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Liu Z, Duan Y, Yang L, Du J, Liu H. Global burden of childhood nutritional deficiencies, 1990-2019. Public Health 2024; 235:26-32. [PMID: 39038426 DOI: 10.1016/j.puhe.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES The aim of this study was to estimate the global burden, trends and health inequality of childhood nutritional deficiencies (CND) from 1990 to 2019. STUDY DESIGN This was an epidemiological study. METHODS Data were extracted from the 2019 Global Burden of Disease study. Estimates and 95% uncertainty intervals (UIs) for the rates and numbers were used to evaluate the global burden of CND. Temporal trends in the burden of CND were examined using Joinpoint analysis and average annual percentage changes. To assess health inequality, the slope index was used. RESULTS In 2019, 52 million new cases of CND and 105,000 deaths related to CND were recorded. Additionally, 435 million prevalence cases and 26 million disability-adjusted life years (DALYs) were recorded in the same year. From 1990 to 2019, the incidence rate of CND generally increased globally, except for the years 2010-2017; conversely, the prevalence, death and DALY rates exhibited decreasing trends over the study period. Half of the analysed regions and countries/territories demonstrated decreasing trends in the incidence, prevalence, death and DALY rates associated with CND. The incidence and prevalence of CND remained high in low-middle sociodemographic index (SDI) and low-SDI regions; however, they exhibited decreasing trends over the 30-year study period. The slope indexes showed that there were no significant changes in SDI-related inequality over 30 years. CONCLUSIONS Despite decreasing trends in the prevalence, death and DALY rates associated with CND over the three decades, the degree of inequality related to SDI in the burden of nutritional deficiencies has not shown a significant decline. In summary, CND remain a major public health burden in middle-SDI and low-SDI countries.
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Affiliation(s)
- Zihao Liu
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Ying Duan
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Ling Yang
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Jing Du
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Huaqing Liu
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
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Shahid M, Xie Y, Bashir S, Noureen N, Song J, Malik NI, Tang K. Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan. CHILDREN (BASEL, SWITZERLAND) 2024; 11:872. [PMID: 39062321 PMCID: PMC11276128 DOI: 10.3390/children11070872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. METHODS Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. RESULTS Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. CONCLUSIONS In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.
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Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China; (M.S.); (Y.X.)
| | - Yuantao Xie
- School of Insurance and Economics, University of International Business and Economics, Beijing 100029, China; (M.S.); (Y.X.)
| | - Shamshad Bashir
- Department of Psychology, Lahore Garrison University, Lahore 54000, Pakistan;
| | - Nazia Noureen
- Department of Psychology, Foundation University Rawalpindi Campus, Rawalpindi 44000, Pakistan;
| | - Jiayi Song
- Tsinghua Shenzhen International School, Tsinghua University, Beijing 100084, China
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan;
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
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Manoochehri S, Faradmal J, Poorolajal J, Asadi FT, Soltanian AR. Risk factors associated with underweight in children aged one to two years: a longitudinal study. BMC Public Health 2024; 24:1875. [PMID: 39004703 PMCID: PMC11247798 DOI: 10.1186/s12889-024-19147-9] [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: 01/22/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1-2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies. METHODS In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight. RESULTS Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10-11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05-10.91), maternal height (AOR = 0.85, 95% CI: 0.79-0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04-7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28-0.97), child age 12-15 months (AOR = 2.27, 95% CI: 1.37-3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70-0.58). CONCLUSION Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.
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Affiliation(s)
- Sara Manoochehri
- Department of Biostatistics, Student Research Committee, PhD Candidate of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Boulevard, Hamadan, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Torkaman Asadi
- Department of Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran.
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Boulevard, Hamadan, Iran.
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Kundu RN, Gautam RK, Chatterjee A, Bharati P, Liczbińska G, Malina RM. Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys. Eur J Clin Nutr 2024; 78:591-606. [PMID: 38467858 DOI: 10.1038/s41430-024-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. METHODS Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. RESULTS Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. CONCLUSIONS The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.
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Affiliation(s)
- Ramendra Nath Kundu
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Rajesh K Gautam
- Department of Anthropology, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India
| | - Arna Chatterjee
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Premananda Bharati
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India
| | - Grażyna Liczbińska
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland.
| | - Robert M Malina
- Professor Emeritus, Department of Kinesiology and Health Education, University of Texas, Austin, TX, 78705, USA
- Adjunct Professor, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
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Jiao B, Iversen I, Sato R, Pecenka C, Khan S, Baral R, Kruk ME, Arsenault C, Verguet S. Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries. PLoS Med 2024; 21:e1004421. [PMID: 38968303 PMCID: PMC11226092 DOI: 10.1371/journal.pmed.1004421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs). METHODS AND FINDINGS We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes. CONCLUSIONS Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.
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Affiliation(s)
- Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Isabelle Iversen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Sadaf Khan
- PATH, Seattle, Washington, United States of America
| | - Ranju Baral
- PATH, Seattle, Washington, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Muhammad A, Shafiq Y, Nisar MI, Baloch B, Pasha A, Yazdani NS, Rizvi A, Muhammad S, Jehan F. Effect of maternal postnatal balanced energy protein supplementation and infant azithromycin on infant growth outcomes: an open-label randomized controlled trial. Am J Clin Nutr 2024:S0002-9165(24)00542-2. [PMID: 38925354 DOI: 10.1016/j.ajcnut.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Maternal undernutrition is a direct risk factor for infant growth faltering. OBJECTIVES We evaluated the effect of postnatal balanced energy protein (BEP) supplementation in lactating women and azithromycin (AZ) in infants on infant growth outcomes. METHODS A randomized controlled superiority trial of lactating mother-newborn dyads was conducted in Karachi, Pakistan. Mothers intending to breastfeed their newborns with mid-upper arm circumference of <23 cm and live infants between 0 and 6 d of life were randomly assigned to 1 of 3 arms in a 1:1:1 ratio. Lactating mothers in the control arm received standard-of-care counseling on exclusive breastfeeding, nutrition, infant immunization, and health promotion plus iron-folate supplementation until the infant was 6 mo old. In intervention arm 1, mothers additionally received two 75-g sachets of BEP per day. In intervention arm 2, along with the standard-of-care and BEP to the mother, the infant also received 1 dose of azithromycin (20 mg/kg) at the age of 42 d . The primary outcome was infant length velocity at 6 mo. The total sample size was 957 (319 in each arm). RESULTS From 1 August, 2018 to 19 May, 2020, 319 lactating mother-newborn dyads were randomly assigned in each arm, and the last follow-up was completed on 20 November, 2020. The mean difference in length velocity (cm/mo) between BEP alone and control was 0.01 (95% confidence interval [CI]: -0.03, 0.06), BEP plus AZ and control was 0.08 (95% CI: 0.03, 0.13), and between BEP + AZ and BEP alone was 0.06 (95% CI: 0.01, 0.11). There were 1.46% (14/957) infant deaths in the trial, and 17.9% (171/957) nonfatal events (injectable treatment and/or hospitalizations) were recorded. CONCLUSIONS Postnatal maternal BEP supplementation and infant AZ administration could modestly improve infant growth outcomes at 6 mo, suggesting potential benefits in simultaneously addressing maternal and infant undernutrition. This trial was registered at clinicaltrials.gov as NCT03564652.
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Affiliation(s)
- Ameer Muhammad
- Vaccines and Other Initiatives to Advance Lives (VITAL) Pakistan Trust, Karachi, Pakistan
| | - Yasir Shafiq
- Center of Excellence for Trauma and Emergencies and Community Health Sciences, The Aga Khan University, Karachi, Pakistan; Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Harvard T. H. Chan School of Public Health, Boston, MA, United States; Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università degli Studi del Piemonte Orientale "Amedeo Avogadro," Vercelli, Italy
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health Medical College, The Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Pediatrics and Child Health Medical College, The Aga Khan University, Karachi, Pakistan
| | - Aneela Pasha
- Department of Pediatrics and Child Health Medical College, The Aga Khan University, Karachi, Pakistan
| | - Nida Salman Yazdani
- Vaccines and Other Initiatives to Advance Lives (VITAL) Pakistan Trust, Karachi, Pakistan
| | - Arjumand Rizvi
- Centre of Excellence in Maternal and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sajid Muhammad
- Centre of Excellence in Maternal and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health Medical College, The Aga Khan University, Karachi, Pakistan.
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Welsh H, Brickley MB. Investigating femoral growth disruption in subadults from the 10th-13th century St. Étienne cemetery of Toulouse, France. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024:e24984. [PMID: 38899835 DOI: 10.1002/ajpa.24984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES The skeleton embodies an individual's environment and lived experiences. Studying childhood growth disruption can, therefore, aid in understanding the experiences of children in the past. This study evaluates growth disruption in a medieval Toulousian subadult sample to explore factors that may have influenced childhood growth and mortality at this site and to assess the utility of Harris line (HL) interpretations in bioarchaeology. MATERIALS AND METHODS Femoral growth disruption was assessed in n = 71 subadults (0.125-12.42 years) from the 10th-13th century St. Étienne cemetery of Toulouse, France, using femoral length, total area, cortical area, and relative cortical area. Femoral radiographs were assessed for HLs. To determine the prevalence of growth disruption, z-scores were calculated using data from the Denver growth study. RESULTS The majority of subadults in this sample suffered from femoral growth disruption. Young children (1.0-3.99 years) were the most affected, with >65% experiencing reduced appositional growth and linear growth stunting at time-of-death. Additionally, while many individuals presented with observable HLs, linear and appositional growth did not significantly differ between individuals with and without HLs. DISCUSSION Maternal malnutrition and inadequate complementary feeding practices likely contributed to the high prevalence of growth disruption among the youngest individuals in the study. The older children and adolescents buried at St. Étienne experienced an amelioration in growth deficits, indicating an improvement in nutrition and/or disease load. The results of this study suggest that more consideration is required when interpreting the presence/absence of HLs, and that studies assessing HLs may benefit from using a more individualistic approach.
