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Moges FY, Mengistu Z, Tilahun SW. Determinants of speech and language delay among children aged 12 months to 12 years at Yekatit 12 Hospital, Addis Ababa, Ethiopia: a case-control study. BMC Pediatr 2024; 24:393. [PMID: 38867169 PMCID: PMC11167758 DOI: 10.1186/s12887-024-04862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Speech and language delay among children can result in social interaction problems, attention difficulties, decreased writing and reading abilities, and poor cognitive and behavioral development. Despite the mounting prevalence of speech and language delays in Ethiopia, there is a lack of literature addressing the factors contributing to this delay. Consequently, this study aims to identify determinants of speech and language delay among children aged 12 months to 12 years at Yekatit 12 Hospital in Addis Ababa, Ethiopia. METHODS We conducted an institutional-based at Yekatit 12 Hospital, unmatched case-control study with 50 cases and 100 controls aged 12 months to 12 years. Interviewer-administered questionnaires were used to collect data from the parents or caregivers of the participating children. Epi Info v7 was used for sample calculation, and SPSS v26 was used for analysis. The chi-square test was performed to determine the relationship between speech and language delay and determining factors, which was then followed by logistic regression. The significant determining factors were identified based on the adjusted odds ratio (AOR), with a 95% CI and p-value (< 0.05). RESULTS Case group constituted 23 males and 27 females, totaling 50 children. Upon completing the multivariate analysis, birth asphyxia [AOR = 4.58, 95CI (1.23-16.99)], bottle-feeding [AOR = 4.54, 95CI (1.29-16.04)], mother-child separation [AOR = 2.6, 95CI (1.05-6.43)], multilingual family [AOR = 2.31, 95CI (1.03-5.18)], and screen time greater than two hours [AOR = 3.06, 95CI (1.29-7.28)] were found to be statistically significant determinants of speech and language delay. CONCLUSIONS Our study found that birth asphyxia, bottle-feeding, mother-child separation, being from a multilingual family, and excessive screen time contribute significantly to speech and language delay. As a result, it is important to develop interventions that target these modifiable factors, while also ensuring that early diagnosis and treatment options are readily accessible.
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Affiliation(s)
- Feven Y Moges
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Zuriyash Mengistu
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sosina W Tilahun
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Tamir TT, Gezhegn SA, Dagnew DT, Mekonenne AT, Aweke GT, Lakew AM. Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey. PLoS One 2024; 19:e0302212. [PMID: 38662745 PMCID: PMC11045052 DOI: 10.1371/journal.pone.0302212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Undernutrition poses a significant global public health challenge, adversely affecting childhood cognitive and physical development while increasing the risk of disease and mortality. Stunting, characterized by impaired growth and development in children due to insufficient psychological stimulation, frequent infections, and inadequate nutrition, remains a critical issue. Although economic growth alone cannot fully address the prevalence of stunting, there exists a robust correlation between a country's income level and childhood stunting rates. Countries with higher incomes tend to have lower rates of childhood stunting. Notably, while childhood stunting is declining worldwide, it remains persistent in Africa. Consequently, this study aims to assess the prevalence of childhood stunting and its determinants in low- and lower-middle-income African countries. METHOD This study conducted a secondary analysis of standard demographic and health surveys in low- and lower-middle-income African countries spanning the period from 2010 to 2022. The analysis included a total sample of 204,214 weighted children under the age of five years. To identify the determinants of stunting, we employed a multilevel mixed-effect model, considering the three levels of variables. The measures of association (fixed effect) were determined using the adjusted odds ratio at a 95% confidence interval. Significance was declared when the association between the outcome variable and the explanatory variable had a p-value less than 0.05. RESULT In low and lower-middle-income African countries, 31.28% of children under five years old experience stunting, with a 95% confidence interval ranging from 31.08% to 31.48%. The results from a multilevel mixed-effect analysis revealed that 24 months or more of age of child, male gender, low and high birth weight, low and high maternal BMI, no and low maternal education, low household wealth index, multiple (twin or triplet) births, rural residence, and low income of countries were significantly associated with childhood stunting. CONCLUSION Stunting among children under five years of age in low- and lower-middle-income African countries was relatively high. Individual, community, and country-level factors were statistically associated with childhood stunting. Equally importantly, with child, maternal, and community factors of stunting, the income of countries needs to be considered in providing nutritional interventions to mitigate childhood stunting in Africa.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Soliyana Adisu Gezhegn
- Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dejen Tegegne Dagnew
- Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Tilahun Mekonenne
- Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Genetu Tadese Aweke
- Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sutinbuk D, Nugraheni SA, Rahfiludin MZ, Setyaningsih Y. Effectiveness of ERKADUTA model to increase stunting prevention behaviors among mothers with toddlers in Indonesia: A quasi-experiment. NARRA J 2024; 4:e688. [PMID: 38798829 PMCID: PMC11125386 DOI: 10.52225/narra.v4i1.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
Stunting, a persistent nutritional issue arising from prolonged inadequate nutrient intake, poses substantial risks such as heightened morbidity, mortality, and compromised cognitive, psychomotor, and verbal development. In Indonesia, addressing stunting in children under two necessitates urgent community empowerment, given its multifaceted nature. The aim of this study was to assess the effects of an intervention targeting mothers of toddlers, called RT kawal baduta (ERKADUTA) model, a local community-based assistance for babies under two years old. A quasi-experiment using pre-test and post-test with a control group design was conducted. Employing a quantitative analytic approach with 112 respondents, the effectiveness of ERKADUTA model to improve the knowledge, attitude, and practice of stunting prevention among mothers with child under two years old was assessed. ERKADUTA program was run for three months. The Wilcoxon test was used to determine score changes before and after program in both groups, while the Mann-Whitney test was used to analyze the score differences of knowledge, attitude and practice between intervention and control groups. Our data indicated that there were changes in knowledge, attitudes, and practices in preventing stunting in both the intervention and control groups. There are significant differences in knowledge (p<0.001, effect size=-0.855), attitude (p<0.001, effect size=-0.864), and practice score (p<0.001, effect size=-0.924) between the intervention and control groups after the intervention. This study highlights that the ERKADUTA model emerged as a potent catalyst in improving stunting prevention behaviors among mothers with toddlers and this model holds promise for addressing the complexities of stunting in Indonesia.
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Affiliation(s)
- Dedek Sutinbuk
- Doctoral Program, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Sri A. Nugraheni
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
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Yirdaw BE, Debusho LK. Multilevel Bayesian network to model child morbidity using Gibbs sampling. Artif Intell Med 2024; 149:102784. [PMID: 38462284 DOI: 10.1016/j.artmed.2024.102784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 03/12/2024]
Abstract
Bayesian networks (BNs) are suitable models for studying complex interdependencies between multiple health outcomes, simultaneously. However, these models fail the assumption of independent observation in the case of hierarchical data. Therefore, this study proposes a two and three-level random intercept multilevel Bayesian network (MBN) models to study the conditional dependencies between multiple outcomes. The structure of MBN was learned using the connected three parent set block Gibbs sampler, where each local network was included based on Bayesian information criteria (BIC) score of multilevel regression. These models were examined using simulated data assuming features of both multilevel models and BNs. The estimated area under the receiver operating characteristics for both models were above 0.8, indicating good fit. The MBN was then applied to real child morbidity data from the 2016 Ethiopian Demographic Health Survey (EDHS). The result shows a complex causal dependencies between malnutrition indicators and child morbidities such as anemia, acute respiratory infection (ARI) and diarrhea. According to this result, families and health professionals should give special attention to children who suffer from malnutrition and also have one of these illnesses, as the co-occurrence of both can worsen the health of a child.
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Affiliation(s)
- Bezalem Eshetu Yirdaw
- Department of Statistics, University of South Africa, c/o Christiaan de Wet Road & Pioneer Avenue, Florida 1709, Johannesburg, South Africa.
| | - Legesse Kassa Debusho
- Department of Statistics, University of South Africa, c/o Christiaan de Wet Road & Pioneer Avenue, Florida 1709, Johannesburg, South Africa.
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5
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Chang HW, Lee EM, Wang Y, Zhou C, Pruss KM, Henrissat S, Chen RY, Kao C, Hibberd MC, Lynn HM, Webber DM, Crane M, Cheng J, Rodionov DA, Arzamasov AA, Castillo JJ, Couture G, Chen Y, Balcazo NP, Lebrilla CB, Terrapon N, Henrissat B, Ilkayeva O, Muehlbauer MJ, Newgard CB, Mostafa I, Das S, Mahfuz M, Osterman AL, Barratt MJ, Ahmed T, Gordon JI. Prevotella copri-related effects of a therapeutic food for malnutrition. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.11.553030. [PMID: 37645712 PMCID: PMC10461977 DOI: 10.1101/2023.08.11.553030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Preclinical and clinical studies are providing evidence that the healthy growth of infants and children reflects, in part, healthy development of their gut microbiomes1-5. This process of microbial community assembly and functional maturation is perturbed in children with acute malnutrition. Gnotobiotic animals, colonized with microbial communities from children with severe and moderate acute malnutrition, have been used to develop microbiome-directed complementary food (MDCF) formulations for repairing the microbiomes of these children during the weaning period5. Bangladeshi children with moderate acute malnutrition (MAM) participating in a previously reported 3-month-long randomized controlled clinical study of one such formulation, MDCF-2, exhibited significantly improved weight gain compared to a commonly used nutritional intervention despite the lower caloric density of the MDCF6. Characterizing the 'metagenome assembled genomes' (MAGs) of bacterial strains present in the microbiomes of study participants revealed a significant correlation between accelerated ponderal growth and the expression by two Prevotella copri MAGs of metabolic pathways involved in processing of MDCF-2 glycans1. To provide a direct test of these relationships, we have now performed 'reverse translation' experiments using a gnotobiotic mouse model of mother-to-offspring microbiome transmission. Mice were colonized with defined consortia of age- and ponderal growth-associated gut bacterial strains cultured from Bangladeshi infants/children in the study population, with or without P. copri isolates resembling the MAGs. By combining analyses of microbial community assembly, gene expression and processing of glycan constituents of MDCF-2 with single nucleus RNA-Seq and mass spectrometric analyses of the intestine, we establish a principal role for P. copri in mediating metabolism of MDCF-2 glycans, characterize its interactions with other consortium members including Bifidobacterium longum subsp. infantis, and demonstrate the effects of P. copri-containing consortia in mediating weight gain and modulating the activities of metabolic pathways involved in lipid, amino acid, carbohydrate plus other facets of energy metabolism within epithelial cells positioned at different locations in intestinal crypts and villi. Together, the results provide insights into structure/function relationships between MDCF-2 and members of the gut communities of malnourished children; they also have implications for developing future prebiotic, probiotic and/or synbiotic therapeutics for microbiome restoration in children with already manifest malnutrition, or who are at risk for this pervasive health challenge.
