1
|
Hossain MA, Das NC, Tariqujjaman M, Siddique AB, Chandrima RM, Uddin MF, Islam SMH, Sayeed A, Ahmed A, Arifeen SE, Mahmood HR, Rahman AE, Hossain AT. Understanding the socio-demographic and programmatic factors associated with adolescent motherhood and its association with child undernutrition in Bangladesh. BMC Public Health 2024; 24:2200. [PMID: 39138565 PMCID: PMC11321164 DOI: 10.1186/s12889-024-19355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Worldwide, a significant number of girls become mothers during adolescence. In Bangladesh, adolescent childbirth is highly prevalent and has adverse effects on children's health and undernutrition. We aimed to identify the relationship between the undernutrition of children and adolescent motherhood, the factors associated with adolescent mothers' age at first birth, and to examine the programmatic factors and gaps influencing children's undernutrition in Bangladesh. METHODS We analysed the 'Bangladesh Demographic and Health Survey' BDHS-17-18 data and desk review. To examine the factors associated with adolescent motherhood and its impact on child undernutrition, data from 7,643 mother-child pairs were selected. Child stunting, wasting, and underweight were measured according to the World Health Organisation (WHO) median growth guidelines based on z-scores - 2. Univariate, bivariate, simple, and multiple logistic regressions were used for analyse. We followed the systematic procedures for the literature review. RESULTS Approximately, 89% of adolescents aged ≤ 19 years were married and 71% of them gave their first childbirth. Children of adolescent mothers (≤ 19 years) were significantly 1.68 times more wasted (aOR: 1.68; 95% CI: 1.08 to 2.64), 1.37 times more underweight (aOR: 1.37; 95% CI: 1.01 to 1.86) and either form 1.32 times more stunting, wasting or underweight (aOR:1.32; 95% Cl: 1.05 to 1.66) compared to the children of adult mothers (> 19 years) after adjusting potential confounders. The factors associated with mothers' first childbirth during adolescence were the age gap between husband and wife 5-10 years (aOR: 1.81; 95% Cl: 1.57-2.10) and age gap > 10 years (aOR: 2.41; 95% Cl: 1.96-2.97) compared with the age group < 5 years, and husbands' education (aOR: 1.29; 95% Cl: 1.04-1.61) compared with the uneducated husbands. In the literature review, we found potential gaps in focusing on the Adolescent Sexual and Reproductive Health (ASRH) program in Bangladesh, from thirty-two programmes only half of them focused on adolescents aged 10-19 years, and eleven programmes focused only on girls. CONCLUSION Children of adolescent mothers are at risk of wasting, underweight, and any form of undernutrition. For effective policies and interventions in Bangladesh, it is important to emphasise delaying adolescent pregnancy and prioritising child undernutrition.
Collapse
Affiliation(s)
- Md Alamgir Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Novel Chandra Das
- Health System and Population Studies Division (HSPSD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Tariqujjaman
- Nutrition Research Division (NRD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abu Bakkar Siddique
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Rubaiya Matin Chandrima
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Fakhar Uddin
- Nutrition Research Division (NRD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - S M Hasibul Islam
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abu Sayeed
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Hassan Rushekh Mahmood
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Singh SK, Chauhan A, Alderman H, Avula R, Dwivedi LK, Kapoor R, Meher T, Menon P, Nguyen PH, Pedgaonker S, Puri P, Chakrabarti S. Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India. MATERNAL & CHILD NUTRITION 2024; 20:e13644. [PMID: 38586943 PMCID: PMC11168363 DOI: 10.1111/mcn.13644] [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: 09/08/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.
Collapse
Affiliation(s)
- Shri K. Singh
- International Institute for Population SciencesMumbaiIndia
| | - Alka Chauhan
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Harold Alderman
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Rasmi Avula
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Rati Kapoor
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Trupti Meher
- International Institute for Population SciencesMumbaiIndia
| | - Purnima Menon
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Phuong H. Nguyen
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Parul Puri
- International Institute for Population SciencesMumbaiIndia
| | - Suman Chakrabarti
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| |
Collapse
|
4
|
Siramaneerat I, Astutik E, Agushybana F, Bhumkittipich P, Lamprom W. Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS). BMC Public Health 2024; 24:1371. [PMID: 38778326 PMCID: PMC11110397 DOI: 10.1186/s12889-024-18824-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: 01/14/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. METHODS The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. RESULTS The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. CONCLUSIONS Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.
Collapse
Affiliation(s)
- Issara Siramaneerat
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand.
| | - Erni Astutik
- Department of Epidemiology, Population Biostatistics and Health Promotion, Faculty of Public Health, Airlangga University, JI. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Farid Agushybana
- Department of Biostatistics and Demography, Faculty of Public Health, Diponegoro University, Jl. Prof. Soedarto, SH. Tembalang, Semarang, Central Java, 50275, Indonesia
| | - Pimnapat Bhumkittipich
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand
| | - Wanjai Lamprom
- Department of Social Science, Faculty of Liberal Arts, Rajamangala University of Technology Thanyaburi (RMUTT), 39 Moo1, Klong 6, Khlong Luang, Pathum Thani, 12110, Thailand
| |
Collapse
|
5
|
de Meijer F, Kimanthi M, Cheruiyot S, Muia AM, Goga D, Azamkhan Mohamed S, Njoga C, Gathu C, Agoi F, Nyamu N, Shabani J. Reimagining nutrition education for pregnant adolescents in the face of climate change: a community approach. BMJ Nutr Prev Health 2024; 7:151-159. [PMID: 38966109 PMCID: PMC11221292 DOI: 10.1136/bmjnph-2023-000745] [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: 08/11/2023] [Accepted: 03/21/2024] [Indexed: 07/06/2024] Open
Abstract
Objectives To explore challenges with current nutrition education for teenage pregnant women in a drought-prone community in Kenya and to elicit the communities' suggestions on how to best adapt it in the face of climate change. Design Nine serial focus group discussions (four with adolescents, two with their parents, two with community health volunteers and one with healthcare workers) were conducted on a purposively selected study population in Kaloleni, Kilifi County, Kenya. Data collection took place between March and November 2022, with a total of 73 participants. An inductive approach was used, and interpretive thematic coding was done as the primary analytic strategy to allow themes derived from participants' reflections. Results First, participants reported that unpredictable rainfall patterns had affected nutrition intake and variety due to reduced yield from farmland, diseases in livestock and insufficient income. Second, participants reported barriers to accessing nutrition education, as it was mainly given in clinics and not targeted at adolescents or men. Third, they experienced challenges in applying nutrition education in daily life due to a mismatch between available foods and cultural practices. Recommendations for the future encompassed equipping individuals with practical cooking skills tailored to available nutrients, initiatives aimed at water conservation and addressing animal health concerns, enhancing accessibility through community-based training programmes and fostering collaborative efforts to ensure the provision of essential nutrients. Conclusion Food choices in Kilifi County are getting more limited due to unpredicted rainfall patterns. Therefore, a reorientation of nutrition education is needed in order to build resilience in the community. Strengthening community action, including developing skills to increase long-term local support, would be needed to ensure the adequate nutrition status of vulnerable groups like pregnant adolescent women.