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Affiliation(s)
- H Welsh
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - M B Brickley
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
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Sari DK, Amelia R, Masyithah D, Tantrakarnapa K. Low serum lipase levels in mothers of children with stunted growth indicate the possibility of low calcium absorption during pregnancy: A cross-sectional study in North Sumatra, Indonesia. PLoS One 2024; 19:e0298253. [PMID: 38843179 PMCID: PMC11156305 DOI: 10.1371/journal.pone.0298253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 12/21/2023] [Indexed: 06/09/2024] Open
Abstract
Stunting is caused by various factors, including low nutritional intake in the first two years of life. This study aimed to investigate the differences in sociodemographic factors and mineral, vitamin, and enzyme parameters in mothers associated with the occurrence of stunting in children. We conducted a cross-sectional study from September to November 2020 on North Sumatra Island, Indonesia. The data collected included sociodemographic characteristics, pregnancy history, birth history, food intake, and laboratory examinations, including measurements of calcium, iron, zinc, vitamin D, pancreatic amylase, and serum lipase levels. This study included 50 healthy mothers aged 18-50 years old with children aged 2 to 60 months. There was a significant difference in serum calcium levels between the groups of mothers of children with normal and stunted growth (p = 0.03, mean difference±standard error (SE) = 0.23±0.12, 95% CI: 0.19-0.45). All of the study subjects were categorized as vitamin D deficient. The mean lipase level in the group of mothers of children with stunted growth was significantly lower than that in the group of mothers of children with normal growth (p = 0.02, mean difference±SE = 4.34±1.83, 95% CI: 0.62-8.06). The conclusion was that serum lipase levels were significantly lower in mothers of children with stunted growth compared to mothers of children with normal growth. Serum lipase levels this low are likely to indicate that a mother is unable to meet her child's calcium needs during pregnancy, increasing the child's risk of stunted growth.
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Affiliation(s)
- Dina Keumala Sari
- Department of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Rina Amelia
- Department of Public Health, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Dewi Masyithah
- Department of Parasitology, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Asebe HA, Asmare ZA, Mare KU, Kase BF, Tebeje TM, Asgedom YS, Shibeshi AH, Lombebo AA, Sabo KG, Fente BM, Bezie MM, Seifu BL. The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis. Front Nutr 2024; 11:1336864. [PMID: 38903623 PMCID: PMC11187342 DOI: 10.3389/fnut.2024.1336864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.
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Affiliation(s)
- Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanose Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Afewerk Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meklit Melaku Bezie
- Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia
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Mim SA, Al Mamun ASM, Sayem MA, Wadood MA, Hossain MG. Association of child marriage and nutritional status of mothers and their under-five children in Bangladesh: a cross-sectional study with a nationally representative sample. BMC Nutr 2024; 10:67. [PMID: 38698456 PMCID: PMC11067235 DOI: 10.1186/s40795-024-00874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Child marriage remains an important problem around the world with young mothers and their under-five children often experiencing under-nutrition. The problem is rarely studied in the Bangladeshi population. This paper was designed to identify the association between child marriage and nutritional status of mothers and their under-five children in Bangladesh. METHODS Nationally representative secondary data was used for this study, data was extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The sample consisted of 7235 mothers aged 18-49 years and their under-five children. The mothers were classified into two classes according to their age at first marriage: (i) child marriage (marriage at < 18 years) and (ii) not child marriage (marriage at ≥ 18 years). The nutritional status of mothers was measured by body mass index (BMI), and under-five children's nutritional status was measured by (i) height-for-age (z-score) (stunting), (ii) weight-for-age (z-score) (underweight), and (iii) weight-for-height (z-score) (wasting). The chi-square test and two-level logistic regression model were used for data analysis using SPSS software (IBM version 20). RESULTS The prevalence of child marriage among Bangladeshi women was 69.0%, with the mean and median of age at the first marriage being 16.57 ± 2.83 years and 16 years, respectively. Of the mothers, 15.2% suffered from chronic energy deficiency (underweight), and 72.8% were married at < 18 years. The prevalence of stunting, underweight, and wasting among under-five children in Bangladesh was 31.0%, 22.0%, and 8.5%, respectively. Compared to women married at the age of ≥ 18 years, there was a significantly higher likelihood of chronic energy deficiency among women who married at < 18 years [Adjusted OR = 1.27, CI: 1.05-1.82; p < 0.05]. Under-five children of mothers married before the age of 18 were more likely to have stunting [Adjusted OR = 1.201, CI: 1.11-1.72; p < 0.05], wasting [Adjusted OR = 1.519, CI: 1.15-2.00; p < 0.01], and underweight [Adjusted OR = 1.150, CI: 1.09-1.82; p < 0.05] compared to children of mothers who married at age ≥ 18. CONCLUSION The rate of child marriage among Bangladeshi women is high, and it is significantly associated with malnutrition among mothers and their under-five children. The Bangladesh government can use the findings of this study to prevent and reduce child marriage and malnutrition among mothers and their under-five children to achieve sustainable development goals by 2030.
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Affiliation(s)
- Shanta Akter Mim
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Abu Sayed Md Al Mamun
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Abu Sayem
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Abdul Wadood
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Golam Hossain
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Asmare AA, Agmas YA. Determinants of coexistence of undernutrition and anemia among under-five children in Rwanda; evidence from 2019/20 demographic health survey: Application of bivariate binary logistic regression model. PLoS One 2024; 19:e0290111. [PMID: 38578819 PMCID: PMC10997128 DOI: 10.1371/journal.pone.0290111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/01/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Undernutrition and anemia are significant public health issues among under-5 children, with potential long-term consequences for growth, development, and overall health. Thus, this study aims to conduct a bivariate binary logistic regression model by accounting for the possible dependency of childhood undernutrition and anemia. METHODS The data came from the DHS program's measurement. A total of 3,206 under-five children were involved in this study. A single composite index measure was calculated for stunting, wasting, and underweight using principal component analysis. A bivariate binary logistic regression model is used to assess the association between undernutrition and anemia given the effect of other predictors. RESULTS Among 3,206 under-five children considered in this study, 1482 (46.2%) and 658 (20.5%) children were agonized by anemia and undernutrition, respectively. In bivariate binary logistic regression model; Urban children [AOR = 0.751, 96% CI: 0.573-0.984; AOR = 0.663, 95% CI: 0.456-0.995] and anemic mothers [AOR = 1.160, 95% CI: 1.104-1.218; AOR = 1.663, 95% CI: 1.242-2.225] were significantly associated with both childhood anemia and undernutrition, respectively. Improved water sources [AOR = 0.681, 95% CI: 0.446-0.996], average-sized children [AOR = 0.567, 95% CI: 0.462-0.696], and diarrhea [AOR = 1.134, 95% CI: 1.120-2.792] were significantly associated with childhood anemia. Large-sized children [AOR = 0.882, 95% CI: 0.791-0.853] and those with fever [AOR = 1.152, 95% CI: 1.312-2.981] were significantly associated with under-five children's undernutrition. CONCLUSION The prevalence of both undernutrition and anemia among under-five-year-old children was high in Rwanda. The following determinants are statistically associated with both childhood undernutrition and anemia: place of residence; source of drinking water; maternal anemia; being a twin; birth size of children; diarrhea; fever; and child age. Anemia and nutritional deficiencies must be treated concurrently under one program, with evidence-based policies aimed at vulnerable populations.
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Affiliation(s)
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, Tuluawlyia, Ethiopia
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Kundu RN, Hossain MG, Haque MA, Mahumud RA, Pal M, Bharati P. Burden of undernutrition among under-five Bengali children and its determinants: Findings from Demographic and Health Surveys of Bangladesh and India. PLoS One 2024; 19:e0301808. [PMID: 38578746 PMCID: PMC10997093 DOI: 10.1371/journal.pone.0301808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/21/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Globally, undernutrition is the leading cause of mortality among under-five children. Bangladesh and India were in the top ten countries in the world for under-five mortality. The aim of the study was to investigate the nutritional status of Bengali under-five children. METHODS Data on 25938 under-five children were retrieved from the Bangladesh Demographic and Health Survey 2017-18 (BDHS) and the National Family Health Survey of India 2015-16 (NFHS-4). Stunting, wasting, underweight and thinness were considered to understand the nutritional status of under-five children. Binary logistic regression was used to identify associated factors of undernutrition among children. RESULTS Over one-quarter of Bengali under-five children were found to be suffering from the problem of stunting (31.9%) and underweight (28.1%), while other nutritional indicators raised serious concern and revealed inter-country disparities. In the cases of wasting, underweight and thinness, the mean z-scores and frequency differences between Bangladesh and India were significant. The nutritional status of Bengali under-five children appeared to have improved in Bangladesh compared to India. Child undernutrition had significant relations with maternal undernutrition in both countries. Girls in Bangladesh had slightly better nutritional status than boys. In Bangladesh, lack of formal education among mothers was a leading cause of child undernutrition. Stunting and underweight coexist with low household wealth index in both counties. CONCLUSIONS The research revealed that various factors were associated with child undernutrition in Bengalis. It has been proposed that programmes promoting maternal education and nutrition, along with household wealth index be prioritised. The study recommends that the Governments of Bangladesh and India should increase the budget for health of children so as to reach the sustainable development goals.
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Affiliation(s)
- Ramendra Nath Kundu
- Department of Anthropology, Former Senior Research Fellow (UGC-NET), West Bengal State University, West Bengal, India
| | - Md Golam Hossain
- Department of Statistics, Health Research Group, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Manoranjan Pal
- Indian Statistical Institute, Economic Research Unit, Kolkata, West Bengal, India
| | - Premananda Bharati
- Indian Statistical Institute, Biological Anthropology Unit, Kolkata, West Bengal, India
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Adediran OA. The effect of women's decision-making on child nutritional outcomes in South Africa. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101355. [PMID: 38350224 DOI: 10.1016/j.ehb.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Women's decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women's decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15-2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women's decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child's weight-for-age and weight-for-height, the result was inconclusive on the child's height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.
