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Nyarko MJ, Ten Ham-Baloyi W, van Rooyen DRM. Qualitative Exploration of Health Professionals' Perceptions of Addressing Malnutrition Within the First 1,000 Days. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:442-451. [PMID: 38639691 DOI: 10.1016/j.jneb.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Explore health professionals' perceptions toward how to address malnutrition within the first 1,000 days of life in underresourced communities. DESIGN A qualitative explorative-descriptive study using 8 face-to-face focus group discussions. SETTING Health facilities serving underresourced communities within Nelson Mandela Bay, Eastern Cape Province, South Africa. PARTICIPANTS Fifty-six health professionals (n = 13 doctors, n = 28 nurses, n = 6 dietitians, and n = 9 social workers) aged between 20 and 60 years, with 1-16 years (5 years average) of working experience. The majority (n = 53; 94.6%) were women. PHENOMENON OF INTEREST Health professionals' perceptions of effective methods or strategies to address malnutrition are referred to as undernutrition. ANALYSIS Content analysis. RESULTS Health professionals perceived socioeconomic conditions; caregiver lack of nutrition knowledge; and behavioral, cultural, and generational infant feeding practices as contributing factors to malnutrition. Participants recommended efforts to strengthen the availability, accessibility, and utilization of contraception, especially for teenagers, increase support to caretakers of children from families, health facilities, and communities, and a multisector and multidisciplinary approach to improve social determinants of health in underresourced communities. CONCLUSIONS AND IMPLICATIONS To address malnutrition within the first 1,000 days of life, data supports that health professionals in underresourced communities require a multisector, multidisciplinary approach. This approach entails educational interventions, peer mentoring and community empowerment through support to and involvement of caregivers of children.
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Affiliation(s)
- Marian Joyce Nyarko
- Department of Nursing Science, Nelson Mandela University, Gqeberha, South Africa
| | - Wilma Ten Ham-Baloyi
- Department of Nursing Science, Nelson Mandela University, Gqeberha, South Africa.
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Ijaiya MA, Anjorin S, Uthman OA. Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003335. [PMID: 38905320 PMCID: PMC11192342 DOI: 10.1371/journal.pgph.0003335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/21/2024] [Indexed: 06/23/2024]
Abstract
In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status.
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Affiliation(s)
- Mukhtar A. Ijaiya
- Data-Lead Africa, Central Business District, Abuja, Federal Capital Territory, Nigeria
| | - Seun Anjorin
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Olalekan A. Uthman
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Kumar P, Kumar S, Mishra M, Jaiswal K, Bharati PP, Yadav RS, Jain PK, Kumar V, Yadav M. Growth Assessment of Under-Five Children of Employed and Unemployed Mothers of Etawah District, Uttar Pradesh: A Cross-Sectional Study. Cureus 2023; 15:e48035. [PMID: 38034210 PMCID: PMC10688233 DOI: 10.7759/cureus.48035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The under-five age group is crucial because the health profile of this age group will have a huge effect on the future development of the nation. Early infancy is marked by several distinct developmental characteristics. Progress in each domain of childhood development is used to track a child's development. Objectives The objectives of the present study were to assess and compare the growth of under-five children of employed and unemployed mothers in the Etawah District of Uttar Pradesh, India. Material and methods A community-based cross-sectional survey was carried out in Etawah district's urban and rural areas between January 2021 and June 2022. A total of 200 mothers with children under the age of five were recruited using the purposive sampling method. To gather pertinent information, a semi-structured, pre-tested, interviewer-administered questionnaire was used. Results In the present study on the comparison of the growth of children among employed and unemployed mothers, it shows that 48 children (50.5%) with a weight between 10.5 and 15 kg were of employed mothers, while 52 children weighing less than 10.5kg were of unemployed mothers (p<0.001). Forty-four children (57.1%) with a chest circumference of more than 48 cm were of employed mothers, while 26 children (78.8%) with a chest circumference of less than 45 cm were of unemployed mothers (p = 0.001). Conclusion The present study indicates that statistically significant differences were found in age-appropriate gain in weight and chest circumference, which was higher among the children of employed mothers in comparison to children of unemployed mothers. There was no statistically significant difference in age-appropriate gain in height, head circumference, or mid-upper arm circumference among the children of employed mothers and unemployed mothers.
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Affiliation(s)
- Pradip Kumar
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Sandip Kumar
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Mohit Mishra
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Kirti Jaiswal
- Physiology, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | | | - R S Yadav
- Botany, Karm Kshetra Post Graduate (K.K. P.G. College, Etawah, IND
| | - P K Jain
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Vineet Kumar
- Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, IND
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Rahayuwati L, Komariah M, Sari CWM, Yani DI, Hermayanti Y, Setiawan A, Hastuti H, Maulana S, Kohar K. The Influence of Mother's Employment, Family Income, and Expenditure on Stunting Among Children Under Five: A Cross-Sectional Study in Indonesia. J Multidiscip Healthc 2023; 16:2271-2278. [PMID: 37601326 PMCID: PMC10437103 DOI: 10.2147/jmdh.s417749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction It is widely acknowledged that the socioeconomic circumstances of a family income are correctly reflected in that family expenditures. The dietary habits of families are influenced by socioeconomic circumstances that may affect stunting. Therefore, this study aims to investigate the household economic predictor stunting (mother's employment, family income, and family expenditure) in children under five. Methods This study used a cross-sectional design. Six districts and cities have been chosen as study areas based on the areas with the highest incidence of stunting in West Java, Indonesia. This study conducted specifically from October to December 2018. Data were examined using descriptive statistics (frequency distribution) and a Spearman Rank bivariate test. A logistic regression was employed to determine the elements that serve as predictors of stunting. Results A total of 731 women with children under five participated in the study. A bivariate analysis showed that mother's employment had an association with stunting among children under five (p = 0.014). Meanwhile, family income and expenditure are not statistically significant associated with stunting (p > 0.05). A multivariate analysis showed that mother's employment was a stunting predictor with odd ratio (OR) 1.810 (p = 0.017). The OR value means that mothers who do not work have a 1.810 chance for their children to experience stunting compared with mothers who have work. However, family income and expenditure have negative projected values (p = 0.580 and p = 0.398, respectively). Conclusion Children under five who are stunted are potentially predictive with mothers' employment, with a chance is higher in mother who do not work. However, family income and expenditure are not predictive of stunting.
