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Oduro MS, Iddi S, Asiedu L, Asiki G, Kadengye DT. Utilizing a multi-stage transition model for analysing child stunting in two urban slum settlements of Nairobi: A longitudinal analysis, 2011-2014. PLoS One 2024; 19:e0272684. [PMID: 38408049 PMCID: PMC10896550 DOI: 10.1371/journal.pone.0272684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Stunting is common among children in many low and middle income countries, particularly in rural and urban slum settings. Few studies have described child stunting transitions and the associated factors in urban slum settlements. We describe transitions between stunting states and associated factors among children living in Nairobi slum settlements. METHODS This study used data collected between 2010 and 2014 from the Nairobi Urban and Demographic Surveillance System (NUHDSS) and a vaccination study nested within the surveillance system. A subset of 692 children aged 0 to 3 years, with complete anthropometric data, and household socio-demographic data was used for the analysis. Height-for-age Z-scores (HAZ) was used to define stunting: normal (HAZ ≥ 1), marginally stunted (-2 ≤ HAZ < -1), moderately stunted (-3 ≤ HAZ < -2), and severely stunted (HAZ < -3). Transitions from one stunting level to another and in the reverse direction were computed. The associations between explanatory factors and the transitions between four child stunting states were modeled using a continuous-time multi-state model. RESULTS We observed that 48%, 39%, 41%, and 52% of children remained in the normal, marginally stunted, moderately stunted, and severely stunted states, respectively. About 29% transitioned from normal to marginally stunted state, 15% to the moderately stunted state, and 8% to the severely stunted state. Also, 8%, 12%, and 29% back transitioned from severely stunted, moderately stunted, and marginally stunted states, to the normal state, respectively. The shared common factors associated with all transitions to a more severe state include: male gender, ethnicity (only for mild and severe transition states), child's age, and household food insecurity. In Korogocho, children whose parents were married and those whose mothers had attained primary or post-primary education were associated with a transition from a mild state into a moderately stunted state. Children who were breastfed exclusively were less likely to transition from moderate to severe stunting state. CONCLUSION These findings reveal a high burden of stunting and transitions in urban slums. Context-specific interventions targeting the groups of children identified by the socio-demographic factors are needed. Improving food security and exclusive breastfeeding could potentially reduce stunting in the slums.
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Affiliation(s)
- Michael S. Oduro
- Pfizer, Inc., Pharm Sci and PGS Statistics, Groton, Connecticut, United States of America
- Department of Applied Statistics and Research Methods, University of Northern Colorado, Greeley, Colorado, United States of America
| | - Samuel Iddi
- Research Division, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Statistics and Actuarial Science, University of Ghana, Legon, Accra, Ghana
| | - Louis Asiedu
- Department of Statistics and Actuarial Science, University of Ghana, Legon, Accra, Ghana
| | - Gershim Asiki
- Research Division, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Damazo T. Kadengye
- Research Division, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Economics and Statistics, Kabale University, Kabale, Uganda
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Martin A, Sprague A, Raub A, Bose B, Bhuwania P, Kidman R, Nandi A, Behrman J, Heymann J. The intergenerational effect of tuition-free lower-secondary education on children's nutritional outcomes in Africa. Glob Public Health 2024; 19:2291703. [PMID: 38118117 DOI: 10.1080/17441692.2023.2291703] [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: 06/20/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children's nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.
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Affiliation(s)
- Alfredo Martin
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Aleta Sprague
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Amy Raub
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Bijetri Bose
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Pragya Bhuwania
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
| | - Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada
| | - Jere Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, University of California, Los Angeles, CA, USA
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Merchant EV, Odendo M, Maiyo N, Govindasamy R, Morin XK, Simon JE, Hoffman DJ. An evaluation of nutrition, culinary, and production interventions using African indigenous vegetables on nutrition security among smallholder farmers in Western Kenya. Front Nutr 2023; 10:1154423. [PMID: 37255934 PMCID: PMC10225545 DOI: 10.3389/fnut.2023.1154423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Nutrition security continues to worsen in sub-Saharan Africa. Current research is limited on how seasonality may influence the impact of nutrition, culinary, and production interventions on food security, diet quality, and consumption of African Indigenous Vegetables (AIV); a culturally accepted source of micro-and-macronutrients that are easily produced due to their adaptation to the local environment. The objective of this study was to evaluate the programmatic impact of AIV interventions on nutrition security among smallholder farmers. Methods In a randomized control trial, five target counties in Western Kenya were randomly assigned to one of four treatments: (1) control; (2) production intervention (PI); (3) nutrition and culinary intervention (NCI); and (4) NCI and PI (NCI/PI). After the counties were randomly assigned to a treatment, 503 smallholder farmers (18-65 years) were selected from participatory farmer groups. The PI consisted of five agricultural production modules delivered between 2016 and 2019. The NCI was delivered twice: (1) household nutrition education (2017) and (2) community culinary training (2019). The NCI/PI included communities receiving both interventions at these time periods. Baseline and endline surveys were administered to all participants once in October 2016 (harvest season) and to all available participants (n = 250) once in June to July 2019 (dry season), respectively. The impact evaluation was analyzed by Household Hunger Scale (HHS), Women's Dietary Diversity Score (WDDS), AIV consumption frequency, and AIV market availability. Statistical tests included descriptive statistics (means and frequencies), paired t-test, McNemar's test, Wilcoxon Signed-Rank test, ANOVA test with Tukey post hoc, and χ2 test. Open-ended questions were aggregated, and responses were selected based on relevancy and thoroughness of the response to provide context to the quantitative data. A value of p < 0.05 was used to denote statistical significance. Results There was an overall decrease in WDDS, HHS, and consumption frequency between baseline and endline attributed to seasonal differences. Despite this, post-intervention, households that received NCI/PI had a higher WDDS relative to the control: WDDS 5.1 ± 1.8 vs. 4.2 ± 1.5, p = 0.035. In addition, between baseline and endline, there was an overall increase in the percentage of respondents that reported an adequate supply of key AIVs, particularly for households that received PI. Furthermore, seasonal effects caused a reported shift in the primary location for purchasing AIVs from the village to the town market. There was no reported difference in HHS. While "diet awareness" significantly influenced diet quality among the NCI treatment group, "production" was reported to have the greatest influence on diet quality among all intervention groups. Discussion The findings revealed that coupled nutrition, culinary, and production interventions could create a protective effect against seasonal fluctuations in the availability and affordability of AIV as evidenced by a higher WDDs. Conclusion and Recommendations These findings suggest that future programming and policy should focus on promoting the availability, accessibility, acceptability, and affordability of improved agronomic practices and germplasm for both smallholder farmers with particular emphasis on AIV varieties that contain high levels of micro-and macronutrients, improved agronomic characteristics (e.g., delayed flowering, multiple harvests, higher yields, and disease resistance), and are aligned with the communities' cultural preferences. In addition, agricultural training and extension services should incorporate nutrition and culinary interventions that emphasize the importance of farmers prioritizing harvests for their household consumption.