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Affiliation(s)
- Olanrewaju Adewole Adediran
- Department of Sustainable Livelihoods, School of Business Leadership (SBL), University of South Africa, South Africa.
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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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Du M, Shi J, Shi S, Wang F. Enhancing children's nutrition: the influence of rural household technology under China's home appliances going to the countryside policy. Front Nutr 2024; 11:1335200. [PMID: 38577159 PMCID: PMC10993694 DOI: 10.3389/fnut.2024.1335200] [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: 11/08/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
This study explores the influence of household technological advancements on children's nutritional intake, specifically within the context of the Chinese government's "Home Appliances Going to the Countryside" (HAGC) initiative. Utilizing data from the China Health and Nutrition Surveys of 2006, 2009, and 2011, we employed a Propensity Score Matching Difference-in-Differences (PSM-DID) framework to ascertain the repercussions of enhanced household technology on the dynamics of children's nutritional consumption patterns. Our analysis reveals that the HAGC-inspired integration of household appliances, including color televisions, washing machines, and refrigerators, has beneficially reshaped the nutritional consumption patterns of children, with a pronounced effect among female children. This finding remains consistent even when employing alternate methodological robustness tests. A deeper examination of the HAGC policy's mechanisms underscores the pivotal roles of parental time allocation, improved food storage capabilities, and augmented information accessibility as significant drivers bolstering children's nutritional intake. These insights bear considerable significance for strategizing interventions aimed at elevating the nutritional wellbeing of children in rural settings, offering valuable input for shaping public health policies tailored for such demographies.
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Affiliation(s)
| | | | | | - Fang Wang
- College of Management, Sichuan Agricultural University, Chengdu, China
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Saleem J, Zakar R, Butt MS, Aadil RM, Ali Z, Bukhari GMJ, Ishaq M, Fischer F. Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan. BMC Public Health 2024; 24:167. [PMID: 38216908 PMCID: PMC10787446 DOI: 10.1186/s12889-024-17701-z] [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: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Malnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan. METHODS A multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children's anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio. RESULTS This study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five. CONCLUSION This study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Rana Muhammad Aadil
- National Institute of Food Sciences and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Zulfiqar Ali
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan
| | | | - Muhammad Ishaq
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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Dake FAA, Christian AK. Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa. BMJ Open 2023; 13:e074601. [PMID: 38135319 DOI: 10.1136/bmjopen-2023-074601] [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] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA. SETTING Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed. DESIGN A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition. METHODS Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15-49 years) and children under five years in the household. RESULTS More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition. CONCLUSION These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.
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Affiliation(s)
- Fidelia A A Dake
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Aaron K Christian
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Shah N, Zaheer S, Safdar NF, Turk T, Hashmi S. Women's awareness, knowledge, attitudes, and behaviours towards nutrition and health in Pakistan: Evaluation of kitchen gardens nutrition program. PLoS One 2023; 18:e0291245. [PMID: 37708133 PMCID: PMC10501633 DOI: 10.1371/journal.pone.0291245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Vulnerability to malnutrition is very high with low-income women and their children in rural Balochistan with contributing factors including lack of awareness about proper nutrition, low literacy, scarcity of vegetables and fruit, and low purchasing power of households. The Food and Agriculture Organization's kitchen garden program provides resources to improve nutrition and health knowledge and promote healthy eating practices. The objective of this study was to assess nutrition and health awareness, knowledge, attitudes, behavioural intentions/behaviours (AKAB) of women who attended the kitchen garden program and trainings. MATERIALS AND METHODS A community based cross-sectional survey (N = 209) using a two-stage cluster sampling method was used to select households with survey participants being mothers with children under five years of age. A pretested questionnaire was administered via face-to-face surveys by trained enumerators in two districts of Balochistan province of Pakistan. Nutrition and health AKAB were constructed indices. Chi-square tests compared statistical differences in AKAB by women attending against a control group who did not-attend kitchen garden interventions. Binary logistic regression analyses were performed to assess kitchen garden program outcomes against key AKAB indicators, while adjusting for covariates. RESULTS Significant differences (p<0.001) were identified between intervention and control groups with women attending kitchen garden being more aware of the components of kitchen garden (65.8% vs 36.8%), and more knowledgeable about causes of illnesses caused by poor nutrition including, iron deficiency anemia, pregnancy, and unborn child health complications, compared to women not attending kitchen gardens program. Logistic regression analysis identified women attending kitchen gardens also had higher odds of being more knowledgeable (OR = 1.59, 95%CI 1.27-1.99, p<0.001), having improved attitudes (OR = 4.86, 95%CI 2.77-8.53, p <0.001), and behavioural intentions/behaviours (OR = 1.98, 95%CI 1.26-3.12, p = 0.003) towards improved nutrition and health. CONCLUSIONS Substantial opportunities exist for achieving improved nutrition and health outcomes with vulnerable groups in Balochistan, through greater participation in kitchen gardens behavioural change programs and interventions. As part of scaling-up efforts, academically rigorous project evaluations should be institutionalized for continuous improvement of nutrition programs to address micronutrient deficiencies in rural communities.
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Affiliation(s)
- Nadia Shah
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Tahir Turk
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
- Communication Partners International (CPI), Springfield, NSW, Australia
| | - Shahkamal Hashmi
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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Pradhan MR, Shete MR. Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Nutr Health 2023; 29:575-590. [PMID: 35238244 DOI: 10.1177/02601060221085809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.
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Affiliation(s)
- Manas Ranjan Pradhan
- Assistant Professor, Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
| | - Mahesh Rajendra Shete
- Data Analyst, Max Institute of Healthcare Management, Indian School of Business, Mohali, India
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Hojati A, Alesaeidi S, Izadi S, Nikniaz A, Farhangi MA. MyKid'sNutrition mobile application trial: a randomized controlled trial to promote mothers' nutritional knowledge and nutritional status of preschool children with undernutrition-a study protocol. Trials 2023; 24:544. [PMID: 37596662 PMCID: PMC10439575 DOI: 10.1186/s13063-023-07503-w] [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: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Childhood malnutrition is a crucial public health issue in developing countries. Mothers' nutritional knowledge significantly affects children's nutritional status. It also appears that mothers with low health literacy are unable to adequately meet their children's nutritional needs because they do not clearly understand their children's nutrition and malnutrition status. METHODS This randomized controlled trial aims to describe the development and study protocol of the MyKid'sNutrition application, a smartphone-based intervention for mothers of preschool (2-6 years old) children. The application contains several contents on children's healthy eating, childhood underweight, children's loss of appetite, and child growth assessment. As part of the MyKid'sNutrition trial, a total of 116 participants will be randomized 1:1 either to (a) treatment as usual and MyKid'sNutrition or (b) treatment as usual alone. The results of this trial will be based on changes in growth indicators and mothers' nutritional knowledge, attitude, and practice within the groups and the differences between them. DISCUSSION Due to their widespread availability throughout society, smartphones can be used to deliver educational content on a large scale at a low cost. In addition, they can provide novel ways for patients to receive support. Hence, it is essential to conduct research studies on these types of interventions. MyKid'sNutrition application offers dietary solutions for such nutritional problems as underweight, loss of appetite, and malnutrition in children. Meanwhile, it provides detailed instructions on how to interact with the child. TRIAL REGISTRATION IRCT.ir IRCT20140907019082N11. Registered on February 19, 2022.
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Affiliation(s)
- Ali Hojati
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sogol Alesaeidi
- Department of Pediatric Medicine, Imam Hossein Hospital, Resident of Pediatric Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Izadi
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nikniaz
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Soofi SB, Khan A, Kureishy S, Hussain I, Habib MA, Umer M, Ariff S, Sajid M, Rizvi A, Ahmed I, Iqbal J, Ahmed KM, Achakzai ABK, Bhutta ZA. Determinants of Stunting among Children under Five in Pakistan. Nutrients 2023; 15:3480. [PMID: 37571417 PMCID: PMC10421501 DOI: 10.3390/nu15153480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1000 days of life. Across south Asia, Pakistan has the second-highest prevalence of stunting. This study assessed the most recent nationally representative data, the National Nutrition Survey (NNS) 2018, to identify the stunting prevalence and determinants among Pakistani children under five. METHODS The NNS 2018, a cross-sectional household-level survey, was used to conduct a secondary analysis. Data on malnutrition, dietary practices, and food insecurity were used to identify the prevalence of stunting among children under five years in terms of demographic, socioeconomic, and geographic characteristics. The prevalence of stunting was calculated using the World Health Organization (WHO) height for age z-score references. Univariate and multivariable logistic regressions were conducted to identify the factors associated with child stunting. RESULTS The analysis showed that out of 52,602 children under five, 40.0% were found to be stunted. Male children living in rural areas were more susceptible to stunting. Furthermore, stunting was more prevalent among children whose mothers had no education, were between 20 and 34, and were employed. In the multivariable logistic regression, male children (AOR = 1.08, 95% CI [1.04-1.14], p < 0.001) from rural areas (AOR = 1.07, 95% CI [1.01-1.14], p = 0.014), with the presence of diarrhea in the last two weeks (AOR = 1.15, 95% CI [1.06-1.25], p < 0.001) and mothers who had no education (AOR = 1.57, 95% CI [1.42-1.73], p < 0.001) or lower levels of education (primary: AOR = 1.35, 95% CI [1.21-1.51], p < 0.001; middle: AOR = 1.29, 95% CI [1.15-1.45], p < 0.001), had higher odds of stunting. Younger children aged < 6 months (AOR = 0.53, 95% CI [0.48-0.58], p < 0.001) and 6-23 months (AOR = 0.89, 95% CI [0.84-0.94], p < 0.001), with mothers aged 35-49 years (AOR = 0.78, 95% CI [0.66-0.92], p = 0.003), had lower odds of stunting. At the household level, the odds of child stunting were higher in lower-income households (AOR = 1.64, 95% CI [1.46-1.83], p < 0.001) with ≥ 7 members (AOR = 1.09, 95% CI [1.04-1.15], p < 0.001), with no access to improved sanitation facilities (AOR = 1.14, 95% CI [1.06-1.22], p < 0.001) and experiencing severe food insecurity (AOR = 1.07, 95% CI [1.01-1.14], p = 0.02). CONCLUSION Child stunting in Pakistan is strongly associated with various factors, including gender, age, diarrhea, residence, maternal age and education, household size, food and wealth status, and access to sanitation. To address this, interventions must be introduced to make locally available food and nutritious supplements more affordable, improve access to safe water and sanitation, and promote female education for long-term reductions in stunting rates.