Collapse
Affiliation(s)
| | - Mary Kimanthi
- Family Medicine, The Aga Khan University, Nairobi, Kenya
| | | | | | - Donnah Goga
- Family Medicine, The Aga Khan University, Nairobi, Kenya
| | | | - Cecilia Njoga
- Family Medicine, The Aga Khan University, Nairobi, Kenya
| | | | - Felix Agoi
- Population Health, The Aga Khan University, Nairobi, Kenya
| | - Nelson Nyamu
- Family Medicine, The Aga Khan University, Nairobi, Kenya
| | - Jacob Shabani
- Family Medicine, The Aga Khan University, Nairobi, Kenya
| |
Collapse
|
6
|
Braddon KE, Keown-Stoneman CDG, Dennis CL, Li X, Maguire JL, O'Connor DL, Omand JA, Randall Simpson J, Birken CS. The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk. Eur J Clin Nutr 2024:10.1038/s41430-024-01420-0. [PMID: 38431673 DOI: 10.1038/s41430-024-01420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk. METHODS In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk. RESULTS This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration. CONCLUSION Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children.
Collapse
Affiliation(s)
- Kate E Braddon
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Xuedi Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Health, Toronto, ON, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- School of Nutrition, Toronto Metropolitan University, Toronto, ON, Canada
| | - Janis Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Mphamba PN, Chirwa GC, Mazalale J. An evolution of inequality of opportunity in the nutritional outcomes of under-five children in Malawi. SSM Popul Health 2024; 25:101606. [PMID: 38292048 PMCID: PMC10825516 DOI: 10.1016/j.ssmph.2024.101606] [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: 10/03/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
Background Malnutrition among children is a significant public health and development issue, especially in low- and middle-income countries, Malawi inclusive, which contributes to preventable diseases and deaths. Significant socioeconomic disparities persist, which affect access to and equal distribution of basic nutrition. This study analyzed the extent and trends of Inequality of Opportunity (IOP) in the nutritional outcomes of children aged 0-59 months. Methods The study used nationally representative data from the 2006, 2013-14, and 2019-20 Malawi Multiple Indicator Cluster Survey. In terms of method, we examined IOP in stunting, wasting, and underweight indicators, using the Human Opportunity Index and the Dissimilarity Index in 55,723 children. The Shapley-value technique decomposed the relative IOP. Results We find the largest share of circumstance-driven inequality in stunting (8.96 percent), followed by underweight (1.91 percent), and then wasting (0.90 percent). The Shapley-value decomposition results indicate the child's age (29.15 percent for stunting, 12.42 percent for underweight, and 52.36 percent for wasting) and gender (8.28 percent, 18.36 percent and 8.87 percent), wealth (6.36 percent, 22.87 percent and 8.54 percent), and mother's education (6.28 percent, 11.29 percent and 5.51 percent) as the dominant contributors to IOP for all three nutritional outcome indicators; stunting, underweight and wasting, respectively. Conclusion The findings suggest that policies aimed at narrowing the wealth and education inequality gap could help equalize nutrition opportunities for children in Malawi.
Collapse
|
8
|
Elmighrabi NF, Fleming CAK, Agho KE. Factors Associated with Childhood Stunting in Four North African Countries: Evidence from Multiple Indicator Cluster Surveys, 2014-2019. Nutrients 2024; 16:473. [PMID: 38398798 PMCID: PMC10892369 DOI: 10.3390/nu16040473] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Stunting remains a significant public health issue among North African children, even though significant progress has been made in reducing hunger and poverty. This study aimed to identify factors associated with stunting among children in four North African countries (Algeria, Egypt, Sudan, and Tunisia). A logistic regression model adjusted for clustering and sampling weights was used to identify factors associated with childhood stunting. It was found that the prevalence of stunting in Algeria, Egypt, Sudan, and Tunisia was 9.7%(95% CI: 9.1, 10.3), 21.1% (95% CI: 19.8, 22.5), 33.8% (95% CI: 32.7, 34.9), and 8.2% (95% CI: 7.3, 9.2), respectively. Stunting was more common among children from Sudan and Egypt. Our analysis showed that a low wealth index, being a boy, low BMI, dietary diversity <5 foods, and low birth weight were associated with stunting from 0 to 23 months; however, rural residency, a low-educated mother, low BMI, family size, and diarrhea were associated with stunting from 24 to 59 months. A collaborative approach that prioritizes maternal health and nutrition, invests in struggling families, and customizes interventions to meet the specific needs of each North African country is essential for eradicating undernutrition by 2030.
Collapse
Affiliation(s)
- Nagwa Farag Elmighrabi
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Department of People Determination and Sustainable Development, Benghazi 18251, Libya
- Department of Nutrition, Faculty of Public Health, University of Benghazi, Benghazi 18251, Libya
| | - Catharine A. K. Fleming
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
| | - Kingsley E. Agho
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia (K.E.A.)
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2750, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| |
Collapse
|
9
|
Stativa E, Rus AV, Lee WC, Salinas KAD, Cossey HM, Lobo A, Nanu M. Predictors of height in Romanian infants 6-23 months old: findings from a national representative sample. J Public Health (Oxf) 2023; 45:e714-e721. [PMID: 37740988 DOI: 10.1093/pubmed/fdad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/09/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The research explored the association between infants' height and various demographic factors in Romania, a country where such critical information has been lacking. METHODS This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6-23 months of age (M = 14.26; SD = 5.15). Infants' height-for-age z-scores (HAZ) were calculated using the World Health Organization's computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother's age, location, marital status, socioeconomic status (SES), as well as infant's term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ. RESULTS The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18-23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age. CONCLUSIONS The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.