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Affiliation(s)
- Emily V. Merchant
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, United States
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, United States
| | - Martins Odendo
- Kenya Agricultural and Livestock Research Organization, Kakamega, Kenya
| | - Norah Maiyo
- Academic Model Providing Access to HealthCare (AMPATH), Eldoret, Kenya
| | - Ramu Govindasamy
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, United States
- Department of Agricultural, Food and Resource Economics, Rutgers University, New Brunswick, NJ, United States
| | - Xenia K. Morin
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, United States
| | - James E. Simon
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, United States
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, United States
| | - Daniel J. Hoffman
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, United States
- Department of Nutritional Sciences, Program in International Nutrition, New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Education and Research, Rutgers University, New Brunswick, NJ, United States
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Balew M, Kibret M. Prevalence of enteric bacterial pathogens in diarrheic under-five children and their association with the nutritional status in Bahir Dar Zuria District, Northwest Ethiopia. BMC Nutr 2023; 9:35. [PMID: 36829261 PMCID: PMC9951487 DOI: 10.1186/s40795-023-00678-0] [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: 12/15/2022] [Accepted: 01/16/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Diarrheal disease is one of the leading causes of child mortality in low and middle-income countries. Low nutritional status and bacterial infections contribute to growth deficiency and death in children. But there is a gap in identifying the bacterial etiology of diarrheal diseases and their association with the nutritional status of under-five children. This study aimed to determine the bacterial etiology of diarrheal diseases and their association with the nutritional status of diarrheic under-five children. METHODS A cross-sectional study was carried out from February 2021 to March 2022 at seven Health Centers in Bahir Dar Zuria district, Ethiopia. A total of 196 diarrheic under-five children visiting the health centers were included in the study. Stool samples were collected from each child for the isolation of Salmonella, Shigella, and E.coli O157:H7. The demographic characteristics and symptoms of children were obtained from parents/guardians. The weight, height, and age of each child were recorded and anthropometric indices were determined by WHO Anthro version 3.2.2 software. The association between bacterial prevalence and the nutritional status of children was analyzed by SPSS version 26 software using Binary logistic regression. All analyses were conducted at a 95% confidence interval and significant association was determined using a p-value < 0.05. RESULTS Of the total children included in the study, 13.1% had either E.coli O157:H7, Shigella, or Salmonella. Watery diarrhea and fever were the most clinical characteristics observed in children who are positive for enteric bacteria. The prevalence of stunted, underweight, and wasted was 56.6%, 24.4%, and 13.2% respectively. Children with wasting were significantly associated with Salmonella detection (OR = 7.2, CI, 1.38-38.1, P = 0.02) whereas stunted and underweight were not associated with bacterial prevalence. CONCLUSION Overall, the prevalence of bacterial pathogens in the study area is high. Stunting, wasting, and being underweight are important nutritional deficits of diarrheic under-five children in the study site. Further studies targeting possible sources of bacteria and determinants of malnutrition in children are suggested. Health sectors found in the district should increase their effort to enhance good nutritional practice through health education and treatment of malnourished children by the provision of micronutrients.
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Affiliation(s)
- Mastewal Balew
- College of Science, Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Mulugeta Kibret
- grid.442845.b0000 0004 0439 5951College of Science, Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia
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Bitew FH, Sparks CS, Nyarko SH, Apgar L. Spatiotemporal Variations and Determinants of Under-Five Stunting in Ethiopia. Food Nutr Bull 2023; 44:27-38. [PMID: 36824032 DOI: 10.1177/03795721231158503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context. OBJECTIVE This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016). METHODS Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses. RESULTS The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting. CONCLUSIONS Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.
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Affiliation(s)
- Fikrewold H Bitew
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Corey S Sparks
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Samuel H Nyarko
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Lauren Apgar
- Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
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Hoffman DJ, Kassim I, Ndiaye B, McGovern ME, Le H, Abebe KT, Ayoya MA. Childhood Stunting and Wasting Following Independence in South Sudan. Food Nutr Bull 2022; 43:381-394. [PMID: 36245391 DOI: 10.1177/03795721221128126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND South Sudan has experienced ongoing civil and environmental problems since gaining independence in 2011 that may influence childhood nutritional status. OBJECTIVE To estimate the prevalence of undernutrition among children in South Sudan in 2018 and 2019 compared to the prevalence in 2010. METHODS Data on height and weight were collected using a 2-stage stratified sample framework in which households were randomly selected at the county level and nutritional status was calculated for all children under 5 years of age to determine height-for-age, weight-for-height, and weight-for-age Z-scores (HAZ, WHZ, and WAZ) and the prevalence of stunting, wasting, and underweight. Linear and logistic regression analyses were used to determine factors associated with nutritional status and the odds ratio for nutritional outcomes. RESULTS In 2010, the mean HAZ, WHZ, and WAZ was -0.78, -0.82, and -1.15, respectively, and the prevalence of stunting, wasting, and underweight was 30%, 23%, and 32%, respectively. In 2018 and 2019, the mean HAZ, WHZ, and WAZ was -0.50, -0.70, -0.77 and -0.53, -0.77, -0.76, respectively. The prevalence of stunting, wasting, and underweight in 2018 and 2019 was 17%, 14%, 15% and 16%, 16%, 17%, respectively. Age was negatively associated with all nutritional indices and girls had higher HAZ, WHZ, and WAZ and a lower mid upper arm circumference (P < .01) compared to boys. The risk of poor nutritional outcomes was associated with vaccine status and varied by state of residence. CONCLUSIONS Following independence in 2010, the prevalence of undernutrition in South Sudan decreased, but the risk for undernutrition varied by state and efforts to address food security and health need to ensure equitable access for all children in South Sudan.
