Trends in prevalence and determinants of stunting in Tanzania: an analysis of Tanzania demographic health surveys (1991-2016)

Feeding Behaviour and Nutritional Status among Children Aged 6 to 23 Months Old in Bahi District in Tanzania

Background

The survival, well-being, and development of young children depend on optimal infant and young child feeding (IYCF) practices. It is imperative to assess nutrition status and feeding behaviour practices in order to develop interventions. The objective of this study is to assess nutrition status, feeding behaviour, and its association with nutrition status among children aged 6 to 23 months old in Bahi district, Tanzania.

Methods

A community-based, cross-sectional study was employed. A multistage sampling technique was used. Bahi district council, wards, and village were randomly selected, and then a systematic random sampling method was used to select participants. Anthropometric measurements were used to determine the nutrition status of children. Process for the Promotion of Child Feeding (ProPAN) manual guided assessment of feeding behaviours associated with nutrition status. Z-score was used to determine the level of malnutrition; the chi-square test and logistic regression were used as descriptive and inferential statistical tests, respectively, to determine the association between nutrition status and feeding behaviour.

Results

Out of 395 children aged between 6 and 23 months, 62.8% were stunted, 25.3% were underweight, and 6.6% were wasted. In the multivariable analysis, the results reveal that stunting was significantly associated with perception of exclusive breastfeeding (number of months) (AOR 4.24, 95%CI: 2.012-8.284) and number of feeds per day (AOR 2.02, 95%CI: 1.00-6.314). With regard to perception of exclusive breastfeeding (number of months), the children whose mothers perceived that children supposed to be breastfed for more than six months were four times more likely to be not stunted compared to those who were perceived to be breastfed less than three months, and the children whose mothers' fed them twice to three times were two times more likely to be not stunted compared to the children who were fed only two times.

Conclusion

Bahi district council has a higher prevalence rate of stunting, underweight, and wasting among children aged 6 to 23 months. Feeding on the first colostrum, exclusive breastfeeding, and breastfeeding for more than six months are the main determinants of nutrition status.

Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey

BACKGROUND

The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania.

METHODS

We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30-49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18.

RESULTS

Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4-2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1-1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7].

CONCLUSION

The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities.

Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania

BACKGROUND

Stunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting.

METHODS

This was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting.

RESULTS

The study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16.

CONCLUSION

The MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.

Uptake of Oral HIV Pre-Exposure Prophylaxis (PrEP) and Associated Factors among Female Sex Workers in Tanga, Tanzania

Pre-exposure prophylaxis (PrEP) prevents HIV infection among female sex workers (FSW). WHO recommends the use of Tenofovir disoproxil fumarate for use in oral PrEP regimens (TDF). Emtricitabine (FTC) 200 mg/Tenofovir Disoproxil Fumarate (TDF) 300 mg (Truvada) daily is the approved PrEP regimen in Tanzania. Evidence is limited on oral PrEP uptake and its associated factors in countries with a high burden of HIV, such as Tanzania. This study aimed to examine the uptake of oral PrEP and its associated factors among FSW in the Tanga region of Tanzania. This community-based cross-sectional study was conducted among 428 FSW. Data were collected through face-to-face interviews and analysed using STATA version 17 and RDSAT. Logistic regression was used to examine the associations of independent factors and PrEP uptake among study participants. About 55% of the recruited FSW used oral PrEP. FSW with three or more children were 2.41 times more likely to take oral PrEP (AOR 2.41, 95% CI: 1.08-4.25, p < 0.05). Moreover, those with a positive attitude were more likely to use oral PrEP (AOR 2.8, 95% CI: 1.88-4.17, p < 0.05). Poor belief was a barrier to PrEP use, and side effects of the drugs were a reason for the discontinuation of PrEP services. Most of the participants preferred PrEP services to be provided in the community. Oral PrEP uptake was 55%. Efforts to scale up PrEP for FSW should address misconceptions regarding PrEP, PrEP sensitization, and improving access through community-based intervention.

Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and determinants of the triple burden of malnutrition among mother-child pairs in low-income and middle-income countries.

DESIGN

Cross-sectional study.

SETTING

Low-income and middle-income countries.

PARTICIPANTS

Women and children.

PRIMARY OUTCOME

Triple burden of malnutrition (overweight/obese mother with undernourished and anaemic under 5 years child).

