different stages of early childhood development have not been concurrently investigated. This study, therefore, aimed to identify the social determinants of age-specific childhood (0-59 months) mortalities, which are disaggregated into neonatal mortality (0-27 days), post-neonatal mortality (1-11 months) and child mortality (12-59 months), and estimate the within-and between-community variations of mortality among under-five children in Nigeria. This study provides evidence to guide stakeholders in planning for effective child survival strategies in the Nigerian communities during the Sustainable Development Goals era.

METHODS

Using the 2016/2017 Nigeria Multiple Indicator Cluster Survey, we performed multilevel multinomial logistic regression analysis on data of a nationally representative sample of 29,786 (weighted = 30,960) live births delivered 5 years before the survey to 18,497 women aged 15-49 years and nested within 16,151 households and 2227 communities.

RESULTS

Determinants of under-five mortality differ across the neonatal, post-neonatal and toddler/pre-school stages in Nigeria. Unexpectedly, attendance of skilled health providers during delivery was associated with an increased neonatal mortality risk, although its effect disappeared during post-neonatal and toddler/pre-school stages. Also, our study found maternal-level factors such as maternal education, contraceptive use, maternal wealth index, parity, death of previous children, and quality of perinatal care accounted for high variation (39%) in childhood mortalities across the communities. The inclusion of other compositional and contextual factors had no significant additional effect on childhood mortality risks across the communities.

CONCLUSION

This study reinforces the importance of maternal-level factors in reducing childhood mortality, independent of the child, household, and community-level characteristics in the Nigerian communities. To tackle childhood mortalities in the communities, government-led strategies should prioritize implementation of community-based and community-specific interventions aimed at improving socioeconomic conditions of women. Training and continuous mentoring with adequate supervision of skilled health workers must be ensured to improve the quality of perinatal care in Nigeria.

High relatedness of invasive multi-drug resistant non-typhoidal Salmonella genotypes among patients and asymptomatic carriers in endemic informal settlements in Kenya

Invasive Non-typhoidal Salmonella (iNTS) disease is a major public health challenge, especially in Sub-Saharan Africa (SSA). In Kenya, mortality rates are high (20-25%) unless prompt treatment is instituted. The most common serotypes are Salmonella enterica serotype Typhimurium (S. Typhimurium) and Salmonella enterica serotype Enteritidis (S. Enteritidis). In a 5 year case-control study in children residing in the Mukuru informal settlement in Nairobi, Kenya, a total of 4201 blood cultures from suspected iNTS cases and 6326 fecal samples from age-matched controls were studied. From the laboratory cultures we obtained a total of 133 S. Typhimurium isolates of which 83(62.4%) came from cases (53 blood and 30 fecal) and 50(37.6%) from controls (fecal). A total of 120 S. Enteritidis consisted of 70(58.3%) from cases (43 blood and 27 fecal) and 50(41.7%) from controls (fecal). The S. Typhimurium population fell into two distinct ST19 lineages constituting 36.1%, as well as ST313 lineage I (27.8%) and ST313 lineage II (36.1%) isolates. The S. Enteritidis isolates fell into the global epidemic lineage (46.6%), the Central/Eastern African lineage (30.5%), a novel Kenyan-specific lineage (12.2%) and a phylogenetically outlier lineage (10.7%). Detailed phylogenetic analysis revealed a high level of relatedness between NTS from blood and stool originating from cases and controls, indicating a common source pool. Multidrug resistance was common throughout, with 8.5% of such isolates resistant to extended spectrum beta lactams. The high rate of asymptomatic carriage in the population is a concern for transmission to vulnerable individuals and this group could be targeted for vaccination if an iNTS vaccine becomes available.