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Affiliation(s)
- Laili Rahayuwati
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Maria Komariah
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Citra Windani Mambang Sari
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Desy Indra Yani
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Yanti Hermayanti
- Department of Maternity Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Arlette Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Hediati Hastuti
- Internship Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Sidik Maulana
- Internship Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Kelvin Kohar
- Clinical Clerkship Program, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Special Capital Region of Jakarta, Indonesia
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Aduful AK, Boamah-Mensah F, Nyarko MY, Neizer ML, Brew YN, Williams LA, Calys-Tagoe BNL, Ackun HKM, Tette EMA. Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1313. [PMID: 37628312 PMCID: PMC10453618 DOI: 10.3390/children10081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children's outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. OBJECTIVE We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. METHODS The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. RESULTS Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child's hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). CONCLUSION Families of children with CP have information, service, and access needs related to their disease severity and family context.
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Affiliation(s)
- Abena K. Aduful
- Department of Family Medicine, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | - Faye Boamah-Mensah
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Mame Yaa Nyarko
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Margaret L. Neizer
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
| | - Yvonne N. Brew
- Department of Child Health, Greater Accra Regional Hospital (GARH), Accra P.O. Box GP 473, Ghana
| | - Lovia A. Williams
- Department of Child Health, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana
| | | | - Henry K. M. Ackun
- Department of Family Medicine, Duffus Health Center, Halifax, NS B3M 3Y7, Canada
| | - Edem M. A. Tette
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana (M.L.N.)
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
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Adem HA, Usso AA, Hebo HJ, Workicho A, Ahmed F. Determinants of acute undernutrition among pregnant women attending primary healthcare unit in Chinaksen District, Eastern Ethiopia: a case-control study. PeerJ 2023; 11:e15416. [PMID: 37304886 PMCID: PMC10249615 DOI: 10.7717/peerj.15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Background Women's undernutrition during pregnancy increases the risks and burdens of maternal and neonatal morbidity, death, and disability through its vicious cycles of irreversible intergenerational negative effects. Despite the high burden of maternal undernutrition during pregnancy in semi-pastoral communities of eastern Ethiopia, there is a paucity of information on its major risk factors. This study revealed determinants of acute undernutrition among pregnant women attending primary healthcare units in Chinaksen district in rural eastern Ethiopia. Method A facility-based case-control study was conducted among 113 cases and 113 controls in Chinaksen district from February 01 to March 30, 2017. Data were entered using EpiData version 3.1 and analyzed using SPSS version 24. Multivariable logistic regression analyses conducted to identify significant determinants of acute undernutrition. Adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of association and statistical significance declared at p value < 0.05. Results Sixty (53.1%) of cases and 56 (49.6%) of controls were in the age group of 25-34 years and their mean ± SD age of cases and controls were 26.6 ± 5.7 and 28 ± 5.5 years, respectively. In this study, larger family size (AOR = 6.98, 95 CI [2.82-17.27]), lack of prenatal dietary advice (AOR = 3.68, 95% CI [1.67-8.00]), did not participate in a cooking demonstration (AOR = 5.41, 95% CI [2.39-12.24]), used substances (AOR = 3.65, 95% CI [1.30-10.23]), absence of basic latrine (AOR = 2.91, 95% CI [1.28-6.58]), low minimum dietary diversity of women (AOR = 2.48, 95% CI [1.20-5.12]), and household food insecurity (AOR = 3.06, 95% CI [1.44-6.51]) were significantly increased the odds of acute undernutrition among pregnant women. Conclusions The study revealed that living in crowded families, lack prenatal dietary advice, did not participate in cooking demonstrations, substances use; lack of toilet, low minimum dietary diversity, and household food insecurity were significant risk factors for acute undernutrition among pregnant women. Strengthening multi-sectoral approaches through improving dietary diversity/quality and food access/quantity would be essential to prevent, and reduce the risks, burdens, and impacts of maternal undernutrition during pregnancy.
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Affiliation(s)
- Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Harari, Ethiopia
| | - Ahmedin Aliyi Usso
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Somali, Ethiopia
| | - Habtemu Jarso Hebo
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Fila Ahmed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Harari, Ethiopia
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Ouaijan K, Hwalla N, Kandala NB, Abi Kharma J, Kabengele Mpinga E. Analysis of predictors of malnutrition in adult hospitalized patients: social determinants and food security. Front Nutr 2023; 10:1149579. [PMID: 37229465 PMCID: PMC10203390 DOI: 10.3389/fnut.2023.1149579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/07/2023] [Indexed: 05/27/2023] Open
Abstract
Background Malnutrition in hospitalized patients is becoming a priority during the patient care process due to its implications for worsening health outcomes. It can be the result of numerous social factors beyond clinical ones. This study aimed to evaluate the link between these various risk factors considered social determinants of health, food security levels, and malnutrition and to identify potential predictors. Methods A cross-sectional observational study was conducted on a random sample of adult patients in five different hospitals in Lebanon. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were interviewed to collect social and economic characteristics and were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status, and (4) source of health coverage. The food security level was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey, targeting both quantity and quality. Results In a random sample of 343 patients, the prevalence of malnutrition according to the GLIM criteria was 35.6%. Patients with low levels of food security, mainly low quality of food, had higher odds of being malnourished (OR = 2.93). Unemployed or retired patients and those who have only completed only elementary school had higher odds of being diagnosed with malnutrition as compared to those who were employed or had university degrees, respectively (OR = 4.11 and OR = 2.33, respectively). Employment status, education level, and type of health coverage were identified as predictors of malnutrition in the multiple regression model. Household location (urban vs. rural) was not associated with malnutrition. Conclusion The social determinants of health identified in our study, mainly the level of education and income level, in addition to food security, were identified as predictors of malnutrition in hospitalized patients. These findings should guide healthcare professionals and national policies to adopt a broader perspective in targeting malnutrition by including social determinants in their nutrition care.