METHODS

Data for this study were drawn from recent 22 low-income and middle-income countries Demographic and Health Surveys. A total weighted sample of 116 795 mother-child pairs was included in the study. STATA V.14.2 was used to clean, code and analyse the data. Multilevel logistic regression was employed to identify factors associated with the problem. Adjusted OR (AOR) with 95% CI and a p<0.05 was reported to indicate statistical association. Model fitness and comparison were done using intraclass correlation coefficient, median OR, proportional change in variance and deviance.

RESULT

The pooled prevalence of the triple burden of malnutrition among mother-child pairs was 11.39%. It showed statistically significant positive associations with mothers aged ≥35 years (AOR 2.25, 95% CI 2.08 to 2.44), family size >10 (AOR 1.17, 95% CI 1.08 to 1.26), delivery by caesarean section (AOR 1.93, 95% CI 1.83 to 2.03), the richest household (AOR 1.72, 95% CI 1.56 to 1.88), grand multiparous (AOR 1.62, 95% CI 1.46 to 1.81), age of child 36-47 months (AOR 1.77, 95% CI 1.64 to 1.90), at a p<0.05. Whereas breast feeding (AOR 0.94, 95% CI 0.89 to 0.99), married mothers (AOR 0.87, 95% CI 0.78 to 0.96), female children (AOR 0.88, 95% CI 0.84 to 0.92), improved toilet (AOR 0.23, 95% CI 0.17 to 0.29), improved source of drinking water (AOR 0.28, 95% CI 0.21 to 0.35), rural residents (AOR 0.66, 95% CI 0.62 to 0.69) had a contrasting relationship with the triple burden of malnutrition.

CONCLUSION

About 1 out of 10 households suffer from the triple burden of malnutrition in low-income and middle-income countries. This study revealed that several maternal, child, household and community-level factors have a significant impact on the triple burden of malnutrition among mother-child pairs.

Epidemiological profile of malnutrition status and spatial distribution of children and adolescents living with HIV/AIDS in Tanzania

OBJECTIVES

To determine the prevalence of malnutrition status, analyse the association between malnutrition status and individual-level factors, and explore the spatial variation among children and adolescents living with HIV/AIDS in Tanzania.

METHODS

The study is based on large-scale baseline routine data from the National AIDS Control Programme on people living with HIV from January 2016 to December 2021 in mainland Tanzania. 70,102 children and adolescents aged 5-19 years receiving active antiretroviral therapy were included in the analysis. Nutritional status of participants was assessed by anthropometric measurement. Pearson's Chi-square test was used to describe the association between individual-level factors with all malnutrition outcomes and spatial analysis was used to investigate spatial distribution of malnutrition. The excess risk of malnutrition for each region was calculated while Anselin Local Moran's I and Getis-Ord statistical tools were used to identify significant hot spots regions of malnutrition.

RESULTS

The mean age of participants was 11.1 (SD 4.7) years, with 71.7% in the 5-14-year age group and 58.4% being girls. 39.2% were attending care and treatment clinics services at hospital level with public ownership. 53.4% started using ARV at age 5-14 years and 55.5% had already switched to second- or third-line ARV with 61.1% using ARV for less than 3 years. 51.2% were in WHO HIV clinical stage III or IV. The prevalence of malnutrition was 36.0% for stunting, 28.9% for underweight, 13.0% for wasting, and 48.0% for anthropometric failure. Individual-level factors which accounted for a higher proportion of malnutrition based on anthropometric failure were male sex (56.3%), age 5-14 years (50.0%), being unmarried (52.9%), being on second- or third-line ARV treatment (51.4%), ART initiation at age 5-14 years (55.7%), ARV for more than 3 years (49.4%), and stage IV of WHO HIV clinical status (57.8%). There were regional hot spots (p < 0.05): the prevalence rate and excess risk of malnutrition for stunting and anthropometric failure were highest in the southern highlands regions, for underweight in the central regions, and for wasting in the northern regions.

CONCLUSIONS

Children and adolescents living with HIV/AIDS in Tanzania suffer from poor nutritional status. Malnutrition does not occur arbitrarily, and the regions identified as hot spots should be given priority for nutritional intervention. Effective nutritional interventions for children living with HIV/AIDS should incorporate multiple approaches by considering unique geographical factors.

Determinants of Weight Disorders in Two- Year- Old Children in Isfahan, Iran

Background

Considering the importance of weight disorders in childhood and its impact until adulthood, this study was conducted to assess the determinants of weight disorders in 2-year-old Iranian children.