Households Hunger: The Key Attribute to Anthropometric Failures of Children in West Oromia (Ethiopia)

Poor nutrition is the underlying cause of child death. However, comprehensive data showing the relationships between dietary-practices, food security, and nutritional status are scant. The present study aimed to examine the association of inappropriate feeding practices and household-hunger with anthropometric measures in children aged 6-23 months. A cross-sectional survey was conducted on randomly selected 525-households. Semi-structured interviewer-administered questionnaires were used to gather data on socio-demographic, child health, dietary-practices and household-hunger. Weight and height/length of the children were measured and analyzed using the new World Health Organization (WHO) Growth Standards. The prevalence of stunting, wasting and underweight as well as composite index of anthropometric failure (CIFA) were used to indicate under-nutrition. The overall prevalence of inappropriate feeding practices was 22.9%, rate of moderate households-hunger was 12.4%, and the prevalence of stunting, underweight and wasting was 16.2%, 6.9% and 6.3%, respectively, while the CIAF was 21.3%. The prevalence was significantly higher in young children aged 12-23 months than in infants aged 6-11 months. Children from households experiencing moderate hunger had significantly higher risk of being stunting (OR: 10.20; 95%CI: 2.00-51.50), underweight (OR:3.89; 95%CI: 1.40-10.90), wasting (OR: 1.97; 95%CI: 0.99-3.90), and CIAF (OR: 1.90; 95%CI: 1.05-3.45), than those residing in households experiencing no or mild hunger. Multi-disciplinary approaches are required to improve household food-security and child dietary practices, thus the nutritional status among young children.

Coping through a drought: the association between child nutritional status and household food insecurity in the district of iLembe, South Africa

OBJECTIVE

To assess and compare the association between household food insecurity and child nutritional status over two time-points taking into consideration the effects of a severe drought.

DESIGN

The study used two cross-sectional household surveys during and after a severe drought, consistent with a natural experiment design.

SETTING

The study took place in the district of iLembe, KwaZulu-Natal, South Africa.

PARTICIPANTS

Households with children aged <5 years were invited to participate in the survey. Anthropometric measures were taken for the respective children in each of the participating households.

RESULTS

The results indicated that all forms of poor nutritional status increased over the two time-points, with the most significant increases being for stunting (P < 0·016) and obesity (P < 0·001). There was evidence of an association between increasing food insecurity and stunting (P < 0·003) at the end of the drought, but not wasting, underweight or overweight. The results indicated a strong link between chronic food insecurity and chronic undernutrition. The results also showed stronger evidence of an association between food insecurity and stunting for urban households (P < 0·001) compared to their rural counterparts (P < 0·019).

CONCLUSIONS

The negative effects of drought appear to contribute to increased rates of child stunting through higher levels of household food insecurity. Future research should assess this relationship through longitudinal studies. Interventions aimed at improving food security may assist in reducing child malnutrition, but policymakers should consider urban-rural differences as well as climatic and environmental events.

How soon do single mothers have another child? A competing risk analysis of second premarital childbearing in sub-Saharan African countries

BACKGROUND

A considerable number of previous studies have examined the trends, correlates, and consequences of premarital childbearing among adolescents and young women in Africa. However, very little is known about whether and how soon single mothers have another premarital birth in sub-Saharan African countries. This study examines the timing of a second premarital birth among single mothers and assesses how it may differ across key socio-demographic variables.

METHODS

We pooled recent Demographic and Health Surveys from 25 sub-Saharan African countries to create a database of 57, 219 single mothers aged 15-49 years. Cumulative incidence graphs and Fine and Gray's competing risk models were used to delineate the timing of a second premarital birth and its socio-demographic correlates.

RESULTS

More than one-third of single mothers in 16 countries have had a second premarital birth in their reproductive life. We also observed that more than 15% of the single mothers in Angola, Benin, the Republic of Chad, Liberia, Namibia, Nigeria, Sierra Leone, and Uganda, have had another premarital birth three years after the first. The incidence of a second premarital birth was significantly lower among women with secondary or higher education, compared to women with less than secondary education (p < 0.05) in most countries. Residence in an urban area compared to rural, was also significantly associated with a low incidence of second premarital birth in 10 countries (p < 0.05).

CONCLUSIONS

Findings indicate a rapid progression to having a second premarital birth in some sub-Sahara African countries, particularly among socio-economically disadvantaged women. The findings suggest the need for tailored interventions for improving the quality of life of single mothers, to reduce the associated burden and consequences of having a premarital birth.