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Affiliation(s)
- Krystel Ouaijan
- Department of Clinical Nutrition, Saint George Hospital University Medical Center, Beirut, Lebanon
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Joelle Abi Kharma
- Faculty of Arts and Sciences, Lebanese American University, Beirut, Lebanon
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Nyarko MJ, van Rooyen DR, Ten Ham-Baloyi W. Preventing malnutrition within the first 1000 days of life in under-resourced communities: An integrative literature review. J Child Health Care 2023:13674935231166427. [PMID: 37011277 DOI: 10.1177/13674935231166427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
This integrative review aimed to summarise existing best evidence practice for preventing malnutrition within the First 1000 Days of Life in under-resourced communities. BioMed Central, EBSCOHOST (Academic Search Complete, CINAHL and MEDLINE), Cochrane Library, JSTOR, Science Direct and Scopus were searched as well as Google Scholar and relevant websites for grey literature. Most recent versions of strategies, guidelines, interventions and policies; published in English, focussing on preventing malnutrition in pregnant women and in children less than 2 years old in under-resourced communities, from January 2015 to November 2021 were searched for. Initial searches yielded 119 citations of which 19 studies met inclusion criteria. Johns Hopkins Nursing Evidenced-Based Practice Evidence Rating Scales for appraising research evidence and non-research evidence were used. Extracted data were synthesised using thematic data analysis. Five themes were derived from extracted data: 1. Improving social determinants of health using a multisector approach; 2. Enhancing infant and toddler feeding; 3. Managing healthy nutrition and lifestyle choices in pregnancy; 4. Improving personal and environmental health practices; and 5. Reducing low-birthweight incidence. Further exploration regarding preventing malnutrition in the First 1000 Days in under-resourced communities is required using high-quality studies. Systematic review registration number: H18-HEA-NUR-001 (Nelson Mandela University).
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Affiliation(s)
- Marian Joyce Nyarko
- Faculty of Health Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
| | - Dalena Rm van Rooyen
- Faculty of Health Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
| | - Wilma Ten Ham-Baloyi
- Faculty of Health Sciences, 56723Nelson Mandela University, Port Elizabeth, South Africa
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Logarajan RD, Nor NM, Ibrahim S, Said R. Social determinants of stunting in Malay children aged <5 years in Malaysia. Nutrition 2023; 111:112030. [PMID: 37172456 DOI: 10.1016/j.nut.2023.112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study aims to assess social determinants of stunting among children aged <5 y within the Malay ethnicity in Malaysia. METHODS This study used data from the National Health and Morbidity Survey 2016: Maternal and Child Health. It includes a sample of 10 686 children, ages 0 to 59 mo, of Malay ethnicity. Height-for-age z score was determined based on the World Health Organization Anthro software. A binary logistic regression model was used to examine the association between the selected social determinants and the occurrence of stunting. RESULTS About 22.5% of children aged <5 y of Malay ethnicity were stunted. For those ages 0 to 23 mo, stunting is more prevalent in boys, in rural areas, and in those who have screen exposure, whereas a reduction of stunting was observed for those children whose mothers work in the private sector and in those who consume formula milk and meat. As for those ages 24 to 59 mo, there was a higher prevalence of stunting for those with self-employed mothers and reduced prevalence in children with hygienic waste disposal practices as well as those who play with toys. CONCLUSIONS The prevalence of stunting among children of Malay ethnicity aged <5 in Malaysia necessitates immediate intervention. It is pertinent to facilitate early identification of those children at risk of stunting for additional care to promote healthy growth.
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Affiliation(s)
- Renuka Devi Logarajan
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Norashidah Mohamed Nor
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Saifuzzaman Ibrahim
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rusmawati Said
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Phiri M, Mulemena D, Kalinda C, Odhiambo JN. Contextual factors and spatial trends of childhood malnutrition in Zambia. PLoS One 2022; 17:e0277015. [PMID: 36327254 PMCID: PMC9632925 DOI: 10.1371/journal.pone.0277015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Understanding the national burden and epidemiological profile of childhood malnutrition is central to achieving both national and global health priorities. However, national estimates of malnutrition often conceal large geographical disparities. This study examined the prevalence of childhood malnutrition across provinces in Zambia, changes over time, and identified factors associated with the changes. METHODS We analyzed data from the 2013/4 and 2018 Zambia demographic and health surveys (ZDHS) to examine the spatial heterogeneity and mesoscale correlates of the dual burden of malnutrition in children in Zambia. Maps illustrating the provincial variation of childhood malnutrition were constructed. Socio-demographic and clinical factors associated with childhood malnutrition in 2013 and 2018 were assessed independently using a multivariate logistic model. RESULTS Between 2013/4 and 2018, the average prevalence of stunting decreased from 40.1% (95% CI: 39.2-40.9) to 34.6% (95% CI:33.6-35.5), wasting decreased from 6.0% (95% CI: 5.6-6.5) to 4.2% (95% CI: 3.8-4.7), underweight decreased from 14.8% (95% CI: 14.1-15.4) to 11.8% (95% CI: 11.2-12.5) and overweight decreased from 5.7% (95% CI: 5.3-6.2) to 5.2% (95% CI: 4.8-5.7). High variability in the prevalence of childhood malnutrition across the provinces were observed. Specifically, stunting and underweight in Northern and Luapula provinces were observed in 2013/14, whereas Lusaka province had a higher degree of variability over the two survey periods. CONCLUSION The study points to key sub-populations at greater risk and provinces where malnutrition was prevalent in Zambia. Overall, these results have important implications for nutrition policy and program efforts to reduce the double burden of malnutrition in Zambia.