Materials and Methods

This cross-sectional study was conducted in 2020 among on 2300 children registered in Comprehensive Health Centers of Isfahan, Iran. Weight disorders, including underweight and overweight were defined according to the standardized National Center for Health Statistics (NCHS)/Centers for Disease Control (CDC) growth charts. Demographic data including gender, birth weight, maternal educational levels and occupation, duration of breastfeeding and the age of beginning complementary food were gathered.

Results

In the present study, 750 children (i.e., 32.6%) had weight disorders. Among them, 53.6% were underweight, 26.3% were overweight, and 12.9% were obese, 7.2%had severe underweight. Female gender, university education of mothers and higher levels of socio-economic status significantly increased the chance of overweight by 14.79%, 22.28%, 27.33% and 24.48%, respectively. Although with the increase in the duration of breastfeeding and the increase of family members, overweight, respectively, decreased by 0.86 and 0.93 fold, but it was not statistically significant. There was an inverse, significant relationship between the duration of breastfeeding with overweight versus underweight.

Conclusion

Underweight and overweight were the two most common weight disorders among 2-year- children, respectively. Control of modifiable risk factors for weight disorders in early life should be underscored in the primary health care system.

Factors Related to Stunting Incidence in Toddlers with Working Mothers in Indonesia

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.

Targeted and Population-Wide Interventions Are Needed to Address the Persistent Burden of Anemia among Women of Reproductive Age in Tanzania

Recent evidence suggests that 44.8% of women of reproductive age (WRA) in Tanzania suffer from anemia. Addressing this public health challenge calls for local evidence of its burden and determinants thereof for policy and tailored interventions. This secondary data analysis used Tanzania Demographic and Health Surveys (TDHS) 2004−2005 and 2015−2016 with a total of 23,203 WRA. Data were analyzed using descriptive statistics to characterize the burden of anemia, regression analyses to examine the adjusted change in the prevalence of anemia and remaining determinants thereof, and the Global Information System (GIS) to map the differences in the burden of anemia in Tanzania over the period of one decade. Considering the risk factors of anemia observed in our study, WRA in Tanzania should have been 15% less likely to suffer from anemia in 2015 compared to 2005. However, a small decline (3.6%) was not evenly distributed across the regions in Tanzania. Factors that remained significantly associated with anemia among WRA in the latest survey include age above 35 years (AOR = 1.564, p = 0.007), education level (AOR = 0.720, p = 0.001), pregnancy status (AOR = 1.973, p < 0.001), and use of contraception (AOR of 0.489, p < 0.001). Our findings suggest that WRA in Tanzania aged above 35 should be the target population to accept the more tailored interventions.

The Burden of Undernutrition and Its Associated Factors Among Children Below 5 Years of Age in Bambao Region, Comoros

Background

Undernutrition remains a major public health problem in low- and middle-income countries and Comoros is no exception. This study aimed to examine the prevalence and identify the risk factors of undernutrition among children under-five years in Bambao region, Comoros.

Methods

This cross-sectional study was conducted in Bambao region among 837 under-five years and their caregivers. Analyses were conducted using both descriptive and logistic regression to examine the magnitude and factors associated with stunting, wasting and underweight.

Results

Prevalence of stunting, wasting and underweight were 21.6, 13.7, and 13.6% respectively. Factors associated with stunting were caregiver's secondary education level compared to no education (AOR = 1.89, 95% CI: 1.04–3.43, P < 0.04), age of child between 13–24 months compared to 0–12 months (AOR = 2.69, 95% CI: 1.44–5.01, P < 0.001), and food insecurity (AOR = 2.55, 95% CI: 1.20–5.41, P < 0.02). Children aged 25–59 months were 78% less likely to have wasting compared to those with 0–12 months (AOR = 0.22, 95% CI: 0.10–0.51, P < 0.001). Wasting was also associated with food insecurity (AOR = 2.70, 95% CI: 1.12–6.49, P < 0.03), and low birthweight (AOR = 3.21, 95% CI: 1.73–5.94, P < 0.001). Children aged between 25–59 months were 86% less likely to have underweight compared to those aged 0–12 months (AOR = 0.14, 95% CI: 0.06–0.36, P < 0.001). Food insecurity (AOR = 2.65, 95% CI: 1.08–6.54, P < 0.03), low birthweight (AOR = 3.15, 95% CI: 1.67–5.93, P < 0.001), and non-exclusively breastfeeding (AOR = 2.37, 95% CI: 1.15–4.90, P < 0.02) were also associated with underweight.