Household Food Insecurity Predicts Childhood Undernutrition: A Cross-Sectional Study in West Oromia (Ethiopia)

Background

Despite mixed reports, food insecurity emerges as a predictor of nutritional status, assumably limiting the quantity and quality of dietary intake. In Ethiopia, the prevalence of childhood undernutrition and food insecurity is highly pronounced. However, whether household food insecurity predicts undernutrition in children was not yet well established. Thus, the aim of the present study was to identify the link between household food access and undernutrition in children aged 6-23 months in West Oromia zones, Ethiopia.

Methods

A cross-sectional study was conducted on a sample of 525 households during June-October 2016. Food access was measured as Household Food Insecurity Access Scale. Semistructured interviewer-administered questionnaires were employed to collect data on sociodemographics, child health, child dietary practices, household food security, and anthropometrics. The height and weight of children aged 6-23 months in each household were measured. Multivariate logistic regression models were constructed to assess the association between household food insecurity and child nutritional status measured from undernutrition indicators.

Results

Overall, more than two-thirds (69%) of households were classified as food insecure (had insufficient access to adequate food), with a mean (SD) household food access score of 7.9 (7.7). The respective prevalence of mild and moderate food-insecure households was 56.6% and 12.4%. Higher proportions of children in food-insecure households were stunted (41.8% vs. 15.5%), underweight (22.0% vs. 6.1%), and wasted (14.9% vs. 6.1%). Overall, the prevalence of child undernutrition was 21.3% in the target population, with 16.2% stunted, 6.9% underweight, and 6.3% wasted. The present finding shows food-secure households were 54% protective (OR: 0.46, 95% CI: 0.25-0.84) for child undernutrition. Compared to children in food-secure households, children who were reportedly living in moderately food-insecure households were over twice more likely stunted (OR: 2.09, 95% CI: 1.02-4.28) and over 4 times more likely underweight (OR: 4.73, 95% CI: 1.81-12.35). However, household food insecurity was not a correlate for acute malnutrition (wasting) in children.

Conclusions

The prevalence of household's food insecurity situation is very common and more pronounced among households with undernourished children aged 6-23 months in Ethiopia. The analysis of this work shows that moderately food-insecure households are a salient predictor for composite undernutrition, stunting, and underweight, but not for wasting. Thus, this finding informs the need for multisectoral strategies and policies to combat household's food insecurity and multiple forms of child undernutrition, beyond the socioeconomic wellbeing.

Social Stratification, Diet Diversity and Malnutrition among Preschoolers: A Survey of Addis Ababa, Ethiopia

In Sub-Saharan Africa, being overweight in childhood is rapidly rising while stunting is still remaining at unacceptable levels. A key contributor to this double burden of malnutrition is dietary changes associated with nutrition transition. Although the importance of socio-economic drivers is known, there is limited knowledge about their stratification and relative importance to diet and to different forms of malnutrition. The aim of this study was to assess diet diversity and malnutrition in preschoolers and evaluate the relative importance of socioeconomic resources. Households with children under five (5467) were enrolled using a multi-stage sampling procedure. Standardized tools and procedures were used to collect data on diet, anthropometry and socio-economic factors. Multivariable analysis with cluster adjustment was performed. The prevalence of stunting was 19.6% (18.5-20.6), wasting 3.2% (2.8-3.7), and overweight/obesity 11.4% (10.6-12.2). Stunting, overweight, wasting and limited diet diversity was present in all social strata. Low maternal education was associated with an increased risk of stunting (Adjusted odds ratio (AOR): 1.8; 1.4-2.2), limited diet diversity (AOR: 0.33; 0.26-0.42) and reduced odds of being overweight (AOR: 0.61; 0.44-0.84). Preschoolers in Addis Ababa have limited quality diets and suffer from both under- and over-nutrition. Maternal education was an important explanatory factor for stunting and being overweight. Interventions that promote diet quality for the undernourished whilst also addressing the burgeoning problem of being overweight are needed.

