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Asebe HA, Asmare ZA, Mare KU, Kase BF, Tebeje TM, Asgedom YS, Shibeshi AH, Lombebo AA, Sabo KG, Fente BM, Bezie MM, Seifu BL. The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis. Front Nutr 2024; 11:1336864. [PMID: 38903623 PMCID: PMC11187342 DOI: 10.3389/fnut.2024.1336864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.
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Affiliation(s)
- Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanose Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Afewerk Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meklit Melaku Bezie
- Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia
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Jain L, Pradhan S, Aggarwal A, Padhi BK, Itumalla R, Khatib MN, Gaidhane S, Zahiruddin QS, Santos CAG, Al-Mugheed K, Alrahbeni T, Kukreti N, Satapathy P, Rustagi S, Heidler P, Marzo RR. Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study. JMIR Public Health Surveill 2024; 10:e41567. [PMID: 38787607 PMCID: PMC11161711 DOI: 10.2196/41567] [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: 09/06/2022] [Revised: 06/12/2023] [Accepted: 11/21/2023] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. OBJECTIVE This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. METHODS We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. RESULTS Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. CONCLUSIONS Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.
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Affiliation(s)
- Lovely Jain
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Arun Aggarwal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | | | - Khalid Al-Mugheed
- Adult Health Nursing and Critical Care, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Tahani Alrahbeni
- Molecular Toxicology and Genetics, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| | - Petra Heidler
- Institute International Trade and Sustainable Economy, IMC Krems University of Applied Sciences, Krems, Austria
| | - Roy Rillera Marzo
- Faculty of Humanities and Health Sciences, Curtin University, Miri Sarawak, Malaysia
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Rahut DB, Mishra R, Bera S. Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutrition 2024; 120:112346. [PMID: 38320385 DOI: 10.1016/j.nut.2023.112346] [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: 08/06/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. METHODS To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. RESULTS This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. CONCLUSIONS This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.
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Affiliation(s)
| | - Raman Mishra
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Subhasis Bera
- International School of Business and Media, Budge Budge, Kolkata, West Bengal, India
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Talukdar R, Ravel V, Barman D, Kumar V, Dutta S, Kanungo S. Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years. Diabetes Metab Syndr 2024; 18:102976. [PMID: 38508036 DOI: 10.1016/j.dsx.2024.102976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries. METHODS PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates. RESULTS Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates. CONCLUSIONS The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.
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Affiliation(s)
- Rounik Talukdar
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vanessa Ravel
- ICMR - National Institute of Epidemiology, Chennai, Tamil Nadu, India.
| | - Diplina Barman
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vivek Kumar
- Deepak Foundation, Katni, Madhya Pradesh, India.
| | - Shanta Dutta
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Suman Kanungo
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
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5
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Grace N, Mbabazi E, Mukunya D, Tumuhamye J, Okechi H, Wegoye E, Olupot-Olupot P, Matovu JK, Hopp L, Napyo A. High burden of wasting among children under-five with hydrocephalus receiving care at CURE children's hospital in Uganda: a cross-sectional study. BMC Nutr 2024; 10:14. [PMID: 38233952 PMCID: PMC10795367 DOI: 10.1186/s40795-024-00819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Hydrocephalus is one of the most common neurological disabilities presenting in children. Although there are limited studies on its association with wasting, neurological comorbidities such as dysphagia have been associated with an increased risk of wasting in children. In this study, we aimed to determine the prevalence and factors