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Affiliation(s)
- Hao-Wei Chang
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Evan M. Lee
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Yi Wang
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Cyrus Zhou
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Kali M. Pruss
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Suzanne Henrissat
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, F-13288, Marseille, France
| | - Robert Y. Chen
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Clara Kao
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Matthew C. Hibberd
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Hannah M. Lynn
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Daniel M. Webber
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Marie Crane
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Jiye Cheng
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Dmitry A. Rodionov
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037 USA
| | - Aleksandr A. Arzamasov
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037 USA
| | - Juan J. Castillo
- Department of Chemistry, University of California, Davis, CA 95616 USA
| | - Garret Couture
- Department of Chemistry, University of California, Davis, CA 95616 USA
| | - Ye Chen
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Chemistry, University of California, Davis, CA 95616 USA
| | - Nikita P. Balcazo
- Department of Chemistry, University of California, Davis, CA 95616 USA
| | | | - Nicolas Terrapon
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, F-13288, Marseille, France
| | - Bernard Henrissat
- Department of Biotechnology and Biomedicine (DTU Bioengineering), Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
- Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Olga Ilkayeva
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27710 USA
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710 USA
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710 USA
| | - Michael J. Muehlbauer
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27710 USA
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710 USA
| | - Christopher B. Newgard
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27710 USA
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710 USA
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710 USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710 USA
| | - Ishita Mostafa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Subhasish Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Mustafa Mahfuz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Andrei L. Osterman
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA 92037 USA
| | - Michael J. Barratt
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Jeffrey I. Gordon
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110 USA
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Haque S, Al Rafi DA, Zaman N, Salman M, Al Noman MA, Hoque MN, Bhattacharjee L, Farquhar S, Yasmin S, Hasan MM, Hira FTZ, Prithi AA, Shammi SA, Banu B, Hossain A. Nutritional status of under-five aged children of ready-made garment workers in Bangladesh: A cross-sectional study. PLoS One 2023; 18:e0284325. [PMID: 37053193 PMCID: PMC10101446 DOI: 10.1371/journal.pone.0284325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country's GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh. METHODS The study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors. RESULTS The study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother's education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother's education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother's education level increased from no education to primary or secondary level, the child would be 0.211 (0.071-0.627) and 0.384 (0.138-1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted. CONCLUSION The study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.
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Affiliation(s)
- Sadika Haque
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Dewan Abdullah Al Rafi
- Department of Agricultural and Resource Economics, The University of Arizona, Tucson, Arizona, United States of America
| | - Nafisa Zaman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Salman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Abdullah Al Noman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Nazmul Hoque
- Student Affairs Division, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Lalita Bhattacharjee
- Senior Nutrition Advisor, Meeting the Undernutrition Challenge Programme, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Samantha Farquhar
- Integrated Coastal Sciences, East Carolina University, Greenville, North Carolina, United States of America
| | - Sabina Yasmin
- Socio Economics Research Division, Bangladesh Livestock Research Institute, Savar Union, Bangladesh
| | - Md Mehedi Hasan
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Fatema Tuj Zohora Hira
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Aunjuman Ara Prithi
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Shamim Ara Shammi
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Bilkish Banu
- Faculty of Social Science and Humanities, Department of Economics, Hajee Mohammad Danesh Science & Technology University, Dinajpur, Bangladesh
| | - Akbar Hossain
- Division of Soil Science, Bangladesh Wheat and Maize Research Institute, Dinajpur, Bangladesh
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7
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Ara G, Sanin KI, Khanam M, Sarker MSA, Tofail F, Nahar B, Chowdhury IA, Boitchi AB, Gibson S, Afsana K, Askari S, Ahmed T. A comprehensive intervention package improves the linear growth of children under 2-years-old in rural Bangladesh: a community-based cluster randomized controlled trial. Sci Rep 2022; 12:21962. [PMID: 36536016 PMCID: PMC9763408 DOI: 10.1038/s41598-022-26269-w] [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: 05/31/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother-infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.
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Affiliation(s)
- Gulshan Ara
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kazi Istiaque Sanin
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mansura Khanam
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Md. Shafiqul Alam Sarker
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Fahmida Tofail
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Baitun Nahar
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Anika Bushra Boitchi
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sarah Gibson
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Kaosar Afsana
- grid.52681.380000 0001 0746 8691BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sufia Askari
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Tahmeed Ahmed
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
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Saha UR, van Wesenbeeck CFA. Changes in the determinants and spatial distribution of under-five stunting in Bangladesh: Evidence from Bangladesh Demographic Health Surveys (BDHS) 1996-97, 2014 and 2017/18. PLoS One 2022; 17:e0278094. [PMID: 36454888 PMCID: PMC9714885 DOI: 10.1371/journal.pone.0278094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Bangladesh has experienced tremendous change in child nutrition over the past few decades, but there are large differences between different regions in progress made. The question is whether continuation of current policies will bring the progress needed to reach national and international targets on child nutrition security. DATA AND METHODS Using national data BDHS 1996/97, 2014, and 2017, this study attempts to map such reductions across Bangladesh and to explore the distribution of covariate effects (joint effects) that are associated with childhood stunting over these two periods, overall and by region. The main contribution of this paper is to link observed stunting scores to a household profile. This implies that different variables are evaluated jointly with stunting to assess the likelihood of being associated with stunting. RESULTS Overall, the covariates: 'Parental levels of education', 'children older than one year old', 'children live in rural area', 'children born at home' formed the country winning profile in 1996/97, whereas parental levels of education disappear in the winning profile for children stunted in 2014. This implies that over the years, Bangladesh has been successful in addressing parental education for long-term reductions in child undernutrition. In addition, the diversity of profiles of households with stunted children increases over time, pointing at successful targeting of policies to increase food security among children over the period. However, in areas where improvements have been insignificant, also the profiles remain stable, indicating a failure of policies to reach the target populations. The analysis for 2017 confirms this picture: the diversity of profiles remains high, with little change in the dominant profiles. CONCLUSION Further decline in stunting is possible through region specific multipronged interventions, targeting children older than one year among vulnerable groups, in addition with strengthening family planning programs as larger families also have a higher risk to have stunted children. In general, the profiles in 2014 and 2017/18 are much more diverse than in 1996, which can be explained by the relative success of specific targeted policies in some divisions, while being much less successful in other regions. In sum, our results suggest that the challenge lies in the implementation of policies, rather than in the generic approach and assumed theory of change.
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Affiliation(s)
- U. R. Saha
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C. F. A. van Wesenbeeck
- Amsterdam Centre for World Food Studies, VU University Amsterdam, Amsterdam, The Netherlands
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9
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Limardi S, Hasanah DM, Utami NMD. Dietary intake and stunting in children aged 6-23 months in rural Sumba, Indonesia. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.341-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background Linear growth retardation in the first two years of life leads to numerous harmful consequences. Lack of diversity in the diet and inadequate amounts of complementary food have been associated with stunted growth in children.
Objective To assess the dietary intake and investigate for associations with stunting among children aged 6-23 months.
Methods This case-control study compared the dietary intake of children aged 6-23 months with and without stunting in the South and West Wewewa subdistricts of Southwest Sumba, East Nusa Tenggara, Indonesia. Complementary food types, dietary diversity, and nutritional intake were assessed and compared between groups. Nutrient intake sufficiency and stunting were analyzed by logistic regression.
Results A total of 200 participants were equally allocated into groups with and without stunting. Only 6% of stunted children received adequate complementary food diversity compared to 14% of non-stunted children (P=0.05). The stunted group had significantly lower consumption of flesh foods (beef, fish, poultry, organ meat, and other kinds of meat) compared to the non-stunted group (7% vs. 16% of subjects, respectively; P<0.05). The median total protein intake was also significantly lower in stunted children compared to non-stunted children [7.72 (IQR 6.46, 11.31) g vs. 10.02 (IQR 6.53, 13.95) g, respectively; P<0.05] although no association was found between protein intake sufficiency and stunting in the multivariate analysis. Only maternal unemployment was positively associated with stunting (OR 2.32; 95%CI 1.26 to 4.26).
Conclusion Overall, most subjects did not receive sufficient amounts of nutrients. Although dietary diversity was not found to be significantly different between those with and without stunting, a significantly lower proportion of stunted children consumed flesh food. The stunted group also received significantly lower protein from their diet although no association was found between nutrient intake sufficiency and stunting. Further studies are needed to longitudinally assess the effects of macronutrient and micronutrient intake sufficiency on linear growth in children.