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Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition; New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research, Rutgers; the State University of New Jersey, New Brunswick, NJ, USA
| | - Ismail Kassim
- UNICEF South Sudan, Totto Chan Compound, Juba, South Sudan
| | - Biram Ndiaye
- UNICEF South Sudan, Totto Chan Compound, Juba, South Sudan
| | - Mark E McGovern
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Huyen Le
- Department of Nutritional Sciences, Program in International Nutrition; New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research, Rutgers; the State University of New Jersey, New Brunswick, NJ, USA
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Rolle ML, Bhebhe A, Munkondya A, Kharbat AF, Kaskie N, McLellan R, Nahed BV, Warf BC, Kunda H, Sichizya K. Qualitative and Quantitative Analysis of Pediatric Post Neurosurgical Care in a Lower Middle-Income Country: The Zambian Experience. World Neurosurg 2022; 167:e784-e788. [PMID: 36049724 DOI: 10.1016/j.wneu.2022.08.098] [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: 06/08/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Pediatric postoperative neurosurgical care is an essential component of a child's treatment pathway. It is important to better understand how neurosurgeons in lower middle-income countries (LMICs) have been able to address socioeconomic and systemic factors to improve their patients' access to quality pediatric postoperative neurosurgical care. We aim to characterize the pediatric neurosurgical postoperative system in place in Zambia and to discuss how these efforts have been implemented to improve outcomes and address socioeconomic barriers to accessing health care. METHODS We acquired a patient list of 90 tenants of House of Hope (HOH)-an out-of-hospital center caring for children awaiting surgery, as well as those recovering from surgery. Of the patient list, 44 patients qualified for our study. Survey responses and occurrence of demographic and clinical characteristics were calculated. Non-normally distributed variables (age) were reported by median and interquartile range (IQR). Dichotomous variables were presented as percentages. Fisher's Exact test was applied to compare categorical data and hospital re-admission. A P-value of <0.05 was considered significant. RESULTS Our study demonstrates two key findings: (1) low 30-day hospital re-admission rate of 9% and (2) favorable postoperative experience by patient families. Of the 44 patients, a majority were 1-year-old children (n = 31, 70%) and female (n = 24, 55%) (IQR 1-2 years). Presenting conditions included: hydrocephalus only (n = 35, 80%), hydrocephalus and myelomeningocele (n = 5, 11%), myelomeningocele only (n = 2, 5%), cerebral palsy (n = 1, 2%), and encephalocele (n = 1, 2%). Half (n = 22, 50%) of the patients lived in east Zambia, 8 (18%) lived in central, 8 (18%) in north, 5 (11%) in south, and 1 (2%) in west Zambia. CONCLUSIONS We report the first qualitative and quantitative analysis of postoperative care for LMIC pediatric neurosurgical patients in the academic literature. Quality, patient-centered postoperative pediatric neurosurgical care that is rooted in addressing socioeconomic determinants of health produces good outcomes in LMICs.
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Affiliation(s)
- Myron L Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arnold Bhebhe
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Aaron Munkondya
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Abdurrahman F Kharbat
- Division of Neurosurgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
| | - Natasha Kaskie
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Rachel McLellan
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Humphrey Kunda
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
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Waghmare H, Mondal NA, Hossain B. Nutritional policies and anaemia among under-five children in selected south Asian countries: 1950-2016. BMC Pediatr 2022; 22:540. [PMID: 36096755 PMCID: PMC9465932 DOI: 10.1186/s12887-022-03597-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite policies and social development, childhood malnutrition remains a significant public health and social challenge in many south Asian countries. Also, there is a lack of study for a comparative understanding between the nutrition policies and nutritional status of under-5 children in south Asian countries. In this context, the present study aims to understand the comparative evolution of nutritional policies and programs in south Asian countries between 1950 to 2016 and assess current nutritional status of children under the age of 5 in Bangladesh, India, Nepal, and Pakistan. Methods This study obtained yearly anaemia data from the Global Health Observatory Data Repository (World Health Statistics) from 1990 to 2016 for comparative analysis. The most recent Demographic Health Survey (DHS) rounds have been taken for four south Asian nations. Bivariate analysis and classical figures have been utilised to demonstrate the findings. Results In Bangladesh, Nepal, India, and Pakistan, the prevalence of anaemia decreased by 33%, 31%, 20%, and 12% from 1990 to 2016, respectively. While analysis of the policy and programs, the problem of under-nutrition in all selected countries stems from the lack of serious implementation of National Nutrition Policies. Conclusion This study suggests that the national nutrition programs require inter-sectoral coordination between central ministries within countries to reduce the anaemia level. In light of Sustainable Development Goals (SDG), a multi-faceted policy should be implemented to prevent and control malnutrition problems in these countries.