Conclusion

More than one in five children under-five is stunted in Bambao region, Comoros. Moreover, more than 13% are underweight or wasted calling for streamlined efforts to address poor feeding practices, food insecurity, low birthweight, and socio-demographic disadvantages in this and other areas with similar context.

Determinants of underweight among children aged 0-23 months in Tanzania

Underweight is the most dependable growth indicator for overall child growth. Tanzania has the highest rate of underweight children in East Africa, with 1.27 million children under the age of five suffering from the condition. This study aimed to determine factors that influence underweight in Tanzanian children aged 0–23 months. We used data from the Tanzania Demographic and Health Survey (TDHS) 2015–2016 to conduct secondary analysis on a sample of 4,327 children aged 0–23 months. Descriptive and inferential statistics such as frequency, chi‐square, binary, and multivariate logistic regression were performed using the Statistical Package of Social Science (SPSS version 25). Statistical significance was defined as a p‐value of less than 0.05. Multivariate analysis found risk factors for underweight children were as follows: child's gender, age, birth weight, mothers' BMI, level of education, and type of toilet facility used by the households. Females had a significantly lower risk of being underweight (AOR = 0.62, 95% CI = 0.48–0.81, p < .05) compared with male children. The odds of being underweight increase with low birth weight (AOR = 2.92, 95% CI = 1.92–4.43, p < .05), low mother's BMI (AOR = 2.48, 95% CI = 1.34–4.58, p < .05), and low educational level (AOR = 1.78, 95% CI = 1.23–2.58, p < .05). Nutrition interventions such as growth monitoring, nutrition counseling, and nutrition education for parents/caregivers are critical to ensuring proper weight gain for all children under 2 years of age.

Malnutrition, anemia, micronutrient deficiency and parasitic infections among schoolchildren in rural Tanzania

Background

Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries. However, not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania.

Methodology/Principal findings

This cross-sectional study enrolled primary schoolchildren aged 6–12 years from Kikwawila and Kiberege wards, Tanzania. In total, 471 schoolchildren underwent a physical examination and provided blood, stool and urine samples for an assessment of the levels of different micronutrients, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14.0% of schoolchildren were found to be anemic. Children diagnosed with Plasmodium falciparum infection were more likely to have low levels of ferritin (aOR: 10.40, 95% CI: 2.88-40.53) and elevated levels of serum soluble transferrin receptor (aOR: 3.59, 95% CI: 1.27-11.23), respectively. Vitamin A (34.71%) and vitamin B12 (8.79%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38–11.44).

Conclusions/Significance

Malnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable.

In this study, we assessed the distribution and risk factors of nutritional indicators, anemia and micronutrient deficiency among schoolchildren of the Kikwawila and Kiberege wards, Tanzania. Our analysis revealed that malnutrition in form of stunting and wasting is still very high among schoolchildren in this region. About 14.0% of children were found to be anemic. Micronutrient deficiency was highly variable ranging from 0.50% (Folate) to 35.0% (Vitamin A). Schoolchildren from most rural schools were more likely to be found stunted and deficient with at least one type of micronutrient. Efforts to control and eliminate malnutrition, anemia, micronutrient deficiency and parasitic infections would benefit from sustainable and integrated approaches such as deworming, micronutrient supplementation, health education, vector control and an improvement in access to clean water and improved sanitation.

Are children in female-headed households at a disadvantage? An analysis of immunization coverage and stunting prevalence: in 95 low- and middle-income countries

Studies of inequalities in child health have given limited attention to household structure and headship. The few existing reports on child outcomes in male and female-headed households have produced inconsistent results. The aim of our analyses was to provide a global view of the influence of sex of the household head on child health in cross-sectional surveys from up to 95 LMICs. Studied outcomes were full immunization coverage in children aged 12-23 months and stunting prevalence in under-five children. We analyzed the most recent nationally-representative surveys for each country (since 2010) with available data. After initial exploratory analyses, we focused on three types of households: a) male-headed household (MHH) comprised 73.1% of all households in the pooled analyses; b) female Headed Household (FHH) with at least one adult male represented 9.8% of households; and c) FHH without an adult male accounted for 15.0% of households. Our analyses also included the following covariates: wealth index, education of the child's mother and urban/rural residence. Meta-analytic approaches were used to calculate pooled effects across the countries with MHH as the reference category. Regarding full immunization, the pooled prevalence ratio for FHH (any male) was 0.99 (0.97; 1.01) and that for FHH (no male) was 0.99 (0.97; 1.02). For stunting prevalence, the pooled prevalence ratio for FHH (any male) was 1.00 (0.98; 1.02) and for FHH (no male) was 1.00 (0.98; 1.02). Adjustment for covariates did not lead to any noteworthy change in the results. No particular patterns were found among different world regions. A few countries presented significant inequalities with different directions of association, indicating the diversity of FHH and how complex the meaning and measurement of household headship may be. Further research is warranted to understand context, examine mediating factors, and exploring alternative definitions of household headship in countries with some association.