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Affiliation(s)
- Million Phiri
- Department of Population Studies, University of Zambia, School of Humanities and Social Sciences, Lusaka, Zambia
- Department of Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Mulemena
- Ministry of Mines and Minerals Development, Lusaka, Zambia
| | - Chester Kalinda
- University of Global Health Equity (UGHE), Bill and Joyce Cummings Institute of Global Health, Institute of Global Health Equity Research (IGHER), Kigali, Rwanda
- Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali, Rwanda
| | - Julius Nyerere Odhiambo
- Ignite Global Health Research Lab, Global Research Institute, William and Mary, Williamsburg, Virginia, United States of America
- * E-mail:
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Nonterah EA, Welaga P, Chatio ST, Kehoe SH, Ofosu W, Ward KA, Godfrey KM, Oduro AR, Newell ML. Children born during the hunger season are at a higher risk of severe acute malnutrition: Findings from a Guinea Sahelian ecological zone in Northern Ghana. MATERNAL & CHILD NUTRITION 2022; 18:e13313. [PMID: 35008126 PMCID: PMC8932825 DOI: 10.1111/mcn.13313] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022]
Abstract
Heightened food insecurity in the hunger season increases the risk of severe acute malnutrition (SAM) in childhood. This study examined the association of season of birth with SAM in a Guinean Sahelian ecological zone. We analyzed routine health and sociodemographic surveillance data from the Navrongo Health and Socio-demographic Surveillance System collected between 2011 and 2018. January-June, the period of highest food insecurity, was defined as the hunger season. We defined moderate acute malnutrition as child mid-upper arm circumference (MUAC) between 115 mm and 135 mm and SAM as MAUC ≤ 115 mm. We used adjusted logistic regression to quantify the association between the season of birth and SAM in children aged 6-35 months. From the 29,452 children studied, 24% had moderate acute malnutrition. Overall, 1.4% had SAM, with a higher prevalence (1.8%) in the hunger season of birth. Compared with those born October-December, adjusted odds ratios (aOR) and 95% confidence interval (95% CI) for SAM were increased for children born in the hunger season: January-March (1.77 [1.31-2.39]) and April-June (1.92 [1.44-2.56]). Low birth weight, age at an assessment of nutritional status, and ethno-linguistic group were also significantly associated with SAM in adjusted analyses. Our study established that being born in the hunger season is associated with a higher risk of severe acute malnutrition. The result implies improvement in the food supply to pregnant and lactating mothers through sustainable agriculture or food system change targeting the hunger season may reduce the burden of severe acute malnutrition.
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Affiliation(s)
- Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul Welaga
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- School of Medicine and Dentistry, C K Tedam University of Technology and Applied Sciences, Navrongo, Upper East Region, Ghana
| | - Samuel T Chatio
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Winfred Ofosu
- Upper East Regional Health Directorate, PMB, Bolgatanga, Ghana
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Abraham R Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Marie-Louise Newell
- Department of Human Development, University of Southampton, Southampton, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Shenavar R, Sajjadi SF, Farmani A, Zarmehrparirouy M, Azadbakht L. Improvement in Anthropometric Measurements of Malnourished Children by Means of Complementary Food and Nutritional Education in Fars Province, Iran: A Community-Based Intervention. Front Nutr 2022; 9:813449. [PMID: 35308266 PMCID: PMC8924542 DOI: 10.3389/fnut.2022.813449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Childhood malnutrition could have adverse impacts on the growth of child and eventually on fertility and general economic growth, and still, this issue remains a worldwide priority and a concern. This study aimed to evaluate the effectiveness of the national nutritional interventions program on the improvement and nutritional status of malnourished children children aged 6–59 months. Methods This community-based intervention study was conducted with 1288 acute and moderately malnourished children aged 6–59 months referred to health centers. Children received combined nutritional education and counseling with the provision of affordable complementary food for 10 months. Anthropometric measurements were assessed monthly according to the standard protocols. Results Our results showed the reduction in the risk of malnutrition among children after nutritional interventions for weight-for-height (WHZ) (P < 0.001), height-for-age (HAZ) (P < 0.001), and weight-for-age (WAZ) (P = 0.008). Total malnourished children indicated improvement in HAZ (<-3 SD: OR = 1.10, P = 0.026), WAZ (<-2SD: OR = 1.21, P < 0.001; <-3SD: OR = 1.60, P < 0.001), and WHZ (<-3SD: OR = 1.10, P = 0.030). Controlling potential confounders (socioeconomic status, childrens' birth supine length, and weight) showed a significant amelioration in HAZ (<-2 SD: OR = 6.20, P = 0.020; <-3 SD: OR = 9, P = 0.003) and WAZ (<-2 SD: OR = 5.85, P = 0.010; <-3 SD: OR = 7.50, P = 0.004). In urban areas, significant amelioration was observed in HAZ (<-3 SD: OR = 1.22, P = 0.010) and WAZ (<-2 SD: OR = 1.24, P = 0.003; <-3 SD: OR = 1.64, P < 0.001). In rural, considerable amelioration was observed in WAZ (<-2 SD: OR = 1.20, P = 0.010; <-3 SD: OR = 1.50, P < 0.001) and WHZ (<-3 SD: OR = 1.20, P = 0.020). Conclusion Nutritional training and counseling as well as complementary food intervention among the malnourished children significantly improved the nutritional status of children. So community-based intervention is recommended to reduce the malnutrition among children.
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Affiliation(s)
- Razieh Shenavar
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
- Department of Community Nutrition, School of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Forough Sajjadi
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Farmani
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Mina Zarmehrparirouy
- Department of Community Nutrition, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Leila Azadbakht
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13
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Amoako Johnson F. Spatiotemporal clustering and correlates of childhood stunting in Ghana: Analysis of the fixed and nonlinear associative effects of socio-demographic and socio-ecological factors. PLoS One 2022; 17:e0263726. [PMID: 35134090 PMCID: PMC8824350 DOI: 10.1371/journal.pone.0263726] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Childhood stunting remains a major public health issue in many low- and middle-income countries. In Ghana, the progress made is insufficient to reach the targets set by the 2025 World Health Assembly and the 2030 United Nations Sustainable Development Goals. Although studies have examined the socio-demographic determinants of childhood stunting, there has not been any systematic study to examine the spatial associative effects of the socio-demographic and socio-ecological factors at the district level, where health programmes are implemented and monitored. Bayesian geo-additive semiparametric regression technique was used to analyse five conservative rounds of Demographic and Health Surveys in Ghana, with socio-ecological covariates derived from the Demographic and Health Survey Program Geospatial Covariate datasets to examine the temporal trends in childhood stunting, the extent of geospatial clustering at the district level and their associative relationships with socio-demographic and socio-ecological factors. The findings show that childhood stunting in Ghana is not spatially randomly distributed but clustered. Clustering of high childhood stunting was observed amongst districts in the Upper West, Upper East, Northern, North East, Savannah, and Western North regions, whilst clustering of low childhood stunting was observed in districts in the Greater Accra, Volta, Bono and the Eastern regions. Whist socio-demographic factors were predominantly associated with clustering of districts with high childhood stunting, the socio-ecological factors were mainly associated with clustering of districts with low childhood stunting. The socio-ecological factors identified to have a nonlinear associative effect with childhood stunting were Insecticide Treated Net (ITN) coverage, nightlight composite, travel time to a main settlement and population density. The findings suggest that targeted interventions at the district level are essential to reducing childhood stunting in Ghana.