Collapse
Affiliation(s)
- Ecaterina Stativa
- The National Institute for Mother and Child Health 'Alessandrescu-Rusescu', Bucharest, Romania
| | - Adrian V Rus
- Southwestern Christian University, Oklahoma, USA
| | - Wesley C Lee
- Southwestern Christian University, Oklahoma, USA
| | | | | | | | - Michaela Nanu
- The National Institute for Mother and Child Health 'Alessandrescu-Rusescu', Bucharest, Romania
| |
Collapse
|
10
|
Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [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: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
Collapse
Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| |
Collapse
|
11
|
Namiiro FB, Batte A, Rujumba J, Nabukeera-Barungi N, Kayom VO, Munabi IG, Serunjogi R, Kiguli S. Nutritional status of young children born with low birthweight in a low resource setting: an observational study. BMC Pediatr 2023; 23:520. [PMID: 37858130 PMCID: PMC10585881 DOI: 10.1186/s12887-023-04356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda. METHODS We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14. RESULTS Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. CONCLUSION Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.
Collapse
Affiliation(s)
- Flaviah B Namiiro
- Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda.
| | - Anthony Batte
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Violet O Kayom
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G Munabi
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-John Hopkins University Institute, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
12
|
Erfina E, Hariati S, Tawali S. Development and evaluation of nursing intervention in preventing stunting in children of adolescent mothers: A mixed-methods research protocol. Nutr Health 2023; 29:369-375. [PMID: 37331967 DOI: 10.1177/02601060231181712] [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] [Indexed: 06/20/2023]
Abstract
Background: Adolescent pregnancies are a global problem occurring in many countries. Adolescent pregnancy is a risk factor for stunting in children. Aim: This study was designed to develop and evaluation of nursing interventions to prevent stunting in children of adolescent mothers. Methods: A mixed-methods explanatory sequential design with two phases approach will be applied. Phase I is a qualitative phenomenology descriptive study that will be used. Participants will be adolescent pregnant women from several community health centers (Puskesmas) and healthcare staff in a community public center (Puskesmas) will be selected by purposive sampling. The study will be conducted at community health centers (Puskesmas) in Makassar, South Sulawesi, Indonesia. Data will be gathered through in-depth interviews and focus group discussions and analyzed using thematic analysis. Subsequently, an experimental pre-post-test design with a control group will be used to measure the effectiveness of the nursing intervention on preventing stunting among adolescent mothers in the quantitative phase by behavior toward stunting prevention for adolescent pregnancy and the nutritional status of children. Conclusion: This study will provide insight from both adolescent mothers' and healthcare staff's perspectives on stunting prevention including nutrition of adolescent pregnancy and breastfeeding. We will evaluate the effectiveness and acceptability of nursing intervention in preventing stunting. This will contribute to the international literature on the use of healthcare staff at community health services (puskesmas) to achieve linear growth due to prolonged food insecurity and illnesses in childhood.
Collapse
Affiliation(s)
- Erfina Erfina
- Maternity Nursing Department, Faculty of Nursing, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Suni Hariati
- Pediatric Nursing Department, Faculty of Nursing, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Suryani Tawali
- Community Medicine Department, Faculty of Medicine, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| |
Collapse
|
13
|
Sosanya ME, Beamon I, Muhammad R, Freeland-Graves JH. Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. BMC Public Health 2023; 23:1487. [PMID: 37542311 PMCID: PMC10401754 DOI: 10.1186/s12889-023-16365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. METHODS A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations. RESULTS The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability. CONCLUSION The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.
Collapse
Affiliation(s)
- Mercy E Sosanya
- Department of Nutritional Sciences, University of Texas at Austin, Austin, USA.
- Department of Nutrition and Dietetics, The Federal Polytechnic, Bauchi, Bauchi, Nigeria.
| | - Isaiah Beamon
- Department of Nutritional Sciences, University of Texas at Austin, Austin, USA
| | - Raza Muhammad
- Department of Nutritional Sciences, University of Texas at Austin, Austin, USA
| | | |
Collapse
|
14
|
Braddon KE, Keown-Stoneman CD, Dennis CL, Li X, Maguire JL, O'Connor DL, Omand JA, Simpson JR, Birken CS. Maternal Preconception Body Mass Index and Early Childhood Nutritional Risk. J Nutr 2023; 153:2421-2431. [PMID: 37356500 DOI: 10.1016/j.tjnut.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Risk factors for problematic child eating behaviors and food preferences are thought to begin during the preconception period. It is unknown if maternal preconception body mass index (BMI) is associated with child nutritional risk factors (eg, poor dietary intake and eating behaviors). OBJECTIVES We aimed to determine whether maternal preconception BMI was associated with child nutritional risk. METHODS In this longitudinal cohort study, a secondary data analysis of children ages 18 mo to 5 y were recruited from The Applied Research Group for Kids (TARGet Kids!), a primary care practice-based research network in Canada. The primary exposure was maternal preconception BMI. The primary outcome was parent-reported child nutritional risk score, measured using the Nutrition Screening for Every Preschooler/Toddler (NutriSTEP), an age-appropriate validated questionnaire. Fitted linear mixed effects models analyzed associations between maternal preconception BMI and child nutritional risk after adjusting for covariates. RESULTS This study included 4733 children with 8611 repeated NutriSTEP observations obtained between ages 18 mo to 5 y. The mean (standard deviation [SD]) maternal preconception BMI was 23.6 (4.4), where 73.1% of mothers had a BMI ≤24.9 kg/m2, and 26.9% had a BMI ≥25 kg/m2. The mean (SD) NutriSTEP total score was 13.5 (6.2), with 86.6% at low risk (score <21) and 13.4% at high risk (score ≥21). Each 1 unit increase in maternal preconception BMI was associated with a 0.09 increase in NutriSTEP total score (95% confidence interval [CI]: 0.05, 0.12; P ≤ 0.001). After stratification, each 1 unit increase in maternal BMI was associated with a 0.06 increase in mean NutriSTEP total score (95% CI: 0.007, 0.11; P = 0.025) in toddlers and 0.11 increase in mean NutriSTEP total score (95% CI: 0.07, 0.15; P < 0.001) in preschoolers. CONCLUSION Higher maternal preconception BMI is associated with slightly higher NutriSTEP total scores. This provides evidence that the preconception period may be an important time to focus on for improving childhood nutrition. This study was registered at clinicaltrials.gov as NCT01869530.