Overview of Poultry Management as a Key Factor for Solving Food and Nutritional Security with a Special Focus on Chicken Breeding in East African Countries

Simple Summary

The poultry sector in most developing countries is largely based on traditional production systems, which are based on indigenous breeds. Beyond economical, nutritional, socio-cultural, and religious functions, the inherent adaptability of indigenous birds to diverse environmental conditions also provides a unique genetic resource critical for addressing the global challenges of food security in this world impacted by climatic change and human population growth. Nevertheless, until recently, the potential of the indigenous chicken remained largely untapped for no strong reason. In this review, we offer an overview of food and nutritional security with a special focus on chicken breeding in East Africa. We highlighted and combined confirming evidence of production performance, phenotypic variability, and genetic diversity of East African indigenous chicken using both morphological and molecular tools. Previous attempts to improve the productivity of indigenous chicken are highlighted, and possible future breeding plans and areas of immediate research are suggested. Considering how indigenous chicken strongly affects the livelihood of the majority of households, and since the poultry sector is likely to be strongly affected by climate change, we recommended that the prospects of chicken breeding in Africa should create a permanent balance between the competing needs of genetic improvement and the genetic diversity of indigenous chickens.

Abstract

The focus of this review is to offer an overview of food and nutritional security, to identify associated constraints, and propose possible alternative solutions for improving the East African poultry sub-sector in the pursuit of food security, focusing on chicken breeding. To better understand the prospects of the poultry industry, we highlighted and combined confirming evidence of the phenotypic variability and genetic diversity of East African chicken genetic resources using both morphological and molecular tools, as well as performance traits. Furthermore, this work gives a detailed indication of what would be lost if indigenous chicken populations are left to suffer the ongoing massive genetic erosions due to various factors, not limited to indiscriminate crossbreeding. Previous and recent attempts to improve the productivity of indigenous chicken are highlighted, and possible future breeding plans and areas of immediate research are suggested as well. This review concludes that under the prevailing conditions, the village chicken production system appears to be the most imperious production system that needs to be extensively developed ; however, for the sustainability of the industry, the proposed improvement strategies should create a permanent balance between the competing needs of genetic improvement and the genetic diversity of the indigenous chicken genetic resource.

Urban-Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991-2016

Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas.

Phenomenology Study of Stunting Nutrition for Babies in the Work Area of Pante Kuyun Health Center, Aceh Jaya District

