Factors Responsible for Childhood Malnutrition: A Review of The Literature

How Livelihood Change Affects Food Choice Behaviors in Low- and Middle-Income Countries: A Scoping Review

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study

BACKGROUND

Multidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have strongly linked malnutrition to poverty. Some international studies point to the worse nutritional status of urban slum children than rural children. Limited data is available regarding the nutritional status of slum children in Karachi. This study aimed to determine characteristics of malnourished children in an urban squatter settlement in Karachi, Pakistan.

METHODS

A case- control study was carried out at the primary healthcare center of a squatter settlement in Karachi, Pakistan. All children under five years of age visiting the primary healthcare center were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. The controls were similar in terms of age group but had z scores between - 2SD and + 2SD. A self- structured risk factor questionnaire that included information about sociodemographic, economic and environmental factors as well as child- related characteristics was researcher administered via face-to-face interviews with the mothers of children. Univariate and multivariate logistic regression analyses were conducted. Crude and adjusted odds ratios were calculated with 95% confidence interval.

RESULTS

A total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion of the sample originated from individuals with low household income. After adjusting for the confounders, childhood malnutrition was significantly associated with a low education level of father (aOR 4.86, 95% CI 2.23-10.60), a monthly income less than 25,000 PKR (89 USD) per month (aOR 7.13, 95% CI 1.67-30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67-7.3), less than six months of exclusive breast feeding (aOR 3.578, CI 1.58-8.08), inappropriate weaning age (aOR 3.71, 95% CI 1.53-9).

CONCLUSION

Malnutrition in children under five years of age in the community is associated with low family income, low paternal education, poor toilet facilities, lack of exclusive breastfeeding and inappropriate weaning age. The implementation of poverty reduction programs, sanitation provision at affordable rates, community-based breast feeding and weaning education intervention are urgently required to efficiently improve children's nutritional status.

Undernutrition among children and its determinants across the parliamentary constituencies of India: a geospatial analysis

In India, undernutrition among children has been extremely critical for the last few decades. Most analyses of undernutrition among Indian children have used the administrative boundaries of a state or a district level as a unit of analysis. This paper departs from such a practice and focuses instead on the political boundaries of a parliamentary constituency (PC) as the unit of analysis. The PC is a critical geopolitical unit where political parties and party candidates make election promises and implement programmes to improve the socio-economic condition of their electorate. A focus on child undernutrition at this level has the potential for greater policy and political traction and could lead to a paradigm shift in the strategy to tackle the problem by creating a demand for political accountability. Different dimensions and new approaches are also required to evaluate the socio-economic status and generate concrete evidence to find solutions to the problem. Given the significance of advanced analytical methods and models embedded into geographic information system (GIS), the current study, for the first time, uses GIS tools and techniques at the PC level, conducting in-depth analysis of undernutrition and its predictors. Hence, this paper examines the spatial heterogeneity in undernutrition across PCs by using geospatial techniques such as univariate and bivariate local indicator of spatial association and spatial regression models. The analysis highlights the high-low burden areas in terms of local hotspots and identifies the potential spatial risk factors of undernutrition across the constituencies. Striking variations in the prevalence of undernutrition across the constituencies were observed. Most of these constituencies that performed poorly both in terms of child nutrition and socio-economic indicators were located in the northern, western, and eastern parts of India. A statistically significant association of biological, socio-economic, and environmental factors such as women's body mass index, anaemia in children, poverty, household sanitation facilities, and institutional births was established. The results highlight the need to bring in a mechanism of political accountability that directly connects elected representatives to maternal and child health outcomes. The spatial variability and pattern of undernutrition indicators and their correlates indicate that priority setting in research may also be greatly influenced by the neighbourhood association.

Dietary habits and physical activity patterns in relation to nutritional status among school-aged children in Pakistan: A cross-sectional study

Background

Childhood malnutrition remains a significant public health problem impacting the physical and mental growth if school aged children, particularly in limited-resource countries.

Objective

The study objective was to assess levels of physical activity, patterns of screen time (S.T.), the relationship between physical activity and screen time patterns, and how these factors affect growth status (adjusting for socioeconomic status).

Methodology

A cross-sectional study included 3,834 children between 6-14 years attending pre-selected schools. Teachers, students, and parents were invited to fill out a standardized questionnaire, and Body Mass Index (BMI) was calculated using Center for disease control (CDC) centile charts. A Chi-square was performed to see the possible association between any height and weight abnormalities and all possible risk factors. Multivariate logistic regression was applied to see the effect of variables significantly associated with univariate analysis.