Collapse
Affiliation(s)
- Kate E Braddon
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Charles Dg Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Xuedi Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Translational Medicine, SickKids Research Institute, Toronto, Ontario, Canada; Department of Paediatrics, Mount Sinai Health, Toronto, Ontario, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; School of Nutrition, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Janis Randall Simpson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Seidu AA, Hagan Jnr JE, Budu E, Aboagye RG, Okyere J, Sakyi B, Adu C, Ahinkorah BO. High-risk fertility behaviour and undernutrition among children under-five in sub-Saharan Africa: a cross-sectional study. BMJ Open 2023; 13:e066543. [PMID: 37369407 PMCID: PMC10410834 DOI: 10.1136/bmjopen-2022-066543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The study examined high-risk fertility behaviour and its association with under-five undernutrition in sub-Saharan Africa (SSA). DESIGN We conducted a cross-sectional analysis of data from 32 sub-Saharan African countries' Demographic and Health Surveys. A weighted sample of 110 522 mother-child pairs was included in final analysis. Multilevel binary logistic regression was used to examine the association between high-risk fertility behaviour and undernutrition. The results were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals (CIs). SETTING Thirty-two countries in SSA. OUTCOME MEASURE Stunting, wasting, and underweight. RESULTS The pooled prevalence of stunting was 31.3%, ranging from 15.0% in Gabon to 51.7% in Burundi. Wasting was highest among children from Burkina Faso (19.1%) and lowest among those from South Africa (1.6%). The overall prevalence of wasting was 8.1%. The prevalence of underweight was 17.0%, with the highest among children in Niger (37.1%) and lowest in South Africa (4.8%). Mothers who gave birth at the age less than 18 years and those with short birth interval were more likely to have their children being stunted, wasted, and underweight. The odds of stunting and wasting were high among children born to women with high parity. However, maternal age at birth more than 34 was associated with lower odds of childhood underweight as against those with age at birth less than 34. CONCLUSION Countries in SSA are encouraged to address the issue of maternal age at birth less than 18, high parity, and shorter birth intervals in order to meet the Global Nutrition targets, which aim to achieve a 40% reduction in the number of stunted children under the age of 5 and to reduce and maintain childhood wasting to less than 5% by 2025.
Collapse
Affiliation(s)
- Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - John Elvis Hagan Jnr
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | | | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barbara Sakyi
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for Social Research in Health, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| |
Collapse
|
16
|
Gebreegziabher E, Bountogo M, Sié A, Zakane A, Compaoré G, Ouedraogo T, Lebas E, Nyatigo F, Glymour M, Arnold BF, Lietman TM, Oldenburg CE. Influence of maternal age on birth and infant outcomes at 6 months: a cohort study with quantitative bias analysis. Int J Epidemiol 2023; 52:414-425. [PMID: 36617176 PMCID: PMC10114123 DOI: 10.1093/ije/dyac236] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Maternal age is increasingly recognized as a predictor of birth outcomes. Given the importance of birth and growth outcomes for children's development, wellbeing and survival, this study examined the effect of maternal age on infant birth and growth outcomes at 6 months and mortality. Additionally, we conducted quantitative bias analysis (QBA) to estimate the role of selection bias and unmeasured confounding on the effect of maternal age on infant mortality. METHODS We used data from randomized-controlled trials (RCTs) of 21 555 neonates in Burkina Faso conducted in 2019-2020. Newborns of mothers aged 13-19 years (adolescents) and 20-40 years (adults) were enrolled in the study 8-27 days after birth and followed for 6 months. Measurements of child's anthropometric measures were collected at baseline and 6 months. We used multivariable linear regression to compare child anthropometric measures at birth and 6 months, and logistic regression models to obtain the odds ratio (OR) of all-cause mortality. Using multidimensional deterministic analysis, we assessed scenarios in which the difference in selection probability of adolescent and adult mothers with infant mortality at 6 months increased from 0% to 5%, 10%, 15% and 20% if babies born to adolescent mothers more often died during the first week or were of lower weight and hence were not eligible to be included in the original RCT. Using probabilistic bias analysis, we assessed the role of unmeasured confounding by socio-economic status (SES). RESULTS Babies born to adolescent mothers on average had lower weight at birth, lower anthropometric measures at baseline, similar growth outcomes from enrolment to 6 months and higher odds of all-cause mortality by 6 months (adjusted OR = 2.17, 95% CI 1.35 to 3.47) compared with those born to adult mothers. In QBA, we found that differential selection of adolescent and adult mothers could bias the observed effect (OR = 2.24, 95% CI 1.41 to 3.57) towards the null [bias-corrected OR range: 2.37 (95% CI 1.49 to 3.77) to 2.84 (95% CI 1.79 to 4.52)], whereas unmeasured confounding by SES could bias the observed effect away from the null (bias-corrected OR: 2.06, 95% CI 1.31 to 2.64). CONCLUSIONS Our findings suggest that delaying the first birth from adolescence to adulthood may improve birth outcomes and reduce mortality of neonates. Babies born to younger mothers, who are smaller at birth, may experience catch-up growth, reducing some of the anthropometric disparities by 6 months of age.
Collapse
Affiliation(s)
- Elisabeth Gebreegziabher
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | | | - Elodie Lebas
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Fanice Nyatigo
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| |
Collapse
|
17
|
Almaatani D, Zurbau A, Khoshnevisan F, Bandsma RHJ, Khan TA, Sievenpiper JL, Van Den Heuvel M. The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies. MATERNAL & CHILD NUTRITION 2023; 19:e13448. [PMID: 36284502 PMCID: PMC9749598 DOI: 10.1111/mcn.13448] [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: 04/19/2022] [Revised: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 12/15/2022]
Abstract
In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2 = 0.00%, PQ < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.