BACKGROUND: Stunting causes organs not to grow and develop optimally. One of the factors that indirectly influence stunting in children is the mother’s parenting style. Parenting includes the family’s ability to provide time, attention, and support in meeting the physical, mental and social needs of children growing in the family. AIM: This is to find out the nutrition parenting patterns of children who are stunted in the working area of the Health Center Pante Kuyun, Aceh Jaya Regency. METHODS: This study uses qualitative methods with a phenomenological approach. This research was conducted in the working area of Pante Kuyun Health Center, Aceh Jaya Regency. The research was carried out for 1 month, starting from August to September. The choice of research location was due to the high incidence of stunting in the area. The number of samples was determined 15 people consisting of 10 children under five who were stunted, two people as the head of the Health Center, and two community leaders from various elements. This study uses recording devices, video recording devices (camcorders), tape recorders, group discussion guidelines, and field notes. Data analysis techniques used in qualitative research include transcript analysis of interview results, data reduction, analysis, data interpretation, and triangulation. RESULTS: Stunting is closely related to the social construction of society. There are differences in social constructs that shape the parenting styles’ understanding for toddlers who are stunted. During pregnancy, most mothers follow the restrictions recommended by their parents and in-laws. The number of taboo foods to be consumed during pregnancy to breastfeeding generally comes from the food group of animal protein sources such as squid, shrimp, crab, shellfish, and so on. These foods are believed to cause the, etc., become sticky, making it difficult for the delivery process, and milk is difficult to pass. It turns out that the customs, culture, and hereditary habits that continue to be carried out influence stunting in children under five. The pattern of nutrition parenting during the postpartum, postpartum period also causes stunting. During postpartum, the culture in society prohibits food other than white rice, and the fish is only anchovies. It turns out that the lack of intake during the postpartum period up to 40 days has an impact on the health of the postpartum, postpartum mother, especially only a little breast milk, dry skin, weakness, dizziness, and even sickness. Community beliefs also influence nutritional care patterns. For infants aged 0–6 months, none of the informants’ toddlers receive exclusive; breastfeeding. Exclusive breastfeeding is not given to children due to the mother’s lack of knowledge about exclusive breastfeeding benefits. The eating habit prioritizes elders’ advice such as parents, in-laws, and religious leaders are still related to myths about health and nutrition in pregnant women and toddlers. The pattern of nutrition parenting performed by mothers for infants >6 months is not under the Indonesian Ministry of Health recommendations. In the Aceh Jaya district, mothers habitually give instant noodles as a substitute for the rice to consume toddlers. However, their mothers also have parenting styles, whereas if the working mothers provide food for toddlers, they are older siblings, grandmothers, or nieces. Inadequate care, such as improper feeding from infancy to toddlerhood, causes toddlers to suffer from illness more often due to disruption of digestion because the baby’s intestines are still vulnerable. CONCLUSION: Parenting affects toddlers who experience stunting in the working area of Pante Kuyun Community Health Center, Aceh Jaya Regency.

Prevalence and Determinants of Undernutrition among 6- to 59-Months-Old Children in Lowland and Highland Areas in Kilosa District, Tanzania: A Cross-Sectional Study

Background

Undernutrition is the most dominant form of malnutrition among children in developing countries. Studies conducted in Tanzania have reported high levels of undernutrition among children below five years of age. However, there is limited information on differences in stunting prevalence across agroecological zones. This study aimed to determine the prevalence of undernutrition and its determinants in the lowland and highland areas in Kilosa District, Tanzania.

Methods

A cross-sectional study was conducted in a sample of 200 randomly selected households from the lowland and 141 from the highland areas of Kilosa District in Morogoro Region, Tanzania. Sociodemographic, feeding practices, hygiene, and sanitation data were collected using a structured questionnaire. Weight and height of children were measured using a standard procedure, and age was calculated from the birth date obtained from the child growth card. Anthropometric data were analyzed by using Emergency Nutrition Assessment (ENA) software. The logistic regression model was used to explore the determinants of undernutrition.

Results

Prevalence of stunting, underweight, and wasting was 41.0%, 11.5%, and 2.5% in lowland and 64.5%, 22.0%, and 1.4% in highland areas, respectively. The prevalence of stunting and underweight was higher in the highland compared to the lowland areas (p < 0.001). Significant determinants of underweight were areas of residence (AOR 4.21, 95% CI: 1.62–10.9), age of the children (AOR 5.85, 95% CI: 1.81–18.97), and child birth weight (AOR, 4.98 95% CI: 1.65–15.05), while determinants of stunting were the area of residence (AOR, 2.77 95% CI: 1.43–5.36), maternal age (AOR, 0.33 95% CI: 0.14–0.79), sex of a child (AOR, 1.89 95% CI: 1.03–3.50), and child birth weight (AOR, 3.29 95% CI: 1.21–8.97).

Conclusion

The prevalence of undernutrition, especially stunting and underweight, was high in the study areas. Determinants of stunting differed between highlands and lowland areas, highlighting the needs of having properly integrated interventions based on the geographical location.

Factors associated with the double burden of malnutrition at the household level: A scoping review

The double burden of malnutrition (DBM) at the household level has been defined as the coexistence of underweight children and overweight mothers within the same household. The objective of the scoping review was to identify and understand factors associated with DBM. We conducted the scoping review of published, peer-reviewed journal articles in two major databases used in public health research (PubMed and Web of Science). A total of 70 articles met the eligibility criteria. The following factors were identified: mother's age, height, educational level, occupation, food intake, breastfeeding, family income, family size, and urbanization type. Overall, results were heterogeneous. Two scenarios have been identified. The first scenario is those obese women with a job, having a sufficient income, a high educational level, the ability to purchase food, and live either in rural or urban areas. The second scenario is obese women without a job, having an insufficient income, a low educational level, without the ability to purchase food, and live either in rural or urban areas. The DBM at the household level is a complex public health problem. There is a need for target-specific interventions to address child undernutrition and maternal overweight/obesity simultaneously.

