Undernutrition among the children below five years of age in Uganda: a spatial analysis approach

Residence-based disparities of composite index of anthropometric failures in East African under five children; multivariate decomposition analysis

BACKGROUND

Undernutrition remains a global challenge and public health concern, despite the presence of policies, programs and interventions. There is substantial evidence that the majority of the rural children under-5 years old have composite index of anthropometric failure than the urban counter parts. Hence, identifying the main contributors of these disparities will help health policy makers, program designers and implementers for the reduction of composite index of anthropometric failures in children under-5 years old in the study areas.

METHODS

The most recent and nationally representative samples of demographic and health surveys of five East African countries data were used for the current study. To appreciate the residence-based differences of composite index of anthropometric failure in under-5 children, the Blinder-Oaxaca decomposition analysis and its extensions were employed to determine the effects of covariates and coefficients. The country specific survey data analysis was performed.

RESULTS

The current study revealed that the burden of composite index of anthropometric failure (CIAF) in under-5 children were 40.69%, 22.04%, 34.06%, 31.99%, and 33.27% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. The residence-based differences in CIAF were 25.49%, 11.38%, 27%, 22.15%, and 20.55% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. Results of the Blinder-Oaxaca decomposition analysis and its extensions revealed that 100% of the rural-urban children under-5 composite index of anthropometric failure disparity was explained by endowment characteristics (covariate effect). Wealth index, mother's education, age of child, type of birth, sex of child and birth interval inequality between rural and urban households explains most of the composite index of anthropometric failure disparity in children under-5 years old.

CONCLUSIONS

The residence-based CIAF differences were high in all study countries. The rural-urban CIAF gap is ascribed by household, maternal and child characteristics. This result implies that rural children under-5 is disproportionally disadvantaged with respect to characteristics than their consequences. Through identification of the underlying factors behind the rural-urban CIAF disparities, the result of this study is important in planning effective intervention measures aiming at reducing residence-based inequalities and the population health outcomes. Therefore, should be given for rural children to reduce CIAF by improving house hold wealth index, women education and attentions to older children, and female children.

The current status of genetic biofortification in alleviating malnutrition in Africa

Africa is a continent where undernutrition and micronutrient deficiencies are common and malnutrition is a major problem. Genetic biofortification (GB) offers a promising way to combat malnutrition. But little is still known about how widely used GB is in Africa today. This review explores the status, achievements, and challenges of GB on the continent today. It draws attention to the potential for enhanced nutritional results from biofortified crops that are enhanced with vital elements like zinc, iron, and vitamin A. Biofortification has a demonstrable positive effect on health and wellness, as evidenced by success stories from several African nations. However, obstacles like a lack of farmer awareness, difficulty obtaining biofortified seeds, and complicated regulations make adoption difficult. Research and collaboration advances hold the potential for increasing GB's effectiveness. This study offers guidance for the future and calls for coordinated efforts to implement GB programs to achieve a well-nourished Africa.

Exploring the Nexus between Food Systems and the Global Syndemic among Children under Five Years of Age through the Complex Systems Approach

The intricate relationship between food systems and health outcomes, known as the food-nutrition-health nexus, intersects with environmental concerns. However, there's still a literature gap in evaluating food systems alongside the global syndemic using the complex systems theory, especially concerning vulnerable populations like children. This research aimed to design a system dynamics model to advance a theoretical understanding of the connections between food systems and the global syndemic, particularly focusing on their impacts on children under five years of age. The framework was developed through a literature review and authors' insights into the relationships between the food, health, and environmental components of the global syndemic among children. The conceptual model presented 17 factors, with 26 connections and 6 feedback loops, categorized into the following 5 groups: environmental, economic, school-related, family-related, and child-related. It delineated and elucidated mechanisms among the components of the global syndemic encompassing being overweight, suffering from undernutrition, and climate change. The findings unveiled potential interactions within food systems and health outcomes. Furthermore, the model integrated elements of the socio-ecological model by incorporating an external layer representing the environment and its natural resources. Consequently, the development of public policies and interventions should encompass environmental considerations to effectively tackle the complex challenges posed by the global syndemic.

The Epidemiological Characteristics and Spatiotemporal Clustering of Measles - China, 2005-2022

Introduction

In recent years, the incidence of measles in China has consistently remained below 1 per 100,000 population, yet the disease has not been eliminated. This study aims to comprehensively analyze the epidemiological characteristics of measles from 2005 to 2022, identify high-risk populations and areas, and propose targeted interventions.

Methods

We utilized data from the China Disease Prevention and Control Information System for our comprehensive analysis. Spatial autocorrelation was employed to examine the spatial clustering of measles, while spatiotemporal scanning analysis was used to detect spatiotemporal clustering to describe measles epidemiology during the study period.

Results

Between 2005 and 2022, 732,218 measles cases were reported in China. Overall, the incidence of measles exhibited a downward trend, particularly during the periods of 2008-2011 and 2015-2022. In 2022, the incidence rate reached its historical low at 0.039 per 100,000 population. Measles predominantly affects young children. Since 2017, global spatial clustering has diminished, although hotspot areas persist in the western provinces. Spatial-temporal scanning identified a high-incidence cluster from 2005 to 2008, comprising 15 provinces in the western, central, and northern regions of China. Conversely, from 2016 to 2022, a low-incidence cluster was detected in the southern and central provinces.