Collapse
Affiliation(s)
- Dina Almaatani
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - Farnaz Khoshnevisan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Robert H. J. Bandsma
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Department of PaediatricsUniversity of TorontoTorontoCanada
- Division of Gastroenterology, Hepatology and NutritionHospital for Sick ChildrenTorontoCanada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Medicine, Division of Endocrinology and MetabolismSt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
| | - Meta Van Den Heuvel
- Department of PaediatricsUniversity of TorontoTorontoCanada
- Division of Paediatric MedicineHospital for Sick ChildrenTorontoCanada
| |
Collapse
|
18
|
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.
Collapse
|
19
|
Agabiirwe CN, Dambach P, Methula TC, Phalkey RK. Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review. Environ Health 2022; 21:98. [PMID: 36274126 PMCID: PMC9590165 DOI: 10.1186/s12940-022-00910-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Weather and climate-related disasters, including floods, impact undernutrition through multiple pathways, including food security, inadequate child care practices, and water and sanitation. This review aimed to provide systematic evidence of the impact of floods on undernutrition in children under five years of age in Low and Middle-income countries (LMICs). METHODS We searched PubMed, Web of Science, Embase, MEDLINE, CINAHL and Scopus for peer-reviewed articles. Popline, WHO Library database (WHOLIS), the International Disaster database (EM-DAT), Food and Agriculture Organisation (FAO), UNICEF and Eldis were searched for grey literature articles. Database searches were first conducted in 2016 and updated in 2020. We included English language articles that reported the effect of floods on undernutrition outcomes in children under 5 years of age in LMICs, without limitation to study design and year of publication. The quality of selected studies was assessed using the National Institutes of Health (NIH) tool for Observational Cohort and Cross-Sectional Studies. RESULTS Of the 5701 articles identified, 14 met our inclusion criteria. The review noted stunting as the most frequently reported significant form of undernutrition in flood-affected areas. Severe and recurrent floods showed the greatest impact on undernutrition. Due to weak and limited evidence, the study is inconclusive on the most significant forms within the short-term and intermediate periods following floods. On the other hand, stunting was noted as the most frequently reported significant form of undernutrition in the long-term period following floods. There was generally little evidence of the effect of floods on micronutrient deficiencies. Factors associated with child undernutrition in the flood-affected areas included age, gender, diarrhoea, maternal and paternal education, maternal age, household size, land ownership and socioeconomic status. Overall, the quality of the evidence was fairly weak, with the main challenge lying in the inability of the studies to establish causal pathways for the observed effects. CONCLUSIONS The review suggests clear plans and strategies for preventing and reducing the long-term impact of floods on undernutrition in children under five years. Future research utilising long-term prospective data is indispensable to provide more robust evidence to guide better prevention measures, response decisions and interventions.
Collapse
Affiliation(s)
- Caroline Noel Agabiirwe
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Peter Dambach
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Thabile Constance Methula
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Revati K Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
20
|
Das M, Jana A, Muhammad T. Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015-2016. Sci Rep 2022; 12:17742. [PMID: 36273013 PMCID: PMC9588050 DOI: 10.1038/s41598-022-20058-1] [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: 09/11/2021] [Accepted: 09/08/2022] [Indexed: 01/18/2023] Open
Abstract
Anthropometric markers are the most important aspect of a child's health assessment. Using large-scale nationally representative data from the National Family Health Survey (NFHS-4), 2015-2016, this study aimed to investigate the relationship between children born to women with high-risk fertility behaviours and children's health outcomes. The sample consisted of 2,55,726 children of currently married women aged 15-49 years in India. The key explanatory variable, high-risk fertility behaviour was defined by women's age at birth (below 18 or above 34 years), birth interval (less than 24 months), and higher birth orders (four and above). The key outcome variables for assessing child health outcomes were stunting, wasting, and underweight in children aged 0-59 months. We used descriptive statistics, Pearson's chi-square test and logistic regression models to analyse the objectives. Approximately 33% of children were born with any single high-risk condition in the last 5 years in India. The bivariate analysis showed that all three components of child health, stunting, wasting, and underweight, were higher among children born to women with high-risk fertility behaviour. The findings from the multivariable analysis suggest that children born with a high risk fertility behaviour were suffering from stunting (AOR = 1.30; 95% CI 1.27-1.33) and underweight (AOR = 1.23; 95% CI 1.20-1.27). In addition, children born to women of multiple high-risk categories had higher odds of stunting (AOR = 1.53; 95% CI 1.46-1.59) and underweight (AOR = 1.38; 95% CI 1.32-1.44) as compared to children born to women with no risk. Our findings highlight an urgent need for effective legislation to prevent child marriage that would be helpful in increasing the maternal age at birth. The government should also focus on the interventions in health education and improvement of reproductive healthcare to promote optimal birth spacing.
Collapse
Affiliation(s)
- Milan Das
- International Institute for Population Sciences (IIPS), Mumbai, India.
| | - Arup Jana
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - T Muhammad
- International Institute for Population Sciences (IIPS), Mumbai, India
| |
Collapse
|
21
|
Susyani S, Febry F, Margarhety I, Sadiq A, Sartono S, Sari IP, Ni’mah T. Maternal Risk Factor on Incidence of Stunting in South Sumatera. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stunting is an adverse result condition of unfulfilled nutritional intake during pregnancy and early childhood, which affects the children’s maximum height and optimal cognitive potential. Stunting is influenced by numerous factors, both from the mother and children. Research has proven that factors related to mothers of children under 5 have essential roles in the incidence of stunting.
AIM: This study intends to analyze the influence of maternal risk factors on the incidence of stunting in children under 5 in districts/cities in South Sumatra.
METHODS: This study is quantitative research with a cross-sectional design, with secondary data sources from Basic Health Research 2018, carried out in 17 districts/cities in South Sumatra.
RESULTS: The mothers’ characteristics most significantly related to stunting in children under 5 in the South Sumatra region are the mother’s height and mother’s education. Mothers with a height <150 cm have a 1.547 times higher risk of having stunting children (95% CI: 1.281–1.868), and mothers with low education have a 1.521 times higher risk of having stunting children (95% CI: 1.094–2.116). Moreover, mothers with secondary education are at 1.473 times higher risk of having stunting children (95% CI: 1.073–2.020).
