Determinants of stunting among children under 2 years in urban informal settlements in Mumbai, India: evidence from a household census

Effects of short birth interval on child malnutrition in the Asia-Pacific region: Evidence from a systematic review and meta-analysis

Child malnutrition remains a significant concern in the Asia-Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia-Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia-Pacific region between September 2000 and May 2023. Fixed-effects or random-effects meta-analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta-analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97-1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88-6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national-level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia-Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality.

Association of parental level of education and child factors on length-for-age indicator among socially vulnerable children aged 6-24 months from a Brazilian state using structural equation modelling

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6-24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: -0·06; P = 0·017), the use of bottle feeding (sDE: -0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: -0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: -0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges.

The association of sociodemographic, nutrition, and sanitation on stunting in children under five in rural area of West Java Province in Indonesia

Background

The prevalence of stunting in Indonesia has decreased gradually. The strategy to reduce stunting is currently prioritized on improving socio-economic levels, fulfilling food intake, and sanitation conditions. This study aims to analyze the association between sociodemographics, nutrition, and sanitation on stunting in rural West Java Province in Indonesia.

Design and methods

A cross-sectional study was conducted in May-August 2022 among 247 mother-children pairs, selected by systematic random sampling from a rural area of West Java Province in Indonesia. The sociodemographic characteristics were measured using a structured questionnaire. The nutritional status of the children under five was assessed by length/height-for-age (HAZ), and was calculated using WHO Anthro software. Sanitation is assessed using observation and interviews with a structured questionnaire.

Results

The prevalence of stunting in children under five was 20.7% (5.3% severely stunted and 15.4% stunted). Binary logistic regression analysis using SPSS version 22.0 show that mother's height as the dominant factor associated with stunting in children under five (AOR = 3.45, 95% CI: 1.12-4.67, p = 0.008). In addition, children's age (AOR = 0.250, 95% CI: 0.104-0.598, p = 0.002); balanced diet practices (AOR = 1.57, 95% CI: 0.965-2.56, p = 0.069), and building materials (AOR = 1.869, 95% CI: 0.87-4.00, p = 0.108 are also related to stunting in children under five.

Conclusions

Efforts to improve maternal nutrition need to be carried out from the period before pregnancy to the first 1000 days of life. Education on healthy home indicators, especially the use of this type of building materials for houses, needs to be done to improve sanitation as an effort to prevent stunting in children under five.

Analysis of the Determinants of Stunting among Children Aged below Five Years in Stunting Locus Villages in Indonesia

Determinants of stunting are a concern in stunting locus villages, especially in East Nusa Tenggara, the province with the highest prevalence of stunting in Indonesia. This study aims to analyze the determinants of stunting in such villages. A cross-sectional research design was conducted on a sample of 166 mothers of children aged 24–59 months selected using a proportional random sampling method in four stunting locus villages in East Nusa Tenggara province, from January to March 2022. Chi-square and binary logistic regression were used to analyze the determinants of stunting with a significance level of p < 0.05. The prevalence of stunting among children aged below five years in the villages was 22.3%. Lack of maternal knowledge (AOR: 5.310; 95% CI: 0.671–41.997) and negative parenting (AOR: 3.026; 95% CI: 1.191–7.871) were associated with higher risk of stunting. Meanwhile, children aged below five years with close birth spacing (AOR: 0.304; 95% CI: 0.087–1.063) had a low risk of stunting. The prevalence of stunting in stunting locus villages needs special attention from the Indonesian government. Maternal knowledge should be enhanced by distributing information related to stunting through formal and non-formal education and teaching good parenting to reduce the prevalence of stunting among children aged below five years in stunting locus villages.

Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis

Background

Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear.

Methods

In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting.

Results

Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months.

Conclusion

The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.

Prevalence and risk predictors of childhood stunting in Bangladesh

BACKGROUND

The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh.

METHODS AND MATERIALS

In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution.

RESULTS

The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children.

CONCLUSIONS

To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.

Secular Growth Trends in Early Childhood—Evidence from Two Low-Income Birth Cohorts Recruited over a Decade in Vellore, India

Stunting and extreme poverty are considered significant risk factors impacting child development in low-and-middle-income countries. We used two birth cohorts recruited 8–9 years apart in urban low-income (slum) settings in Vellore, south India and analyzed secular growth trends and their predictors. In the rotavirus cohort recruited between 2002 and 2003, 373 children completed the 3-year follow-up. “The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development” (MAL-ED) cohort recruited between 2010 and 2012 had 215 children completing follow-up. The MAL-ED cohort had better socio-economic status (SES) markers and mothers were better educated compared with the previous cohort. Children in the MAL-ED cohort had less stunting at 1, 2, and 3 years of age. The linear mixed effects model evaluating linear growth during the first 3 years of age showed that low birth weight and being a female child were associated with stunting in both cohorts. There was no association between SES and stunting in the rotavirus cohort, whereas SES was associated with linear growth in the MAL-ED cohort. Future studies could incorporate nutritional and nonnutritional interventions in vulnerable populations to evaluate their effect on birth weight as well as early childhood stunting.

Stunting Prevention with Education and Nutrition in Pregnant Women: A Review of Literature

Background : Stunting is a major nutritional problem in children under five years old which has an impact on slowing growth by reducing the number and development of body cells, including brain cells and other organs. Pregnant women are one of the groups who are vulnerable to nutritional problems, related to the process of growth and development of the fetus in the womb. The role of education and nutrition is important during pregnancy because it has implications for the health of mothers and children in later life. The aimed of this review was to identify research about effect stunting prevention and education and nutrition to pregnant women. Methods : A database review undertaken using Pubmed, CHINAHL and Google Scholar from 2011-2021 to collect focused study on education and nutrition research on pregnant women to prevent stunting. A total of 1788 articles were identified. These were scaned and 18 articles were retrieved with 13 articles shortlisted for to in depth review. Results : Education with using audiovisual media, moringa leaf ice cream and early nutrition has proved effective in increasing pregnant women knowledge regarding stunting prevention. Providing nutritional supplements/nutrients for moringa oliefera, folic acid and iron, specific nutrition, LNS, PM2A PROCOMIDA, nutrition before pregnancy, supplements antenatal iron and folic acid, prenatal micronutrients have an effect on reducing children stunting. Conclusion: Audio visual education can convery health knowledge because easily to facilitate the reception of health message for pregnant women. Continuous education and monitoring of the of pregnant women diet every month during pregnancy classes at the posyandu are needed to prevent stunting in children.