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Affiliation(s)
- Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.A.); (J.I.)
| | - Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Sumra Kureishy
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Muhammad Atif Habib
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Shabina Ariff
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.A.); (J.I.)
| | - Muhammad Sajid
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Arjumand Rizvi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
| | - Junaid Iqbal
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.A.); (J.I.)
| | - Khawaja Masuood Ahmed
- Ministry of Health Services Regulation & Coordination, Islamabad 44020, Pakistan; (K.M.A.); (A.B.K.A.)
| | | | - Zulfiqar A. Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan; (S.B.S.); (A.K.); (S.K.); (I.H.); (M.A.H.); (M.U.); (M.S.); (A.R.); (I.A.)
- Lawson Centre for Nutrition, University of Toronto, Toronto, ON M5S 1A8, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Rehman A, Qing P, Cui X. Drivers of Nutritional Change in Pakistan: A Decomposition Analysis. Nutrients 2023; 15:3124. [PMID: 37513542 PMCID: PMC10384884 DOI: 10.3390/nu15143124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The global reduction in child undernutrition highlights the international and national commitment to prioritizing future generations' health. This study aims to find out the previous trends in nutrition and the key drivers of these changes in different regions of Pakistan. For empirical investigation, we employed a regression-based decomposition model by using two distinct rounds of demographic and health surveys: 2012-13 and 2017-18. Results showed children with stunted growth reduced substantially in Balochistan, while Punjab exhibited the highest progress for underweight children. Regression estimates showed that maternal nutritional status and household wealth were more pronounced in reducing all measures of child malnutrition. Some determinants, including mother age at marriage and prenatal visits to the hospital, are significant only for long-term nutritional status-stunting, while mother education contributed to reducing wasted and underweight children. The rest of the factors, like father education and household environment, appear to play a humble role in explaining nutritional improvements. From disaggregated analysis based on different regions, we found that modeled factors used in this study explained changes disproportionately. Thus, it is recommended to use multidimensional nutrition policies incorporating a broader range of sectors, and region-specific programs should be designed for more effective outcomes.
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Affiliation(s)
- Azka Rehman
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China
- College of Economics and Management, Huazhong Agricultural University, Wuhan 430070, China
| | - Ping Qing
- College of Economics and Management, Huazhong Agricultural University, Wuhan 430070, China
| | - Xia Cui
- School of Economics and Statistics, Guangzhou University, Guangzhou 510006, China
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23
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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Asmare AA, Agmas YA. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr 2023; 9:82. [PMID: 37420303 DOI: 10.1186/s40795-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Malnutrition is the main cause of illness and death in children under the age of five. It affects millions of children worldwide, putting their health and future in jeopardy. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHOD The study was carried out in 10 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Zimbabwe, Kenya, Zambia, and Malawi. A weighted total sample of 53,322 children under the age of five was included. Given the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate binary logistic regression model was employed to analyze the relationship between stunting, wasting, and underweight. RESULT The study included 53,322 children, and 34.7%, 14.8%, and 5.1% were stunted, underweight, and wasted, respectively. Almost half of the children (49.8%) were female, and 22.0% lived in urban areas. The estimated odds of children from secondary and higher education mothers being stunted and wasted were 0.987; 95% CI: 0.979 - 0.994 and 0.999; 95% CI: 0.995 - 0.999, respectively, times the estimated odds of children from no education mothers. Children from middle-class families were less likely to be underweight than children from poorer families. CONCLUSION The prevalence of stunting was higher than in the sub-Saharan Africa region, but the prevalence of wasting and underweight was lower. According to the study's findings, undernourishment among young children under the age of five continues to be a significant public health issue in the East African region. Governmental and non-governmental organizations should therefore plan public health participation focusing on paternal education and the poorest households in order to improve the undernutrition status of children under five. Additionally, improving the delivery of healthcare at health facilities, places of residence, children's health education, and drinking water sources are essential for lowering child undernutrition indicators.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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Gaiser ML, Winkler AS, Klug SJ, Nkurunziza S, Stelzle D. Determinants of stunting among children under age five in Burundi: Evidence from the 2016-2017 Burundi Demographic and Health Survey (BDHS 2016-17). Food Sci Nutr 2023; 11:4100-4112. [PMID: 37457191 PMCID: PMC10345696 DOI: 10.1002/fsn3.3400] [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: 10/04/2022] [Revised: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023] Open
Abstract
Burundi has one of the highest prevalence of stunting in the world. This study aimed to identify determinants of stunting among children under age five in Burundi. A total of 4993 children with anthropometric measurements from the 2016-2017 Burundi Demographic and Health Survey were included in the study. Stunting was assessed from the height-for-age Z-scores (HAZ). Logistic regression models were analyzed to identify demographic, maternal, child-related, and structural variables that influence stunting. In total, 56.9% of children under age five were stunted, of those 31.0% moderately and 25.9% severely. Multivariable logistic regression indicated that older children, male children (adjusted OR (aOR) = 1.41, 95% CI 1.24-1.61), and children who were perceived as small (aOR = 2.00, 95% CI 1.55-2.59) or very small at birth (aOR = 2.37, 95% CI 1.57-3.59) were significantly more likely to be stunted. Moreover, children of single mothers, with lower levels of education, who were underweight at the time of the survey (aOR = 1.95, 95% CI 1.42-2.68), who had short stature (aOR = 3.76, 95% CI 2.50-5.66) or who conceived more than four children (aOR = 1.22, 95% CI 1.05-1.42) were more commonly stunted. Stunting was more prevalent in rural areas (aOR = 2.53, 95% CI 1.72-3.73) and in households with no access to improved types of toilet facilities (aOR = 1.27, 95% CI 1.10-1.45). The results of this study show that the prevalence of stunting in children under age five in Burundi is alarmingly high and underscores the urgent need for decisive and determined action.
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Affiliation(s)
- Manuel L. Gaiser
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
| | - Andrea S. Winkler
- Center for Global Health, Department of NeurologyTechnical University of MunichMunichGermany
- Department of Community Medicine and Global Health, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
| | - Sandra Nkurunziza
- Health Community Department, Faculty of MedicineUniversity of BurundiBujumburaBurundi
| | - Dominik Stelzle
- Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunchenGermany
- Center for Global Health, Department of NeurologyTechnical University of MunichMunichGermany
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26
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Ghodsi D, Rasekhi H, Yari Z, Roustaee R, Nikooyeh B, Faramarzi A, Eini-Zinab H, Neyestani TR. Prediction and analysis of trends in the nutritional status of children under 5 years in Iran: reanalysis of the results of national surveys conducted between 1998 and 2020. Front Nutr 2023; 10:1083318. [PMID: 37252238 PMCID: PMC10213970 DOI: 10.3389/fnut.2023.1083318] [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: 10/28/2022] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Background and aim Malnutrition is a major public health problem, especially in developing countries. The aim of this study was to analyze the trend in malnutrition among children under 5 years of age in Iran over recent decades and to estimate malnutrition status for 2020. Methods This study took the form of a secondary analysis of the reports and data from three cross-sectional national surveys on children's nutritional status conducted between 1998 and 2017. Anthropometric indices, including markers of underweight, wasting, stunting, overweight, and obesity, were used as indicators of the nutritional status of children under 5 years. Malnutrition indicators are reported separately based on regional food security status. Linear mixed-effects modeling was used to predict the status of malnutrition indicators for 2020. Results The results of this study indicated a downward trend in the prevalence of stunting, underweight, and wasting, from 15.4 to 4.8%, 10.9 to 4.3%, and 4.9 to 4.3%, respectively, between 1998 and 2017. The proportion of children at risk of overweight and prevalence of childhood overweight/obesity showed a downward trend between 2010 and 2017, from 3.73 to 3.02% and from 12.1 to 10.3%, respectively. However, the trend varied between different provinces. Estimates of the prevalence of malnutrition in 2020 also indicated a decrease in the prevalence of all indicators among children. Conclusion Despite the decreasing trend in malnutrition over the past three decades, the prevalence of stunting, underweight, and wasting is still high in food-insecure provinces. Moreover, following the COVID-19 pandemic and its economic consequences, an increase in the prevalence of malnutrition, especially in food-insecure provinces, is plausible.