associated with wasting in children less than five years with hydrocephalus. METHODS We conducted a cross-sectional study at various satellite clinics of CURE Children's Hospital in Uganda between September and November 2021. Children with hydrocephalus were identified at the outpatient departments of the satellite clinics of the Cure Children's Hospital and these include Mbale, Gulu, Lira, Jinja and Katalemwa. A structured questionnaire was used to collect information on several variables including (1) for the mother: socio-demographic characteristics, partner support, and wealth index (2) for the child: socio-demographic characteristics, clinical symptoms, feeding difficulties and neural comorbidity. Anthropometric measurements were also taken and these included the mid-upper arm circumference. Data were analysed using Stata version 14. We estimated adjusted odds ratios and their corresponding 95% confidence intervals while relying on multivariable logistic regression models. RESULTS The prevalence of wasting among children with hydrocephalus was 23.2% (n = 89/384) (95%CI: 19 - 27.7%). Their mean age was 19.5 months (SD 16.8). Most of the children were below 12 months (47.9%) and were male (57.5%). The factors associated with wasting among children with hydrocephalus included: having; difficulty in chewing and swallowing (AOR = 2.6, (95%CI:1.05-3.94), a poor appetite (AOR = 1.74, (95%CI: 1.31-2.32), difficulty in breathing (AOR = 1.9, (95%CI: 1.18-3.16), chocking on food (AOR = 1.42, (95%CI:1.1-1.9) and attending the Mbale satellite clinic (AOR = 2.1 (95% CI 1.19-3.7). Children under 5 years of age with hydrocephalus that were born to women whose highest level of education was 7 to 10 years of formal schooling (AOR = 0.32, 95%CI: (0.12-0.87) were less likely to be wasted. CONCLUSIONS AND RECOMMENDATIONS The prevalence of wasting among children with hydrocephalus was high. The factors associated with wasting were mainly feeding challenges. We recommend that children with hydrocephalus should be given greater attention regarding their nutrition especially those with various forms of feeding difficulties. The caregivers of children with hydrocephalus should receive counseling on nutrition and on the best modalities to rely on while feeding their children.
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Affiliation(s)
- Naula Grace
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Edith Mbabazi
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Josephine Tumuhamye
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Humphrey Okechi
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - Emmanuel Wegoye
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - Peter Olupot-Olupot
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Joseph Kb Matovu
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Leah Hopp
- Department of Community Health, Akisyon a Yesu Presbyterian Clinic, Nakaale, Karamoja, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
- Department of Nursing Sciences, School of Medicine, Kabale University, Kabale, Uganda.
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Comley-White N, Ntsiea V, Potterton J. Physical functioning in adolescents with perinatal HIV. AIDS Care 2024; 36:60-69. [PMID: 37229771 DOI: 10.1080/09540121.2023.2214862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
Perinatal HIV impacts on growth and development in childhood, with physical impairments such as growth limitations, decreased physical activity, reduced exercise tolerance and cardiopulmonary dysfunction continuing into adolescence. There is limited data on other physical functioning domains in perinatally HIV-infected adolescents (PHIVA) thus the aim of this study was to establish the physical sequelae of perinatal HIV in adolescents. This South African cross-sectional study compared PHIVA with HIV-negative adolescents, assessing anthropometry, muscle strength, endurance and motor performance. All ethical considerations were adhered to. The study included 147 PHIVA and 102 HIV-negative adolescents, aged 10-16 years. The majority (87.1%) of PHIVA were virally suppressed however, they still showed significant deficits in height (p < 0.001), weight (p < 0.001) and BMI (p = 0.004). Both groups performed poorly in muscle strength and endurance but did not differ significantly. In motor performance, the PHIVA scored significantly lower for manual dexterity and balance, with significantly more PHIVA with motor difficulty. A regression analysis showed that viral suppression predicted muscle strength (p = 0.032) and age positively predicted endurance (p = 0.044) and negatively predicated aiming and catching (p = 0.009). In conclusion, PHIVA face growth deficits and challenges with motor performance, especially with manual dexterity and balance.