Participatory Epidemiology: Principles, Practice, Utility, and Lessons Learnt

Participatory epidemiology (PE) evolved as a branch of veterinary epidemiology and has been largely employed for the control and early warning of infectious diseases within resource-limited settings. It was originally based on combining practitioner communication skills with participatory methods to facilitate the involvement of animal caretakers and owners (embracing their knowledge, experience, and motivations) in the identification and assessment of animal disease problems, including in the design, implementation, monitoring and evaluation of disease control programs, policies, and strategies. With the importance of understanding social perceptions and drivers receiving increasing recognition by epidemiologists, PE tools are being adapted for an increasingly wide range of settings and endeavors. More recently, PE tools have been adapted for use in food and nutrition security programs, One Health activities, wildlife disease surveillance and as part of mixed-methods research across a range of socio-economic settings. This review describes the evolution of PE (in relation to veterinary epidemiology and briefly in relation to public health epidemiology), the underpinning philosophy and principles essential to its effective application and the importance of gender-sensitive approaches and data triangulation, including conventional confirmatory testing. The article also provides illustrative examples highlighting the diversity of approaches and applications of PE, hallmarks of successful PE initiatives and the lessons we can learn when these are missing. Finally, we look forward, describing the particular utility of PE for dealing with emerging infectious diseases, gaining attention of field-level cross-sector officials who can escalate concerns to a higher level and for continuing to raise the voices of those less-heard (such as women, minority groups, and remote communities with limited exposure to formal education) in defining the problems and planning activities that will likely impact directly on their well-being and livelihoods.

The burden and correlates of childhood undernutrition in Tanzania according to composite index of anthropometric failure

Background

Undernutrition is a public health problem worldwide. Tanzania has made significant achievements in the reduction of childhood undernutrition over the past two decades. However, the exact burden of undernutrition was under-estimated when using conventional indices of stunting, wasting and underweight. The objective of this study was to determine the overall prevalence of undernutrition, describe the trends and examine the correlates associated with undernutrition among children under-five years using the composite index of anthropometric failure (CIAF). This study aims to understand the real burden and drivers of undernutrition to improve design, implementation and monitoring of appropriate interventions to ameliorate all form of childhood undernutrition in the country.

Methods

About 37,205 mother-child pairs were retrieved and analyzed from the Tanzania Demographic and Health Surveys (TDHS) conducted in various years from 1991, 1996, 1999, 2004–05, 2009–10, to 2015–16. The anthropometric data of children under-five years were used to determine the overall burden and trends of undernutrition using CIAF. The recent TDHS surveys from 2005 to 2015 were used to examine the correlates of CIAF. To determine the correlates, multivariate analysis was conducted to estimate the prevalence ratios (PR) with 95% confidence intervals (CI) using Poisson regression with robust variance.

Results

The prevalence of CIAF declined significantly from 50% in 1991 to 38.2% in 2015 (p < 0.001). The correlates of CIAF vary across surveys. The multivariate analysis of recent 2015 survey revealed that the prevalence of CIAF was significantly higher for older children (p < 0.001), children living in rural areas (p = 0.028), and those born with non-educated (p = 0.009) or single mothers (p = 0.008). The prevalence of CIAF was significantly lower for girls (p < 0.001), being born with overweight/obese mothers (p < 0.001), living with older head of the household (p < 0.001) or living in richest household (p < 0.001). Moreover, children who were born with low birth weight (p < 0.001), or having fever (p = 0.044) were most likely to have anthropometric failure. However, consumption of diversified diet was not found to be associated with anthropometric failure (p > 0.05).

Conclusion

About one in every three under-five years children are suffering from either one or multiple forms of anthropometric failure in Tanzania. There is a significant decline trends in overall burden of undernutrition in Tanzania from the past 25 years, as measured by CIAF. Multiple factors including those related to mothers, children and household socio-economic characteristics have the potential to influence childhood undernutrition. Efforts to reduce the burden of undernutrition should mainly focus on reducing poverty and raising people’s living standards.