Results

Approximately 2,447 (63.8%) children were between 11-14 years old and 1,387 (36.2%) were between 4-10 years old. The mean height was 143.71 ± 16.51 centimetres, the mean weight was 36.5 ± 12.9 kilogram, and the mean BMI was 17.16 ± 3.52. Multivariate logistic regression status and junk food combined affected stunting socioeconomic status was significantly associated with being underweight p = 0.001.

Conclusion

Childhood obesity and stunting remain significant problems in Pakistani school-going children. These are significantly associated with poverty, a lack of physical activity opportunities, and available food quality.

A combined model of child malnutrition and morbidity in Ethiopia using structural equation models

Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68-0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88-0.99), 48 months and above (AOR = 0.71, 95% CI 0.65-0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78-0.91), high-income households (AOR = 0.66, 95% CI 0.61-0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75-0.85) and higher education level (AOR = 0.57, 95% CI 0.41-0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77-0.99), fourth and higher (AOR = 0.88, 95% CI 0.79-0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64-0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80-0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94-0.097), from middle income (AOR = 0.97, 95% CI 0.96-0.99), high-income households (AOR = 0.94, 95% CI 0.93-0.96), birth spacing 24-47 months (AOR = 0.99, 95% CI 0.98-1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94-0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices.

Dietary diversity and associated factors among children (6-23 months) in Gedeo zone, Ethiopia: cross - sectional study

INTRODUCTION

Different foods and food groups are good sources for various macro- and micronutrients. Diversified diet play an important role in both physical and mental growth and development of children. However, meeting minimum standards of dietary diversity for children is a challenge in many developing countries including Ethiopia.

OBJECTIVE

To assess dietary diversity and associated factors among children (6-23 months) in Gedieo Zone, Ethiopia.

METHOD

Community based cross-sectional study was carried out at Gedieo Zone, Ethiopia, from January to March 15, 2019. Multi-stage sampling technique was used to get a total of 665 children with the age of between 6 and 23 months from their kebeles. Data was collected by using face-to-face interview with structured questionnaire. Data was entered into Epidata version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. Variables having p < 0.25 at bivariate analysis were fitted to multivariable analysis. Multivariable logistic regression model was used at 95% confidence interval and with P-Value < 0.05. Bivariate.

RESULT

A total of 665 children were participated with response rate of 96.2%. Only 199(29.9%) of children were met the minimum requirements for dietary diversity. Age of children [AOR 4.237(1.743-10.295))], Educational status [AOR 2.864(1.156-7.094)], Number of families [AOR 2.865(1.776-4.619))] and household wealth index [AOR4.390(2.300-8.380)] were significantly associated with Dietary Diversity of children.

CONCLUSION

Only, one out of four children aged of 6-23 months attained the minimum dietary diversity score. Children from low socioeconomic status and mothers with no formal educational attainment need special attention to improve the practice of appropriate feeding of children.

Utilizing "Positive deviance inquiry" to explore factors influencing child health: A qualitative study

BACKGROUND

India is a lower middle-income country with one of the fastest growing economies in the world. Despite improvements in its economy, it has a high child mortality rate, with significant differences in child mortality both between and within different states. In this research, we tend to explore factors as to how a particular child's growth is optimal. With this aim, we utilized positive deviance inquiry to study the factors influencing under five child's health.

MATERIALS AND METHODS

This qualitative study was carried out in Naigoan, an urban health setting of metropolitan city with 37 sample size between July 2020 and September 2020. It consisted of total 16 in-depth interviews (IDIs), 3 focus group Discussion (FGDs), and 7 key informant interviews (KIIs) which were performed by predesigned guides.

RESULTS

Various themes evolved with the interviews; however, triangulation of the concept (from FGDs, IDIs, and KIIs) occurred with the following themes: satisfaction among mothers for health-care services, community participation, family support, and new interventions.

CONCLUSION

Mothers' satisfaction to health-care services, community participation, family support, and innovations by the health-care providers are the influencing factors in promoting child's health. Further research can be conducted to understand the in-depth understanding of each factor.