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Affiliation(s)
- Hanumant Waghmare
- Department of Migration and Urban Studies, Post-Doctoral Fellow, International Institute for Population Sciences, Mumbai, Maharashtra, Pin: 400088, India
| | - Nasim Ahamed Mondal
- Department of Social Sciences, Research Scholar, University of Warsaw, Warsaw, Poland.,Centre of Migration Research, Research Associate, University of Warsaw, Warsaw, Poland
| | - Babul Hossain
- Doctoral Fellow, International Institute for Population Sciences, Mumbai, Maharashtra, Pin: 400088, India.
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Ahmed AT, Abas AH, Elmi A, Omer A. Determinants of severe acute malnutrition among children aged 6-36 months in Kalafo district (riverine context) of Ethiopia. Sci Rep 2022; 12:5198. [PMID: 35338207 PMCID: PMC8956698 DOI: 10.1038/s41598-022-09184-y] [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] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/17/2022] [Indexed: 12/26/2022] Open
Abstract
Malnutrition remains prevalent and existing health problem globally. Particularly Undernutrition is a major public health issue in developing countries. Globally the causes of severe acute undernutrition varies across context. The aim of this study was to identify the determinants of severe acute malnutrition to uncover contextual factors based on UNICEF conceptual framework, as there was no study done in a similar context in Ethiopia. Health facility based (health post) un-matched case control study with Key informant interview was conducted to identify determinant factors of severe acute malnutrition (SAM) among children between 6 and 36 months. 246 children (82 cases and 164) with their mothers or care takers participated the study which was conducted between December 20, 2019 to January 20, 2020 in Kalafo district in Shebele River. Odds ratio with 95% confidence interval was calculated to identify the determinants of SAM among children aged 6-36 months using multivariate logistic regression. The odds of severe acute malnutrition was 2.28 (1.22, 4.26); 4.68 (2.29, 9.58); 2.85 (1.26, 6.45); 2.39 (1.16, 4.96) and 3.262 (1.46, 7.31) and 3.237 (1.45, 7.23); respectively for mothers with three or more under five children, Children with inadequate dietary diversity, experienced diarrhea in past 2 weeks, their mothers had not nutrition counselling during pregnancy and younger (6-11 and 12-17 months) children as compared to controls. The finding of this study reveals the main determinants of severe acute malnutrition in riverine context are multi-level. In addition to this, poor childcare and polygamy identified in qualitative finding. Decisive and multi-sectoral approach is required to addressing SAM in the riverine area.
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Affiliation(s)
- Ahmed Tahir Ahmed
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia.
| | - Abdulahi Haji Abas
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
| | - Abdifatah Elmi
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
| | - Abdilahi Omer
- Public Health Department, College of Medicine and Health Science, Jigjiga University, P.O. Box 1020, Jijiga, Ethiopia
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Duguma HT, Forsido SF, Belachew T, Hensel O. Changes in Anti-nutritional Factors and Functional Properties of Extruded Composite Flour. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.713701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Development of complementary foods by mixing plant-based (cereals, pulses, oilseeds, and others) ingredients and employing various processing techniques is widely reported. However, information on comparison of anti-nutritional factors and functional properties of extruded and unextruded complementary flours made from a multi-mix is limited. In this regard, this study aims to investigate the influence of extrusion cooking on anti-nutritional and functional properties of newly developed extruded oats, soybean, linseed, and premix composite complementary flours.Methods: Thirteen different blending ratios of oats, soybean, linseed, and premix were generated using a constrained D-optimal design of the experiment. Each of the 13 blends was divided into two groups: extrusion cooked and unextruded composite flour sample. Anti-nutritional and functional properties were determined using standard methods for both composite flours. ANOVA was used to determine if there was a significant difference for extruded and unextruded composite flours and paired t-tests were used to check variation between extruded and unextruded.Results: The phytate content of the extruded and unextruded composite flours was 158.93–191.33 mg/100 g and 175.06–203.10 mg/100 g, respectively, whereas the tannin content of the extruded and unextruded composite flours was 8.4–22.89 mg/100 g and 23.67–36.97 mg/100 g, respectively. There was a statistically significant (p < 0.05) difference among the extruded composite flours in terms of phytate and condensed tannin content. Paired t-test has indicated a significant (p < 0.05) difference between extruded and unextruded composite flours for phytate and tannin. Water absorption capacity and bulk density have shown a significant (p < 0.05) difference among extruded and unextruded composite flours. An increase in the proportion of soybean and linseed flour was associated with an increase in phytate, tannin, and water absorption capacity of composite flours. However, bulk density was increased with an increasing proportion of oat in the blend.Conclusion: The findings revealed that extrusion cooking significantly reduced phytate and condensed tannin content and improved the functional properties of the composite complementary food flour. Further investigation is needed on other anti-nutritional factors that are not included in this report.