CONCLUSION: The maternal risk factors most associated with stunting in children under five in South Sumatra are maternal height and mother’s education.
Collapse
|
22
|
Alam MZ, Islam MS. Is there any association between undesired children and health status of under-five children? Analysis of a nationally representative sample from Bangladesh. BMC Pediatr 2022; 22:445. [PMID: 35879700 PMCID: PMC9310505 DOI: 10.1186/s12887-022-03489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Child health, especially childhood mortality, is one of the critical indicators of human development. No child mortality is desirable, but it is still high in Bangladesh. We aimed to assess the effect of the child's desired status on childhood morbidity and mortality in Bangladesh. METHODS We used the data from the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2017-18 and restricted the analyses to children born in the past five years preceding the survey. We estimated the undesired status (excess in boy, girl, both, and parity) by subtracting an ideal number of children from the total live birth. We measured childhood mortality (perinatal, early neonatal, neonatal, post-neonatal, infant, child, and under-five mortality), morbidity (fever, diarrhea, cough, and acute respiratory infectious-ARI), nutritional problems (stunting, wasting, underweight, and low birth weight), and treatments (postnatal care, treatment for fever, diarrhea/cough, and vitamin A supplementation). Finally, we utilized the chi-square test and multilevel mixed-effects logistic regression analyses. RESULTS The prevalence of undesired children was 19.2%, 21.5%, 3.7%, and 25.4% for boys, girls, both boys and girls, and parity, respectively. Age, education, residence, division, and wealth index were significantly associated with undesired children. The prevalence of under-five mortality was 3.3% among desired children, almost double (5.4%) among undesired children. The likelihood of under-five mortality was [adjusted odds ratio (aOR): 2.05, p ≤ 0.001] higher among undesired children. Despite lower under-five mortality among higher socioeconomic status, the relative contribution of undesired children to under-fiver mortality was substantial. The undesired girl children were associated with an increased likelihood of moderately wasting (aOR: 1.28, p = 0.072), severely underweight (aOR: 1.41, p = 0.066), and low birth weight (aOR: 1.50, p ≤ 0.05). Moreover, the undesired children were 19% (p ≤ 0.05) more likely to be infected with fever. The undesired children had lower treatment for diarrhea and fever/cough and were less likely to get vitamin A supplementation (aOR: 0.71, p ≤ 0.001). CONCLUSIONS The share of childhood morbidity, mortality, and malnutrition were higher among undesired children. Every child should be wanted, and no unwanted pregnancies are desirable; thereby, the government should reemphasize the proper use of family planning methods to reduce child mortality and malnutrition.
Collapse
Affiliation(s)
- Md. Zakiul Alam
- Department of Population Sciences, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Md. Syful Islam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, 2220 Bangladesh
| |
Collapse
|
23
|
Khaliq A, Wraith D, Nambiar S, Miller Y. A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children. BMC Public Health 2022; 22:879. [PMID: 35505427 PMCID: PMC9063291 DOI: 10.1186/s12889-022-13098-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children. METHODS A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies. RESULTS The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive. CONCLUSION Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.
Collapse
Affiliation(s)
- Asif Khaliq
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Darren Wraith
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| | - Smita Nambiar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, 4059, Australia
| | - Yvette Miller
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| |
Collapse
|
24
|
Ketema B, Bosha T, Feleke FW. Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis. J Nutr Sci 2022; 11:e28. [PMID: 35573460 PMCID: PMC9066325 DOI: 10.1017/jns.2022.26] [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: 12/21/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022] Open
Abstract
Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.
Collapse
Key Words
- Bale Robe
- EBF, Exclusive Breastfeeding
- Ethiopia
- HAZ, Height-for-Age Z-score
- Infant and young child
- MAD, Minimum Acceptable Diet
- MDD, Minimum Diet Diversity
- MMF, Minimum Meal Frequency
- MUAC, Mid-upper arm circumference
- MUACAZ, Mid-upper arm circumference-for-age Z-score
- PCA, Principal Component Analysis
- PI, Principal Investigator
- SPSS, Statistical Product and Service Solutions
- Stunting
- UNICEF, United Nations Children's Fund
- Underweight
- WAZ, Weight-for-Age Z-score
- WHO, World Health Organization
- WHZ, Weight-for-Height Z-Score
- Wasting
- sd, Standard Deviation
Collapse
Affiliation(s)
- Bezawit Ketema
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Tafese Bosha
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fentaw Wassie Feleke
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
- College of Health Science, Woldia University, P.O. Box 400, Woldia, Ethiopia
| |
Collapse
|
25
|
Čvorović J. Maternal age at marriage and child nutritional status and development: evidence from Serbian Roma communities. Public Health Nutr 2022; 25:1-34. [PMID: 35260202 PMCID: PMC9991790 DOI: 10.1017/s1368980022000544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/12/2021] [Accepted: 03/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children. DESIGN Roma nationally representative population-based study. Proxies for child nutritional outcomes included children's individual-level height-for-age z (HAZ) and weight-for-age z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO's reference population (children aged 0-59 months), and Early Child Development (children aged 36-59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes, and other sociodemographic determinants as possible confounders. SETTING Aggregated data from UNICEF's fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements. SUBJECTS Children (n= 2652) aged 0-59 months born to ever-married women aged 15-48. RESULTS 64% of women married before age 18, 19% of children were stunted, 9% wasted, and Early Child Development score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0-24) emerged as the main predictor of children's nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child's age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes. CONCLUSIONS Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children's wellbeing include improved sanitation, child characteristics, maternal literacy and reproductive behavior, and parental investment.