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Affiliation(s)
- Delaram Ghodsi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rasekhi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Yari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roshanak Roustaee
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahereh Nikooyeh
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hassan Eini-Zinab
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R. Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Atalell KA, Dessie MT, Wubneh CA. Mapping wasted children using data from the Ethiopia Demographic and Health Surveys between 2000 and 2019: A bayesian geospatial analysis. Nutrition 2023; 108:111940. [PMID: 36682270 DOI: 10.1016/j.nut.2022.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Undernutrition, particularly wasting, is continuing to be a major challenge in developing countries like Ethiopia. However, data on the geographic variations over time are limited. We aimed to investigate the spatiotemporal variation of wasting in Ethiopia using two decades of Ethiopia Demographic and Health Surveys data, from 2000 to 2019. METHODS Trend and geospatial regression analysis using a bayesian framework were used to predict wasting in Ethiopia among children aged <5 y. The primary outcomes (wasting) were obtained from the Ethiopia Demographic and Health Surveys conducted between 2000 and 2019. Covariates were accessed from different publicly available credible sources at a high resolution. The spatial binomial regression model through the bayesian framework was fitted to identify drivers of wasting among children in Ethiopia. RESULTS The overall national prevalence of wasting among children aged <5 y in Ethiopia was 11.9% in 2000, 11.1% in 2005, 10.2% in 2011, 12.3% in 2016, and 9.4% in 2019, with substantial spatial variation across subnational and local levels over time. Spatial clustering of wasting was observed in eastern Ethiopia (Afar and Somali regions). Altitude (mean regression coefficient = -0.38; 95% credible interval, -0.69 to -0.07) and population density (mean regression coefficient = -0.02; 95% credible interval, -0.03 to -0.01) were negatively associated with wasting, whereas distance to health facilities (mean regression coefficient = 0.13; 95% credible interval, 0.03-0.23) was positively associated with wasting. CONCLUSIONS The reduction in the national prevalence of wasting among children was not as expected. Spatial clustering of wasting was observed in the northern, northeastern, eastern, and western parts of Ethiopia. Spatial clustering of wasting was associated with altitude, precipitation, population density, distance to health facilities, travel time to the nearest cities, and distance to a water body. Early screening and treatment of wasted children should be strengthened. Furthermore, outreach community awareness, especially in rural parts of the country, should be recommended through community health extension workers.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Logarajan RD, Nor NM, Ibrahim S, Said R. Social determinants of stunting in Malay children aged <5 years in Malaysia. Nutrition 2023; 111:112030. [PMID: 37172456 DOI: 10.1016/j.nut.2023.112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study aims to assess social determinants of stunting among children aged <5 y within the Malay ethnicity in Malaysia. METHODS This study used data from the National Health and Morbidity Survey 2016: Maternal and Child Health. It includes a sample of 10 686 children, ages 0 to 59 mo, of Malay ethnicity. Height-for-age z score was determined based on the World Health Organization Anthro software. A binary logistic regression model was used to examine the association between the selected social determinants and the occurrence of stunting. RESULTS About 22.5% of children aged <5 y of Malay ethnicity were stunted. For those ages 0 to 23 mo, stunting is more prevalent in boys, in rural areas, and in those who have screen exposure, whereas a reduction of stunting was observed for those children whose mothers work in the private sector and in those who consume formula milk and meat. As for those ages 24 to 59 mo, there was a higher prevalence of stunting for those with self-employed mothers and reduced prevalence in children with hygienic waste disposal practices as well as those who play with toys. CONCLUSIONS The prevalence of stunting among children of Malay ethnicity aged <5 in Malaysia necessitates immediate intervention. It is pertinent to facilitate early identification of those children at risk of stunting for additional care to promote healthy growth.
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Affiliation(s)
- Renuka Devi Logarajan
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Norashidah Mohamed Nor
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Saifuzzaman Ibrahim
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rusmawati Said
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Waseem M, Li X, Jamil I, Islam AHMS, Abbas Q, Raza MH, Eliw M. Do crop diversity and livestock production improve smallholder intra-household dietary diversity, nutrition and sustainable food production? Empirical evidence from Pakistan. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1143774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Crop diversification and livestock production is an important strategy to enhance nutrition, sustainable food production, and improve food security, especially at the smallholder household level. However, existing evidences are mixed and there are limited information about the relationship among agriculture crops, household income diversification (HID), and household dietary diversity (HDD) among smallholder farmers in developing country setting like Pakistan. Therefore, this study aims to understand the role of crop diversification (CD) on HDD, nutrition, and sustainable agriculture and food production in the context of smallholder households in Punjab, Pakistan. The study employed ordered probit regression and cross-sectional data from 450 households collected using 24-h recall method. Regression results indicate that crop diversity and intra-household dietary diversity are positively associated across adults, adolescents, and children in all the study districts. Moreover, annual income, key crops grown by the household and family education are also the significant drivers of dietary diversity. Greater travel distance between markets was the most crucial factor in all regions which significantly affect dietary diversity. The overall research findings indicated that crop diversification and livestock production in the selected areas is significantly contributing to improve nutrition and sustainable food production. Therefore this study recommends for promoting crop diversification and livestock production for sustainable agricultural development and improving nutrition in the context of developing countries like Pakistan.
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Hentschel E, Tomlinson H, Hasan A, Yousafzai A, Ansari A, Tahir-Chowdhry M, Zamand M. Risks to Child Development and School Readiness Among Children Under Six in Pakistan: Findings from a Nationally Representative Phone Survey. INTERNATIONAL JOURNAL OF EARLY CHILDHOOD = REVUE INTERNATIONALE DE L'ENFANCE PRESCOLAIRE = REVISTA INTERNACIONAL DE LA INFANCIA PRE-ESCOLAR 2023:1-39. [PMID: 37360191 PMCID: PMC9994389 DOI: 10.1007/s13158-023-00353-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 06/28/2023]
Abstract
This paper analyzes the risks to child development and school readiness among children under age 6 in Pakistan. Drawing on a nationally representative telephone survey conducted in the midst of a global pandemic, between December 2021 and February 2022, we present the first nationally representative estimates of child development for children under 3 years of age and school readiness for children 3-6 years of age, using internationally validated instruments. The paper examines how risk factors that were exacerbated due to the COVID-19 pandemic, such as parental distress, lack of psychosocial stimulation, food insecurity, low maternal education, no enrollment in early childhood education, and living in a rural area, are associated with children's outcomes. The data indicate that more than half (57 percent) of parents with children under age 3 were distressed and that 61 percent of households reported cutting down on the size of or skipping meals since the start of the pandemic. The data reveal that over half of parents fail to engage in adequate psychosocial stimulation with their child and enrollment in early childhood education is very low (39 percent). The paper finds that child development outcomes decline rapidly as the number of risks increase. Specifically, for children under 3 years, lack of psychosocial stimulation at home and higher levels of parental distress were most significantly associated with lower child development levels. For a child aged 3-6 years, early childhood education enrollment and the amount of psychosocial stimulation the child received at home had the strongest association with school readiness scores.
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Affiliation(s)
- Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
- Education Global Practice, World Bank, Washington, USA
| | | | - Amer Hasan
- Education Global Practice, World Bank, Washington, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Amna Ansari
- Education Global Practice, World Bank, Washington, USA
| | | | - Mina Zamand
- Education Global Practice, World Bank, Washington, USA
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Bitew FH, Sparks CS, Nyarko SH, Apgar L. Spatiotemporal Variations and Determinants of Under-Five Stunting in Ethiopia. Food Nutr Bull 2023; 44:27-38. [PMID: 36824032 DOI: 10.1177/03795721231158503] [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: 02/25/2023]
Abstract
BACKGROUND Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context. OBJECTIVE This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016). METHODS Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses. RESULTS The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting. CONCLUSIONS Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.
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Affiliation(s)
- Fikrewold H Bitew
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Corey S Sparks
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Samuel H Nyarko
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Lauren Apgar
- Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
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Jansen S, Apondi E, Ayaya SO, Kim J, McHenry MS. Growth Anthropometrics as a Metric of Malnutrition Disparities Among Young Children Affected by HIV who are Orphaned Maternally, Paternally, or Totally in Western Kenya: A Retrospective Chart Review. Glob Pediatr Health 2023; 10:2333794X231156045. [PMID: 36814531 PMCID: PMC9940225 DOI: 10.1177/2333794x231156045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
This retrospective study investigated growth outcomes of Kenyan children born to women living with HIV, comparing children who were orphaned maternally, paternally, and totally (both parents deceased) to those who were non-orphaned. We reviewed HIV clinic visits performed in Kenya from January 2011 to August 2016 in children 0 to 4 years of age. Malnutrition was assessed using stunting, underweight status, and wasting (z-scores of ≤-2). Descriptive statistics, Chi-square, t-tests, multivariable logistic regression, and ANCOVA models were performed. Of 15 027 total children in the study population, 3.5% (n = 520) were orphaned maternally, 8.1% (n = 1222) were orphaned paternally, and 2.2% (n = 336) were orphaned totally. Children who were orphans had higher rates of malnutrition compared to non-orphans (P < .001). Children who were orphaned maternally and totally had lower anthropometric mean scores, presented to clinic later, and were more likely to be living with HIV. Children who are orphaned maternally or totally should be targeted in interventional strategies.
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Affiliation(s)
- Shae Jansen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Jiae Kim
- Indiana University, Bloomington, IN, USA
| | - Megan S. McHenry
- Indiana University School of Medicine, Indianapolis, IN, USA,Megan S. McHenry, Indiana University School of Medicine, 410 W. 10th Street, Suite 2000V, Indianapolis, IN, USA.
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Islam MZ, Rahman M, Khan N. Exploring the association between child nutritional disorders and short birth interval: Evidence from 2017/18 Bangladesh demographic and Health Survey data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Lawal SA, Okunlola DA, Adegboye OA, Adedeji IA. Mother's education and nutritional status as correlates of child stunting, wasting, underweight, and overweight in Nigeria: Evidence from 2018 Demographic and Health Survey. Nutr Health 2023:2601060221146320. [PMID: 36591921 DOI: 10.1177/02601060221146320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: This study examined the nexus between mother's education and nutritional status and their relationships with child stunting, wasting, underweight, and overweight. Methods: The data of 34,193 under-five (U-5) children from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed using descriptive statistics, and binary and complementary log-logistic regression models. Results: The prevalence of child stunting, wasting, underweight, and overweight were 36.51%, 6.92%, 21.73%, and 2.05%, respectively. Compared to children born to mothers with at least secondary education, uneducated women's children (odds ratio (OR) = 1.55; 95% confidence interval (CI) = 1.32-1.82) and those of women with primary education (OR = 1.49; 95% CI = 1.28-1.72) were more likely to be stunted. Similarly, children born to uneducated women (OR = 1.51; 95% CI = 1.24-1.83) were more likely to be underweight than women with at least secondary education. The likelihood of child underweight (OR = 1.71; 95% CI = 1.45-2.01) and wasting (rate ratio (RR) = 1.82; 95% CI = 1.47-2.26) were higher among underweight mothers, respectively, than those with normal body mass index (BMI). The likelihood of child stunting (OR = 0.75; 95% CI = 0.67-0.84) and underweight (OR = 0.66; 95% CI = 0.57-0.77) were lower among obese/overweight mothers compared to those with normal BMI, but their children were more likely to be overweight (RR = 1.77; 95% CI = 1.27-2.48). Conclusion: Attainment of higher education by mothers should be promoted to prevent childhood nutritional imbalances, and sensitization on healthy dietary habits and lifestyles should be promoted among women, especially the overweight/obese, to reduce their risk of having overweight children.