Determinan Balita Stunting di Jawa Timur: Analisis Data Pemantauan Status Gizi 2017

Background: Stunting in early life will have adverse functional consequences, including poor cognition and low levels of education. The study aimed to determine the determinants of stunting toddlers in East Java.Methods: The study uses secondary data from the 2017 PSG. Using the multi-stage cluster random sampling method, a sample of 10,814 toddlers aged 0-59 months was taken. The analyzed variables consisted of the dependent variable nutritional status of toddlers, 7 independent variables: residence, toddler age, mother's age, marital status of mothers, mother's education level, and working status of mothers. Determination of determinants using the Binary Logistic Regression test.Results: Toddlers living in urban areas were 0.855 times more at risk of stunting compared to toddlers living in rural areas (OR 0.885; 95% CI 0.798-0.980). Toddlers who have mothers with elementary education and below 2.206 times have more risk of stunting compared to toddlers who have mothers with college education (OR 2.206; 95% CI 1,835-12,651). Toddlers who have mothers with junior high school education were 1,676 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1.676; 95% CI 1.395-2.015). toddlers who have mothers with high school education are 1,266 times more likely to have stunting risk compared to toddlers who have mothers with tertiary education (OR 1,266; 95% CI 1,058-1,514).Conclusion: There were 4 variables that have proven to be significant as determinants of stunting in East Java Province, namely residence, age of toddler, age of toddler mother, and mother's level of educationABSTRAK Latar Belakang: Stunting dalam kehidupan awal akan mempunyai konsekuensi fungsional yang merugikan, termasuk kognisi yang buruk dan tingkat pendidikan yang rendah. Variabel ini perlu diperhatikan karena menurut Unicef, ada faktor sosial budaya yang berperan dalam terjadinya permasalahan stunting. Penelitian ditujukan untuk menentukan determinan balita stunting di Jawa Timur.Metode: Penelitian menggunakan data sekunder survei Pemantauan Status Gizi tahun 2017 (PSG 2017). Dengan metode multi-stage cluster random sampling, diambil sampel 10.814 balita berusia 0-59 bulan. Varibel yang dianalisis terdiri dari variabel dependen status gizi balita, 7 variabel independen: tempat tinggal, umur balita, umur ibu balita, status perkawinan ibu balita, tingkat pendidikan ibu balita, dan status bekerja ibu balita. Penentuan determinan dengan menggunakan uji Regresi Logistik Biner.Hasil: Balita yang tinggal di daerah perkotaan 0,855 kali lebih memiliki risiko stunting dibandingkan dengan balita yang tinggal di daerah pedesaan (OR 0,885; 95% CI 0,798-0,980). Balita yang memiliki ibu dengan pendidikan SD ke bawah 2,206 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 2,206; 95% CI 1,835-12,651). Balita yang memiliki ibu dengan pendidikan SLTP 1,676 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,676; 95% CI 1,395-2,015). balita yang memiliki ibu dengan pendidikan SLTA 1,266 kali lebih memiliki risiko stunting dibandingkan dengan balita yang memiliki ibu dengan pendidikan perguruan tinggi (OR 1,266; 95% CI 1,058-1,514).Kesimpulan: Ada 4 variabel yang terbukti signifikan sebagai determinan kejadian stunting di Provinsi Jawa Timur, yaitu tempat tinggal, umur balita, umur ibu balita, dan tingkat pendidikan ibu balita. 

Regional Disparities in the Decline of Anemia and Remaining Challenges among Children in Tanzania: Analyses of the Tanzania Demographic and Health Survey 2004-2015

The burden of child anemia is on the decline globally but remains prevalent in low- and middle-income countries, including Tanzania. Evidence suggests regional variation and a slow pace of decline even in areas with high food production. The factors behind such decline and remaining challenges behind child anemia remain understudied in Tanzania. This secondary data analysis utilized data including 7361 and 7828 children from the Tanzania Demographic and Health Surveys (TDHS) conducted in 2004–2005 and 2015–2016 separately to examine the decline of child anemia and regional variation thereof. We used a geographic information system (GIS) to visualize the changes and differences between regions and the two study periods, and used regression analyses to examine the recent determinants of child anemia. Anemia has declined among children under five in Tanzania by 42% over a one-decade period, but remained high in relatively high food-producing regions. The risk of anemia is still higher among boys compared to girls (AOR = 1.39, p = 0.005), 41% higher among children lived in households with more than three under-five children compared to those households with only one child (p = 0.002); lower among children whose mothers were educated (p < 0.001) or had first given birth when aged over 25 (p = 0.033); and 34% less among children in the wealthiest households (p < 0.001). Efforts are needed to address social determinants of health, especially targeting women’s empowerment through decreasing the number of children and encouraging child spacing, and poverty reduction, particularly in high food producing regions.