Collapse
Affiliation(s)
- Jelena Čvorović
- Institute of Ethnography, Serbian Academy of Sciences and Arts, Belgrade,
| |
Collapse
|
26
|
Santosa A, Novanda Arif E, Abdul Ghoni D. Effect of maternal and child factors on stunting: partial least squares structural equation modeling. Clin Exp Pediatr 2022; 65:90-97. [PMID: 33957035 PMCID: PMC8841971 DOI: 10.3345/cep.2021.00094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stunting is affected by various factors from mother and child. Previous studies assessed only one or more influencing variables. Unfortunately, nor the significant influence of maternal and child factors nor the indicators contributing to maternal and child factors that affect the stunting incidence have ever been analyzed. PURPOSE This study analyzed the effect of maternal and child factors on stunting and the significant indicators that shape the maternal and child factors that impact stunting. METHODS This was a case-control study. Overall, 132 stunted children and 132 nonstunted children in Purbalingga Regency, Central Java Province, participated in the research. Direct interviews and medical record reviews were conducted to assess the studied variables. The research data were tested using the partial least squares structural equation with a formative model. RESULTS Maternal factors directly affected the occurrence of stunting (t=3.527, P<0.001) with an effect of 30.3%. Maternal factors also contributed a significant indirect effect on stunting through child factors (t=4.762, P<0.001) with an effect of 28.2%. Child factors affected the occurrence of stunting (t= 5.749, P<0.001) with an effect of 49.8%. The child factor was influenced by maternal factor with an effect of 56.7% (t=10.014, P<0.001). The moderation analysis results demonstrated that maternal and child factors were moderate predictive variables of stunting occurrence. CONCLUSION Child factors have more significant and direct effects on stunting than maternal factors but are greatly affected by them.
Collapse
Affiliation(s)
- Agus Santosa
- Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | | | | |
Collapse
|
27
|
Sk R, Banerjee A, Rana MJ. Nutritional status and concomitant factors of stunting among pre-school children in Malda, India: A micro-level study using a multilevel approach. BMC Public Health 2021; 21:1690. [PMID: 34530789 PMCID: PMC8447797 DOI: 10.1186/s12889-021-11704-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background Malnutrition was the main cause of death among children below 5 years in every state of India in 2017. Despite several flagship programmes and schemes implemented by the Government of India, the latest edition of the Global Nutrition Report 2018 addressed that India tops in the number of stunted children, which is a matter of concern. Thus, a micro-level study was designed to know the level of nutritional status and to study this by various disaggregate levels, as well as to examine the risk factors of stunting among pre-school children aged 36–59 months in Malda. Method A primary cross-sectional quantitative survey was conducted using structured questionnaires following a multi-stage, stratified simple random sampling procedure in 2018. A sum of 731 mothers with at least one eligible child aged 36–59 months were the study participants. Anthropometric measures of children were collected following the WHO child growth standard. Children were classified as stunted, wasted, and underweight if their HAZ, WHZ, and WAZ scores, respectively, were less than −2SD. The random intercept multilevel logistic regression model has been employed to estimate the effects of possible risk factors on childhood stunting. Results The prevalence of stunting in the study area is 40% among children aged 36–59 months, which is a very high prevalence as per the WHO’s cut-off values (≥40%) for public health significance. Results of the multilevel analysis revealed that preceding birth interval, low birth weight, duration of breastfeeding, mother’s age at birth, mother’s education, and occupation are the associated risk factors of stunting. Among them, low birth weight (OR 2.22, 95% CI: 1.44–3.41) and bidi worker as mothers’ occupation (OR 1.92, 95% CI: 1.18–3.12) are the most influencing factors of stunting. Further, about 14 and 86% variation in stunting lie at community and child/household level, respectively. Conclusion Special attention needs to be placed on the modifiable risk factors of childhood stunting. Policy interventions should direct community health workers to encourage women as well as their male partners to increase birth interval using various family planning practices, provide extra care for low birth weight baby, that can help to reduce childhood stunting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11704-w.
Collapse
Affiliation(s)
- Rayhan Sk
- Centre for the Study of Regional Development, School of Social Sciences, JNU, New Delhi, India.
| | - Anuradha Banerjee
- Centre for the Study of Regional Development, School of Social Sciences, JNU, New Delhi, India
| | - Md Juel Rana
- International Institute for Population Sciences, Mumbai, India
| |
Collapse
|
28
|
Adedokun ST, Yaya S. Factors associated with adverse nutritional status of children in sub-Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries. MATERNAL & CHILD NUTRITION 2021; 17:e13198. [PMID: 33960678 PMCID: PMC8189196 DOI: 10.1111/mcn.13198] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
Undernutrition is linked to almost half of all deaths in under-five children. In 2019, 144 million under-five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub-Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub-Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child's sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub-Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women's educational level and improvement in living conditions in rural areas.
Collapse
Affiliation(s)
- Sulaimon T. Adedokun
- Department of Demography and Social StatisticsObafemi Awolowo UniversityIle‐IfeNigeria
| | - Sanni Yaya
- Faculty of MedicineUniversity of ParakouParakouBenin
| |
Collapse
|
29
|
Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014-2018): Analysis of Demographic Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094578. [PMID: 33925898 PMCID: PMC8123503 DOI: 10.3390/ijerph18094578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.
Collapse
|
30
|
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. J Nutr Metab 2021; 2021:6627557. [PMID: 33936812 PMCID: PMC8055427 DOI: 10.1155/2021/6627557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
|
31
|
Mekonnen AG, Odo DB, Nigatu D, Sav A, Abagero KK. Women's empowerment and child growth faltering in Ethiopia: evidence from the Demographic and Health Survey. BMC Womens Health 2021; 21:42. [PMID: 33516229 PMCID: PMC7847175 DOI: 10.1186/s12905-021-01183-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite numerous national and international efforts to alleviate child growth faltering, it remains a global health challenge. There is a growing body of literature that recognizes the importance of women's empowerment in a wide range of public health topics, such as the utilization of maternal healthcare services, agricultural productivity, and child nutrition. However, in Ethiopia, the relationship between women's empowerment and child nutritional status is not studied at the national level. This study aimed to determine the association between women's empowerment and growth faltering in under-5 children in Ethiopia. METHODS The data source for this analysis is the 2016 Ethiopian Demographic and Health Survey (EDHS): a nationally representative household survey on healthcare. The EDHS employed a two-stage stratified cluster sampling technique. We computed standard women's empowerment indices, following the Survey-based Women's emPowERment index approach. A multilevel logistic regression model that accounted for cluster-level random effects was used to estimate the association between women's empowerment and child growth faltering (stunting, wasting and underweight). RESULTS Attitude to violence, social independence, and decision-making were the three domains of women's empowerment that were associated with child growth faltering. One standard deviation increase in each domain of empowerment was associated with a reduction in the odds of stunting: attitude towards violence (AOR = 0.92; 95% CI 0.88-0.96; p < 0.001), social independence (AOR = 0.95; 95% CI 0.89-0.99; p = 0.049), and decision-making (AOR = 0.93; 95% CI 0.87-0.99; p = 0.023). Similarly, each standard deviation increase in attitude towards violence (AOR = 0.93; 95% CI 0.89-0.98; p = 0.008), social independence (AOR = 0.91; 95% CI 0.86-0.97; p = 0.002), and decision-making (AOR = 0.92; 95% CI 0.86-0.99; p = 0.020) were associated with a decrease in the odds of having underweight child. CONCLUSIONS Ensuring women's empowerment both in the household and in the community could have the potential to decrease stunting and underweight in a rapidly developing country like Ethiopia. Policymakers and health professionals need to consider women's empowerment in this unique context to improve nutritional outcomes for children and alleviate growth faltering.