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Affiliation(s)
- Fiifi Amoako Johnson
- Department of Population and Health, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
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Social determinants of malnutrition in Chilean children aged up to five. BMC Public Health 2022; 22:44. [PMID: 34996396 PMCID: PMC8740415 DOI: 10.1186/s12889-021-12455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to ascertain the Social Determinants (SDs) of malnutrition (over and undernutrition) of Chilean children aged up to five. Methods The study was carried out using a sample of children from zero to five years old (n = 1,270,485; 52.2% female) from the National Socioeconomic Characterization Survey (CASEN) 2017. A multinomial logistic regression model was used, where the “child nutritional status” outcome variable assumed three possible values: normal nutrition, overnutrition, and undernutrition, while taking those variables reported in previous literature as independent variables. Results The model, by default, set normal nutrition as the reference group, Count R2 = 0.81. Results show a higher likelihood of both overnutrition and undernutrition among male children from the lowest quintiles, with native ethnic backgrounds, reporting health problems, having public health insurance, and who attend kindergarten. Additionally, higher probabilities of undernutrition in younger than two and living in the north of the country, while overnutrition is more likely in the south. Conclusions Socioeconomic variables are fundamentally related to both over and undernutrition; the current single schema program to prevent malnutrition should consider SDs such as ethnicity and geographical location, among others; moreover, successful nutritional programs—which focused on the lowest quintiles, need to be expanded to other vulnerable groups and pay more attention to overnutrition.
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Clinical Characteristics and Underlying Factors Related to Recovery from Severe Pneumonia in Under-Five Children with or without Malnutrition Treated at Health Care Facilities in Bangladesh. CHILDREN-BASEL 2021; 8:children8090778. [PMID: 34572210 PMCID: PMC8471729 DOI: 10.3390/children8090778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Severe pneumonia with co-morbidity of malnutrition is one of the leading causes of death among children younger than five years of age. We aimed to compare the clinical features related to recovery from severe pneumonia in malnourished and well-nourished under-five children. A significantly lesser proportion of malnourished children compared to well-nourished recovered from rapid breathing (86.5% vs. 90.2%; p = 0.035), chest wall in-drawing (90.5% vs. 93.9%; p = 0.019), and fever (92.2% vs. 95.2%; p = 0.021) on day six after admission to health-care facilities. Malnourished children with severe pneumonia had significantly more rapid breathing (Adjusted Odds Ratio (AOR)) 1.636, 95% Confidence interval (CI) 1.150–2.328 p = 0.006), chest wall in-drawing (AOR 1.698, 95% CI 1.113–2.590, p = 0.014), and fever (AOR 1.700, 95% CI 1.066–2.710, p = 0.026) compared to those in well-nourished children. The study results suggested the lesser disappearance of clinical features among the malnourished children in Bangladesh underscores their vulnerability to severe pneumonia.
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Ghosh PK, Das P, Goswam DR, Islam A, Chowdhury S, Mollah MM, Harun GD, Akhtar Z, Chowdhury F. Maternal Characteristics Mediating the Impact of Household Poverty on the Nutritional Status of Children Under 5 Years of Age in Bangladesh. Food Nutr Bull 2021; 42:389-398. [PMID: 34058896 DOI: 10.1177/0379572121999016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We explored the maternal characteristics that mediate the effect of household poverty on childhood undernutrition. METHODS We used the population-based Bangladesh Demographic Health Survey data from 2014 for demographic characteristics, child and maternal factors. RESULTS Of the 7173 under-5 children, 3456 (48.2%) had undernutrition. The prevalence of undernutrition was less common in wealthy households (poorest vs richest: adjusted prevalence ratio [aPR] = 1.37), mothers having history of antenatal care (ANC) visits (no visit vs ≥ 4 visits: aPR = 1.22), maternal higher education (no education vs higher education: aPR = 1.54), and mothers with good nutritional status (underweight vs healthy: aPR = 1.13). The risk of undernutrition (37.1%) was attributed to household wealth, mediated 55% by maternal factors; of which 20% by maternal education, 21% by ANC visits, and 14% by maternal nutritional status. CONCLUSIONS Our study findings outlined higher maternal education, ≥ 4 ANC visits and good maternal nutritional status in mediating the impact of household wealth on childhood nutrition.
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Affiliation(s)
- Probir Kumar Ghosh
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pritimoy Das
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Doli Rani Goswam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ausraful Islam
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sukanta Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Zubair Akhtar
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- 56291International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Olatosi OO, Alade AA, Naicker T, Busch T, Oyapero A, Li M, Pape J, Olotu J, Awotoye W, Hassan M, Adeleke C, Adeyemo WL, Shaffer J, Marazita ML, Butali A. Dental Caries Severity and Nutritional Status of Nigerian Preschool Children. JDR Clin Trans Res 2021; 7:154-162. [PMID: 33764218 DOI: 10.1177/23800844211002108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child's nutrition and growth. AIM This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria. STUDY DESIGN This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used. RESULTS A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<-3 = severely wasted, -2 to -3 = wasted, -2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft (r = -0.181, P < 0.05 and r = -0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant (r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively). CONCLUSION Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight. KNOWLEDGE TRANSFER STATEMENT The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.