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Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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Roba AA, Başdaş Ö. Multilevel analysis of trends and predictors of concurrent wasting and stunting among children 6-59 months in Ethiopia from 2000 to 2019. Front Nutr 2023; 10:1073200. [PMID: 37720379 PMCID: PMC10502729 DOI: 10.3389/fnut.2023.1073200] [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: 10/18/2022] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Emerging evidence indicates that children can be concurrently wasted and stunted (WaSt), increasing their mortality risk. However, more is needed to know about WaSt in Ethiopia. Therefore, this study aimed to determine the trends and predictors of WaSt using Ethiopian Demographic and Health Survey datasets from 2000 and 2019. Methods The study included a total weighted sample of 34,930 children aged 6-59 months. Descriptive and weighted multilevel mixed-effects (fixed and random effects) logistic regression analyses were carried out. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Results The prevalence of WaSt was 1,682 (4.82%) with a significantly decreasing trend, yielding a percent change of -57.51% (-69.37% to -23.52%) from 2000 to 2019. In the adjusted model, the odds of WaSt increased in boys, children with a shorter preceding birth interval, small birth size, delayed initiation of complementary foods, diarrhea, fever, and anemia, mother's lack of formal education, and being a farmer, and poor/middle wealth index, and lack of mass media exposure. WaSt was inversely related to the child's age. Adjusted ICC and MOR were 31.16% and 3.20%, respectively. Conclusion and recommendations The study highlights the importance of considering individual and community-level factors to address WaSt, such as timely initiation of complementary foods, improving access to health services, quality diet, and prevention of communicable diseases. Furthermore, programs that have positive impacts on formal education and employment opportunities for girls, as well as that increase access to mass media, are required.
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Affiliation(s)
- Aklilu Abrham Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
| | - Öznur Başdaş
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
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Mertens A, Benjamin-Chung J, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF. Child wasting and concurrent stunting in low- and middle-income countries. Nature 2023; 621:558-567. [PMID: 37704720 PMCID: PMC10511327 DOI: 10.1038/s41586-023-06480-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Getu BD, Azanaw KA, Zimamu LY, Adal GM, Tibebu NS, Emiru TD, Atalell KA. Wasting and its associated factors among children aged from 6 to 59 months in Debre Tabor town, Amhara region of Ethiopia, 2019: a multicentre community-based cross-sectional study. BMJ Open 2023; 13:e071679. [PMID: 37407062 DOI: 10.1136/bmjopen-2023-071679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Wasting is acute malnutrition that has harmful short-term consequences for children and is determined by an inadequate diet. This study aimed to assess the prevalence and associated factors of wasting among children aged 6-59 months in Debre Tabor town, Ethiopia. DESIGN This study was a community-based cross-sectional. SETTING The study was conducted at Debre Tabor town, Ethiopia. PARTICIPANTS A total of 436 children aged 6-59 months participants were enrolled. OUTCOME MEASURES A weight-for-height z-score, which is below -2 SD of the WHO median standard curve, was used to measure wasting. Logistic regression analyses were done to see which independent variables have an association with the dependent variable and a p value of <0.05 was considered significant at the 95% CI. RESULTS The result revealed that wasting in children aged 6-59 months was 6.2%. Children in the age group of 6-11 months were 4.3 times more likely to have wasted than those in the age group of 24-59 months (adjusted OR (AOR): 4.3; 95% CI: 1.5 to 12.5). Similarly, parents who have poor wealth status in their family are 3.1 times more likely to have wasted children than those who have rich wealth status in their family (AOR: 3.1 (1.01 to 9.35)). Moreover, mothers who gave birth at the age group of 20-25 years were 4.3 times more likely to have wasted children than those who gave birth at an age group of greater than 30 years (AOR: 4.3 (4.3 (1.56 to 12.5)). CONCLUSION Wasting is still an important public health problem for children in the age group of 6-59 months. The age of the child, the wealth status of the family, and giving birth before 20 years of age were significantly associated with wasting. Therefore, the government of Ethiopia should pay further attention to the wealth status of the family; create awareness among the mothers regarding childhood undernutrition care, and design further nutritional intervention programmes.