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10
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Child undernutrition and associated factors among children 6-23 months old in largely food insecure areas of rural Ethiopia. J Nutr Sci 2022; 11:e63. [PMID: 35992573 PMCID: PMC9379930 DOI: 10.1017/jns.2022.61] [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: 11/15/2021] [Revised: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 12/14/2022] Open
Abstract
Child malnutrition is the leading public health problem in Sub-Saharan Africa, resulting in poor health and economic losses. Ethiopia has one of the highest child undernutrition rates in the world that occurs to multifaceted factors, including food insecurity. Thus, we performed a cross-sectional study to assess the prevalence and risk factors for child undernutrition in largely food insecure areas of Ethiopia. Data were collected from 354 mother-child pairs from the Siraro district. Both bivariate and multivariate logistic regression was used for statistical analysis. Variables with a P-value of <0⋅05 in multivariate analysis were used to detect statistical significance at a 95 % confidence level. About 67 % of households are food insecure. The prevalence of stunting wasting and underweight were 42⋅7, 9⋅9 and 27⋅7 %, respectively. Female gender, higher age of the child (12-23 months v. 6-11 months), living in a household with five or more siblings, not getting therapeutic zinc supplement at least once, inadequate diet diversity, lack of growth monitoring service, and maternal own income increases the likelihood of child undernutrition. It can be concluded that child undernutrition is a severe public health problem in the study area. Improving primary healthcare services related to zinc supplementation, growth monitoring and promotion, and improving infant and child feeding practices can be considered as a strategy to address the problem.
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11
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Food Safety Practices and Stunting among School-Age Children—An Observational Study Finding from an Urban Slum of Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138044. [PMID: 35805701 PMCID: PMC9265275 DOI: 10.3390/ijerph19138044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Background: Food safety incorporates the handling, preparation, and storage of food materials in ways that prevent foodborne illness. We aimed to investigate the typical food safety practices in a Bangladeshi slum context and to explore if stunting among school-age children was associated with various components of food safety. Method: We analysed the MAL-ED birth cohort data from the Bangladesh site. A total of 265 healthy children were enrolled in the study; we could follow up and collect food safety-related data from 187 participants. Results: The average age of the children was 6.5 years (standard deviation or SD 0.04) and 49% of them were female. About 26% of the children were stunted. In our bivariate analysis, caregivers’ handwashing practice after using the toilet, treatment of drinking water, presence of insects/pests in the cooking area, and child’s eating ready-made/street food more than three times per day were significantly associated with stunting. After adjusting for pertinent factors, treatment of drinking water (adjusted odds ratio or AOR = 2.50, 95% confidence interval or CI: 1.03, 6.05), and child’s eating ready-made/street food more than three times/day (AOR = 2.34, 95%CI: 1.06, 5.15) remained significantly associated with stunting. Conclusions: Diverse aspects of food safety practices have a substantial association with stunting among school-age children living in an unhygienic slum environment in Dhaka, Bangladesh.
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12
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Tella intake among pregnant and lactating mothers: may it affect child growth? J Nutr Sci 2022; 11:e42. [PMID: 35720175 PMCID: PMC9171593 DOI: 10.1017/jns.2022.40] [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: 11/18/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Alcohol abuse among women is a public health importance that may impair prenatal and postnatal growth. Tella is among the most common homemade alcoholic beverages in rural Ethiopia, but little is known about the magnitude of tella intake during pregnancy and lactation or its effects on child growth. The present study investigated associations between maternal tella intake and the growth of their children. A cross-sectional mixed-methods study was conducted with mothers (n 228) and their 12–36-month-old children and with key informants (n 12). Tella intake during most recent pregnancy and lactation was estimated retrospectively by glasses per drinking event and frequency of events. Nearly 80 % of mothers had consumed some amount of tella during their most recent pregnancy and lactation. Furthermore, 72 % of children had tasted or drunk tella at some time during their life. Stunting was 42 % and was significantly associated with maternal tella consumption at least every other day during pregnancy (adjusted odds ratio (AOR) 4⋅97, 95 % confidence interval (CI) 2⋅20, 11⋅25), male sex (AOR 2⋅31, 95 % CI 1⋅27, 4⋅19), two or more under-5-year-old children in the household (AOR 3⋅52, 95 % CI 1⋅49, 8⋅33) and family size >5 (AOR 1⋅84, 95 % CI 1⋅01, 3⋅36). Underweight was 24⋅6 % and was associated with the child drinking tella with their mother (AOR 4⋅23, 95 % CI 1⋅99, 8⋅97), being male (AOR 3⋅73, 95 % CI 1⋅73, 7⋅94), having ≥3 diarrhoeal episodes in the last 3 months (AOR 11⋅83, 95 % CI 4⋅22, 33⋅14) and being in the older age group (AOR 2⋅98, 95 % CI 1⋅09, 8⋅13). The associations between tella intake and child growth suggest the need to mitigate the effects of tella on child anthropometry.
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13
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Das S, Chowdhury VP, Gazi MA, Fahim SM, Alam MA, Mahfuz M, Mduma E, Ahmed T. Associations of Enteric Protein Loss, Vaccine Response, Micronutrient Deficiency, and Maternal Depressive Symptoms with Deviance in Childhood Linear Growth: Results from a Multicountry Birth Cohort Study. Am J Trop Med Hyg 2022; 106:tpmd210403. [PMID: 35405659 PMCID: PMC9209933 DOI: 10.4269/ajtmh.21-0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 01/26/2022] [Indexed: 11/07/2022] Open
Abstract
We identified the determinants of positive (children who had a birth weight < 2.5 kg and/or maternal height < 145 cm but were nonstunted at 24 months of age) and negative (children who had a birth weight ≥ 2.5 kg and maternal height ≥ 145 cm but were stunted at 24 months of age) deviance in childhood linear growth. We found that socioeconomic status (β = 1.54, P < 0.01), serum retinol (β = 0.05, P < 0.01), hemoglobin (β = 0.36, P < 0.01), length-for-age Z-score (LAZ) at birth (β = 0.47, P < 0.01), and tetanus vaccine titer (β = 0.182, P < 0.05) were positively and maternal depressive symptom (β = -0.05, P < 0.01), serum ferritin (β = -0.03, P < 0.01), male sex (β = -1.08, P < 0.01), and α1-antitrypsin (β = -0.81, P < 0.01) were negatively associated with positive deviance. Further, diarrhea episodes (β = 0.02, P < 0.01), male sex (β = 0.72, P < 0.01), and α1-antitrypsin (β = 0.67, P < 0.01) were positively and hemoglobin (β= -0.28, P < 0.01), soluble transferrin receptor level (β = -0.15, P < 0.01), and LAZ score at birth (β = -0.90, P < 0.01) were negatively associated with negative deviance. To summarize, enteric protein loss, micronutrient deficiency, vaccine responses and maternal depressive symptoms were associated with linear growth deviance in early childhood. In such a background, public health approaches aimed at reducing the risk of intestinal inflammation and altered gut permeability could prove fruitful in ensuring desired linear growth in children. In addition, maternal mental health issue should also be considered, especially for promoting better nutritional status in children in the context of linear growth deviance.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Visnu Pritom Chowdhury
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Esto Mduma
- Haydom Global Health Institute, Haydom, Tanzania
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Public Health Nutrition, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Office of Executive Director, icddr,b, Dhaka, Bangladesh
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Anato A. Predictors of wasting among children under-five years in largely food insecure area of north Wollo, Ethiopia: a cross-sectional study. J Nutr Sci 2022; 11:e8. [PMID: 35291271 PMCID: PMC8889084 DOI: 10.1017/jns.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Child undernutrition is widespread in low- and middle-income countries and is linked with weakened immunity and increased risks of morbidity and mortality. Ethiopia has made a marked reduction in stunting, but there has, however, been little progress in wasting reduction and limited evidence in food insecure areas may hamper the design of effective interventions. Therefore, the aim of the present study was to determine the contributing factors to persistent high prevalence of wasting among 6-59-month-old children. A community-based cross-sectional study was employed in February to March 2020, and included 384 mother-child pairs. Data were collected using a structured interviewer-administered questionnaire. Bivariate and multivariable logistic regression analyses were conducted. The overall prevalence of wasting was 12⋅8 % (95 % CI 9⋅1, 16⋅1); with 5⋅8 % severely wasted. Factors significantly associated with wasting were child age 6-23 (v. 24-59 months), delayed initiation of breast-feeding, diarrhoeal illness in the last 2 weeks, poor dietary diversity and low socioeconomic status. The present findings support that aligning poverty reduction interventions and healthcare services is important to accelerate wasting reduction more equitably and achieve the World Health Assembly's target and SDG goal #2 in the coming years. Improving accessibility and affordability of nutritious foods and early diagnosis and treatment of childhood morbidity are critical to address childhood wasting in the context of food insecure areas.
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Affiliation(s)
- Anchamo Anato
- Department of Human Nutrition, School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
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15
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Billah SM, Ferdous TE, Kelly P, Raynes‐Greenow C, Siddique AB, Choudhury N, Ahmed T, Gillespie S, Hoddinott J, Menon P, Dibley MJ, Arifeen SE. Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh. MATERNAL & CHILD NUTRITION 2022; 18:e13267. [PMID: 34467669 PMCID: PMC8710107 DOI: 10.1111/mcn.13267] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022]
Abstract
Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6-23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2-0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99-1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11-0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01-27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11-1.57) in 6-23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06-0.49) and 0.16 (0.05-27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Tarana E. Ferdous
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Patrick Kelly
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Abu Bakkar Siddique
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Nuzhat Choudhury
- Nutrition and Clinical Science DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Science DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Stuart Gillespie
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - John Hoddinott
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Purnima Menon
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Michael John Dibley
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Shams El Arifeen
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
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16
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Molani Gol R, Kheirouri S, Alizadeh M. Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:65-83. [PMID: 35000681 DOI: 10.1016/j.jneb.2021.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years. DESIGN This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. SETTING AND PARTICIPANTS PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles. MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight. CONCLUSIONS AND IMPLICATIONS The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.