The Nutritional and Micronutrient Status of Urban Schoolchildren with Moderate Anemia is Better than in a Rural Area in Kenya

Low diet quality is a driver of general and micronutrient malnutrition in urban and rural areas. The objective was to compare malnutrition and micronutrient deficiencies linked to dietary intake among urban and rural schoolchildren from food insecure settings in Kenya. The cross-sectional study was conducted among urban and rural schoolchildren aged 7–9 years. Height and weight were measured, venous blood samples were assessed and data on dietary intake was collected. After screening out children with hemoglobin >12.2 g/dL and moderate or severe undernutrition, a total of 36 urban and 35 rural children participated. The prevalence of moderate underweight, wasting, and stunting were lower in urban than in rural children, with significant differences in median z-scores for underweight (p < 0.001) and wasting (p < 0.001). Significantly higher values for serum ferritin (p = 0.012) and zinc (p < 0.001) were found in urban children. Yet, the median adequacy ratios were higher for vitamin C (p = 0.045), iron (p = 0.003), and zinc (p = 0.003) in rural than in urban children. General nutritional, iron, and zinc status were significantly better in slightly anemic urban children than in rural ones. Improving the nutrition of schoolchildren in urban and rural settings requires different dietary approaches.

Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

The association between household socio-economic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-Saharan Africa: a systematic review

Adverse birth outcomes and infant undernutrition remain the leading causes of morbidity and mortality in sub-Saharan Africa (SSA). Impaired infant growth and development, which often begins during foetal development, may persist during the first 2 years of life and has been associated with higher risks of cardiometabolic diseases. This systematic review assessed the associations between maternal demographic characteristics and household socio-economic status (SES), and preterm birth (PTB), small for gestational age, low birth weight (LBW), stunting, wasting and underweight in children under 2 years of age in SSA countries. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched for publications in three electronic databases (PubMed, Scopus and ScienceDirect). Eleven studies on children under 2 years of age, in four SSA regions, published in English between 1990 and 2018, were included. All the studies were observational in design (cross-sectional or cohort studies). Maternal education was the most commonly explored exposure. Most studies (63.3%) focused on undernutrition during the first 2 years of life: LBW, PTB and stunting. Lower maternal education, maternal unemployment and lower household wealth index were the SES factors most commonly associated with adverse birth outcomes and infant undernutrition. Maternal marital status was not associated with any infant outcomes. The definitions of the SES varied, which may explain discrepancies between studies. Nutrition intervention programs in SSA need to promote education and poverty alleviation in women at reproductive age, starting from pre-pregnancy, to optimise infant growth and development and prevent the increase in the prevalence of cardiometabolic diseases.

Climate-Driven Adaptation, Household Capital, and Nutritional Outcomes among Farmers in Eswatini

Globally, communities are increasingly impacted by the stressors of climate change. In response, people may adapt to maintain their livelihoods and overall health and nutrition. However, the relationship between climate adaptation and human nutrition is poorly understood and results of adaptation are often unclear. We investigated the relationship between adaptation and child nutrition, in Eswatini (formerly Swaziland) during an extreme drought. Households varied in both adaptation behavior and household resources and we found that, overall, households that adapted had better child nutrition than those that didn't adapt. When controlling for the influence of household capital, we found that more vulnerable households, those with greater dependence on natural resources and lower income, had a stronger positive relationship between adaptation and nutrition than less vulnerable households. We also found that some adaptations had stronger positive relationships with nutrition than others. In our system, the adaptation that most strongly correlated with improved nutrition, selling chickens, most likely benefits from local social networksand consistent demand, and performed better than other adaptations. Our results emphasize the need to measure adaptation outcomes and identify and support the types of adaptations are most likely to improve nutrition in the future.

Food Insecurity Is Associated with Prediabetes Risk Among U.S. Adolescents, NHANES 2003-2014