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Affiliation(s)
- Bisrat Dessie Getu
- Department of Nursing, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
| | | | | | - Gashaw Mekete Adal
- Department of Nursing, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Desie Emiru
- Department of Pediatrics and Child Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Manivannan MM, Vaz M, Swaminathan S. Perceptions of healthcare providers and mothers on management and care of severely wasted children: a qualitative study in Karnataka, India. BMJ Open 2023; 13:e067592. [PMID: 37258068 DOI: 10.1136/bmjopen-2022-067592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To explore perceptions of healthcare providers and mothers of children with severe wasting on the perceived reasons for severe wasting, constraints on the management and barriers to caregiving and care-seeking practices. DESIGN In-depth qualitative interviews conducted with healthcare providers and mothers of children with severe wasting. SETTING Urban and rural locations in Karnataka state, India. PARTICIPANTS Healthcare providers (anganwadi workers, accredited social health activists, auxiliary nurse midwives, junior health assistant, medical officers, nutrition counsellors) from public healthcare centres and mothers of children with severe wasting. RESULTS Forty-seven participants (27 healthcare providers, 20 mothers) were interviewed. Poverty of households emerged as the underlying systemic factor across all themes that interfered with sustained uptake of any intervention to address severe wasting. Confusion of 'thinness' and shortness of stature as hereditary factors appeared to normalise the condition of wasting. Management of this severe condition emerged as an interdependent phenomenon starting at the home level coupled with sociocultural factors to community intervention services with its supplemental nutrition programme and clinical monitoring with therapeutic interventions through an institutional stay at specialist referral centres. A single-pronged malnutrition alleviation strategy fails due to the complexity of the ground-level problems, as made apparent through respondents' lived experiences. Social stigma, trust issues between caregivers and care-seekers and varying needs and priorities as well as overburdened frontline workers create challenges in communication and effectiveness of services resulting in perpetuation of severe wasting. CONCLUSIONS To ensure a continuum of care in children with severe wasting, economic and household constraints, coordinated policies across the multidimensional determinants of severe wasting need to be addressed. Context-specific interventions are necessary to bridge communication gaps between healthcare providers and caregivers.
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Affiliation(s)
- Madhu Mitha Manivannan
- Division of Nutrition, St. John's Research Institute, St John's Medical College, St. John's National Academy of Health Sciences, a recognized research centre of University of Mysore, Bangalore, Karnataka, India
| | - Manjulika Vaz
- Division of Health and Humanities, St John's Research Institute, St John's Medical College, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Sumathi Swaminathan
- Division of Nutrition, St. John's Research Institute, St John's Medical College, St. John's National Academy of Health Sciences, a recognized research centre of University of Mysore, Bangalore, Karnataka, India
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Sokhela H, Govender L, Siwela M. Complementary Feeding Practices and Childhood Malnutrition in South Africa: The Potential of Moringa Oleifera Leaf Powder as a Fortificant: A Narrative Review. Nutrients 2023; 15:nu15082011. [PMID: 37111230 PMCID: PMC10145218 DOI: 10.3390/nu15082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Poor complementary feeding is a common practice in developing regions, including South Africa (SA), and is one of the main contributing factors to childhood malnutrition. This paper reviews the literature on complementary feeding practices in SA and the potential of fortifying home-prepared complementary foods with Moringa oleifera to improve their nutritional composition. Studies that investigated complementary feeding practices, indigenous crops, nutritional benefits of Moringa oleifera, and the use of MOLP as a fortificant both locally and globally were included in this review. In SA, maize meal and commercial cereal are the most commonly used complementary infant foods. The diet consumed by children from vulnerable households commonly has insufficient nutrients. Foods consumed are generally high in starch and low in other essential nutrients, including good-quality protein. Impoverished individuals consume poor-quality foods as they are unable to afford a diversified diet with food from different food groups, such as protein, fruits, and vegetables. In SA, various programs have been implemented to reduce the incidence of childhood malnutrition. However, childhood malnutrition remains on the rise. This shows a need for complementary food-based strategies that can be implemented and sustained at a household level. This can be conducted through the use of accessible indigenous crops such as Moringa oleifera. Moringa oleifera contains essential nutrients such as proteins, amino acids, vitamins, and minerals. Therefore, it could possibly be used as a home-prepared complementary food fortificant to enhance nutritional composition. Before complementary foods can be fortified with Moringa oleifera, popular home-prepared complementary foods must be identified.