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Affiliation(s)
- Roghayeh Molani Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C, Briend A, Myatt M, Garenne M, Sear R, Kerac M. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Health 2021; 5:bmjgh-2020-004030. [PMID: 33328202 PMCID: PMC7745319 DOI: 10.1136/bmjgh-2020-004030] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. METHODS We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0-59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random-effects model. RESULTS 74 studies were identified: 44/74 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13 to 1.40). 38 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.29 95% CI 1.22 to 1.37). 23 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.14, 95% CI 1.02 to 1.26). There was some limited evidence that the female advantage, indicated by a lower risk of stunting and underweight, was weaker in South Asia than other parts of the world. 43/74 (58%) studies discussed possible reasons for boy/girl differences; 10/74 (14%) cited studies with similar findings with no further discussion; 21/74 (28%) had no sex difference discussion. 6/43 studies (14%) postulated biological causes, 21/43 (49%) social causes and 16/43 (37%) to a combination. CONCLUSION Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice.
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Affiliation(s)
- Susan Thurstans
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Seal
- Institute for Global Health, University College London, London, UK
| | - Jonathan Wells
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - Carmel Dolan
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Kobenhavn, Denmark.,School of Medicine, Center for Child Health Research
| | | | - Michel Garenne
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.,Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France.,FERDI, Université d'Auvergne, Clermont-Ferrand, France.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for MARCH (Maternal, Adolescent & Reproductive Child Health), London School of Hygiene and Tropical Medicine, London, UK
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18
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Khan JR, Tomal JH, Raheem E. Model and variable selection using machine learning methods with applications to childhood stunting in Bangladesh. Inform Health Soc Care 2021; 46:425-442. [PMID: 33851897 DOI: 10.1080/17538157.2021.1904938] [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: 10/21/2022]
Abstract
Childhood stunting is a serious public health concern in Bangladesh. Earlier research used conventional statistical methods to identify the risk factors of stunting, and very little is known about the applications and usefulness of machine learning (ML) methods that can identify the risk factors of various health conditions based on complex data. This research evaluates the performance of ML methods in predicting stunting among under-5 aged children using 2014 Bangladesh Demographic and Health Survey data. Besides, this paper identifies variables which are important to predict stunting in Bangladesh. Among the selected ML methods, gradient boosting provides the smallest misclassification error in predicting stunting, followed by random forests, support vector machines, classification tree and logistic regression with forward-stepwise selection. The top 10 important variables (in order of importance) that better predict childhood stunting in Bangladesh are child age, wealth index, maternal education, preceding birth interval, paternal education, division, household size, maternal age at first birth, maternal nutritional status, and parental age. Our study shows that ML can support the building of prediction models and emphasizes on the demographic, socioeconomic, nutritional and environmental factors to understand stunting in Bangladesh.
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Affiliation(s)
- Jahidur Rahman Khan
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia.,Department of Climate and Envirnoment Health, Biomedical Research Foundation, Dhaka, Bangladesh
| | - Jabed H Tomal
- Department of Mathematics and Statistics, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Enayetur Raheem
- Department of Climate and Envirnoment Health, Biomedical Research Foundation, Dhaka, Bangladesh
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Das S, Fahim SM, Alam MA, Mahfuz M, Bessong P, Mduma E, Kosek M, Shrestha SK, Ahmed T. Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: results from a multi-country birth cohort study. Public Health Nutr 2021; 24:1428-1437. [PMID: 32404220 PMCID: PMC8025093 DOI: 10.1017/s136898002000004x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To measure the role of water, sanitation and hygiene (WASH) practices on recovery from stunting and assess the role of timing of stunting on the reversal of this phenomenon. DESIGN Data from the MAL-ED multi-country birth cohort study was used for the current analysis. Generalised linear mixed-effects models were used to estimate the probability of reversal of stunting with WASH practice and timing of stunting as the exposures of interest. SETTING Seven different countries across three continents. PARTICIPANTS A total of 612 children <2 years of age. RESULTS We found that not WASH practice but timing of stunting had statistically significant association with recovery from stunting. In comparison with the children who were stunted at 6 months, children who were stunted at 12 months had 1·9 times (β = 0·63, P = 0·03) more chance of recovery at 24 months of age. And, children who were stunted at 18 months of age even had higher odds (adjusted OR = 3·01, β = 1·10, P < 0·001) of recovery than children who were stunted at 6 months. Additionally, mother's height (β = 0·59, P = 0·04) and household income (β = 0·02, P < 0·05) showed statistically significant associations with the outcome. CONCLUSIONS The study provided evidence for the role of timing of stunting on the recovery from the phenomenon. This novel finding indicates that the programmes to promote linear growth should be directed at the earliest possible timepoints in the course of life.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research (icddr,b), Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research (icddr,b), Bangladesh
| | - Md Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research (icddr,b), Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research (icddr,b), Bangladesh
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | - Esto Mduma
- Haydom Global Health Institute, Haydom, Tanzania
| | - Margaret Kosek
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA, USA
| | - Sanjaya K Shrestha
- Walter Reed/Armed Forces Research Institute of Medical Sciences (AFRIMS) Research Unit Nepal (WARUN), Kathmandu, Nepal
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research (icddr,b), Bangladesh
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20
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Bektas I, Arkan G. The Effect of Perceived Social Support of Syrian Mothers on Their Infant Feeding Attitudes. J Pediatr Nurs 2021; 57:e40-e45. [PMID: 33059967 DOI: 10.1016/j.pedn.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study was conducted to investigate the effect of perceived social support of mothers who were Syrian refugees in Turkey on attitudes toward feeding their babies. DESIGN AND METHOD This study used a cross-sectional design and investigated the demographic characteristics, perceived social support, and infant feeding attitudes of the mothers who migrated from Syria and came to the Health Education Center for Immigrants to receive healthcare services. RESULTS The mean age of the mothers (n = 150) who participated in the study was 24.51 + 5.84 years, and the mean duration of their stay in Turkey was 4.12 ± 1.57 years. The mean number of pregnancies of the mothers was 2.62 ± 1.4, and the mean number of children was 2.33 ± 1.28. As a result of the analysis, we have determined that thesub-dimension of perceived social support from a special person significantly affects the continuation of breastfeeding of mothers during the first six months (p < 0.05). The perceived social support of mothers and other variables in the model were found to explain 14.6% of the breastfeeding attitude. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The attitudes of Syrian mothers toward feeding their babies were affected by perceived social support from a special person. It is recommended to aidsocial support systems for immigrant women to develop positive attitudes toward breastfeeding.
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Affiliation(s)
- Ilknur Bektas
- Dokuz Eylul University, Faculty of Nursing, Department of Pediatric Nursing, Turkey.
| | - Gulcihan Arkan
- Dokuz Eylul University, Faculty of Nursing, Department of Public Health Nursing, Turkey
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21
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Evaluating association of vaccine response to low serum zinc and vitamin D levels in children of a birth cohort study in Dhaka. Vaccine 2020; 39:59-67. [PMID: 33121844 PMCID: PMC7735373 DOI: 10.1016/j.vaccine.2020.10.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
MAL-ED Bangladesh birth cohort data used in the analysis. Relationship between vaccine titers and micronutrient data explored. Positive association found between serum zinc level and tetanus vaccine titer. The finding implicates the importance of improving zinc nutrition status of the children.
Background Vaccine-preventable infectious diseases are often responsible for childhood morbidity and high rates of mortality. Immune response to the vaccine is associated with multiple factors in early childhood and measured by antibody titers. Among them, micronutrient deficiencies such as vitamin D and zinc deficiencies are the most important in resource-limited settings like Bangladesh. Objective We aimed to evaluate the association of vaccine response to low serum zinc and vitamin D levels in children. Methods We evaluated vaccine response for measles and poliovirus, tetanus and pertussis toxoid, and Ig A antibody levels to rotavirus by ELISA and serum vitamin D and zinc at 7 and 15 months in the MAL-ED birth cohort of the Bangladesh site. By using population-specific generalized estimating equations (GEE), the association between each explanatory variable and the binary outcome variable was examined longitudinally where the dependent variable was vaccine titers and the independent variables were low serum vitamin D and zinc levels. Results The GEE multivariable model identified a positive association between serum zinc level and tetanus vaccine titer (OR: 1.84; 95% CI: 1.07–3.17 and p value = 0.028) after adjusting for age, gender, birth weight, WAMI score, diarrhea, ALRI, exclusive breastfeeding, serum ferritin, serum retinol and undernutrition (stunting, wasting, underweight). No association was found between the rest of the vaccine titers with serum vitamin D and zinc level (p > 0.05). Conclusion In the MAL-ED birth cohort, where children were followed for five years, serum zinc level had a positive impact on tetanus vaccine titers.
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22
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Islam MS, Zafar Ullah AN, Mainali S, Imam MA, Hasan MI. Determinants of stunting during the first 1,000 days of life in Bangladesh: A review. Food Sci Nutr 2020; 8:4685-4695. [PMID: 32994930 PMCID: PMC7500796 DOI: 10.1002/fsn3.1795] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022] Open
Abstract
Stunting is a major problem in Bangladesh, with a prevalence of 31% in 2017. The prevalence of stunting in children aged under two has reduced by only 6% since 2004. After children reach 2 years of age, the consequences of stunting become almost irreversible. This paper seeks to examine and analyze the determinants associated with stunting during the first 1,000 days of life in Bangladesh to assist in developing evidence-based interventions in Bangladesh. A literature review was conducted comprehensively on all relevant peer-reviewed and gray literature of studies conducted in Bangladesh. The existing literature was searched and examined using the World Health Organization (WHO) conceptual framework for stunting. Evidence indicates that low maternal weight, lack of maternal education, severe food insecurity, lack of access to suitable nutrition, nonexclusive breastfeeding, pathogen-specific diarrhea, and low weight and height at birth are associated with early childhood stunting in Bangladesh. The relation of the quality of drinking water with stunting is not clear in Bangladesh. Literature about the association between stunting and determinants such as the political economy, education systems, and agriculture and food systems is not found. This synthesis shows that the factors of stunting are multifaceted. As such, a multi-sectoral approach is essential in Bangladesh, employing evidence-based interventions to address the determinants that contribute to the risk of stunting to achieve the global nutrition target by 2025.