Collapse
Affiliation(s)
| | | | - Dabere Nigatu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adem Sav
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kiya Kedir Abagero
- Non Communicable Disease Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| |
Collapse
|
32
|
Jeyakumar A, Jungari S, Nair R, Menon P, Babar P, Bhushan B, Yogita H, Ali J, Saddichha M, Bhagyashree M, Monika P, Sakshi S. Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra. Ecol Food Nutr 2020; 60:377-393. [PMID: 33334182 DOI: 10.1080/03670244.2020.1858407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city.A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators.Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding.Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.
Collapse
Affiliation(s)
- Angeline Jeyakumar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.,School of Tourism and Hospitality Management, University of Johannesburg, Johannesburg, South Africa
| | - Suresh Jungari
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Raji Nair
- Department of Paediatrics, UNICEF, Mumbai, India
| | - Pramila Menon
- Dr. D.Y. Patil Medical College and Hospital, Pimpri - Chinchwad, India
| | - Prasad Babar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Barai Bhushan
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Hulsurkar Yogita
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Janan Ali
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Marathe Saddichha
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Mitragotri Bhagyashree
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Phadake Monika
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Sneha Sakshi
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| |
Collapse
|
33
|
Fagbohungbe TH, Gayawan E, Orunmoluyi OS. Spatial prediction of childhood malnutrition across space in Nigeria based on point-referenced data: an SPDE approach. J Public Health Policy 2020; 41:464-480. [PMID: 32807912 DOI: 10.1057/s41271-020-00246-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Malnutrition remains a leading cause of child mortality in Nigeria. The spatial analysis based on areal level approaches could, in reality, conceal variations at smaller units. Using point-referenced data from Nigeria Demographic and Health Survey, we quantify the prevalence of malnutrition among under-five children in Nigeria at 1.63 by 1.63 km spatial resolution, and compute the exceedance probability maps for stunting, wasting and underweight at 20% threshold level using the stochastic partial differential equation approach with Bayesian inference based on integrated nested Laplace approximation. Results show divergence prevalence of the malnutrition indicators among children living in neighbouring locations and that the prevalence of stunting and underweight increase with age. The prevalence of stunting was uneven among children living in Kebbi, Zamfara, Sokoto, Kaduna, Kano, Katsina, Bauchi, Gombe and Taraba states with more concentrations in the northern fringes of some of the states. Except for few locations in about three states, the probability is more than 90% that the prevalence of stunting in all parts of the country exceeds 20% but this was not the case for wasting. The findings can assist in location-specific policy formulation and implementations.
Collapse
Affiliation(s)
| | - Ezra Gayawan
- Informetrics Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam. .,Faculty of Mathematics & Statistics, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | | |
Collapse
|
34
|
Aheto JMK. Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana. BMC Public Health 2020; 20:644. [PMID: 32380990 PMCID: PMC7206751 DOI: 10.1186/s12889-020-08782-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under-five malnutrition is a major public health issue contributing to mortality and morbidity, especially in developing countries like Ghana where the rates remain unacceptably high. Identification of critical risk factors of under-five malnutrition using appropriate and advanced statistical methods can help formulate appropriate health programmes and policies aimed at achieving the United Nations SDG Goal 2 target 2. This study attempts to develop a simultaneous quantile regression, an in-depth statistical model to identify critical risk factors of under-five severe chronic malnutrition (severe stunting). METHODS Based on the nationally representative data from the 2014 Ghana Demographic and Health Survey, height-for-age z-score (HAZ) was estimated. Multivariable simultaneous quantile regression modelling was employed to identify critical risk factors for severe stunting based on HAZ (a measure of chronic malnutrition in populations). Quantiles of HAZ with focus on severe stunting were modelled and the impact of the risk factors determined. Significant test of the difference between slopes at different selected quantiles of severe stunting and other quantiles were performed. A quantile regression plots of slopes were developed to visually examine the impact of the risk factors across these quantiles. RESULTS Data on a total of 2716 children were analysed out of which 144 (5.3%) were severely stunted. The models identified child level factors such as type of birth, sex, age, place of delivery and size at birth as significant risk factors of under-five severe stunting. Maternal and household level factors identified as significant predictors of under-five severe stunting were maternal age and education, maternal national health insurance status, household wealth status, and number of children under-five in households. Highly significant differences exist in the slopes between 0.1 and 0.9 quantiles. The quantile regression plots for the selected quantiles from 0.1 to 0.9 showed substantial differences in the impact of the covariates across the quantiles of HAZ considered. CONCLUSION Critical risk factors that can aid formulation of child nutrition and health policies and interventions that will improve child nutritional outcomes and survival were identified. Modelling under-five severe stunting using multivariable simultaneous quantile regression models could be beneficial to addressing the under-five severe stunting.
Collapse
Affiliation(s)
- Justice Moses K Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon-Accra, Ghana.
| |
Collapse
|
35
|
Modjadji P, Madiba S. Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3021. [PMID: 31438531 PMCID: PMC6747220 DOI: 10.3390/ijerph16173021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa. METHODS A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren. RESULTS Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight. CONCLUSIONS The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.
Collapse
Affiliation(s)
- Perpetua Modjadji
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa.
| | - Sphiwe Madiba
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa
| |
Collapse
|