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Affiliation(s)
- Hlengiwe Sokhela
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg 3201, South Africa
| | - Laurencia Govender
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg 3201, South Africa
| | - Muthulisi Siwela
- Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg 3201, South Africa
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Jansen S, Apondi E, Ayaya SO, Kim J, McHenry MS. Growth Anthropometrics as a Metric of Malnutrition Disparities Among Young Children Affected by HIV who are Orphaned Maternally, Paternally, or Totally in Western Kenya: A Retrospective Chart Review. Glob Pediatr Health 2023; 10:2333794X231156045. [PMID: 36814531 PMCID: PMC9940225 DOI: 10.1177/2333794x231156045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
This retrospective study investigated growth outcomes of Kenyan children born to women living with HIV, comparing children who were orphaned maternally, paternally, and totally (both parents deceased) to those who were non-orphaned. We reviewed HIV clinic visits performed in Kenya from January 2011 to August 2016 in children 0 to 4 years of age. Malnutrition was assessed using stunting, underweight status, and wasting (z-scores of ≤-2). Descriptive statistics, Chi-square, t-tests, multivariable logistic regression, and ANCOVA models were performed. Of 15 027 total children in the study population, 3.5% (n = 520) were orphaned maternally, 8.1% (n = 1222) were orphaned paternally, and 2.2% (n = 336) were orphaned totally. Children who were orphans had higher rates of malnutrition compared to non-orphans (P < .001). Children who were orphaned maternally and totally had lower anthropometric mean scores, presented to clinic later, and were more likely to be living with HIV. Children who are orphaned maternally or totally should be targeted in interventional strategies.
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Affiliation(s)
- Shae Jansen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Jiae Kim
- Indiana University, Bloomington, IN, USA
| | - Megan S. McHenry
- Indiana University School of Medicine, Indianapolis, IN, USA,Megan S. McHenry, Indiana University School of Medicine, 410 W. 10th Street, Suite 2000V, Indianapolis, IN, USA.
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Mavragani A, Hailegebreal S, Sako S, Haile F, Gilano K, Seboka BT, Kashala K. Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models. JMIR Public Health Surveill 2023; 9:e39744. [PMID: 36753309 PMCID: PMC9947770 DOI: 10.2196/39744] [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: 05/20/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. OBJECTIVE This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. METHODS We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model's assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. RESULTS In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (-40.40, 95% CI -40.41 to -40.32), home delivery (-35.51, 95% CI -35.55 to -35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (-12.65, 95% CI -12.69 to -12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). CONCLUSIONS According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services.
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Affiliation(s)
| | - Samuel Hailegebreal
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Sewunet Sako
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Firehiwot Haile
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Kasarto Gilano
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Kefita Kashala
- Department of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
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Age-appropriate feeding practices and their association with undernutrition among children aged 6-23 months in aspirational districts of India: a multinomial analysis. J Biosoc Sci 2023; 55:1-21. [PMID: 34749840 DOI: 10.1017/s0021932021000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
'Health and nutrition' is one among the five areas covered by the Aspirational District Programme in India, which aims to achieve the Sustainable Development Goals (SDGs). The reduction of undernutrition in under-five children has remained a major focus of the SDGs, especially at the ages of 6-23 months as this affects child development. This study used National Family Health Survey 2015-16 data to examine appropriate feeding practices and their associations with undernutrition among children aged 6-23 months in the 124 aspirational districts of India. Multinomial logistic regression analysis was used to analyse the association between feeding practices and undernutrition, adjusting for covariates. A total of 13,851 children aged 6-23 months were included in the analysis. Child nutritional outcomes, and children receiving the recommended minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD), were poorer in the aspirational compared with non-aspirational districts. However, the proportions of children who continued to breastfed, i.e. currently breastfeeding and the proportion of children who were receiving appropriate breastfeeding, i.e. receiving complementary feeding, in addition to breast milk, were higher in the aspirational districts. Appropriate breastfeeding and MDD were found to be associated negatively with undernutrition. While the continuation of breastfeeding increased the odds of children being undernourished, appropriate breastfeeding lowered the odds. The significant predictors of undernourishment among the study children were the child being male, of higher birth order, older and of smaller than average birth size; mother's lower educational level, mother's lower BMI of mothers and being a teenage mother; and poor household drinking water, sanitation facilities and lower economic status. This study suggests that educating mothers, especially illiterate and poor mothers, about appropriate breastfeeding and dietary diversity could help prevent and reduce child undernutrition in the aspirational districts of India.