Objective: Food insecurity has been linked to adverse health consequences. We sought to determine if food insecurity was related to obesity and prediabetes risk in U.S. adolescents. We also investigated if Supplemental Nutrition Assistance Program (SNAP) utilization mitigated any observed risks. Materials and Methods: We used linear and logistic regression analysis of cross-sectional data from a nationally representative sample of U.S. adolescents aged 12-19 years participating in the National Health And Nutrition Examination Survey 2003-2014 who had an income:poverty ratio of <5.0 and had complete data regarding metabolic laboratory assessments, food security, and socioeconomic status (n = 2662). Results: Food insecurity was present in 18.40% (95% confidence interval (CI): 16.47-20.37) among U.S. adolescents meeting inclusion criteria. Food insecurity was associated with increased odds of elevated blood pressure (adjusted odds ratio [aOR] = 1.57, 95% CI: 1.11-2.22) and prediabetes (aOR = 1.94, 95% CI: 1.16-3.25). SNAP usage was associated with higher body mass index z-score (e.g., mean: 0.80 vs. 0.59, P = 0.02), increased insulin resistance, and increased prediabetes odds among food-secure adolescents relative to nonusage. Conclusions: Food insecurity is relatively prevalent among U.S. adolescents with an income:poverty ratio of <5.0. Food insecurity is related to laboratory abnormalities and corresponding adverse health outcomes among U.S. adolescents in this relatively large sample. SNAP usage was associated with adverse health observations among food-secure adolescents. Ongoing efforts are still needed toward food assistance as important public health efforts aimed at mitigating the adverse outcomes related to food insecurity.

Estimating the Double Burden of Malnutrition among 595,975 Children in 65 Low- and Middle-Income Countries: A Meta-Analysis of Demographic and Health Surveys

INTRODUCTION

Given the changing global nutrition landscape, the double burden of malnutrition is a major public health challenge in many developing countries. The main aim of this study is to estimate the double burden of malnutrition among children in low- and middle-income countries (LMICs).

METHODS

This study used cross-sectional data from Demographic and Health Surveys (2001-2016). A meta-analysis was conducted to estimate the prevalence of malnutrition indicators in 595,975 children under five years from 65 LMICs. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random-effect model was used. Sensitivity analysis was also performed, to examine the effects of outliers.

RESULTS

The pooled estimate for stunting, wasting, underweight, and overweight/obesity was 29.0%, 7.5%, 15.5%, and 5.3% respectively. Countries with the highest coexistence of undernutrition and overweight/obesity were: South Africa (stunting 27.4% (95% CI: 25.1, 29.8); overweight/obesity 13.3% (95% CI: 11.5, 15.2)), Sao Tome and Principe (stunting 29.0% (95% CI: 26.8, 31.4); overweight/obesity 10.5% (95% CI: 9.0, 12.1)), Swaziland (stunting 28.9% (95% CI: 27.3, 30.6); overweight/obesity 10.8% (95% CI: 9.7, 12.0)), Comoros (stunting 30.0% (95% CI: 28.3, 31.8); overweight/obesity 9.3% (95% CI: 8.3, 10.5)), and Equatorial Guinea (stunting 25.9% (95% CI: 23.4, 28.7); overweight/obesity 9.7% (95% CI: 8.0, 11.6)).

CONCLUSIONS

There is an urgent need to strengthen existing policies on child malnutrition to integrate and scale up opportunities for innovative approaches which address the double burden of malnutrition in children under five years in LMICs.

A Report of Health Related Anthropometric Indices in 2-5 Years Old Children of Golestan Province of Iran in 2015

Pediatric malnutrition is an enormous health issue all around the world and its distribution is different in distinct areas of a country. This study has been designed to report the anthropometric status and some socio-economic factors among 2–5 years old children from Golestan province of Iran to show a better view of pediatric health status and better planning for future actions. This study was carried out by clustered-randomized sampling method on 1,382 of 2–5 years old children in urban and rural areas of Golestan province. Anthropometric measurements were performed and World Health Organization child growth standards were used for further analyses. The prevalence of stunting in boys and girls were 7.4% and 7.5% in urban and 4.1% and 5.4% in rural areas. The prevalence of underweight in boys and girls were 6.9% and 4.7% in urban and 5.7% and 4.4% in rural areas. The prevalence of subjects being at risk for overweight were 17.8% and 11.7% in boys and girls, respectively, in urban areas and were 11.1% and 9.2% in rural areas, respectively. There was a marginally significant difference between urban boys and girls in terms of weight status (p = 0.067). In this study remarkably high prevalence of malnutrition, especially a high dominance of overweight, was reported in Golestan province of Iran. Follow-up investigation to identify the cause of malnutrition and to establish public health policies are needed to revise these health issues in Golestan province of Iran.