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Affiliation(s)
- Saheed Akinmayowa Lawal
- Department of Public Health, School of Public and Allied Health Babcock University, Ilishan-Remo, Nigeria
| | - David Aduragbemi Okunlola
- Department of Sociology, College of Social Sciences and Public Policy, Florida State University, Tallahassee, FL, USA
- 605694Viable Knowledge Masters, Abuja, Nigeria
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Australia Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Isaac A Adedeji
- Department of Public Health, School of Public and Allied Health Babcock University, Ilishan-Remo, Nigeria
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Li H, Ren H, Guo X, Chen Z. Nutritional deficiencies in low-sociodemographic-index countries: a population-based study. Front Nutr 2023; 10:985221. [PMID: 37139449 PMCID: PMC10149740 DOI: 10.3389/fnut.2023.985221] [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: 07/03/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Background We aimed to estimate the burden of nutritional deficiency according to sex and age in countries with a low sociodemographic index (SDI). Methods Following the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, estimated annual percentage changes (EAPCs) were calculated to determine trends in the age-standardized rates of incidence and disability-adjusted life-years (DALYs) of nutritional deficiency and its main subcategories from 1990 to 2019 in low-SDI countries. Findings From 1990 to 2019, the age-standardized incidence and DALY rates of nutritional deficiency showed decreasing trends, with EAPCs of -0.90 [95% confidence interval (CI), 1.06 to -0.75] and -3.20 (95% CI, -3.29 to -3.10), respectively, in low-SDI countries. In 2019, of the subcategories analyzed, vitamin A deficiency had the highest age-standardized incidence rate and protein-energy malnutrition had the highest age-standardized DALY rate. From 1990 to 2019, the greatest decrease in the age-standardized incidence rate was observed for vitamin A deficiency and the greatest decrease in the age-standardized DALY rate was observed for protein-energy malnutrition. At the national level, from 1990 to 2019, the greatest increase in the age-standardized incidence rate of overall nutritional deficiency was observed in males in Afghanistan (EAPC: 0.28; 95% CI, 0.07 to 0.49). Of the age groups analyzed, the highest incidence and DALY rates of overall nutritional deficiency and dietary iron deficiency were observed in children aged 1-4 years. Interpretation The age-standardized incidence and DALY rates of nutritional deficiency decreased significantly from 1990 to 2019, especially for vitamin A deficiency and protein-energy malnutrition. Overall nutritional deficiency and dietary iron deficiency occurred primarily in children aged 1-4 years.
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Affiliation(s)
- Huansong Li
- Department of Rehabilitation Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Huiming Ren
- Department of Rehabilitation Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Xu Guo
- Department of Rehabilitation Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Zhu Chen
- Department of Laboratory, Ningbo No.2 Hospital, Ningbo, China
- *Correspondence: Zhu Chen,
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Mother's perception of size at birth is a weak predictor of low birth weight: Evidence from Nepal Demographic and Health Survey. PLoS One 2023; 18:e0280788. [PMID: 36693063 PMCID: PMC9873179 DOI: 10.1371/journal.pone.0280788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
Birth weight is a consistent predictor of morbidity and survivability in infancy and later life. This study aims to assess the accuracy of the mother's perception of size at birth to predict low birth weight(LBW). This study used data from Nepal Demographic and Health Survey (NDHS 2016). Information about 5060 mother pairs was obtained from the NDHS dataset. However, birth weight data were available for 3095 children, and therefore they were only included in the further analysis. The predictive accuracy of the mother's perception of size at birth to predict LBW was measured by sensitivity, specificity, positive predictive value, and negative predictive value. Factors associated with the discordance among the mother's perception of birth size and birth weight were calculated using multinomial logistic regression analysis. The mother's perception of birth size had low sensitivity (62%) and positive predictive value (46.7%) but high specificity (90.1%) and negative predictive value (94.4%) to predict the LBW. The overall agreement between birth weight(<2500gram vs > = 2500 grams) and the mother's perceived size at birth (small vs average or above average) was 86% (Kappa = 0.45, 95%CI: 0.40-0.51), which is composed of a higher share of the agreement to identify non-LBW babies(79%) and a low share to identify LBW babies (7%). Among the five categories of mothers' perception of size at birth and birth weight, the agreement was 67.2% (Kappa = 0.29, 95% CI: 0.26-0.33). Education status, ethnicity, multiple births, and sex of the newborn child were significantly associated with the discordance between the mother's perceived size at birth and birth weight. A moderate agreement was found among the mother's perception of birth size and birth weight. Mothers were more likely to correctly identify non-LBW babies compared to LBW babies based on their perception of size at birth. Efforts should be intensified to promote the practice of weighing the baby at birth.
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Determinants of Child Stunting, Wasting, and Underweight: Evidence from 2017 to 2018 Pakistan Demographic and Health Survey. J Nutr Metab 2023; 2023:2845133. [PMID: 36915292 PMCID: PMC10008110 DOI: 10.1155/2023/2845133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/23/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Child malnutrition persists in low-resource countries such as Pakistan, indicating an urgent need for interventions and policies aimed to address this critical population health issue. The World Health Organization Global Target 2025 includes the reduction of malnourishment in the form of stunting, wasting, and low weight. This study aims to examine the prevalence of factors associated with three measures of child malnutrition, i.e., stunting, wasting, and low weight in Pakistan. This study uses a secondary data analysis design based on data from Pakistan Demographic and Health Survey (2017-18) that used a two-stage cluster sampling approach. National level data covering urban and rural areas were used for this study consisting of 4,226 children less than 5 years of age. Univariate and multivariable analyses using logistic regression models were conducted. Over 23% of the children were underweight, 8.0% suffered wasting, and 37.7% were stunted. Children with small size at birth (<45.7 cm), those who were average in size (45.7 to 60 cm) at birth were less likely to be stunted (AOR, 0.4890) and underweight (AOR, 0.538). Children with large size at birth (>60 cm) were also less likely to be stunted (AOR, 0.288) and underweight (AOR, 0.538). Children who consumed fresh milk were less likely to be classified as wasted (AOR, 0.524) than those children who did not consume fresh milk. The children in high- and middle-economic status families were less likely to be stunted, underweight, or wasted. Children of mothers who had secondary and higher education were less likely to be stunted (AOR, 0.584) and were less likely to be underweight (AOR, 0.668) than illiterate mothers' children. Children of working mothers were less likely to be wasted compared to children of nonworking mothers (AOR, 0.287). Maternal BMI is also inversely associated with being underweight because overweight and obese mothers were less likely to have underweight children (AOR, 0.585). Our findings reflect a need to design targeted public health policies and community-based education that emphasize the mother's education on nutrition health and provide socioeconomic resources that enable mothers to provide dietary needs that prevent malnutrition.
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Prevalence and associated factors of stunting, wasting and underweight of children below five using quintile regression analysis (PDHS 2017-2018). Sci Rep 2022; 12:20326. [PMID: 36434025 PMCID: PMC9700674 DOI: 10.1038/s41598-022-24063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
The objective of the current study is to identify the risk factors for malnutrition among the age of under-five children's in Pakistan. This is secondary data analysis for the data taken from Pakistan Demographic and Health Survey (PDHS 2017-18) and was analyzed by implementing quantile regression analysis. The sample size included 12,708 alive children in the study, for which the data collection period was from November 22, 2017, to April 30, 2018. The prevalence of malnutrition among boys is high (51.2%). Older age mother's children have more prevalence of malnutrition (20.7%). A child born with small body size (underweight: Q0.25: - 0.625; Q0.50: - 0.623; Q0.75: - 0.426 and wasting: Q0.50: - 0.513); having uneducated mother (underweight: Q0.25: - 0.387; Q0.50: - 0.247; Q0.75: - 0.328), belonged to a poor household (underweight: Q0.50: - 0.251),residing in rural areas (underweight: Q0.25: - 0.443), not following properly breastfeeding practices (underweight: Q0.50: - 0.439; Q0.75: - 0.438) have negative effect on different measures of malnutrition and this effect is significantly raises across different quantiles of stunting , wasting and underweight (at p value < 0.01 and < 0.05). Older age mother (stunting: Q0.50: 0.777; Q0.75: 1.078; underweight Q0.20: 0.568; Q0.50: 0.429; Q0.75: 0.524) and higher birth order number (stunting: Q0.50: 0.415; Q0.75: 0.535), have a positive effect on three measures of under-nutrition and this effect is gradual raises at different quantile of stunting, wasting and underweight. Elder and smoker mothers were proved associated risk factors of both stunting and being underweight in Pakistan. Moreover, Proper breastfeeding practices, better economic status, average or above the average birth weight of the child, and milk consumption are found protective factors against stunting, wasting, and underweight children in Pakistan.