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Affiliation(s)
| | | | | | - Md Akhter Imam
- Monitoring, Evaluation and Research Bangladesh National Nutrition Council Dhaka Bangladesh
| | - Md Imran Hasan
- Center for Medical Research and Development Dhaka Bangladesh
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23
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Tafese Z, Reta Alemayehu F, Anato A, Berhan Y, Stoecker BJ. Child Feeding Practice and Primary Health Care as Major Correlates of Stunting and Underweight among 6- to 23-Month-Old Infants and Young Children in Food-Insecure Households in Ethiopia. Curr Dev Nutr 2020; 4:nzaa137. [PMID: 32923922 PMCID: PMC7475004 DOI: 10.1093/cdn/nzaa137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/04/2020] [Accepted: 08/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Child undernutrition is a major public health problem in Ethiopia. Stunting is highest in food-insecure areas and insufficient evidence may impair the design of suitable interventions. OBJECTIVES This study aimed to identify key factors contributing to undernutrition among 6- to 23-mo-old children. METHODS A community-based cross-sectional study in food-insecure areas of Amhara and Oromia regions in April-June, 2018, enrolled 464 mother-child dyads. Bivariate and multivariate logistic regression analyses were conducted. RESULTS The prevalence of stunting (43.1%), wasting (12.3%), and underweight (27.3%) were high. Factors significantly associated with both stunting and underweight were child age of 12-23 mo (vs 6-11 mo), female, more siblings, lack of zinc supplement for diarrhea, inadequate diet diversity, and lack of iodized salt in complementary food. Conclusions: Our findings support the need to emphasize appropriate child feeding practices and iodized salt utilization. Improvement of primary health care services related to micronutrient supplementation and family spacing also are important to address child undernutrition in the study area.
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Affiliation(s)
- Zelalem Tafese
- School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Anchamo Anato
- School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Yifru Berhan
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Barbara J Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
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RUKAMBILE ELPIDIUS, MUSCATELLO GARY, SINTCHENKO VITALI, THOMSON PETERC, MAULAGA WENDE, MMASSY RICHARD, DE BRUYN JULIA, KOCK RICHARD, DARNTON-HILL IAN, ALDERS ROBYN. Determinants of diarrhoeal diseases and height-for-age z-scores in children under five years of age in rural central Tanzania. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E409-E423. [PMID: 33150230 PMCID: PMC7595080 DOI: 10.15167/2421-4248/jpmh2020.61.3.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/10/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Childhood diarrhoeal diseases and stunting are major health problems in low- and middle-income countries (LMICs). Poor water supply, sanitation services and hygiene, frequently encountered in resource-poor settings, contribute to childhood diarrhoea and stunting. METHODS Data on demographic characteristics, hygiene practices, sanitation and human-animal interactions (predictors) and child height-for-age z-scores (HAZ) (outcome) were collected once, while diarrhoea incidences were collected fortnightly for 24 months (outcome). RESULTS Drinking water from public taps (OR = 0.51, 95% CI. 0.44-0.61; p < 0.001) and open wells (OR = 0.46, 95% CI. 0.39-0.54; p < 0.001) and older age of children (OR = 0.43, 95% CI. 0.27-0.67; p < 0.001) were protective against diarrhoea. Inappropriate disposal of children's faeces (OR = 1.15, 95% CI. 1.02-1.31; p = 0.025), sharing water sources with animals in the dry season (OR = 1.48, 95% CI. 1.29-1.70; p < 0.001), overnight sharing of houses with cats (OR = 1.35, 95% CI. 1.16-1.57; p < 0.001) and keeping chickens inside the house overnight regardless of room (OR = 1.39, 95% CI. 1.20-1.60; p < 0.001) increased the risk of diarrhoea. The Sukuma language group (p = 0.005), washing hands in running water (p = 0.007), access of chickens to unwashed kitchen utensils (p = 0.030) and overnight sharing of the house with sheep (p = 0.020) were associated with higher HAZ in children. CONCLUSIONS Until a more precise understanding of the key risk factors is available, these findings suggest efforts towards control of diarrhoea and improved linear growth in these areas should be directed to increased access to clean and safe water, hand-washing, sanitation, and improved animal husbandry practices.
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Affiliation(s)
- ELPIDIUS RUKAMBILE
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Australia
- Tanzania Veterinary Laboratory Agency, Dar es Salaam, Tanzania
| | - GARY MUSCATELLO
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
| | - VITALI SINTCHENKO
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Australia
- Centre for Infectious Diseases and Microbiology - Public Health, Westmead Hospital and New South Wales Health Pathology, Sydney, Australia
| | - PETER C. THOMSON
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Australia
| | - WENDE MAULAGA
- Tanzania Veterinary Laboratory Agency, Dar es Salaam, Tanzania
| | | | - JULIA DE BRUYN
- Natural Resources Institute, University of Greenwich, United Kingdom
| | - RICHARD KOCK
- The Royal Veterinary College, University of London, United Kingdom
| | - IAN DARNTON-HILL
- The University of Sydney, Faculty of Medicine and Health, Brisbane, Australia
| | - ROBYN ALDERS
- Kyeema Foundation, Brisbane, Australia
- Centre for Global Health Security, Chatham House, London, United Kingdom
- Development Policy Centre, Australian National University, Canberra, Australia
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, United States
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25
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Aflatoxin exposure was not associated with childhood stunting: results from a birth cohort study in a resource-poor setting of Dhaka, Bangladesh. Public Health Nutr 2020; 24:3361-3370. [PMID: 32618233 PMCID: PMC8314919 DOI: 10.1017/s1368980020001421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < -2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city. DESIGN In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models. SETTING AND PARTICIPANTS The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months. RESULTS Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09-5·79), 1·52 (range 0·06-6·35), 3·43 (range 0·15-65·60) and 3·70 (range 0·09-126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room. CONCLUSIONS A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist.
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Costa PN, Soares AM, Filho JQ, Junior FS, Ambikapathi R, Rogawski McQuade ET, Guerrant RL, Caulfield LE, Lima AAM, Maciel BLL. Dietary intake from complementary feeding is associated with intestinal barrier function and environmental enteropathy in Brazilian children from the MAL-ED cohort study. Br J Nutr 2020; 123:1003-1012. [PMID: 31964426 PMCID: PMC7282865 DOI: 10.1017/s0007114520000215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
A child's diet contains nutrients and other substances that influence intestinal health. The present study aimed to evaluate the relations between complementary feeding, intestinal barrier function and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project cohort study. Habitual dietary intake from complementary feeding was estimated using seven 24-h dietary recalls, from 9 to 15 months of age. Intestinal barrier function was assessed using the lactulose-mannitol test (L-M), and EE was determined as a composite measure using faecal biomarkers concentrations - α-1-antitrypsin, myeloperoxidase (MPO) and neopterin (NEO) at 15 months of age. The nutrient adequacies explored the associations between dietary intake and the intestinal biomarkers. Children showed adequate nutrient intakes (with the exception of fibre), impaired intestinal barrier function and intestinal inflammation. There was a negative correlation between energy adequacy and L-M (ρ = -0·19, P < 0·05) and between folate adequacy and NEO concentrations (ρ = -0·21, P < 0·01). In addition, there was a positive correlation between thiamine adequacy and MPO concentration (ρ = 0·22, P < 0·01) and between Ca adequacy and NEO concentration (ρ = 0·23; P < 0·01). Multiple linear regression models showed that energy intakes were inversely associated with intestinal barrier function (β = -0·19, P = 0·02), and fibre intake was inversely associated with the EE scores (β = -0·20, P = 0·04). Findings suggest that dietary intake from complementary feeding is associated with decreased intestinal barrier function and EE in children.
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Affiliation(s)
- P. N. Costa
- Nutrition Post-Graduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - A. M. Soares
- Department of Physiology and Pharmacology, INCT – Instituto de Biomedicina do Semiárido Brasileiro (IBISAB), Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - J. Q. Filho
- Department of Physiology and Pharmacology, INCT – Instituto de Biomedicina do Semiárido Brasileiro (IBISAB), Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - F. S. Junior
- Department of Physiology and Pharmacology, INCT – Instituto de Biomedicina do Semiárido Brasileiro (IBISAB), Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - R. Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | | | - R. L. Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - L. E. Caulfield
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. A. M. Lima
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - B. L. L. Maciel
- Nutrition Post-Graduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Sanchez JJ, Alam MA, Stride CB, Haque MA, Das S, Mahfuz M, Roth DE, Sly PD, Long KZ, Ahmed T. Campylobacter infection and household factors are associated with childhood growth in urban Bangladesh: An analysis of the MAL-ED study. PLoS Negl Trop Dis 2020; 14:e0008328. [PMID: 32407313 PMCID: PMC7252635 DOI: 10.1371/journal.pntd.0008328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 05/27/2020] [Accepted: 04/27/2020] [Indexed: 01/24/2023] Open
Abstract
The dual burden of enteric infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Campylobacter infection, in particular, is highly prevalent in low- and middle-income countries, including Bangladesh. We examined longitudinal data to evaluate the trajectories of change in child growth, and to identify associations with Campylobacter infection and household factors. The study analyzed data from 265 children participating in the MAL-ED Study in Mirpur, Bangladesh. We applied latent growth curve modelling to evaluate the trajectories of change in children's height, as measured by length-for-age z-score (LAZ), from age 0-24 months. Asymptomatic and symptomatic Campylobacter infections were included as 3- and 6-month lagged time-varying covariates, while household risk factors were included as time-invariant covariates. Maternal height and birth order were positively associated with LAZ at birth. An inverse association was found between increasing age and LAZ. Campylobacter infection prevalence increased with age, with over 70% of children 18-24 months of age testing positive for infection. In the final model, Campylobacter infection in the preceding 3-month interval was negatively associated with LAZ at 12, 15, and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at 15, 18, and 21 months of age. Duration of antibiotic use and access to treated drinking water were negatively associated with Campylobacter infection, with the strength of the latter effect increasing with children's age. Campylobacter infection had a significant negative effect on child's growth and this effect was most powerful between 12 and 21 months. The treatment of drinking water and increased antibiotic use have a positive indirect effect on linear child growth trajectory, acting via their association with Campylobacter infection.