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Muche A, Melaku MS, Amsalu ET, Adane M. Using geographically weighted regression analysis to cluster under-nutrition and its predictors among under-five children in Ethiopia: Evidence from demographic and health survey. PLoS One 2021; 16:e0248156. [PMID: 34019545 PMCID: PMC8139501 DOI: 10.1371/journal.pone.0248156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/20/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Malnutrition among under-five children is a common public health problem and it is one of the main cause for the mortality of under-five children in developing countries, including Ethiopia. Therefore, lack of evidence about geographic heterogeneity and predictors of under-nutrition hinders for evidence-based decision-making process for the prevention and control programs of under-nutrition in Ethiopia. Thus, this study aimed to address this gap. METHODS The data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2016. A total of 9,384 under-five children nested in 645 clusters were included with a stratified two-stage cluster sampling. ArcGIS version 10.5 software was used for global, local and ordinary least square analysis and mapping. The spatial autocorrelation (Global Moran's I) statistic was held in order to assess the pattern of wasting, stunting, and underweight whether it was dispersed, clustered, or randomly distributed. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of under-nutrition indicators through SaTScan version 9.6 software. Geographically weighted regression (GWR) version 4.0 software was used to model spatial relationships in the GWR analysis. Finally, a statistical decision was made at p-value<0.05 with 95%CI for ordinary least square analysis and geographically weighted regression. MAIN FINDINGS Childhood under-nutrition showed geographical variations at zonal levels in Ethiopia. Accordingly, Somali region (Afder, Gode, Korahe, Warder Zones), Afar region (Zone 2), Tigray region (Southern Zone), and Amhara region (Waghmira Zones) for wasting, Amhara region (West Gojam, Awi, South Gondar, and Waghmira Zones) for stunting and Amhara region (South Wollo, North Wollo, Awi, South Gondar, and Waghmira zones), Afar region (Zone 2), Tigray region (Eastern Zone, North Western Zone, Central Zone, Southern Zone, and Mekele Special Zones), and Benshangul region (Metekel and Assosa Zones) for underweight were detected as hot spot (high risk) regions. In GWR analysis, had unimproved toilet facility for stunting, wasting and underweight, father had primary education for stunting and wasting, father had secondary education for stunting and underweight, mothers age 35-49 years for wasting and underweight, having female children for stunting, having children eight and above for wasting, and mother had primary education for underweight were significant predictors at (p<0.001). CONCLUSIONS Our study showed that the spatial distribution of under-nutrition was clustered and high-risk areas were identified in all forms of under-nutrition indicators. Predictors of under-nutrition were identified in all forms of under-nutrition indicators. Thus, geographic-based nutritional interventions mainly mobilizing additional resources could be held to reduce the burden of childhood under-nutrition in hot spot areas. In addition, improving sanitation and hygiene practice, improving the life style of the community, and promotion of parent education in the identified hot spot zones for under-nutrition should be more emphasized.
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Affiliation(s)
- Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Erkihun Tadesse Amsalu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Fabiano V, Barcellini L, Sartorio MUA, Pendezza E, Leone A, Meneghin F, Dilillo D, Zuccotti GV. Nutritional status of children and adolescents in three Serbian enclaves in Kosovo and Metohija. BMC Public Health 2021; 21:794. [PMID: 33894743 PMCID: PMC8070319 DOI: 10.1186/s12889-021-10848-z] [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: 01/14/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate nutritional status of children and adolescents living in three Serbian enclaves in Kosovo and Metohija. Methods We conducted an observational cross-sectional, population-based study, enrolling children and adolescents who underwent a pediatric screening performed in the three Serbian enclaves of Gračanica, Gornje Kusce and Velika Hoča in Kosovo and Metohija. Children and adolescents (5–19 years) of all ethnic groups were evaluated in one of the three free outpatient medical facilities in rural villages in Kosovo. Body weight and height were measured, height-for-age z- scores (HAZ) and BMI-for-age z-scores (BAZ) indicators were analyzed. The anthropometric indicators HAZ and BAZ distributions were compared between sex and ages using Fisher’s exact test. A two-sample Z-test for proportions was used to detect differences in individual categories of height- and BMI-for-age categories across sexes and age classes. Results Three hundred twenty-eight children and adolescents (184 females, 56.1% and 144 males, 43.9%) aged between 5 and 19 years were enrolled in the study. 241/328 participants showed a normal linear growth; with significantly more girls (78.3%) than boys (67.4%) being in the normal category. Similarly, a significant difference in BAZ distribution between sexes was noted, with more females being in the normal BMI category compared to males (63.0% vs 50.0%, respectively). Underweight and severe underweight subjects showed a prevalence of 1.5 and 0.6%, respectively. Overweight and obesity prevalence was 19.5 and 9.1%, respectively, which was comparable to World Health Organization overweight and obesity prevalence data for Serbia. Conclusions Prevalence of undernutrition and severe undernutrition in children and adolescents living in three Serbian enclaves in Kosovo and Metohija is small. By contrast, a tendency to an increase in overweight and obesity, especially in the male population, was noted.
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Affiliation(s)
- Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Lucia Barcellini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy.
| | - Marco Ugo Andrea Sartorio
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università di Milano, Milan, Italy
| | - Fabio Meneghin
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Università di Milano, Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Università di Milano, 32, Via Castelvetro, 20154, Milan, Italy
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Donovan CV, McElroy P, Adair L, Pence BW, Oloo AJ, Lal A, Bloland P, Nahlen B, Juliano JJ, Meshnick S. Association of Malnutrition with Subsequent Malaria Parasitemia among Children Younger than Three years in Kenya: A Secondary Data Analysis of the Asembo Bay Cohort Study. Am J Trop Med Hyg 2021; 104:243-254. [PMID: 33200723 PMCID: PMC7790106 DOI: 10.4269/ajtmh.20-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/22/2020] [Indexed: 11/07/2022] Open
Abstract
Malaria and malnutrition remain primary causes of morbidity and mortality among children younger than 5 years in Africa. Studies investigating the association between malnutrition and subsequent malaria outcomes are inconsistent. We studied the effects of malnutrition on incidence and prevalence of malaria parasitemia in data from a cohort studied in the 1990s. Data came from the Asembo Bay cohort study, which collected malaria and health information on children from 1992 to 1996 in western Kenya. Infants were enrolled at birth and followed up until loss to follow-up, death, end of study, or 5 years old. Anthropometric measures and blood specimens were obtained monthly. Nutritional exposures included categorized Z-scores for height-for-age, weight-for-age, and weight-for-height. Febrile parasitemia and afebrile parasitemia were assessed with thick and thin blood films. Multiply imputed and weighted multinomial generalized estimating equation models estimated odds ratios (OR) for the association between exposures and outcomes. The sample included 1,182 children aged 0-30 months who contributed 18,028 follow-up visits. There was no significant association between malnutrition and either incident febrile parasitemia or prevalent febrile parasitemia. Prevalence ORs for afebrile parasitemia increased from 1.07 (95% CI: 0.89, 1.29) to 1.35 (1.03, 1.76) as stunting severity increased from mild to severe, and from 1.16 (1.02, 1.33) to 1.35 (1.09, 1.66) as underweight increased from mild to moderate. Stunting and underweight did not show a significant association with subsequent febrile parasitemia infections, but they did show a modest association with subsequent afebrile parasitemia. Consideration should be given to testing malnourished children for malaria, even if they present without fever.
