A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children

Determinants of stunting among under-five children: Evidence from Cambodian Demographic and Health Survey 2021-2022

BACKGROUND

Epidemiological and nutritional modifications are causing an increase in stunting in many low- and middle-income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under-five children in Cambodia.

METHODS

A secondary dataset consisting of 3268 under-five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)-2021/2022 dataset. The Chi-square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting.

RESULTS

Findings revealed that about 21% of under-five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520-0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under-five stunting is significantly influenced by factors such as the child's age, size at birth, mother's age at first birth, mother's body mass index (BMI), father's educational status, cooking fuel, and wealth index.

CONCLUSIONS

It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under-five children in Cambodia.

Prevalence and associated factors of coexisting forms of malnutrition in children under 5 years age in a rural area of Cameroon

BACKGROUND

Malnutrition of children under 5 years of age is persistent in Cameroon principally in rural areas. Moreover, there is limited knowledge of coexisting forms of malnutrition (CFM) among children of this age. Therefore, the aim of this study was to assess the prevalence of CFM in a cohort of children under 5 years and to identify the associated factors.

METHODS

A cross-sectional study was conducted in the Health Districts of the locality of Dschang in the West region of Cameroon between June 2021 to November 2021. Data were collected from 200 under-five children of both sexes and an interviewer-administered questionnaire was administered to consented children's mothers/guardians. Malnutrition in children was assessed by WHO growth standards (weight-for-height, weight-for-age, height-for-age and body mass index-for-age). The different CFM were defined by the presence of two autonomous forms of malnutrition in the same child. Logistic regression analyses were done to identify factors associated to different coexisting forms of malnutrition.

RESULTS

The results obtained showed prevalences of 4.20% for the coexistence of underweight with wasting, 7.8% for the coexistence of underweight with stunting and 14.8% for the coexistence of stunting with overweight. Lower maternal age (15-24 years old; OR = 0.09; p = 0.05) and lower education level (primary education, OR = 23.33; p = 0.00) were associated with the coexistence of underweight with wasting. Marital status (single mother, OR = 0.28; p = 0.00) was associated to the coexistence of stunting with overweight/obesity.

CONCLUSION

The findings of this study provide evidence on the coexistence of different forms of malnutrition among children below five years of age in rural area of Cameroon. These finding would guide future research, policies, and programs on the management of malnutrition in rural areas of Cameroon.

Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review

Background and Aims

One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY.

Methods/Literature Search Strategy

Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review.

Results

The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY.

Conclusion

The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.

Assessing the relationship of maternal short stature with coexisting forms of malnutrition among neonates, infants, and young children of Pakistan

Evidence from previous studies suggests a strong association between pediatric undernutrition and maternal stature. However, there's a scarcity of evidence regarding the relationship between maternal stature and pediatric coexisting forms of malnutrition (CFM). This study examined the prevalence and trends of CFM at the individual, household, and community levels, using data from the Demographic & Health Surveys (DHS) of Pakistan. Furthermore, this study assessed the association between pediatric CFM and short maternal stature while adjusting for multiple covariates. A panel cross-sectional analysis was conducted using data from the 2012-2013 and 2017-2018 Pakistan Demographic & Health Survey (PDHS). We included data from 6194 mother-child dyads aged 15-49 years and 0-59 months, respectively, while excluding data from pregnant mothers and dyads with incomplete anthropometric variables and anthropometric outliers. Across the two survey periods, our findings reveal a significant decline in pediatric malnutrition, including CFM, alongside a concurrent increase in maternal overweight/obesity. Three out of four households had either a malnourished mother, and/or a malnourished child, and/or both. Our study demonstrates that short maternal stature increased the odds of various forms of pediatric undernutrition by two-to-threefolds (p < .041), but we did not find an association with wasting, overweight/obesity, and nutritional paradox. This underscores the heightened vulnerability of children born to short-stature mothers to various forms of pediatric undernutrition. Addressing the high prevalence of pediatric undernutrition among children of short-stature mothers necessitates a comprehensive approach that considers an individual's nutritional status throughout their entire life cycle.

The Value of an Ecological Approach to Improve the Precision of Nutritional Assessment: Addressing Contributors and Implications of the "Multiple Burdens of Malnutrition"

Globally, children are exposed to multiple health risks associated with diet and nutrition. Rather than simply being a condition of having too much or too little food, malnutrition is more a syndrome comprising multiple burdens of coexisting and reciprocal malnutrition, infection, or other conditions. Importantly, children with such syndromes (e.g., stunting and anemia, which are neither specific nor necessarily sensitive to nutritional status) are more likely to also have irreversible functional outcomes such as poor growth, impaired immune function, or cognitive delays. The global health community has identified nutrition-related targets (e.g., Sustainable Development Goals (SDGs) and World Health Organization (WHO) Global Nutrition Targets) that, for multiple reasons, are difficult to address. Moreover, as the complexity of the global health context increases with persistent pandemics of infectious diseases and the rising prevalence of noncommunicable diseases, there is a growing appreciation that conditions selected as nutrition/health targets indeed represent syndromes for which nutritional status serves as both an input and outcome. In recognition of the impact of these combined challenges and the role of the multiple manifestations of malnutrition, we suggest an approach to nutritional assessment that is intended to improve the precision of context-specific, equitable approaches to health promotion, disease prevention, and treatment.