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Affiliation(s)
- J. Johanna Sanchez
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Christopher B. Stride
- The Institute of Work Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Md. Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Daniel E. Roth
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Peter D. Sly
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kurt Z. Long
- Children’s Health Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Das S, Sanchez JJ, Alam A, Haque A, Mahfuz M, Ahmed T, Long KZ. Dietary Magnesium, Vitamin D, and Animal Protein Intake and Their Association to the Linear Growth Trajectory of Children from Birth to 24 Months of Age: Results From MAL-ED Birth Cohort Study Conducted in Dhaka, Bangladesh. Food Nutr Bull 2020; 41:200-210. [PMID: 32064926 DOI: 10.1177/0379572119892408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence suggests lack of understanding of the association of specific nutrients with different time points of linear growth trajectory. OBJECTIVE We investigated the role of dietary macro- and micronutrients on length-for-age z (LAZ) score trajectory of children across first 24 months of their life. METHODS The MAL-ED Bangladesh birth cohort study recruited 265 healthy newborn children after birth. The linear growth trajectory of those children was modeled using latent growth curve modeling (LGCM) technique. RESULTS Dietary magnesium intake at 9 to 11 months was positively associated (coefficient β = 0.006, P < .02) with LAZ at 12 months. Animal protein intake at 15 to 17 months, in turn, was positively associated (β = 0.03, P < .03) with LAZ at 18 months. However, vitamin D intake at 15 to 17 months was negatively associated (β = -0.06, P < .02) with LAZ at 18 months. Other micro- and macronutrients did not show any statistically significant association with the linear growth trajectory. We also found that birth weight (β = 0.91, P < .01), treating water (β = 0.35, P < 0.00), and maternal height (β = 3.4, P < .00) were positively associated with intercept. Gender had a significant negative association with the intercept, but a positive association with the slope (β = -0.39, P < .01; β = 0.08, P < .04), respectively. Conversely, birth weight had negative association with the slope (β = -0.12, P < .01). CONCLUSIONS Dietary magnesium and animal protein were positively and vitamin D was negatively associated with the linear growth trajectory. Maternal height, birth weight, gender, and treatment of drinking water also played significant roles in directing the trajectory.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - J Johanna Sanchez
- Faculty of Medicine, Children's Health Research Centre, University of Queensland, Brisbane, Australia
| | - Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Kurt Z Long
- Faculty of Medicine, Children's Health Research Centre, University of Queensland, Brisbane, Australia.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Lungu EA, Darker C, Biesma R. Determinants of healthcare seeking for childhood illnesses among caregivers of under-five children in urban slums in Malawi: a population-based cross-sectional study. BMC Pediatr 2020; 20:20. [PMID: 31952484 PMCID: PMC6966883 DOI: 10.1186/s12887-020-1913-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND There is considerable evidence that health systems, in so far as they ensure access to healthcare, promote population health even independent of other determinants. Access to child health services remains integral to improving child health outcomes. Cognisant that improvements in child health have been unevenly distributed, it is imperative that health services and research focus on the disadvantaged groups. Children residing in urban slums are known to face a health disadvantage that is masked by the common view of an urban health advantage. Granted increasing urbanisation rates and proliferation of urban slums resulting from urban poverty, the health of under-five children in slums remains a public health imperative in Malawi. We explored determinants of healthcare-seeking from a biomedical health provider for childhood symptoms of fever, cough with fast breathing and diarrhoea in three urban slums of Lilongwe, Malawi. METHODS This was a population-based cross-sectional study involving 543 caregivers of under-five children. Data on childhood morbidity and healthcare seeking in three months period were collected using face-to-face interviews guided by a validated questionnaire. Data were entered in CS-Pro 5.0 and analysed in SPSS version 20 using descriptive statistics and logistic regression analyses. RESULTS 61% of caregivers sought healthcare albeit 53% of them sought healthcare late. Public health facilities constituted the most frequently used health providers. Healthcare was more likely to be sought: for younger than older under-five children (AOR = 0.54; 95% CI: 0.30-0.99); when illness was perceived to be severe (AOR = 2.40; 95% CI: 1.34-4.30); when the presenting symptom was fever (AOR = 1.77; 95% CI: 1.10-2.86). Home management of childhood illness was negatively associated with care-seeking (AOR = 0.54; 95% CI: 0.36-0.81) and timely care-seeking (AOR = 0.44; 95% CI: 0.2-0.74). Caregivers with good knowledge of child danger signs were less likely to seek care timely (AOR = 0.57; 95% CI: 0.33-0.99). CONCLUSIONS Even in the context of geographical proximity to healthcare services, caregivers in urban slums may not seek healthcare or when they do so the majority may not undertake timely healthcare care seeking. Factors related to the child, the type of illness, and the caregiver are central to the healthcare decision making dynamics. Improving access to under-five child health services therefore requires considering multiple factors.
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Affiliation(s)
| | - Catherine Darker
- Department of Public Health & Primary Care, Trinity College Dublin, Tallaght Hospital, Dublin 24, 24 Ireland
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University of Groningen, P.O Box 196, 9700 AD Groningen, Netherlands
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Habimana S, Biracyaza E. Risk Factors Of Stunting Among Children Under 5 Years Of Age In The Eastern And Western Provinces Of Rwanda: Analysis Of Rwanda Demographic And Health Survey 2014/2015. Pediatric Health Med Ther 2019; 10:115-130. [PMID: 31695558 PMCID: PMC6821046 DOI: 10.2147/phmt.s222198] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stunting is one of the most public health burdens in Rwanda. Most deaths due to stunting are associated with inappropriate feeding practices that occur in the first 5 years of life. This study aimed at determining the risk factors for stunting in children under 5 years of age in the Eastern and Western provinces of Rwanda. METHOD Cross-sectional study using secondary data from Rwanda Demographic Health Survey 2014/2015. RESULTS Stunting was highly prevalent in eastern province compared to Western province. It was also highly prevalent in rural area in both provinces. Results indicated a significant association between maternal education and stunting (=6.868; p=0.001), maternal age group (=15.44; p=0.017), maternal occupation (=30.012; p=0.000), wealth index (=14.327; p=0.006), sex of child (=2.91; p=0.008) and giving child fortified food (=4.256; p=0.039). Results indicated that antenatal care visits were significantly associated with stunting (=6.653; p=0.01). Sharing a toilet was significantly associated with stunting (=25.88; p=0.000). Multiple logistic regression indicated that the gender of child [OR=1.08; 95% CI (1.057-1.093), p=0.008], household wealth index [OR=0.386; 95% CI (0.357-0.414)] and breastfeeding [OR=0.02; 95% CI (0.004-0.036), p=0.013] were the risk factors of stunting in eastern and western provinces. CONCLUSION Immediate and appropriate interventions targeted at community management of acute malnutrition and stunting are needed to manage the associated morbidity and mortality. Strengthening the health system for improving child health through prioritizing maternal and child by addressing poverty and increase food access is mostly needed. These tactics yield more sustainable improvement in child nutrition within Eastern and Western provinces.
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Affiliation(s)
- Samuel Habimana
- Rwanda Resilience and Grounding Organization (RRGO), Kigali, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Hossain M, Nahar B, Haque MA, Mondal D, Mahfuz M, Naila NN, Gazi MA, Hasan MM, Haque NMS, Haque R, Arndt MB, Walson JL, Ahmed T. Serum Adipokines, Growth Factors, and Cytokines Are Independently Associated with Stunting in Bangladeshi Children. Nutrients 2019; 11:nu11081827. [PMID: 31394828 PMCID: PMC6723106 DOI: 10.3390/nu11081827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Growth in young children is controlled through the release of several hormonal signals, which are affected by diet, infection, and other exposures. Stunting is clearly a growth disorder, yet limited evidence exists documenting the association of different growth biomarkers with child stunting. This study explored the association between different growth biomarkers and stunting in Bangladeshi children. A quasi-experimental study was conducted among 50 stunted (length-for-age Z-score (LAZ) < -2 SD) and 50 control (LAZ ≥ -2 SD) children, aged 12-18 months, residing in a Bangladeshi slum. The enrolled stunted children received an intervention package, which included food supplementation for three months, psychosocial stimulation for six months, and routine clinical care on community nutrition center at the study field site. The controls received routine clinical care only. All children were clinically screened over the study period. Length, weight, fasting blood and fecal biomarkers were measured. All biomarkers levels were similar in both groups except for oxyntomodulin at enrolment. Leptin (adjusted odds ratio, AOR: 4.0, p < 0.01), leptin-adiponectin ratio (AOR 5.07 × 108, p < 0.01), insulin-like growth factor-1 (IGF-1) (AOR 1.02, p < 0.05), and gamma interferon (IFN-γ) (AOR 0.92, p < 0.05) levels were independently associated with stunting at enrolment. Serum leptin, leptin-adiponectin ratio, interleukin-6 (IL-6), IL-10, tumor necrosis factor-alpha (TNF-α), and fecal alpha-1-antitrypsin (AAT) levels increased significantly (p < 0.001), while IFN-γ levels significantly decreased among stunted children after six months of intervention. Leptin, leptin-adiponectin ratio, IGF-1, and IFN-γ are independently associated with stunting in Bangladeshi children. This trial was registered at clinicaltrials.gov as NCT02839148.