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Ewune HA, Abebe RK, Sisay D, Tesfa GA. Prevalence of wasting and associated factors among children aged 2-5 years, southern Ethiopia: a community-based cross-sectional study. BMC Nutr 2022; 8:160. [PMID: 36585708 PMCID: PMC9805277 DOI: 10.1186/s40795-022-00657-x] [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: 03/12/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Wasting (acute malnutrition) is the most serious form of malnutrition for children in the near term. Malnutrition has a variety of causes, all of which are interconnected and hierarchically related. The purpose of this study was to assess the prevalence of wasting and its associated determinants among children under the age of five in the Wonago district, Gedeo zone, southern Ethiopia. METHODS Community based cross-sectional study was conducted from October 1 to 30, 2021 using a systematic random sampling technique. Data were entered using Epidata manager and STATA v.20 software was used for analysis. Descriptive statistics were reported to describe the study population. To identify associated factors of wasting, bivariate and multivariate logistic regression analysis were fitted. Variables having p-value < 0.05 were declared statistically significant predictors of wasting. RESULTS A total of 390 respondents participated with a response rate of 92.6%. The prevalence of wasting among children aged 2-5 years in Wonago district was 36.4% (95% CI: 31.76-41.32). Moderate household food insecurity (AOR = 0.35, 95%CI: 0.14-0.83), history of recurrent illness (AOR = 0.15, 95%CI: 0.26-0.84), and duration of breastfeeding greater than 2 years (AOR = 0.15, 95%CI: 0.26-0.84) were significantly associated with wasting. CONCLUSION Almost one-third of the children were wasted. Household food insecurity, breastfeeding, and recurrent illness were significantly associated with wasting among children aged 24-59 months. It is recommended that interventions be designed with food security, disease prevention, and breastfeeding awareness in mind and put the spotlight on food and nutrition policy to insure children's nutritional status.
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Affiliation(s)
- Helen Ali Ewune
- grid.472268.d0000 0004 1762 2666Human nutrition department, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Reta Kassa Abebe
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Getanew Aschalew Tesfa
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
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Abdulla F, El‐Raouf MMA, Rahman A, Aldallal R, Mohamed MS, Hossain MM. Prevalence and determinants of wasting among under-5 Egyptian children: Application of quantile regression. Food Sci Nutr 2022; 11:1073-1083. [PMID: 36789038 PMCID: PMC9922126 DOI: 10.1002/fsn3.3144] [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: 06/21/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Wasting is one of the symptoms of malnutrition that has been connected to the deaths of malnourished children. This study was intended to explain the effect of socio-demographic and economic factors on under-5 wasting by evaluating their conditional effect across the distribution of weight-for-height Z (WHZ) scores using the quantile regression (QR) model. The weighted sample which included 13,680 children under 5 years was taken from the countrywide Egyptian DHS 2014 survey. The results depicted that about 2% of Egyptian children were severely wasted, with the prevalence of wasting being around 8%. It was discovered that across the WHZ distribution, the child's features, maternal characteristics, father's education, and social factors had significant but varied contributions in explaining the wasting status of under-5 children. It was revealed that female children had a significant weight advantage, notably 0.21 standard deviation (SD) higher weight at the 95th quantile over their male counterparts. The WHZ score was also found to be significantly positively associated with both age and household's wealth status at the lower and upper tails of the WHZ distribution, respectively. Moreover, in comparison with children whose mothers were underweight, those whose mothers were normal or overweight had higher WHZ scores, with a 1.45 SD increase in WHZ scores at the 95th quantile for mothers who were normal weights. Furthermore, the children who were breastfed, whose mothers received antenatal care (ANC) services, and/or who had educated parents had an advantage in terms of WHZ scores than their counterparts. In addition, the children with higher birth order and/or who resided in urban areas had weight disadvantages compared to their counterparts. Therefore, in order to improve children's nutritional status and achieve the Sustainable Development Goals (SDGs) by 2030, the government and public-private owner organizations must work together at the community level focusing on vulnerable groups.