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Affiliation(s)
- Catherine V. Donovan
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peter McElroy
- U.S. President’s Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda Adair
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Brian W. Pence
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Aggrey James Oloo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Altaf Lal
- Malaria Elimination Demonstration Project, Foundation for Disease Elimination and Control of India, Mandla, India
| | - Peter Bloland
- Global Immunization Division, U.S Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Nahlen
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | - Jonathan J. Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven Meshnick
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Pacific R, Martin HD, Kulwa K, Petrucka P. Contribution of Home and School Environment in Children's Food Choice and Overweight/Obesity Prevalence in African Context: Evidence for Creating Enabling Healthful Food Environment. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:283-295. [PMID: 32922118 PMCID: PMC7455532 DOI: 10.2147/phmt.s257549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/24/2020] [Indexed: 12/04/2022]
Abstract
This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from <5% to >40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.
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Affiliation(s)
- Renatha Pacific
- Department of Food Biotechnology and Nutrition Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.,Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Haikael D Martin
- Department of Food Biotechnology and Nutrition Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Kissa Kulwa
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Regina, SK, Canada
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Vaivada T, Akseer N, Akseer S, Somaskandan A, Stefopulos M, Bhutta ZA. Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline. Am J Clin Nutr 2020; 112:777S-791S. [PMID: 32860401 PMCID: PMC7487433 DOI: 10.1093/ajcn/nqaa159] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development. OBJECTIVE This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries. METHODS We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time. RESULTS Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height. CONCLUSIONS Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Selai Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Ahalya Somaskandan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Akseer N, Vaivada T, Rothschild O, Ho K, Bhutta ZA. Understanding multifactorial drivers of child stunting reduction in Exemplar countries: a mixed-methods approach. Am J Clin Nutr 2020; 112:792S-805S. [PMID: 32649742 PMCID: PMC7487431 DOI: 10.1093/ajcn/nqaa152] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several countries have notably reduced childhood stunting relative to economic growth over the past 15-20 y. The Exemplars in Stunting Reduction project, or "Exemplars," studies success factors among these countries with a lens toward replicability. OBJECTIVES This paper details the standardized mixed-methods framework for studying determinants of childhood stunting reduction applied in Exemplars studies. METHODS An expert technical advisory group (TAG), criteria for identifying Exemplar countries, evidence-based frameworks, mixed methodologies (quantitative, qualitative, policy, literature review), effective research partnerships, case study process and timeline, and data triangulation and corroboration are presented. RESULTS Experts in health, nutrition, and evaluation methods were selected at the study outset to provide technical support to all phases of research (TAG). Exemplar countries were selected by the TAG, who considered quantitative data (e.g., annual rates of stunting change compared with economic growth, country population size) and qualitative insights (e.g., logistics of country work, political stability). Experienced country research partners were selected and an inception meeting with stakeholder consultations was held to launch research and garner support. Evidence-based conceptual frameworks underpinned all Exemplars research activities. A systematic review of published peer-reviewed and grey literature was undertaken, along with in-depth policy and program analysis of nutrition-specific and -sensitive investments. Both descriptive and advanced quantitative analysis was undertaken (e.g., equity analyses, difference-in-difference regression, Oaxaca-Blinder decomposition). Qualitative data collection using in-depth interviews and focus groups was conducted with national and community stakeholders (i.e., child care workers and mothers) to understand country experiences. The case study process was iterative, and all research outputs were triangulated to develop the stunting reduction narrative for each country. Findings were shared with country experts for weigh-in and corroboration through dissemination events. CONCLUSIONS Exemplars research uses a mixed-methods framework for studying positive outliers that can be applied across diverse health and development outcomes.
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | | | - Kevin Ho
- Gates Ventures, Kirkland, Washington, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Descriptive Study of Children's Nutritional Status and Identification of Community-Level Nursing Diagnoses in a School Community in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176108. [PMID: 32839373 PMCID: PMC7504264 DOI: 10.3390/ijerph17176108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/23/2022]
Abstract
Effectively responding to children’s nutritional status and eating behaviors in Mozambique requires a community-based care approach grounded in sound nursing research that is evidence-based. The Community Assessment, Intervention, and Empowerment Model (MAIEC) is a nursing theoretical model that is based upon clinical decision-making for community health nurses using communities as a unit of care. We used the MAIEC to identify a community-based nursing diagnosis to address children’s nutritional status and eating behaviors in Mozambique. Objectives: (1) to conduct a descriptive study of children’s nutritional status and eating behaviors in a school community in Mavalane, Mozambique, and (2) to identify a community-based nursing diagnosis using the MAIEC clinical decision-making matrix in the same school community. Method: a cross-sectional, quantitative study was conducted to assess the nutritional status of children using anthropometric data, including brachial perimeter and the tricipital skinfold, and standard deviation for the relation of weight–height, in a sample of 227 children. To assess community management of the problem and identify a community-based nursing diagnosis, we surveyed 176 parents/guardians and 49 education professionals, using a questionnaire based on the MAIEC clinical decision matrix as a reference. Results: malnutrition was identified in more than half of the children (51.3%). We also identified a community-based nursing diagnosis of impaired community management related to the promotion of child health and healthy eating evidenced by the lack of community leadership, participation, and processing among more than 70% of the community members (parents/guardians and education professionals). Conclusion: a nursing diagnosis and diagnostic criteria for nutritional status and community management were identified. The need to intervene using a multidisciplinary public health approach is imperative, with the school community as the unit of care. In addition, reliable anthropometric data were identified as important criteria to complement the nursing diagnosis and guide future public health interventions.