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Affiliation(s)
- Muttaquina Hossain
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh.
| | - Baitun Nahar
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Amran Gazi
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Mehedi Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | | | - Rashidul Haque
- Enteric and Respiratory Infections, icddr,b, Dhaka 1212, Bangladesh
| | - Michael B Arndt
- PATH, Seattle, WA 98109, USA
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98109, USA
- Childhood Acute Illness and Nutrition Network, Nairobi 00200, Kenya
- Departments of Medicine, University of Washington, Seattle, WA 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98109, USA
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
- James P. Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh
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Deichsel EL, Pavlinac PB, Richardson BA, Mbori-Ngacha D, Walson JL, McGrath CJ, Farquhar C, Bosire R, Maleche-Obimbo E, John-Stewart GC. Birth size and early pneumonia predict linear growth among HIV-exposed uninfected infants. MATERNAL AND CHILD NUTRITION 2019; 15:e12861. [PMID: 31222958 DOI: 10.1111/mcn.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/27/2022]
Abstract
Stunting remains a global health priority, particularly in sub-Saharan Africa. Identifying determinants of linear growth in HIV-exposed uninfected (HEU) infants can inform interventions to prevent stunting in this vulnerable population. HIV-infected mothers and their uninfected infants were followed monthly from pregnancy to 12-month post-partum in Nairobi, Kenya. Mixed-effects models estimated the change in length-for-age z-score (LAZ) from birth to 12 months by environmental, maternal, and infant characteristics. Multivariable models included factors univariately associated with LAZ. Among 372 HEU infants, mean LAZ decreased from -0.54 (95% confidence interval [CI] [-0.67, -0.41]) to -1.09 (95% CI [-1.23, -0.96]) between 0 and 12 months. Declines in LAZ were associated with crowding (≥2 persons per room; adjusted difference [AD] in 0-12 month change: -0.46; 95% CI [-0.87, -0.05]), use of a pit latrine versus a flush toilet (AD: -0.29; 95% CI [-0.57, -0.02]), and early infant pneumonia (AD: -1.14; 95% CI [-1.99, -0.29]). Infants with low birthweight (<2,500 g; AD: 1.08; 95% CI [0.40, 1.76]) and birth stunting (AD: 1.11; 95% CI [0.45, 1.78]) experienced improved linear growth. By 12 months of age, 46 infants were stunted, of whom 11 (24%) were stunted at birth. Of the 34 infants stunted at birth with an available 12-month LAZ, 68% were not stunted at 12 months. Some low birthweight and birth-stunted HEU infants had significant linear growth recovery. Early infant pneumonia and household environment predicted poor linear growth and may identify a subgroup of HEU infants for whom to provide growth-promoting interventions.
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Affiliation(s)
- Emily L Deichsel
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Patricia B Pavlinac
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Barbra A Richardson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | | | - Judd L Walson
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington.,Child Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Christine J McGrath
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Carey Farquhar
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Grace C John-Stewart
- Biostatistics, Global Health, Epidemiology, Medicine, University of Washington, Seattle, Washington
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Das S, Alam MA, Mahfuz M, Arifeen SE, Ahmed T. Relative contributions of the correlates of stunting in explaining the mean length-for-age z-score difference between 24-month-old stunted and non-stunted children living in a slum of Dhaka, Bangladesh: results from a decomposition analysis. BMJ Open 2019; 9:e025439. [PMID: 31366637 PMCID: PMC6678062 DOI: 10.1136/bmjopen-2018-025439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Using MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) Bangladesh birth cohort data, we sought to measure the relative contributions of the most predictive correlates of stunting to mean length-for-age z (LAZ) score difference between stunted and non-stunted children at 24 months of age. SETTING Dhaka, Bangladesh PARTICIPANTS: 211 slum-dwelling children enrolled within 17 days of their birth. VARIABLES AND METHOD The explanatory variables were identified from the following groups: maternal characteristics, birth characteristics, macronutrient intake, socioeconomic status, morbidity and serum micronutrient level. At step 1, predictive correlates of stunting were identified longitudinally (from 9 to 24 months of age) using generalized estimating equations (GEE) model. Then, the relative contributions of the most predictive correlates of stunting to mean LAZ score difference between stunted and non-stunted children at 24 months of age was measured using Blinder-Oaxaca decomposition analysis RESULTS: The GEE multivariable model identified maternal height, birth weight, people per room, gender, having separate room for kitchen and energy intake as the most predictive correlates of stunting. At 24 months, mean LAZ score difference between stunted and non-stunted children was 1.48. The variable by variable decomposition of the LAZ gap identified maternal height (coefficient: -3.04; 95% CI: 0.35 to -6.44), birth weight (coefficient: -0.21; 95% CI: 0.88 to -1.30), people per room (coefficient: 0.31; 95% CI: 0.92 to -0.30) and energy intake (coefficient: -0.12; 95% CI: 0.22 to -0.46) as the top most factors responsible for the mean LAZ score difference between stunted and non-stunted children at 24 months of age. CONCLUSIONS The relative contributions of maternal height and birth weight to LAZ gap signifies that improvement in nutritional status of a women during her adolescence and pregnancy would have an impact on birth weight of her offspring, and ultimately, on linear growth of the child.
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Affiliation(s)
- Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Huey SL, Finkelstein JL, Venkatramanan S, Udipi SA, Ghugre P, Thakker V, Thorat A, Potdar RD, Chopra HV, Kurpad AV, Haas JD, Mehta S. Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study. Front Public Health 2019; 7:191. [PMID: 31355176 PMCID: PMC6639755 DOI: 10.3389/fpubh.2019.00191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.
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Affiliation(s)
- Samantha Lee Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Julia Leigh Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
| | - Sudha Venkatramanan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Shobha A. Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | | | | | - Anura V. Kurpad
- Department of Physiology, St. John's Research Institute, Bangalore, India
| | - Jere Douglas Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
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Goudet SM, Bogin BA, Madise NJ, Griffiths PL. Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC). Cochrane Database Syst Rev 2019; 6:CD011695. [PMID: 31204795 PMCID: PMC6572871 DOI: 10.1002/14651858.cd011695.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low- and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. Urban slums are complex environments in terms of biological, social, and political variables and the outcomes of nutritional interventions need to be assessed in relation to these variables. For the purposes of this review, we followed the UN-Habitat 2004 definitions for low-income informal settlements or slums as lacking one or more indicators of basic services or infrastructure. OBJECTIVES To assess the impact of nutritional interventions to reduce stunting in infants and children under five years old in urban slums from LMIC and the effect of nutritional interventions on other nutritional (wasting and underweight) and non-nutritional outcomes (socioeconomic, health and developmental) in addition to stunting. SEARCH METHODS The review used a sensitive search strategy of electronic databases, bibliographies of articles, conference proceedings, websites, grey literature, and contact with experts and authors published from 1990. We searched 32 databases, in English and non-English languages (MEDLINE, CENTRAL, Web of Science, Ovid MEDLINE, etc). We performed the initial literature search from November 2015 to January 2016, and conducted top up searches in March 2017 and in August 2018. SELECTION CRITERIA Research designs included randomised (including cluster-randomised) trials, quasi-randomised trials, non-randomised controlled trials, controlled before-and-after studies, pre- and postintervention, interrupted time series (ITS), and historically controlled studies among infants and children from LMIC, from birth to 59 months, living in urban slums. The interventions included were nutrition-specific or maternal education. The primary outcomes were length or height expressed in cm or length-for-age (LFA)/height-for-age (HFA) z-scores, and birth weight in grams or presence/absence of low birth weight (LBW). DATA COLLECTION AND ANALYSIS We screened and then retrieved titles and abstracts as full text if potentially eligible for inclusion. Working independently, one review author screened all titles and abstracts and extracted data on the selected population, intervention, comparison, and outcome parameters and two other authors assessed half each. We calculated mean selection difference (MD) and 95% confidence intervals (CI). We performed intervention-level meta-analyses to estimate pooled measures of effect, or narrative synthesis when meta-analyses were not possible. We used P less than 0.05 to assess statistical significance and intervention outcomes were also considered for their biological/health importance. Where effect sizes were small and statistically insignificant, we concluded there was 'unclear effect'. MAIN RESULTS The systematic review included 15 studies, of which 14 were randomised controlled trials (RCTs). The interventions took place in recognised slums or poor urban or periurban areas. The study locations were mainly Bangladesh, India, and Peru. The participants included 9261 infants and children and 3664 pregnant women. There were no dietary intervention studies. All the studies identified were nutrient supplementation and educational interventions. The interventions included zinc supplementation in pregnant women (three studies), micronutrient or macronutrient supplementation in children (eight studies), nutrition education for pregnant women (two studies), and nutrition systems strengthening targeting children (two studies) intervention. Six interventions were adapted to the urban context and seven targeted household, community, or 'service delivery' via systems strengthening. The primary review outcomes were available from seven studies for LFA/HFA, four for LBW, and nine for length.The studies had overall high risk of bias for 11 studies and only four RCTs had moderate risk of bias. Overall, the evidence was complex to report, with a wide range of outcome measures reported. Consequently, only eight study findings were reported in meta-analyses and seven in a narrative form. The certainty of evidence was very low to moderate overall. None of the studies reported differential impacts of interventions relevant to equity issues.Zinc supplementation of pregnant women on LBW or length (versus supplementation without zinc or placebo) (three RCTs)There was no evidence of an effect on LBW (MD -36.13 g, 95% CI -83.61 to 11.35), with moderate-certainty evidence, or no evidence of an effect or unclear effect on length with low- to moderate-certainty evidence.Micronutrient or macronutrient supplementation in children (versus no intervention or placebo) (eight RCTs)There was no evidence of an effect or unclear effect of nutrient supplementation of children on HFA for studies in the meta-analysis with low-certainty evidence (MD -0.02, 95% CI -0.06 to 0.02), and inconclusive effect on length for studies reported in a narrative form with very low- to moderate-certainty evidence.Nutrition education for pregnant women (versus standard care or no intervention) (two RCTs)There was a positive impact on LBW of education interventions in pregnant women, with low-certainty evidence (MD 478.44g, 95% CI 423.55 to 533.32).Nutrition systems strengthening interventions targeting children (compared with no intervention, standard care) (one RCT and one controlled before-and-after study)There were inconclusive results on HFA, with very low- to low-certainty evidence, and a positive influence on length at 18 months, with low-certainty evidence. AUTHORS' CONCLUSIONS All the nutritional interventions reviewed had the potential to decrease stunting, based on evidence from outside of slum contexts; however, there was no evidence of an effect of the interventions included in this review (very low- to moderate-certainty evidence). Challenges linked to urban slum programming (high mobility, lack of social services, and high loss of follow-up) should be taken into account when nutrition-specific interventions are proposed to address LBW and stunting in such environments. More evidence is needed of the effects of multi-sectorial interventions, combining nutrition-specific and sensitive methods and programmes, as well as the effects of 'up-stream' practices and policies of governmental, non-governmental organisations, and the business sector on nutrition-related outcomes such as stunting.