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Affiliation(s)
- Faruq Abdulla
- Department of Applied Health and NutritionRTM Al‐Kabir Technical UniversitySylhetBangladesh
| | - M. M. Abd El‐Raouf
- Basic and Applied Science Institute, Arab Academy for Science, Technology and Maritime Transport (AASTMT)AlexandriaEgypt
| | - Azizur Rahman
- School of Computing, Mathematics and EngineeringCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Ramy Aldallal
- Department of Accounting, College of Business Administration in Hawtat Bani TamimPrince Sattam bin Abdulaziz UniversityAl‐KharjSaudi Arabia
| | - Mohamed S. Mohamed
- Department of Mathematics, College of ScienceTaif UniversityTaifSaudi Arabia
| | - Md. Moyazzem Hossain
- Department of StatisticsJahangirnagar UniversityDhakaBangladesh,School of Mathematics, Statistics and PhysicsNewcastle UniversityNewcastle upon TyneUK
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Impact of Drinking Water Source and Sanitation Facility on Malnutrition Prevalence in Children under Three: A Gender-Disaggregated Analysis Using PDHS 2017-18. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111674. [PMID: 36360402 PMCID: PMC9688703 DOI: 10.3390/children9111674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The proposed research studied the determinants of male and female child malnutrition in Pakistan. More specifically, it observed the role of the sanitation facility and drinking water source as important determinants of malnutrition in a gender analysis. METHODS Novel data of 1010 children under three years of age from PDHS 2017-18 were used. A CIAF (Cumulative Index for Anthropometric Failure) was established to assess malnourishment in the children. Discrete-choice logistic methodology was applied in this empirical research to study the likelihood of malnourishment in children. RESULTS The logistic regression results depicted that factors such as a child belonging to a deprived area, the status of home wealth, and the education of the mother were common determinants of malnutrition in children. Factors such as a child having diarrhea (OR = 1.55, CI = 0.96-2.50) and the drinking water source (OR = 0.62, CI = 0.37-1.03) were separate prominent predictors of malnutrition in male children whereas the sanitation facility was the main determinant of malnutrition in female children (OR = 0.64, CI = 0.43-0.95). CONCLUSION This study concludes that important links exist between the drinking water source and male child malnutrition and between sanitation facilities and female child malnutrition.