Analysing child linear growth trajectories among under-5 children in two Nairobi informal settlements

OBJECTIVE

We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi.

DESIGN

We used longitudinal data for the period 2007-2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child.

SETTING

Two urban informal settlements in Nairobi, Kenya.ParticipantsUnder-5 children (n 1917) and their mothers (n 1679).

RESULTS

The findings show that child weight at birth, exclusive breast-feeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother's age, marital status) and household-level factors (socio-economic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further.

CONCLUSIONS

Findings from the study point to the need to improve the targeting of child health programmes directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breast-feeding, immunization status and mother's background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings.

Trends in socioeconomic inequalities in child undernutrition: Evidence from Nigeria Demographic and Health Survey (2003 - 2013)

OBJECTIVE

The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria.

METHODS

The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method.

RESULTS

The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child's age (0-23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West).

CONCLUSIONS

To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria.

Food insecurity and the risk of undernutrition complications among children and adolescents: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis was performed to examine the association between household food insecurity and the risk of being underweight, stunting, and wasting in children and adolescents.

METHODS

Pertinent studies were identified by searching PubMed, Web of Science, and Scopus databases up to June 2018. A total of 21 studies met the inclusion criteria to be included in the pooled analysis. The risk ratio of 55 173 individuals from 12 different countries were pooled in these studies for our meta-analysis.

RESULTS

It was found that food insecurity increased the risk of stunting (odds ratio [OR] = 1.17; 95% confidence interval [CI]: 1.09-1.25) and underweight (OR = 1.17; 95% CI: 1.01-1.36) but not of wasting (OR = 1.04; 95% CI: 0.96-1.12). Subgroup analysis by age indicated that food insecurity increased the risk of stunting (OR = 1.20; 95% CI: 1.02-1.39) and underweight (OR = 1.34; 95% CI: 1.02-1.77) in children older than 5 y. This association was significant just for stunting risk (OR = 1.14; 95% CI: 1.05-1.23) in children younger than 5 y. Furthermore, among children and adolescents, risk of stunting or being underweight increased by the intensification of the level of food insecurity in food-insecure households. Furthermore, subgroup analysis by country development levels showed that children and adolescents living in developing countries had higher risk of stunting (OR = 1.16; 95% CI: 1.05-1.27).

CONCLUSIONS

Household food insecurity appears to be associated with higher risk of stunting and being underweight among children and adolescents. In addition, the intensification of the level of food insecurity and the increased age of children may increase the risk of stunting or being underweight in food-insecure households. Also, the level of economic development is an important factor in the effects of food insecurity on risk of stunting.

Kin support and child health: Investigating two approaches in an African slum

Extensive research from sub-Saharan Africa shows that mothers frequently rely on help from other family members to ensure their children's health and well-being. Yet, there is considerable debate about the relative importance of support from grandmothers versus fathers. Using an innovative survey instrument to interview 462 unmarried mothers in a slum area of Nairobi, Kenya, we provide insight into this debate by showing that a status versus transfers approach to measuring kin support asks subtly different questions and yields different results. A status approach reflects an evolutionary perspective that argues that maternal grandmothers have a greater incentive than non-residential fathers to provide material and practical support for young children. In contrast, a transfers approach is consistent with social support theories whereby the social capital provided by fathers may be more beneficial to children's health than that afforded by grandmothers. Demonstrating that different approaches to measuring kin support matter highlights the need for kin research that crosses disciplinary boundaries and encourages the development of more nuanced family policies designed to protect children's health in Africa.

Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010

Objective

To assess the factors associated with malnutrition among children <5 years in Burkina Faso.

Design

This study was based on secondary analysis of cross-sectional population-based data from Burkina-Faso Demographic Health Surveys 2010.

Setting

This study was carried out in Burkina Faso, West Africa.

Participants

The participants were 6337 children <5 years and their mothers.

Main outcome measures

Demographic characteristics, child nutrition and health status, and maternal and household information were collected. Survey-specific SAS procedures for weighting, clustering and stratification in the survey design were used. The distribution of different nutritional status, such as underweight, stunting and wasting and the effects of risk factors on malnutrition was analyzed.