Determinants of coexisting forms of undernutrition among under-five children: Evidence from the Bangladesh demographic and health surveys

In many underdeveloped and developing countries, epidemiological and nutritional transitions are leading to an increase in malnutrition, resulting in pediatric diseases and eventually deaths. Therefore, this study intents to determine the important factors of the presence of coexisting forms of malnutrition (CFM), i.e., pediatric undernutrition. This study used the latest Bangladesh Demographic and Health Survey (BDHS)-2017/18 dataset consisting of 7127 under-five children. The logistic regression model has been utilized to gain explicit and in-depth knowledge of the relationship between the presence of pediatric undernutrition with socioeconomic and demographic factors. Findings revealed that about 31%, 22%, and 8% suffered from stunted, underweight, and wasted, respectively. The prevalence of stunted, underweighted, wasted, and CFM among children in the Sylhet division is higher than in any other region. A child of a secondary-level completed mother is 27.6% (OR: 0.724, 95% CI: 0.58-0.90) less likely to suffer from undernutrition than a child of an uneducated mother. The rate of undernutrition of children was less among children of highly educated parents. Age, birth order of the child, twin status, mother's age, body mass index (BMI), working status, parental educational qualification, cooking fuel, toilet facility, region, residence, and wealth index are important for determining the nutritional status of a child. The authors believe that the study findings will be helpful to the policymakers to take proper actions for achieving the sustainable development goal (SDGs) by reducing pediatric undernutrition in Bangladesh by 2030.

Mapping Concurrent Wasting and Stunting Among Children Under Five in India: A Multilevel Analysis

Objectives: The study aims to examine the coexisting forms, patterns, and predictors of concurrent wasting and stunting (WaSt) among children under five in India. Methods: We used data from the National Family Health Survey to understand the trend and association of WaSt among children under five-year-old in India. Univariate analysis and cross-tabulations were performed for WaSt cases. The association was determined using multilevel binary logistic regression and multilevel regression, and the results were provided as adjusted odds ratios (aOR) with 95% confidence intervals at the significance level of p < 0.05. Results: The prevalence of WaSt has decreased from 8.7% in 2005-06 to 5.2 percent in 2019-2020. The proportion of WaSt children grew rapidly from 6 to 18 months, peaked at 19 months (8%), then dropped after 24 months. The prevalence of concurrent wasting and stunting is higher among boys compared to girls. Compared to children of different birth orders, those in the higher birth order are 1.2 times more likely to be WaSt cases (aOR = 1.20, 95% CI = 1.09, 1.33). The education of the mother is strongly correlated with WaSt instances, and children of more educated mothers have a 47% lower chance of being WaSt cases (aOR = 0.63, 95% CI = 0.57, 0.71). Children from wealthy families are 52% less likely to be WaSt cases (aOR = 0.48, 95% CI = 0.43, 0.55). Conclusion: This study emphasizes the importance of concurrent wasting and stunting and its relationship with socioeconomic factors among children under five in India.

The Human Gut Virome and Its Relationship with Nontransmissible Chronic Diseases

The human gastrointestinal tract contains large communities of microorganisms that are in constant interaction with the host, playing an essential role in the regulation of several metabolic processes. Among the gut microbial communities, the gut bacteriome has been most widely studied in recent decades. However, in recent years, there has been increasing interest in studying the influences that other microbial groups can exert on the host. Among them, the gut virome is attracting great interest because viruses can interact with the host immune system and metabolic functions; this is also the case for phages, which interact with the bacterial microbiota. The antecedents of virome-rectification-based therapies among various diseases were also investigated. In the near future, stool metagenomic investigation should include the identification of bacteria and phages, as well as their correlation networks, to better understand gut microbiota activity in metabolic disease progression.

Association of Infant Feeding Indicators and Infant Feeding Practices with Coexisting Forms of Malnutrition in Children under Six Months of Age

Breastmilk is the only recommended source of nutrition for infants below six months of age. However, a significant proportion of children are either on supplemental breastfeeding (SBF) or weaned due to the early introduction of solid/semi-solid/soft food and liquids (SSF) before six months of age. There is good evidence that exclusive breastfeeding (EBF) in infants below six months of age protects them from preventable illnesses, including malnutrition. The relationship between infant feeding practices and coexisting forms of malnutrition (CFMs) has not yet been explored. This study examined the association of different feeding indicators (continuation of breastfeeding, predominant feeding, and SSF) and feeding practices (EBF, SBF, and complete weaning) with CFM in infants aged below six months in Pakistan. National and regional datasets for Pakistan from the last ten years were retrieved from the Demographic Health Surveys (DHS) and UNICEF data repositories. In Pakistan, 34.5% of infants have some form of malnutrition. Among malnourished infants, 44.7% (~15.4% of the total sample) had a CFM. Continuation of breastfeeding was observed in more than 85% of infants, but less than a quarter were on EBF, and the rest were either SBF (65.4%) or weaned infants (13.7%). Compared to EBF, complete weaning increased the odds of coexistence of underweight with wasting, and underweight with both wasting and stunting by 1.96 (1.12–3.47) and 2.25 (1.16–4.36), respectively. Overall, breastfed children had lower odds of various forms of CFM (compared to non-breastfed), except for the coexistence of stunting with overweight/obesity. Continuation of any breastfeeding protected infants in Pakistan from various types of CFM during the first six months of life.