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Gudu E, Obonyo M, Omballa V, Oyugi E, Kiilu C, Githuku J, Gura Z, Ransom J. Factors associated with malnutrition in children < 5 years in western Kenya: a hospital-based unmatched case control study. BMC Nutr 2020; 6:33. [PMID: 32742713 PMCID: PMC7389647 DOI: 10.1186/s40795-020-00357-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 06/18/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally, under-nutrition accounts for > 3 million deaths annually among children < 5 years, with Kenya having ~ 35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya. METHODS We conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height ≤ -2SD or ≥ +2SD; weight-for-age ≤ -2SD or ≥ +2SD; or height-for-age ≤ -2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses. RESULTS A total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR = 7.9; 95% CI: 1.5-41.2), deworming (OR = 0.8; 95% CI: 0.4-1.2), and pre-lacteal feeding (OR = 1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR = 13.9; 95% CI: 2.8-68.6); low birth weight (AOR = 3.3; 95% CI: 1.4-7.6), and paternal lack of formal education (AOR = 4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition. CONCLUSION Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.
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Affiliation(s)
- Edwin Gudu
- Ministry of Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Mark Obonyo
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Victor Omballa
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elvis Oyugi
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Cecilia Kiilu
- West Pokot County Health Department, Kapenguria, West Pokot Kenya
| | - Jane Githuku
- Ministry of Health, Field Epidemiology & Laboratory Training Program, Nairobi, Kenya
| | - Zeinab Gura
- Ministry of Health, Division for Human Resource for Health Development, Nairobi, Kenya
| | - James Ransom
- Piret Partners Consulting, 611 Pennsylvania Avenue SE, Unit 358, Washington, DC 20003 USA
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Yuan B, Dinssa FF, Simon JE, Wu Q. Simultaneous quantification of polyphenols, glycoalkaloids and saponins in African nightshade leaves using ultra-high performance liquid chromatography tandem mass spectrometry with acid assisted hydrolysis and multivariate analysis. Food Chem 2020; 312:126030. [DOI: 10.1016/j.foodchem.2019.126030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
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Jacob Arriola KR, Ellis A, Webb-Girard A, Ogutu EA, McClintic E, Caruso B, Freeman MC. Designing integrated interventions to improve nutrition and WASH behaviors in Kenya. Pilot Feasibility Stud 2020; 6:10. [PMID: 32042436 PMCID: PMC6998333 DOI: 10.1186/s40814-020-0555-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/23/2020] [Indexed: 01/05/2023] Open
Abstract
Background Child stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya. Methods This intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility. Results Using authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages. Conclusions This study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.
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Affiliation(s)
- Kimberly R Jacob Arriola
- 1Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Anna Ellis
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Amy Webb-Girard
- 3Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emily Awino Ogutu
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emilie McClintic
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Bethany Caruso
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Matthew C Freeman
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Yaya S, Odusina EK, Uthman OA, Bishwajit G. What does women's empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries. Glob Health Res Policy 2020; 5:1. [PMID: 31956697 PMCID: PMC6961273 DOI: 10.1186/s41256-019-0129-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023] Open
Abstract
Background The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries. The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development, labour supply, productivity, economic growth and development. This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries. Methods The study utilized secondary datasets of women in their child bearing age (15–49 years) from the latest Demographic and Health Survey (DHS) conducted in 2011–2017 across 30 sub Saharan Africa countries. The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence. Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status. Results Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status (stunted and underweight) at p < 0.001. These characteristics were also statistically significantly associated with empowerment status of women (Decision-making, Violence attitudes and Experience of violence) at p < 0.001 except for child age and sex. The association between childhood nutritional statuses and women’s empowerment (all three empowerment measures) was significant after controlling for other covariates that could also influence childhood nutrition statuses at p < 001. Two of the empowerment measures (attitudes towards violence and experience of violence) showed positive association with childhood nutritional statuses while the third (decision-making) showed negative association. Conclusion There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries. Women’s empowerment was found to be related to childhood nutritional status. Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.
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Affiliation(s)
- Sanni Yaya
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada.,2The George Institute for Global Health, The University of Oxford, Oxford, UK
| | | | - Olalekan A Uthman
- 4Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Ghose Bishwajit
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada
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Water, sanitation and hygiene (WASH) in sub-Saharan Africa and associations with undernutrition, and governance in children under five years of age: a systematic review. J Dev Orig Health Dis 2020; 12:6-33. [PMID: 31902390 DOI: 10.1017/s2040174419000898] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700). The search terms returned 15,351 articles for screening, with 46 articles included. This is indicative of a limited body of knowledge; however, the number of publications on this topic has been increasing, suggesting burgeoning field of interest. Targeted research on the governance of WASH through the identification of the various role players and stakeholders at various levels, while understanding the policy environment in relation to particular health-related outcomes is imperative to address the burden of child undernutrition.
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Yuan B, Byrnes D, Dinssa FF, Simon JE, Wu Q. Quantity assessment of polyphenols, glycoalkaloids and saponins in Solanum scabrum berries of different genetic sources and maturity by HPLC/UV-visible/MS methods. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2019; 99:3578-3587. [PMID: 30628085 DOI: 10.1002/jsfa.9579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/18/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Solanum scabrum berries in sub-Saharan Africa are prolific but neglected as an agricultural resource. Recognition and application of such underutilized resources rely on systematic study of the relevant phytochemicals of commercial value. RESULTS The quantities of a total of 54 phytochemicals in Solanum scabrum berries were assessed using HPLC-MS methods. Berries from eight different genetic sources were analyzed with two entries monitored across different maturation stages. There was a significant variation among mature berries in the accumulation of phenolic acids, 91.5-794 mg·100 g-1 dry weight (DW); flavonols, 76.3-897 mg·100 g-1 DW; anthocyanins, 178-4650 mg·100 g-1 DW; glycoalkaloids, 1.76-1630 mg·100 g-1 DW; and saponins, 82.2-606 mg·100 g-1 DW. Fruit development from immature to post-frost harvest featured dynamic changes in phytochemical composition and, despite remarkable differences in the absolute magnitude of content, the trend of change was generally similar in different genetic sources. CONCLUSIONS The genotype-dependent difference in toxic glycoalkaloids in mature berries may partially explain the consumption controversy as it reflects glycoalkaloid content. The analytical methods applied in this work should serve for quality control of glycoalkaloids thereby improving the safe utilization of this berry. In addition, the selection and breeding of new genotypes with low and safe levels of glycoalkaloids and saponins in the berry could be of value in sub-Saharan Africa to increase nutrition and generate new income opportunities for growers. © 2019 Society of Chemical Industry.