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Affiliation(s)
- O O Olatosi
- Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine University of Lagos, Lagos, Nigeria
| | - A A Alade
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - T Naicker
- Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - T Busch
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - A Oyapero
- Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - M Li
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - J Pape
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - J Olotu
- Department of Anatomy, University of Port Harcourt, Port Harcourt, Nigeria
| | - W Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - M Hassan
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - C Adeleke
- Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
| | - W L Adeyemo
- Department of Oral and Maxillofacial Surgery, University of Lagos, Lagos, Nigeria
| | - J Shaffer
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Iowa Institute of Oral Health Research, University of Iowa, Iowa City, IA, USA
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Abdullahi AT, Farouk ZL, Imam A. Common mental disorders in mothers of children attending out-patient malnutrition clinics in rural North-western Nigeria: a cross-sectional study. BMC Public Health 2021; 21:185. [PMID: 33478451 PMCID: PMC7818054 DOI: 10.1186/s12889-021-10227-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/12/2021] [Indexed: 01/28/2023] Open
Abstract
Background Children with uncomplicated severe acute malnutrition are managed routinely within out-patient malnutrition treatment programs. These programs do not offer maternal mental health support services, despite maternal mental health playing a significant role in the nutritional status of children. Additionally, the burden of maternal Common Mental Disorders (CMDs) is poorly described among mothers of children attending these programs. This study thus determined the burden and risk factors for maternal CMDs among children attending out-patient malnutrition clinics in rural North-western Nigeria. Methods We conducted a cross-sectional study among 204 mothers of children with severe acute malnutrition who attending eight out-patient malnutrition clinics in Jigawa, North-western Nigeria. We used the World Health Organization Self-Reporting Questionnaire-20 (WHO SRQ-20) screening tool, a recognised and validated proxy measure for CMDs to identify mothers with CMDs. The prevalence of maternal CMDs was determined by identifying the proportion of mothers with SRQ scores of ≥8. Risk factors for CMD were determined using multivariable logistic regression. Results Maternal CMD prevalence in children attending these facilities was high at 40.7%. Non-receipt of oral polio vaccine (OPV) (AOR 6.23, 95%CI 1.85 to 20.92) increased the odds for CMD. While spousal age above 40 (AOR 0.95, 95%CI 0.90 to 0.99) and long years spent married (AOR 0.92, 95%CI 0.85 to 0.98) decreased the odds for CMD. Conclusions Our findings indicate maternal CMD burden is high in out-patient malnutrition clinics in North-western Nigeria. Maternal mental health services would need to be integrated into the community management of acute malnutrition programs to provide more holistic care, and possibly improve long-term outcomes after discharge from these programs.
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Affiliation(s)
- Aminu T Abdullahi
- Department of Psychiatry, Bayero University Kano, Kano, Nigeria.,Department of Psychiatry, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria
| | - Zubaida L Farouk
- Center for Infectious Diseases Research, Bayero University Kano, Kano, Nigeria.,Department of Paediatrics, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria
| | - Abdulazeez Imam
- Department of Vaccines and Immunity, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, P.O. Box 273, Atlantic Boulevard, Fajara, Gambia.
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Sharma S. A conceptual model and framework of nutrition-sensitive and specific interventions across Life stages in India. J Family Med Prim Care 2021; 10:3976-3982. [PMID: 35136755 PMCID: PMC8797081 DOI: 10.4103/jfmpc.jfmpc_789_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
A large segment of the maternal and child population in low- and middle-income countries (LMIC) is malnourished. There has been a considerable amount of literature on different evidence-based actions that work well with pregnant women or lactating mothers. However, we lack a comprehensive framework of evidence-based nutrition interventions for LMIC that endorse actions along the life course, that is, from adolescence to lactation and childhood, for improved child health and nutrition. Considering the need, this study aimed to explore and design a model and framework for improving maternal and child nutrition. A systematic review of the literature was conducted to identify evidence-based interventions that reduce malnutrition and improve maternal and child health and nutrition. The literature search was made using Google, Google Scholar, and PubMed. The search of the literature in the last 5 years was made. Our conceptual model illustrates key nutrition approaches at different levels (from individual to system levels). The promotion, prevention, monitoring, and management framework (based on nutrition-specific interventions) sorts out actions across each set of the population (pregnant, lactating, and newly married women and adolescent girls) for improved nutrition and health. Our nutrition-sensitive intervention framework, in the way to target basic causes of undernutrition, highlight actions that may result in improved maternal and child health and nutrition in the long run. Encapsulating the wide array of interventions across the life course, our model and framework hold importance as they contain evidence-based actions as suggested by the international agencies and are contextualized for India.
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Kumeh OW, Fallah MP, Desai IK, Gilbert HN, Silverstein JB, Beste S, Beste J, Mukherjee JS, Richardson ET. Literacy is power: structural drivers of child malnutrition in rural Liberia. BMJ Nutr Prev Health 2020; 3:295-307. [PMID: 33521541 PMCID: PMC7841815 DOI: 10.1136/bmjnph-2020-000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country's civil war and were further exacerbated by the 2014-2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations. METHODS Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers' experiences, as well as health workers' understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data. RESULTS Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition. DISCUSSION The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.