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Rajabzadeh-Dehkordi M, Mohammadi-Nasrabadi F, Nouri M, Ahmadi A, Faghih S. Determinants and consequences of food insecurity in families having children under the age of 2 years. Nutr Health 2022:2601060221135923. [PMID: 36412042 DOI: 10.1177/02601060221135923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Today, food insecurity is recognized as an important public health problem that can have detrimental effects on families. Aim: The aim of this study was to assess the determinants and consequences of food insecurity in families having children under the age of 2 years. Method: In this cross-sectional study, 307 mothers and their children under the age of 2 years were selected by stratified random sampling. Demographic and socioeconomic data were collected by completing questionnaires through face-to-face interview. Household food insecurity (HFI) status was determined using the United States Department of Agriculture (USDA) household food security questionnaire. Results: Based on the results, 67.4% of families were high food secure. Low and very low food security was 25.7% and 6.9%, respectively. House size (Beta = -0.019, 95% CI: -0.029, -0.009), father's job (Beta = -4.758, 95% CI:-6.777, -2.738), father education (Beta = -0.370, 95% CI: -0.717, -0.023), and economic status (Beta = -0.628, 95% CI: -0.809, -0.448) were significantly related to the USDA total food insecurity score (p < 0.05). Regression analysis showed that children birth weight, father's body mass index (BMI), and mother's waist circumference had a significant positive correlation with weight for age (Z-score) of children. Children's birth weight, father's BMI, and HFI status had significant and positive correlation with weight for length (Z-score). Moreover, the significant association between children's birth height, mother's BMI, and mother's waist circumference with length for age (Z-score) were observed (p < 0.05). Conclusion: We found the father's job was the most effective factor in food insecurity and economic status of the family was in the second place. Also, HFI had a relationship with weight status of children under the age of 2 years.
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Affiliation(s)
- Milad Rajabzadeh-Dehkordi
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Food and Nutrition Policy and Planning Research Department, National Nutrition & Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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Ajmal S, Ajmal L, Ajmal M, Nawaz G. Association of Malnutrition With Weaning Practices Among Infants in Pakistan. Cureus 2022; 14:e31018. [PMID: 36475148 PMCID: PMC9717723 DOI: 10.7759/cureus.31018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/17/2023] Open
Abstract
Background An appropriate diet is critical for the growth and development of infants, especially in the first two years of life. Despite considerable efforts made by government and local authorities to raise awareness, mothers still lack basic knowledge of weaning practices; as a result, infants face a growing number of health problems in their later years of life. This research aims to investigate the association between malnutrition and knowledge of different weaning practices among mothers and to study the factors influencing it. Methodology The current study was a cross-sectional study conducted at Mayo Hospital, Services Hospital, and Jinnah Hospital, Lahore, Pakistan between November 2019 and May 2020. A total of 200 infants of both genders aged between one and 12 months were included in the study. Knowledge and practices of complementary feeding by the mothers were assessed using a close-ended, pre-tested questionnaire. Results Mothers of 200 infants were interviewed and it was found that 79.5% of the infants were being breastfed while 24% never received breast milk. Among those who never received breast milk were given liquids (25%) and semi-solid foods (64.5%). Of the mothers, 8% started weaning at an early age (less than six months old) while the remaining started weaning at the age of six months or later and reported that their infants were either underweight or had reduced heights for that age. Based on the medical reports obtained from the hospital after getting parental consent, it was also found that the infants had distinct signs of deficiency of vitamins A and D, iron, and folate. Conclusions The majority of infants were breastfed, and, in most cases, weaning started at an age of less than six months. Most of the infants were fed semi-solid food as their first complementary food. Two-thirds of the infants were underweight for that age, and one-fifth had reduced heights. Based on deficiency statistics, mothers should be encouraged to start weaning at six months to have minimized malnourishment instances in infants.
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Affiliation(s)
- Sidra Ajmal
- Chemistry and Biochemistry, University of Oklahoma, Norman, USA
| | - Laiba Ajmal
- Chemistry and Biochemistry, University of Oklahoma, Norman, USA
| | - Maleeha Ajmal
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | - Gul Nawaz
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
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Intersectional Inequalities in Anthropometric Failure among Indian Children: Evidence from the National Family Health Survey (2015-2016). J Biosoc Sci 2022:1-28. [PMID: 36193705 DOI: 10.1017/s0021932022000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children.More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.
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Li X, Li Y, Xing X, Liu Y, Zhou Z, Liu S, Tian Y, Nima Q, Yin L, Yu B. Urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old: evidence from a cross-sectional study in Tibet. Public Health Nutr 2022; 26:1-10. [PMID: 36098091 PMCID: PMC10131156 DOI: 10.1017/s1368980022001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess urban-rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old. DESIGN A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination. SETTING Tibet, China. PARTICIPANTS Children under 5 years old in Tibet. RESULTS Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = -0·23, 95 % CI: -0·38, -0·08), Z-scores of weight-for-age (β = -0·24, 95 % CI: -0·39, -0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05). CONCLUSIONS High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children's nutrition is urgently needed in areas above 3500 m, especially in rural ones.
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Affiliation(s)
- Xianzhi Li
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yajie Li
- Tibet Center for Disease Control and Prevention, Lhasa, People’s Republic of China
| | - Xiangyi Xing
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Department of Pharmacy, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yu Liu
- Chongqing Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Zonglei Zhou
- Department of Epidemiology, School of Public Health, Fudan University, People’s Republic of China
| | - Shunjin Liu
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Yunyun Tian
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, People’s Republic of China
| | - Li Yin
- Meteorological Medical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
- Clinical Research Center, Panzhihua Central Hospital, Panzhihua, People’s Republic of China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University – Hong Kong Polytechnic University, Chengdu, People’s Republic of China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
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Abebe HT, Taffere GR, Fisseha MA, Bezabih AM. Risk Factors and Spatial Distributions of Underweight Among Children Under-Five in Urban and Rural Communities in Tigray, Northern Ethiopia: Using Ordinal Logistic Regression Analysis. NUTRITION AND DIETARY SUPPLEMENTS 2022. [DOI: 10.2147/nds.s371773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Laksono AD, Sukoco NEW, Rachmawati T, Wulandari RD. Factors Related to Stunting Incidence in Toddlers with Working Mothers in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10654. [PMID: 36078367 PMCID: PMC9518173 DOI: 10.3390/ijerph191710654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Previous studies have suggested that a toddler stunting is closely related to maternal characteristics. Working mothers, as a group, are vulnerable to having a stunted toddler. The present research aimed to analyze factors related to stunting incidence in toddlers with working mothers in Indonesia. The study sampled 44,071 toddlers with working mothers. The final stage used a multinomial logistic regression test. The study found that working mothers living in rural areas have a higher probability of having stunted or severely stunted toddlers. Maternal age partially affects the incidence of stunted toddlers in Indonesia. Mothers in the ≤19 age group are 1.461 (95% CI 1.140-1.872) times more likely than those in the ≥45 group to have a severely stunted toddler. Those who were never married were 1.433 (95% CI 1.006-2.043) times more likely than those who were divorced/widowed to have a severely stunted toddler. A married mother was 0.734 (95% CI 0.617-0.872) times less likely to have a severely stunted toddler than a divorced/widowed mother. Better education is protective against working mothers having stunted toddlers. Moreover, the present study found that the toddler's age determined the incidence of stunted toddlers. This study concluded that there are five variables related to stunting incidence in toddlers with working mothers in Indonesia: residence, age, marital status, education, and toddler age.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, Government of Indonesia, Jakarta 10340, Indonesia
| | - Noor Edi Widya Sukoco
- National Research and Innovation Agency, Government of Indonesia, Jakarta 10340, Indonesia
| | - Tety Rachmawati
- National Research and Innovation Agency, Government of Indonesia, Jakarta 10340, Indonesia
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Chekol YT, Arefaynie M, Kassa AA, Alene TD, Ngusie HS. Determinants of wasting among children aged 6-59 months in North-East Ethiopia: a community-based case-control study. BMJ Open 2022; 12:e057887. [PMID: 35918114 PMCID: PMC9351319 DOI: 10.1136/bmjopen-2021-057887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Childhood acute malnutrition, in the form of wasting defined by Weight-for-Height Z-Scores, is a major public health concern. It is one of the main reasons for the death of children in developing countries like Ethiopia. Accordingly, this study aimed to assess determinants of wasting among children aged 6-59 months in Meket district, North Wollo zone, North-East Ethiopia. SETTING The study was conducted among communities in Meket district, North Wollo zone, North-East Ethiopia. PARTICIPANTS A total of 327 (109 cases and 218 controls) children aged 6-59 months participated in the study. Children from 6 months to 59 months of age who match the definition of case/wasted/ and control/not wasted were eligible for the study. However, children who had physical deformities which make anthropometric measurements inconvenient were excluded from the study. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcome measure was wasting. RESULT The mean ages of the cases and controls were 21.77±11.41 months and 20.13±11.39 months, respectively. Factors that were significantly associated with wasting were: maternal decision making on the use of household money (adjusted odd ratio (AOR)=3.04, 95% CI 1.08 to 7.83), complementary feeding started in a month (AOR=3.02, 95% CI 1.097 to 6.97), food diversity score (AOR=2.64, 95% CI 1.64 to 5.23), frequency of complementary feeding (AOR=6.68, 95% CI 3.6 to 11.25) and history of acute respiratory infections (ARIs) 2 weeks preceding the survey (AOR=3.21, 95% CI 1.07 to 7.86). CONCLUSION Our result implies that the right time to introduce complementary foods, the frequency of feeding and also the amount of food consumed were some of the crucial factors that needed to be changed in child nutrition to reduce wasting. Furthermore, within the framework of our study, the empowerment of women in the decision-making process and the prevention of ARI should be seen as a necessary benchmark for acute malnutrition.
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Affiliation(s)
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Assefa Andargie Kassa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tilahun Dessie Alene
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtamu Setegn Ngusie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Wells JCK, Marphatia AA, Cortina‐Borja M, Manandhar DS, Reid AM, Saville NM. Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9539981 DOI: 10.1002/ajpa.24560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives Maternal factors shape the risk of infant undernutrition, however the contributions of age at marriage versus age at pregnancy are rarely disentangled. We explore these issues in a population from lowland rural Nepal, where median ages at marriage and first pregnancy are 15 and 17 years respectively and marriage almost always precedes pregnancy. Methods We analyzed data on first‐time mothers (n = 3002) from a cluster‐randomized trial (2012–2015). Exposures were ages at marriage and pregnancy, categorized into groups. Outcomes were z‐scores for weight (WAZ), length (LAZ), head circumference (HCAZ), and weight‐for‐length (WLZ), and prevalence of wasting and stunting, for neonates (<8 days) and infants (6–12 months). Mixed linear and logistic regression models tested associations of marriage and pregnancy ages with outcomes, adjusting for parental education, household assets, caste, landholding, seasonality, child sex, intervention arm, randomization strata and cluster. Results For neonates, pregnancy <18 years predicted lower LAZ, and <19 years predicted lower WAZ and HCAZ. Results were largely null for marriage age, however early pregnancy and marriage at 10–13 years independently predicted neonatal stunting. For infants, earlier pregnancy was associated with lower LAZ and HCAZ, with a trend to lower WAZ for marriage 10–13 years. Early pregnancy, but not early marriage, predicted infant stunting. Conclusions Early marriage and pregnancy were associated with poorer growth, mainly in terms of LAZ and HCAZ. Associations were stronger for neonatal than infant outcomes, suggesting pregnancy is more susceptible to these stresses. Early marriage and pregnancy may index different social and biological factors predicting child undernutrition.