Results

Out of 6337 children <5 years, 51.0% of children were male and 57.8% of children had an average size at birth. There were 15.6, 21.5 and 10.6% of children who recently suffered from diarrhea, fever and acute respiratory infection, respectively. Child sex, age, size at birth, child morbidity, mother's education and body mass index and household wealth index were significantly associated with undernutrition among children <5 years in Burkina Faso.

Conclusions

In addition to the improvement of household wealth index, more health and nutritional education for mothers should be implemented by the government to improve health and nutritional status of children <5 years in Burkina Faso.

Body mass index and wealth index: positively correlated indicators of health and wealth inequalities in Nairobi slums

Introduction

Wealth index is a known predictor of body mass index (BMI). Many studies have reported a positive association between BMI and socioeconomic status (SES). However, an in-depth investigation of the relationship between BMI and wealth index is lacking for urban slum settings.

Objective

To examine the association between BMI and wealth index in an urban slum setting in Nairobi, Kenya.

Methods

A total of 2003 adults between 40 and 60 years of age were included. BMI was derived from direct weight and height measurements. Wealth Index was computed using the standard principal component analysis of household amenities ownership. The relationship between BMI and wealth index was assessed using both linear and logistic regression models.

Results

We found that BMI linearly increased across the five quintiles of wealth index in both men and women, after adjusting for potential confounding factors. The prevalence of obesity increased from 10% in the first wealth quintile to 26.2% in the fifth wealth quintile. The average BMI for women entered the overweight category at the second quintile wealth status, or the third quintile for the total population.

Conclusion

There exists a strong positive relationship between BMI and wealth index in slum settings. Health promotion interventions aimed at reducing obesity may consider using wealth index in priority setting.

The effect of case management and vector-control interventions on space-time patterns of malaria incidence in Uganda

BACKGROUND

Electronic reporting of routine health facility data in Uganda began with the adoption of the District Health Information Software System version 2 (DHIS2) in 2011. This has improved health facility reporting and overall data quality. In this study, the effects of case management with artemisinin-based combination therapy (ACT) and vector control interventions on space-time patterns of disease incidence were determined using DHIS2 data reported during 2013-2016.

METHODS

Bayesian spatio-temporal negative binomial models were fitted on district-aggregated monthly malaria cases, reported by two age groups, defined by a cut-off age of 5 years. The effects of interventions were adjusted for socio-economic and climatic factors. Spatial and temporal correlations were taken into account by assuming a conditional autoregressive and a first-order autoregressive AR(1) process on district and monthly specific random effects, respectively. Fourier trigonometric functions were incorporated in the models to take into account seasonal fluctuations in malaria transmission.

RESULTS

The temporal variation in incidence was similar in both age groups and depicted a steady decline up to February 2014, followed by an increase from March 2015 onwards. The trends were characterized by a strong bi-annual seasonal pattern with two peaks during May-July and September-December. Average monthly incidence in children < 5 years declined from 74.7 cases (95% CI 72.4-77.1) in 2013 to 49.4 (95% CI 42.9-55.8) per 1000 in 2015 and followed by an increase in 2016 of up to 51.3 (95% CI 42.9-55.8). In individuals ≥ 5 years, a decline in incidence from 2013 to 2015 was followed by an increase in 2016. A 100% increase in insecticide-treated nets (ITN) coverage was associated with a decline in incidence by 44% (95% BCI 28-59%). Similarly, a 100% increase in ACT coverage reduces incidence by 28% (95% BCI 11-45%) and 25% (95% BCI 20-28%) in children < 5 years and individuals ≥ 5 years, respectively. The ITN effect was not statistically important in older individuals. The space-time patterns of malaria incidence in children < 5 are similar to those of parasitaemia risk predicted from the malaria indicator survey of 2014-15.

CONCLUSION

The decline in malaria incidence highlights the effectiveness of vector-control interventions and case management with ACT in Uganda. This calls for optimizing and sustaining interventions to achieve universal coverage and curb reverses in malaria decline.