Risk Factors for Mucormycosis in COVID-19 Patients

: Opportunistic infections, such as mucormycosis, in coronavirus disease 2019 (COVID-19) patients has become a new health challenge. Since opportunistic infections can exacerbate COVID-19 patients' status, it is vital to identify the risk factors to prevent, diagnose, and treat them as soon as possible. Viral, fungal, environmental, and host factors may be responsible for this situation. Long hospital stays, impaired host immune system function due to viral infection, and excessive consumption of glucocorticoids in managing COVID-19 patients are the main risk factors for the increased risk of mucormycosis in COVID-19 patients. Educating health care workers and considering the association between mucormycosis of the paranasal sinuses and different strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the cause of COVID-19 can help prevent invasive fungal sinusitis in COVID-19 patients.

Effects of dietary and health factors on nutritional status of children in pastoral settings in Borana, southern Ethiopia, August-October 2015

BACKGROUND

Childhood undernourishment is a major public health problem globally, and being responsible for higher mortalities in children and enormous health costs in sub-Saharan Africa. However, scarcity of data on the magnitude of malnutrition and its underlying causes, especially in the pastoral system, limits the effectiveness of potential interventions. This study addresses the nutritional status and factors associated with malnutrition among children in Borana pastoral system, southern Ethiopia.

METHODS

A community based cross-sectional study, using multistage cluster sampling, was conducted from August to October 2015. Dietary diversity score (DDS), milk and meal frequencies, anthropometric measurements, and socio-economic variables were recorded for 538 children aged 6-59 months. Multivariable generalized linear model (GLM) with log link function was applied to ascertain determinants of malnutrition. The strength of association was assessed based on prevalence ratio (PR).

RESULTS

Prevalence of underweight, stunting, and wasting were 28.3 % (95 % CI: 24.4-32.1), 41.1 % (95 % CI: 36.7-45.1), and 9.8 % (95 % CI: 7.3, 12.4), respectively. Children who consumed more diverse foods were at a lower risk of being underweight (PR = 0.72, 95 % CL: 0.59-0.88), stunted (PR = 0.80, 95 % CL: 0.68-0.93) and wasted (PR = 0.42, 95 % CL: 0.27-0.66). Intake of increased milk frequency was also associated with lower risk of underweight (PR = 0.86, 95 %CL: 0.76-0.97), stunting (PR = 0.83, 95 %CL: 0.75-0.91) and wasting (PR = 0.73, 95 %CL: 0.56-0.96). The risk of underweight (PR = 1.02, 95 %CL: 1.01-1.03), stunting (PR = 1.01, 95 %CL: 1.00-1.02) and wasting (PR = 1.01, 95 %CL: 1.00-1.04) had increased with age, and no difference was observed between boys and girls. Children who lived far away from health care facilities were 1.2 and 2.4 times more likely to be stunted and wasted, respectively than those residing near a health care facility. Ownership of toilet and living close to market were associated with reduced stunting, whereas illness was associated with increased risk of underweight.

CONCLUSIONS

The high prevalence of stunting among pastoral children is a serious public health concern and calls for urgent action. Association of nutritional status of children with dietary intake, and health status, access to health services and toilet availability underlines the need for improved nutrition practices, health care facilities and sanitary conditions in the study area.

Holistic-comprehensive approaches to improve nutritional status of children under five years

Background: Malnutrition has been identified as the leading cause of illness and death in almost half of children under 5 years. Hence, to prevent the impact of malnutrition on physical and psychological development, family physicians need to explore new approaches in the health care delivery models that go beyond the scope of practice. A holistic-comprehensive approach will help the physicians develop a more thorough assessment of nutritional status. This study aims to determine factors associated with the nutritional status of children under five years using holistic-comprehensive approaches.

Design and Methods: A case–control design was implemented, with emphasis on the identification of cases and control groups; 48 children confirmed malnutrition cases and 48 control without malnutrition were recruited from a Community Integrated Health Center in East Java, Indonesia. The characteristics of agent, host and environment between groups were compared and analyzed using correlation coefficients, odds ratio, logistic regression analysis, and Structural Equation Modeling-Partial Least Square (SEM-PLS).

Results: The SEM-PLS results showed that environmental factors have a greater influence on nutritional status (t-value >1.96), compared to the host factors. Furthermore, environmental factors having significant associations with nutritional status were poor socioeconomic status, low maternal educational level and not having exclusive breastfeeding. Also, the results of correlation coefficients and OR showed that birth weight (p=0.000, OR=33) and socioeconomic status (p=0.000, OR=22.3) had strong correlations with nutritional status.

Conclusions: Holistic-comprehensive approaches can be used as new ways to determine factors that may be associated with nutritional status of children under 5 years of age.