Conclusions

China has made significant progress in measles prevention and control. The recent low incidence and absence of substantial spatiotemporal clustering indicate that China is nearing measles elimination. However, there is a continuing need to enhance prevention and control efforts among very young children and in historic incidence hotspots in western provinces. Additionally, improving the diagnosis of vaccine-associated rash illnesses is essential.

Environmental Predictors of Undernutrition Among Under-5 Children at Dabat District Health Facilities, Northwest Ethiopia, 2023

Background

In Ethiopia, undernutrition remains a significant public health concern throughout the year due to persistent household food insecurit. The intensifying conflict in the Dabat district, involving the Ethiopian government and the Tigray Liberation Front, has increased the threat of undernutrition among under-5 children. The cessation of humanitarian aid has worsened food insecurity, increasing the vulnerability of the children in the region. However,there was no data showing the prevalence and environmental pridictors of undernutrition in the Dabat district, northwestern Ethiopia. Therefore, the objective of this study was to determine the prevalence of undernutrition and identify environmental pridictors in this study setting.

Methods

This institutional-based cross-sectional study was conducted from January to March 2023. A total of 400 under-5 children were included in this study using systematic random sampling techniques with a 100% response rate. The study included all under-5 children who visited healthcare facilities during the data collection period. However, it excluded children under-5 who had physical deformities, were critically ill, or had congenital abnormalities or known chronic diseases such as HIV/AIDS, tuberculosis, or chronic heart diseases. Binary logistic regression was used to determine environmental predictors of undernutrition, with statistical significance at a P-value of ⩽.05.

Results

The overall prevalence of undernutrition was found to be 12% (95% CI: 8.72-21.5). Among those affected, 32.8% (95% CI: 21.5-39.8) were stunted, 37.9% (95% CI: 28.8-47.50) were underweight, and 29.3% (95% CI: 21.3-29.7) were wasted. The environmental predictors of undernutrition were latrine use, recent diarrhea episodes, mothers' occupation and place of residence, water treatment before consumption, water sources and storage, water extraction methods, and mothers' handwashing habits.

Conclusions and recommendations

The study found a higher prevalence of undernutrition among under-5 children compared to the 2019 Ethiopia Mini Demographic and Health Survey. This study recommended raising awareness about establishing private toilets, promoting water treatment, proper latrine use, and handwashing practices. Training on personal hygiene and economic support for households should also be provided. Healthcare providers should offer quality health services for under-5 children. Further research is needed to explore specific nutrient deficiencies using laboratory methods.

Modeling the Risk Factors of Undernutrition among Children below Five Years of Age in Uganda Using Generalized Structural Equation Models

INTRODUCTION

The prevalence of undernutrition among children below five years of age, in Uganda and the world over, remains very high. About 45% of all global deaths among children below five years of age are attributed to undernutrition. A number of studies using different statistical approaches affirm this effect, yet some factors indicate the influence of other factors within the system. This study, therefore, uses a method that demonstrates how different variables feed into each other.

AIM

The aim of this study was to establish the major factors associated with an increased likelihood of undernutrition and the paths showing how these risk factors influence undernutrition.

METHODS

Data from the Uganda Demographic and Health Survey (UDHS, 2016) were used for this study. A sample of 4530 children, whose age, height, and weight measurements were recorded, was considered for this study. Additionally, the study used generalized structural equation models to identify the multifaceted natures and paths of the risk factors that influence undernutrition among children below five years of age. The study relied on the UNICEF 2020 conceptual framework to identify and analyze the direct and indirect effects of these risk factors of undernutrition.

RESULTS

From the perspective of a male child, having a perceived small size at birth, a low birth weight, being breastfed for less than 6 months, having no formal education from mothers, limited income-generating opportunities, a low wealth status, and notable episodes of diarrhea were among the key factors associated with an increased likelihood of undernutrition. The identified paths were as follows: (i) Having no education, as this was associated with limited working opportunities and a low income, which increases the likelihood of low household wealth status, hence increasing the chances of undernutrition. (ii) Exposure to a rural setting was associated with an increased likelihood of undernutrition through association with poor and or low employment levels within the rural areas. (iii) A shorter duration of breastfeeding was associated with children in urban areas, resulting in an increased likelihood of undernutrition. (iv) Children aged between 6 and 47 months had a higher likelihood of undernutrition.

CONCLUSIONS

An approach that addresses and recognizes all these factors at different levels, along the established paths, should be implemented to effectively reduce undernutrition among children below five years of age.

A Qualitative Exploration on Perceived Socio-Cultural Factors Contributing to Undernutrition Among Under-Fives in the Southern Highlands of Tanzania

Objective: Under nutrition especially among under-fives is a major public health challenge in Tanzania. However, the contribution of cultural practices to child under nutrition is often overlooked. This study aimed to explore the perceived socio-cultural factors contributing to the persisting under nutrition among under-fives in Tanzania. Methods: The study applied focus group discussion (FDGs) with forty practitioners to examine the sociocultural factors contributing to under nutrition during early childhood. The study participants were purposively selected and thematic analysis was used to identify themes within the data. Results: This study revealed that, under nutrition for under-fives is caused by a number of socio-cultural factors including existence of gender inequality related to dietary practices and qualities, women's excessive workload, patriarchy social-norm, excessive alcohol use and cultural taboos prohibiting women and girls from eating certain types of nutrient dense foods. Conclusion: The study highlights the multiplicity of factors including socio-cultural perspectives contributing to under nutrition among under-fives, and calls for a concerted efforts in developing and implementing issue-specific and culturally sensitive strategies towards elimination of child under nutrition.