Household food security in an urban slum: Determinants and trends

Introduction:

As we are moving from millennium development goals to sustainable development goals, food insecurity is imposing a formidable challenge to the policymakers, especially in developing countries such as India. A survey conducted in the urban slum areas of Vellore district, 6 years back, had reported food insecurity as high as 75%. The current study was a resurvey to assess the food security status in the aforementioned area.

Materials and Methods:

A community-based survey was conducted in which data were collected using a self-administered questionnaire from 150 households, selected through multistaged cluster sampling, who had given oral consent to be a part of the survey. The prevalence of food security calculated from this study was compared with the results from a previous survey to look for any significant improvement.

Results:

Nearly 42.7% of the households were food secure, while 26.7% were food insecure without hunger and 30.6% were food insecure with some degree of hunger. Low socioeconomic status (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.29–8.16; P < 0.012) and presence of debt (OR: 3.84, 95% CI: 1.90–7.73; P < 0.001) were the major risk factors for food insecurity. A comparison with the findings from the previous study has shown a statistically significant improvement in food security from 25.4% to 42.7% (Chi-square: 27.072, df: 2, P < 0.0001).

Conclusion:

Although food security levels have shown marked improvement over the years, much needs to be done for India to be free from the shackles of hunger.

Risk factors associated with poor health outcomes for children under the age of 5 with moderate acute malnutrition in rural fagita lekoma district, Awi Zone, Amhara, Ethiopia, 2016

BACKGROUND

Left untreated, moderate acute malnutrition (MAM) in children can lead to severe acute malnutrition, stunting, developmental delays, and death. Despite recent progress the prevalence of malnutrition remains high throughout Ethiopia. The ability to make accurate prognoses and develop effective treatment strategies for children with MAM is currently limited and, as result, a significant proportion of children with MAM fail to recover even with treatment. We seek to address this limitation by assessing the risk factors for poor outcomes among children under the age of 5 with MAM in a rural area of Ethiopia's Amhara Region. This region is considered relatively food secure and does not have food supplementation treatment programs.

METHODS

We conducted a prospective cohort study of 404 randomly sampled children, 0-59 months old stratified by household food security status. We followed the study children for approximately 2 months, assessing their health status; and used bivariate and multivariate Cox-proportional hazard regression models to identify risk factors for poor health outcomes.

RESULTS

Household food security was significantly associated with low recovery from MAM: 191 (60%) of children in food-insecure and 129 (40%) of children in food-secure households had poor health outcomes. The risk factors found to be significantly associated with poor health outcomes included the duration of exclusive breastfeeding (AHR 1.50, 95%CI: 1.05, 2.15), dietary diversity (AHR 1.74, 95%CI: 1.18, 2.54), and maternal mid-upper arm circumference (AHR=1.36, 95% CI: 1.04, 1.86). Children from pregnancies that were wanted but unplanned had 80% higher incidence of poor health outcomes than others, and children from pregnancies that were both unwanted and unplanned had more than double the incidence of poor health outcomes compared to their counterparts.

CONCLUSION

We found that without treatment, the majority of children from food insecure households and over a third of children from food secure households did not recover from MAM. Maternal factors particularly the mother's ability to plan her pregnancy were the main determinants of recovery in this study. Together these findings support arguments for targeting of nutrition support programs to vulnerable households regardless of regional food security status, and for closely integrating robust family planning, and antenatal care services with nutrition interventions.

Who Helps Single Mothers in Nairobi? The Role of Kin Support

Single mothers often turn to their extended kin for financial assistance and to help with child care. Such support may be especially important in areas of high poverty and poor environmental conditions. Using novel kinship data, this paper assesses the extent of support given by over 3,000 relatives to 462 single mothers living in a slum area of Nairobi, Kenya. Contrary to stereotypes about families in sub-Saharan Africa, the active kin network of single mothers is relatively small and nearly a fifth of mothers do not receive any financial or child care assistance. Different types of kin offer different kinds of support according to culturally proscribed roles. However, support also depends heavily on kin's employment status, geographic proximity, and age. These findings offer a nuanced picture of how single women living in slum areas draw upon their kin network to cope with their daily demands as mothers.