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Affiliation(s)
- Sophie M Goudet
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
| | - Barry A Bogin
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
| | | | - Paula L Griffiths
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
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Kac G, Arnold CD, Matias SL, Mridha MK, Dewey KG. Gestational weight gain and newborn anthropometric outcomes in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2019; 15:e12816. [PMID: 30903801 DOI: 10.1111/mcn.12816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/07/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
Low gestational weight gain (GWG) is a known predictor of fetal growth restriction in higher income countries, but there is little information on this association in lower income countries. Our objective is to describe the association between GWG and birth outcomes among pregnant women in rural Bangladesh. Pregnant women were identified in a community-based programme and enrolled into the study at an average of 13 weeks' gestation (n = 4,011). Maternal weight and height were measured at enrolment, maternal weight was measured at 36 weeks' gestation, and newborns were measured after birth. Rate of GWG (g/weeks) was calculated, and women were categorized as having adequate or inadequate GWG (Institute of Medicine recommendations). Newborn anthropometric outcomes included weight-for-age z score (WAZ), length-for-age z score (LAZ), head-circumference-for-age z score (HCZ), body mass index (BMI)-for-age z score (BMIZ), low birthweight (LBW < 2,500 g), WAZ < -2, LAZ < -2, HCZ < -2, BMIZ < -2, and small for gestational age (SGA: <10th percentile). Multivariate models were adjusted for confounders. Only 26% of the 2,562 women in these analyses had adequate GWG. Compared with newborns of women with inadequate GWG, infants of women with adequate GWG had a lower risk of adverse anthropometric outcomes (relative risk [95% confidence interval]: LBW = 0.68 [0.59, 0.80], LAZ < -2 = 0.64 [0.51, 0.80], HCZ < -2 = 0.75 [0.60, 0.93], BMIZ < -2 = 0.70 [0.59, 0.83], and SGA = 0.80 [0.73, 0.86]), but there was no significant difference in mean (SE) duration of gestation, 39.7 (0.08) versus 39.7 (0.05) weeks. In this population, GWG rate is a strong predictor of newborn anthropometric outcomes, but not duration of gestation.
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Affiliation(s)
- Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, California
| | - Susana L Matias
- Department of Nutrition, University of California, Davis, Davis, California
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
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Septiawahyuni HD, Suminar DR. KECUKUPAN ASUPAN ZINC BERHUBUNGAN DENGAN PERKEMBANGAN MOTORIK PADA BALITA STUNTING DAN NON-STUNTING. AMERTA NUTRITION 2019. [DOI: 10.20473/amnt.v3i1.2019.1-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: One Indicator of successful health development are toddlers free from stunting. The cause of stunting is a lack of macro and micro nutrients and chronic infectious diseases. Micronutrients such as zinc have a role in growth which affects the hormones that play a role in bone growth. The role of zinc in motoric development indirectly is in arranging and releasing neurotransmitters that can affect nerve stimulation in the brain. This neurotransmitters will deliver nerve stimulation so that motor motion occurs. Motor development is a motion that involves muscles, brain and nerve that are controlled by the central part of the motor that is brain. Objectives: The purpose of this study was to analyze the relationship between adequacy of zinc intake and motoric development in stunted and non-stunted toddlers.Methods: This type of research is an observational study with cross sectional design. The sample size was 50 toddlers, consisted of 25 stunting toodlers and 25 non-stunting toddlers and lived in Puskesmas Wilangan, Nganjuk District, chosen by simple random sampling technique. Adequacy of zinc intake data was assessed using the Food Recall Form 3x 24 hours. Measurement of motoric development using the Pre-Screening Development Questionnaire (KPSP). Descriptive and inferential data analysis using Chi Square Test. Results: The result showed that there was a correlation between the level of zinc adequacy and motor development in the stunting toddler group (p=0.04) and non-stunting toddlers group (p=0.031).Conclusions: The level of adequacy of zinc has enough motor development better than the level of zinc sufficiency is less in the group of non-stunting toddlers.ABSTRAKLatar Belakang: Salah satu indikator keberhasilan pembangunan kesehatan adalah balita terbebas dari stunting. Penyebab stunting yaitu kekurangan zat gizi makro maupun mikro dan penyakit infeksi kronis. Zat gizi mikro seperti zinc mempunyai peran pada pertumbuhan yaitu mempengaruhi hormon-hormon yang berperan dalam pertumbuhan tulang. Selain itu, peran zinc pada perkembangan motorik secara tidak langsung yaitu dalam menyusun dan melepas neurotransmitter yang dapat mempengaruhi rangsangan syaraf di dalam otak. Neurotransmitter ini akan menghantarkan rangsangan syaraf sehingga gerak motorik terjadi. Perkembangan motorik merupakan gerak yang melibatkan otot, otak dan syaraf yang dikontrol pada bagian pusat motorik yaitu otak.Tujuan: Tujuan penelitian adalah untuk menganalisis hubungan kecukupan asupan zinc dengan perkembangan motorik pada balita stunting dan non-stunting. Metode: Jenis penelitian tergolong penelitian observasional dengan desain cross-sectional. Sampel penelitian berjumlah 50 balita, terdiri dari 25 balita stunting dan 25 balita non-stunting yang bertempat tinggal di wilayah kerja Puskesmas Wilangan Kabupaten Nganjuk, dipilih dengan teknik simple random sampling. Data kecukupan asupan zinc dinilai menggunakan formulir Food Recall yang dilakukan 3x24 jam. Pengukuran perkembangan motorik menggunakan Kuesioner Pra Skrining Perkembangan (KPSP). Analisis data secara deskriptif dan Inferensial menggunakan uji Chi Square.Hasil: Hasil penelitian menunjukkan terdapat hubungan antara tingkat kecukupan zinc dengan perkembangan motorik pada kelompok balita stunting (p=0,04) dan kelompok balita non-stunting (p=0,031). Kesimpulan: Tingkat kecukupan zinc cukup mempunyai perkembangan motorik yang lebih baik daripada tingkat kecukupan zinc kurang pada kelompok balita non-stunting.
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Individual-, maternal- and household-level factors associated with stunting among children aged 0-23 months in Bangladesh. Public Health Nutr 2018; 22:85-94. [PMID: 30404673 DOI: 10.1017/s1368980018002926] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Childhood stunting remains a major public health concern in Bangladesh. To accelerate the reduction rate of stunting, special focus is required during the first 23 months of a child's life when the bulk of growth takes place. Therefore the present study explored individual-, maternal- and household-level factors associated with stunting among children under 2 years of age in Bangladesh. DESIGN Data were collected through a nationwide cross-sectional survey conducted between October 2015 and January 2016. A two-stage cluster random sampling procedure was applied to select 11 428 households. In the first stage, 210 enumerations areas (EA) were selected with probability proportional to EA size (180 EA from rural areas, thirty EA from urban slums). In the second stage, an average of fifty-four households were selected from each EA through systematic random sampling. SETTING Rural areas and urban slums of Bangladesh.ParticipantsA total of 6539 children aged 0-23 months. RESULTS Overall, 29·9 % of the children were stunted. After adjusting for all potential confounders in the modified Poisson regression model, child's gender, birth weight (individual level), maternal education, age at first pregnancy, nutrition (maternal level), administrative division, place of residence, socio-economic status, food security status, access to sanitary latrine and toilet hygiene condition (household level) were significantly associated with stunting. CONCLUSIONS The study identified a number of potentially addressable multilevel risk factors for stunting among young children in Bangladesh that should be addressed through comprehensive multicomponent interventions.
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Bhowmik KR, Das S. On selection of an appropriate logistic model to determine the risk factors of childhood stunting in Bangladesh. MATERNAL AND CHILD NUTRITION 2018; 15:e12636. [PMID: 30033556 DOI: 10.1111/mcn.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/10/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
Stunting is the core measure of child health inequalities as it reveals multiple dimensions of child health and development status. The main focus of this study is to show the procedure of selecting the most appropriate logistic regression model for stunting by developing and comparing several plausible models, which ultimately helps to identify the predictors of childhood stunting in Bangladesh. This study utilizes child anthropometric data collected in the 2014 Bangladesh Demographic and Health Survey. Valid height-for-age anthropometric indices were available for a total of 6,931 children aged 0-59 months, of which about 36% were stunted. Ordinary logistic, survey logistic, marginal logistic, and random intercept logistic regression models were developed assuming independence, sampling design, cluster effect, and hierarchy of the data. Based on a number of model selection criteria, random intercept logistic model is found the most appropriate for the studied children. A number of child, mother, household, regional, and community-level variables were included in the model specification. The factors that increased the odds of stunting are children older than 11 months, short birth interval, recent morbidity of children, lower maternal education, young maternity, lower maternal body mass index, poor household wealth, urban residential place, and living in Sylhet division. Findings of this study recommend to utilize an appropriate logistic model considering the issues relevant to the data, particularly sampling design and clustering for determining the risk factors of childhood stunting in Bangladesh.
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Affiliation(s)
- Kakoli Rani Bhowmik
- Department of Biostatistics, Hasselt University, Hasselt, Belgium.,Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Sumonkanti Das
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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