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Affiliation(s)
- Odell W Kumeh
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Ministry of Health of Liberia, Monrovia, Montserrado, Liberia
| | - Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia, Montserrado, Liberia
| | - Ishaan K Desai
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B Silverstein
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Beste
- Partners In Health, Harper, Liberia
- Division of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason Beste
- Partners In Health, Harper, Liberia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Joia S Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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Sarker AR, Sultana M, Sheikh N, Akram R, Ali N, Mahumud RA, Alam K, Morton A. Inequality of childhood undernutrition in Bangladesh: A decomposition approach. Int J Health Plann Manage 2019; 35:441-468. [PMID: 31702080 DOI: 10.1002/hpm.2918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Undernutrition is one of the major public health concerns in Bangladesh. This study examined the trends and patterns of childhood undernutrition, inequality, and its socioeconomic contributors in Bangladesh. METHODS Data were extracted from the last four rounds of the Bangladesh Demographic Health Survey (BDHS). A regression-based decomposition method was applied to assess the socioeconomic contributors of inequality. RESULTS Although the prevalence of childhood undernutrition has declined during the period 2004 to 2014, the rate of undernutrition is higher among the children of mothers who had lower education, live in rural areas, and are from the poorest wealth quintile. Socioeconomic status accounted for almost half of the total inequality in the prevalence of both stunting and underweight among children, whereas maternal education was ranked second among the contributors. CONCLUSIONS Findings of the study indicate that undernutrition inequalities in terms of socioeconomic aspects appear to have widened over time. Improving economic activity and maternal education will improve the nutritional status of children and as a consequence reduce inequality. Therefore, investments in education, creation of working opportunities, and empowerment of vulnerable and disadvantaged people along with nutrition-specific interventions will be important measures to eliminate this inequality at the population level.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Nurnabi Sheikh
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Raisul Akram
- Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- School of Commerce, and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Khorshed Alam
- School of Commerce, and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
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Boah M, Azupogo F, Amporfro DA, Abada LA. The epidemiology of undernutrition and its determinants in children under five years in Ghana. PLoS One 2019; 14:e0219665. [PMID: 31365528 PMCID: PMC6668784 DOI: 10.1371/journal.pone.0219665] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 06/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding the burden and contextual risk factors is critical for developing appropriate interventions to control undernutrition. METHODS This study used data from the 2014 Ghana Demographic and Health Survey to estimate the prevalence of underweight, stunting, and wasting. Single multiple logistic regressions were used to identify the factors associated with underweight, wasting and stunting. The study involved 2720 children aged 0-59 months old and mother pairs. All analyses were done in STATA/IC version 15.0. Statistical significance was set at p<0.05. RESULTS The prevalence of underweight, wasting and stunting were 10.4%, 5.3%, and 18.4% respectively. The age of the child was associated with underweight, wasting and stunting, whereas the sex was associated with wasting and stunting. Normal or overweight/obese maternal body mass index category, high woman's autonomy and middle-class wealth index were associated with a lower odds of undernutrition. The factors that were associated with a higher odds of child undernutrition included: low birth weight (<2.5 kg), minimum dietary diversity score (MDDS), a higher (≥4th) birth order number of child, primary educational level of husband/partner and domicile in the northern region of Ghana. CONCLUSION There is still a high burden of child undernutrition in Ghana. The age, sex, birth weight, birth order and the MDDS of the child were the immediate factors associated with child undernutrition. The intermediate factors that were associated with child undernutrition were mainly maternal related factors and included maternal nutritional status and autonomy. Distal level factors which were associated with a higher odds of child undernutrition were the wealth index of the household, paternal educational status and region of residence. We recommend that interventions and policies for undernutrition should address socioeconomic inequalities at the community level while factoring in women empowerment programmes.
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Affiliation(s)
- Michael Boah
- Ghana Health Service, Bolgatanga, Upper East Region, Ghana
| | - Fusta Azupogo
- Department of Family and Consumer Sciences, Faculty of Agriculture, University for Development Studies, Tamale, Ghana
| | - Daniel Adjei Amporfro
- Department of Social Medicine and Health Service Management, Harbin Medical University, Harbin, China
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Aber H, Kisakye AN, Babirye JN. Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. Pan Afr Med J 2018; 31:17. [PMID: 30918545 PMCID: PMC6430833 DOI: 10.11604/pamj.2018.31.17.14955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Malnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. Methods A household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software. Results A household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70). Conclusion Adherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households.
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Affiliation(s)
- Harriet Aber
- Makerere University College of Health Sciences School of Public Health, Kampala, Uganda
| | - Angela Nakanwagi Kisakye
- Makerere University College of Health Sciences School of Public Health, Kampala, Uganda.,African Field Epidemiology Network, Kampala, Uganda
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Nabwera HM, Moore SE, Mwangome MK, Molyneux SC, Darboe MK, Camara-Trawally N, Sonko B, Darboe A, Singhateh S, Fulford AJ, Prentice AM. The influence of maternal psychosocial circumstances and physical environment on the risk of severe wasting in rural Gambian infants: a mixed methods approach. BMC Public Health 2018; 18:109. [PMID: 29304780 PMCID: PMC5756408 DOI: 10.1186/s12889-017-4984-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe wasting affects 16 million under 5's and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants. METHODS We undertook a case-control study from November 2014 to June 2015, in rural Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < -3 on at least 1 occasion in infancy. Controls with a WLZ > -3 in the same interval, matched on age, gender, village size and distance from the clinic were selected. Standard questionnaires were used to assess maternal socioeconomic status, water sanitation and hygiene and maternal mental health. Conditional logistic regression using a multivariable model was used to determine the risk factors for severe wasting. Qualitative in depth interviews were conducted with mothers and fathers who were purposively sampled. A thematic framework was used to analyse the in-depth interviews. RESULTS Two hundred and eighty (77 cases and 203 controls) children were recruited. In-depth interviews were conducted with 16 mothers, 3 fathers and 4 research staff members. The mean age of introduction of complementary feeds was similar between cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe wasting were associated with increased frequency of complementary feeds (range 1-8) [adjusted OR 2.06 (95%: 1.17-3.62), p = 0.01]. Maternal adherence to the recommended infant care practices was influenced by her social support networks, most importantly her husband, by infant feeding difficulties and maternal psychosocial stressors that include death of a child or spouse, recurrent ill health of child and lack of autonomy in child spacing. CONCLUSION In rural Gambia, inappropriate infant feeding practices were associated with severe wasting in infants. Additionally, adverse psychosocial circumstances and infant feeding difficulties constrain mothers from practising the recommended child care practices. Interventions that promote maternal resilience through gender empowerment, prioritising maternal psychosocial support and encouraging the involvement of fathers in infant and child care promotion strategies, would help prevent severe wasting in these infants.