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Affiliation(s)
- Jonathan C. K. Wells
- Population, Policy and Practice Research and Teaching Department UCL Great Ormond Street Institute of Child Health London UK
| | | | - Mario Cortina‐Borja
- Population, Policy and Practice Research and Teaching Department UCL Great Ormond Street Institute of Child Health London UK
| | | | - Alice M. Reid
- Department of Geography University of Cambridge Cambridge UK
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Haque MA, Wahid BZ, Tariqujjaman M, Khanam M, Farzana FD, Ali M, Naz F, Sanin KI, Faruque ASG, Ahmed T. Stunting Status of Ever-Married Adolescent Mothers and Its Association with Childhood Stunting with a Comparison by Geographical Region in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116748. [PMID: 35682329 PMCID: PMC9180893 DOI: 10.3390/ijerph19116748] [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: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
The adolescence period is considered a life stage worthy of strategic health investments since it is a critical period of physical and neuro-maturational development. Adolescent girls face different health difficulties in that phase of life. Children born to adolescent mothers are at a higher risk of undernutrition. This paper aims to estimate the prevalence of stunting among adolescent mothers and their children in Bangladesh by time period and determine the associated factors of adolescent maternal stunting status. We also sought to establish the relationship between maternal and childhood stunting by comparing the geographical regions in Bangladesh. We derived data from the nationally representative Bangladesh Demographic and Health Survey, which was conducted between 2007 and 2017/18. The outcome variables of this study were ever-married adolescent girls’ stunting status and their children’s stunting status. Interaction analysis between administrative division and maternal stunting status was conducted with childhood stunting as the outcome variable to investigate the impact of maternal stunting status on their children’s stunting compared to geographical location. Our results indicated that in comparison to other divisions, the frequency of stunting among children and adolescent mothers was higher in the Sylhet region. It also revealed that children whose mothers were stunted had a 2.36 times increased chance of being stunted. Our study suggests that education for women could help them attain self-sufficiency and, as a result, reduce the prevalence of poor childhood nutrition, especially stunting.
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Mokalla TR, Rao Mendu VV. Application of quantile regression to examine changes in the distribution of Height for Age (HAZ) of Indian children aged 0–36 months using four rounds of NFHS data. PLoS One 2022; 17:e0265877. [PMID: 35622855 PMCID: PMC9140296 DOI: 10.1371/journal.pone.0265877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The prevalence of stunting among under- three Indian children though decreased, still it is considered to be alarmingly high. In most of the previous studies, traditional (linear and logistic) regression analyses were applied. They were limited to encapsulated cross-distribution variations. The objective of the current study was to examine how the different determinants were heterogeneous in various percentiles of height for age (HAZ) distribution.
Methods and findings
This article examined the change in the HAZ distribution of children and examined the relationships between the key co-variate trends and patterns in HAZ among children aged <3 years over a period of 24 years. Four successive rounds of the National Family Health Survey data 1992–93, 1998–99, 2005–06, and 2015–16 were used for analysis. The final study included 206579 children aged <3 years (N = 106136 male, 100443 female). To explain and analyse differences in the HAZ distribution, the lambda-mu-sigma (LMS) method was used. Trends in height for age (HAZ) distribution over time were analysed using separate gender-stratified quantile regression (QR). The selected socio-economic, demographic and other predictors were considered for this analysis. The quantile regressions have indicated that mothers who have higher than primary level education were more proactive in mitigating malnutrition among children at the lower end of the distribution. The age, birth order, mother’s body-mass-index (BMI) and economic status, among children, were some more determining factors for HAZ. Results of selected quantile regression were estimated at the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantiles.
Conclusions
The outcome of various covariates working differently across the HAZ distribution was suggested by quantile regression. The major discrepancies in different aspects were underlined by socioeconomic and demographic aspects among the Indian population. The heterogeneity of this effect was shown using quantile regression. Policymakers may choose to concentrate on the most important factors when formulating policies to lessen the prevalence of stunting in India.
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Affiliation(s)
- Thirupathi Reddy Mokalla
- Biostatistics, Public Health Nutrition Division, ICMR-National institute of Nutrition, Jamai-Osmania, Hyderabad, Telangana, India
| | - Vishnu Vardhana Rao Mendu
- Department of Health Research, ICMR-National Institute of Medical Statistics, MOHFW, New Delhi, India
- * E-mail:
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Gasparinho C, Gonçalves MH, Chissaque A, Silva GL, Fortes F, Gonçalves L. Wasting, Stunting, and Anemia in Angolan Children after Deworming with Albendazole or a Test-and-Treat Approach for Intestinal Parasites: Binary Longitudinal Models with Temporal Structure in a Four-Arm Randomized Trial. Nutrients 2022; 14:nu14112185. [PMID: 35683985 PMCID: PMC9183140 DOI: 10.3390/nu14112185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Undernutrition, anemia, and intestinal parasitic infections are public health problems in Angola, especially in pre-school children. We analyzed binary data from a longitudinal four-arm randomized parallel trial conducted in Bengo Province, northern Angola, over the course of two years, with seven follow-up assessments to explore the effects of four interventions (deworming and a test-and-treat approach for intestinal parasites, at both the individual and household levels) on wasting and stunting, and to understand their indirect benefits for anemia, malaria, diarrhea, and vomiting. A total of 121 children with intestinal parasitic infections received baseline treatment, and were allocated to the four arms (1:1:1:1). Using continuous outcome variables of height-for-age (HAZ) and weight-for-height (WHZ) statistical approaches did not reveal a clear benefit of any particular arm (Pathogens 2021, 10, 309). Next, HAZ and WHZ were transformed into binary variables of stunting and wasting, respectively, considering their mild-to-severe (Z-score < −1) and moderate-to-severe degrees (Z-score < −2). Original clinical data (on anemia, diarrhea, vomiting, and malaria) were also analyzed. From a binary longitudinal analysis with different dependence structures, using the R package bild, fitted models revealed the potential benefit of a test-and-treat approach at the individual level for wasting compared with annual albendazole at the individual level, especially considering mild-to-severe forms (ORadj = 0.27; p = 0.007). All arms showed similar effects on stunting, compared with annual albendazole, at a 5% significance level. Time and age at baseline presented favorable effects in the percentage of stunting using both severity degrees. Results showed a decreased chance of having anemia and diarrhea over time, although with no significant differences between arms. Data from longitudinal studies are essential to study the direct and indirect effects of interventions, such as deworming, and to explore additional approaches aiming at better understanding the temporal structure of nutrition and health outcomes in children.
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Affiliation(s)
- Carolina Gasparinho
- Centro de Investigação em Saúde de Angola (CISA), Rua Direita de Caxito, Caxito, Angola
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Correspondence: (C.G.); (L.G.)
| | - Maria Helena Gonçalves
- Departamento de Matemática, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 8005-139 Faro, Portugal;
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
| | - Assucênio Chissaque
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Instituto Nacional de Saúde, Distrito de Marracuene, Maputo 264, Mozambique
| | - Giovani L. Silva
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
- Departamento de Matemática, Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001 Lisbon, Portugal
| | - Filomeno Fortes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
| | - Luzia Gonçalves
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), 1349-008 Lisbon, Portugal; (A.C.); (F.F.)
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Faculdade de Ciências da Universidade de Lisboa, 1749-016 Lisbon, Portugal;
- Correspondence: (C.G.); (L.G.)
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Nutritional health status: association of stunted and wasted children and their mothers. BMC Pediatr 2022; 22:255. [PMID: 35524191 PMCID: PMC9074292 DOI: 10.1186/s12887-022-03309-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Across the globe, 149 and 49 million children are stunted and wasted, respectively. Prevalence of stunting and wasting is 40.2 and 17.7% in children of Pakistan. Stunting and wasting are accompanied with genetics, dietary factor, lack of information, bottle feeding, illiterate parents, less birth interval, infection such as diarrhoea, low birth weight, mother suffering from malnutrition during pregnancy, breastfeeding, pharmaceutical, and hormonal, psychosocial, and low social-economic status. Methods Stunted and wasted children and their mothers were called on and detail discussions related to research plan were carried out. Informed consent was assured from mothers, for participation in the study. The demographics, anthropometrics, vital signs observations, body composition, clinical signs and symptoms, dietary intake and associated biomarkers (CBC, level of urea nitrogen in blood, serum albumin globulin and serum creatinine.) were tools for nutritional health status assessment. SPSS software was implied on data. Results The study found that 27.2% mothers were belonged to stunted children, 17.3% belonged to wasted children, and 50.9% belonged to those children who were suffering from both stunting and wasting condition.57.9% mothers who were illiterate belong to stunted and wasted children. CBC and Hb test was prominent, stunted and wasted children had Hb 9.88 mg/dL, whereas, their mothers had 10.8 mg/dL as average Hb. The average height and weight of stunted and wasted children was 68.6 cm and 7.11 kg respectively. Dietary patterns and diet quality of both mothers and children were poor, due to lack of affordability; they were not able to eat healthy food. Conclusion Stunting and wasting ultimately resulted in poor growth and development of children. Most of children were anemic, they height and weight less than WHO growth standards. They had less knowledge and poor intake of food diet pattern so children growth was poor.
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