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Affiliation(s)
- Bo Yuan
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
- Department of Food Science, Rutgers University, New Brunswick, NJ, USA
| | - David Byrnes
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
| | | | - James E Simon
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
| | - Qingli Wu
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
- Department of Food Science, Rutgers University, New Brunswick, NJ, USA
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Abstract
Malnutrition continues to be a major killer of children, predominantly in low- and middle-income countries such as India. An ecological study was undertaken to correlate different demographic factors with the prevalence of underweight children. Based on findings from the National Family Health Survey 4 (2015-2016), 81 districts were analysed from three states in the eastern part of India. The findings suggest that female literacy (r = -0.556) and improved sanitation (r = -0.741) reduces the burden of malnutrition. Regarding childbirth, four antenatal visits (ANC), institutional deliveries, full immunisation, early breast feeding and adequate diet also reduce the degree of malnutrition among children. For preventing malnutrition, emphasis should be laid on improving social determinants and maternal health awareness.
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Marinda PA, Genschick S, Khayeka-Wandabwa C, Kiwanuka-Lubinda R, Thilsted SH. Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia. PLoS One 2018; 13:e0204009. [PMID: 30248126 PMCID: PMC6152956 DOI: 10.1371/journal.pone.0204009] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 08/31/2018] [Indexed: 01/03/2023] Open
Abstract
Background This study examines socio-economic determinants of food consumption patterns amongst women of reproductive age and children aged 6–59 months from urban poor settlements of Lusaka and their implications for nutritional status. Particular emphasis was placed on the role of fish in their diets and nutritional status. Methods A cross-sectional survey design was applied, in which 714 mother-child dyads, with children aged 6–59 months were enrolled. A three-stage randomized cluster sampling approach was applied. Results The mean dietary diversity score among children aged 6–23 and 24–59 months was 2.98 (±1.27) and 3.478 (±1.07), respectively. In children aged 6–23 months, there was a significant difference in their nutritional status, based on fish consumption (χ2 = 10.979, df = 2, p = 0.004). Children from poorer households consumed mostly small fish (Kapenta). The quantity of fish consumed by children was significantly associated with stunting in both age groups, odds ratio = 0.947 (95% CI: 0.896, 1.000) for children aged 6–23 months and odds ratio = 1.038 (95% CI: 1.006, 1.072) for children aged 24–59 months old. Other significant risk factors for stunting in children aged 6–23 months were the child’s age, mother’s body mass index, access to treated water and child morbidity. Child’s age, mother’s educational level and wealth status were determinants of dietary diversity in children aged 6–59 months as shown by the Poisson regression. Conclusion Nutritional status of children aged 6–23 months is associated with fish consumption, with children consuming fish less likely to be stunted. Small fish (Kapenta) is an animal-source food that is particularly important in the diet of children in urban poor households in Zambia and contributes to better nutritional outcomes. As all small fish stem from capture fisheries, sustainable one health environmental integration, monitoring and management strategies are desirable.
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Affiliation(s)
- Pamela A. Marinda
- The University of Zambia, School of Agricultural Sciences, Department of Food Science and Nutrition, Lusaka, Zambia
- * E-mail:
| | | | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, Tianjin city, Nankai District, China
| | - Rebecca Kiwanuka-Lubinda
- The University of Zambia, School of Agricultural Sciences, Department of Agricultural Economics and Extension, Lusaka, Zambia
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Trends and determinants of stunting among under-5s: evidence from the 1995, 2001, 2006 and 2011 Uganda Demographic and Health Surveys. Public Health Nutr 2018; 21:2915-2928. [PMID: 30156173 PMCID: PMC6190071 DOI: 10.1017/s1368980018001982] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To describe trends of childhood stunting among under-5s in Uganda and to assess the impact of maternal education, wealth and residence on stunting. Design Serial and pooled cross-sectional analyses of data from Uganda Demographic and Health Surveys (UDHS) of 1995, 2001, 2006 and 2011. Prevalence of stunting and mean height-for-age Z-score were computed by maternal education, wealth index, region and other sociodemographic characteristics. Multivariable logistic and linear regression models were fitted to survey-specific and pooled data to estimate independent associations between covariates and stunting or Z-score. Sampling weights were applied in all analyses. Setting Uganda. Subjects Children aged <5 years. Results Weighted sample size was 14 747 children. Stunting prevalence decreased from 44·8% in 1995 to 33·2% in 2011. UDHS reported stunting as 38% in 1995, underestimating the decline because of transitioning from National Center for Health Statistics/Centers for Disease Control and Prevention standards to WHO standards. Nevertheless, one in three Ugandan children was still stunted by 2011. South Western, Mid Western, Kampala and East Central regions had highest odds of stunting. Being born in a poor or middle-income household, of a teen mother, without secondary education were associated with stunting. Other persistent stunting predictors included small birth size, male gender and age 2–3 years. Conclusions Sustained decrease in stunting suggests that child nutrition interventions have been successful; however, current prevalence does not meet Millennium Development Goals. Stunting remains a public health concern and must be addressed. Customizing established measures such as female education and wealth creation while targeting the most vulnerable groups may further reduce childhood stunting.
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