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Affiliation(s)
- Helen M Nabwera
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia. .,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
| | - Sophie E Moore
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Martha K Mwangome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya
| | - Sassy C Molyneux
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya.,University of Oxford, Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, OX3 7BN, UK
| | - Momodou K Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | | | - Bakary Sonko
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Alhagie Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Seedy Singhateh
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Anthony J Fulford
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Andrew M Prentice
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
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25
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Iftikhar A, Bari A, Bano I, Masood Q. Impact of maternal education, employment and family size on nutritional status of children. Pak J Med Sci 2017; 33:1401-1405. [PMID: 29492067 PMCID: PMC5768833 DOI: 10.12669/pjms.336.13689] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the impact of maternal education, employment, and family size on nutritional status of children. Methods It was case control study conducted at OPD of children Hospital Lahore, from September 2015 to April 2017. Total 340 children (170 cases and 170 controls) with age range of six months to five years along with their mothers were included. Anthropometric measurements were plotted against WHO growth Charts. 170 wasted (<-2 SD) were matched with 170 controls (≥ -2 SD). Maternal education, employment and family size were compared between the cases and control. Confounding variables noted and dichotomized. Univariate analysis was carried out for factors under consideration i.e.; Maternal Education, employment and family size to study the association of each factor. Logistic regression analysis was applied to study the independent association. Results Maternal education had significant association with growth parameters; OR of 1.32 with confidence interval of (CI= 1.1 to 1.623). Employment status of mothers had OR of 1.132 with insignificant confidence interval of (CI=0.725 to 1.768). Family size had OR of one with insignificant confidence interval (CI=0.8 -1.21). Association remained same after applying bivariate logistic regression analysis. Conclusion Maternal education has definite and significant effect on nutritional status of children. This is the key factor to be addressed for prevention or improvement of childhood malnutrition. For this it is imperative to launch sustainable programs at national and regional level to uplift women educational status to combat this ever increasing burden of malnutrition.
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Affiliation(s)
- Aisha Iftikhar
- Dr. Aisha Iftikhar, FCPS. Department of Peadiatrics Medicine, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Attia Bari
- Dr. Attia Bari, DCH, MCPS, FCPS. Department of Peadiatrics Medicine, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Iqbal Bano
- Dr. Iqbal Bano, FCPS. Department of Peadiatrics Medicine, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Qaisar Masood
- Dr. Qaisar Masood, DCH, MCPS. Department of Peadiatrics Medicine, Nawaz Sharif Hospital, Lahore, Pakistan
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26
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Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E863. [PMID: 28788108 PMCID: PMC5580567 DOI: 10.3390/ijerph14080863] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/24/2023]
Abstract
Introduction: Child undernutrition is a major public health problem. One third of all undernourished children globally reside in Sub-Saharan Africa (SSA). The aim of this study was to systematically review studies to determine the factors associated with stunting, wasting and underweight in SSA and contribute to the existing body of evidence needed for the formulation of effective interventions. Methods: This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Five computerized bibliographic databases were searched: Scopus, PubMed, PsycINFO, CINAHL and Embase. The included studies were rated using eight quality-appraisal criteria derived from the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist: sample size, sampling methodology, response rate, outcome measures, statistical analyses, control for confounding, study limitation, and ethical consideration. Results: Of a total of 2810 articles retrieved from the five databases, 49 studies met our inclusion criteria. The most consistent factors associated with childhood stunting, wasting and underweight in SSA were: low mother's education, increasing child's age, sex of child (male), wealth index/SES (poor household), prolonged duration of breastfeeding (>12 months), low birth weight, mother's age (<20 years), source of drinking water (unimproved), low mother's BMI (<18.5), birth size (small), diarrhoeal episode, low father's education and place of residence (rural). Conclusions: The factors that predispose a child to undernutrition are multisectoral. To yield a sustainable improvement in child nutrition in SSA, a holistic multi-strategy community-based approach is needed that targets the factors associated with undernutrition, thereby setting the region on the path to achieving the WHO global nutrition target by 2025.
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Affiliation(s)
- Blessing J Akombi
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
| | - John J Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Nidhi Wali
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Penrith, NSW 2571, Australia.
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Khattak UK, Iqbal SP, Ghazanfar H. The Role of Parents' Literacy in Malnutrition of Children Under the Age of Five Years in a Semi-Urban Community of Pakistan: A Case-Control Study. Cureus 2017; 9:e1316. [PMID: 28690950 PMCID: PMC5498125 DOI: 10.7759/cureus.1316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives: According to a recent survey, Pakistan was ranked as the third highest country with malnutrition and the under-five child mortality. No realistic solution for this growing problem has been found despite the fact that the struggle to tackle the issue of malnutrition among young Pakistani children has been going on for the last several decades. The objective of our study was to look into the relationship between parental education and malnutrition in Pakistan and to make a recommendation to improve the nutritional condition of the children. Method: We carried a case-control study among 400 mothers from February 2016 to July 2016 in a primary health care center located in a peri-urban community in Pakistan. A self-constructed questionnaire comprising of 75 questions was used to collect the data. Results: The mean age of mother was found to be 27.61 ± 5.130. The majority of the mothers were uneducated 168 (42.0%) while only 116 (29.0%) fathers were uneducated. About 226 (56.5%) of the children had a normal nutritional status while 102 (25.5%) had first-degree malnutrition, 52 (13.0%) had second-degree malnutrition, and 20 (5.0%) had a third-degree malnutrition. Higher paternal educational status (p = 0.008) and maternal educational status (p = 0.011) were found to be significantly associated with normal child nutritional status. Conclusion: It is recommended that the education of parents, especially females, in the rural and semi-urban areas should be promoted and given due importance. The focus of all these programs should be the mother in terms of security, employment, literacy, justice, healthcare, food, shelter, and social equality.
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Affiliation(s)
- Umme K Khattak
- Community and Family Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Saima P Iqbal
- Community and Family Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Haider Ghazanfar
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
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Huda TM, Hayes A, El Arifeen S, Dibley MJ. Social determinants of inequalities in child undernutrition in Bangladesh: A decomposition analysis. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28271627 DOI: 10.1111/mcn.12440] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 11/29/2022]
Abstract
Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic-related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well-off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health-seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Tette EMA, Sifah EK, Tete-Donkor P, Nuro-Ameyaw P, Nartey ET. Feeding practices and malnutrition at the Princess Marie Louise Children’s hospital, Accra: what has changed after 80 years? BMC Nutr 2016. [DOI: 10.1186/s40795-016-0082-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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