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. Does a child's mid‐upper arm circumference‐for‐age
z
‐score represent another nutritional indicator of childhood malnutrition status? MATERNAL & CHILD NUTRITION 2022; 18:e13404. [PMID: 35821653 PMCID: PMC9480943 DOI: 10.1111/mcn.13404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
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Shirisha P, Muraleedharan VR, Vaidyanathan G. Wealth related inequality in women and children malnutrition in the state of Chhattisgarh and Tamil Nadu. BMC Nutr 2022; 8:86. [PMID: 35996127 PMCID: PMC9394049 DOI: 10.1186/s40795-022-00580-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Child and maternal malnutrition are the most serious health risks in India, accounting for 15% of the country’s total disease burden. Malnutrition in children can manifest as ‘stunting’ (low height in relation to age) or ‘wasting’ (low weight in relation to height) or both and underweight or obesity among women. Other nutritional indicators show that India lags behind, with high levels of anaemia in women of reproductive age. The study aims to analyse the wealth related inequalities in the nutrition status among women and children of different wealth quintiles in a high focus state (Chhattisgarh; CG) and a non-high focus state (Tamil Nadu; TN) in India. Methods We used National Family Health Survey-3rd (2005–06) & 4th (2015–16) to study the trends and differentials of inequalities in the nutrition status. We have used two summary indices. - absolute inequalities using the slope index of inequality (SII), and relative inequalities using the concentration index (CIX). Results There is reduction in wealth related inequality in nutrition status of women and children from all wealth quintiles between 2005–06 and 2015–16. However the reduction in inequality in some cases such as that of severe stunting among children was accompanied by increase among children from better off households The values of SII and CIX imply that malnutrition except obesity is still concentrated among the poor. The prevalence of anaemia (mild, moderate and severe) has reduced among women and children in the past decade. The converging pattern observed with respect to prevalence of mild and moderate anaemia is not only due to reduction in prevalence of anaemia among women from poor households but an increase in prevalence in rich households. Conclusion Malnutrition remains a major challenge in India, despite encouraging progress in maternal and nutrition outcomes over the last decade. Our study findings indicate the importance of looking at the change in inequalities of nutrition status of women and children of different wealth quintiles sub nationally. Given the country’s rapidly changing malnutrition profile, with progress across several indicators of under nutrition but rapidly rising rates of overweight/obesity, particularly among adults, appropriate strategies needs to be devised to tackle the double burden of malnutrition.
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Affiliation(s)
- P Shirisha
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India.
| | - V R Muraleedharan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
| | - Girija Vaidyanathan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
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Kundu S, Sayeed A, Azene AG, Rezyona H, Banna MHA, Khan MSI. Exploring the Factors Associated with Dietary Diversity of Children Aged 6-59 Months in Some Rural and Slum Areas of Bangladesh amid the COVID-19 Pandemic: A Mixed-Effect Regression Analysis. Curr Dev Nutr 2022; 6:nzac109. [PMID: 35957740 PMCID: PMC9362760 DOI: 10.1093/cdn/nzac109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Dietary diversity (DD) is a key component of diet quality, and malnutrition due to poor diet quality leads to child morbidity and mortality. However, in Bangladesh, there is a lack of information on childhood DD (for children aged 6-59 mo) amid the coronavirus disease 2019 (COVID-19) pandemic. Objectives The purpose of this study was to assess the minimum DD and its associated factors among children aged 6-59 mo during the COVID-19 pandemic in Bangladesh. Methods A cross-sectional study was carried out in 6 districts of Bangladesh. A total of 1190 respondents were included using cluster random sampling. The Individual Dietary Diversity Score (IDDS) for children was used to assess the children's DD. Factors associated with DD of children were identified using a multilevel binary logistics regression model. Results About 70% of the children aged 6-59 mo had minimum DD during the COVID-19 pandemic in Bangladesh. Children who belonged to slum areas [adjusted odds ratio (AOR): 0.45; 95% CI: 0.24, 0.83], family income 12,000-15,000 Bangladeshi taka (BDT) (AOR: 1.79; 95% CI: 1.06, 3.05) and >15,000 BDT (AOR: 2.59; 95% CI: 1.47, 4.57), mothers aged 26-30 y (AOR: 0.35; 95% CI: 0.20, 0.62) and >30 y (AOR: 0.43; 95% CI: 0.22, 0.85), respondents who had 2 children <5 y old (AOR: 0.43; 95% CI: 0.28, 0.66), and children aged 12-23 mo (AOR: 1.89; 95% CI: 1.14, 3.20) were significantly associated with DD among children aged 6-59 mo. Conclusions The findings of this study highlight the need for food and nutrition-related intervention, particularly targeting mothers of younger age and with >2 children <5 y old, mothers from slum regions, and fathers who were unemployed, to improve children's DD practices.
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Affiliation(s)
- Satyajit Kundu
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
- School of Public Health, Southeast University, Nanjing, China
| | - Abu Sayeed
- Department of Post-Harvest Technology and Marketing, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Humayra Rezyona
- Department of Food and Nutrition, Government College of Applied Human Science, Dhaka, Bangladesh
| | - Md Hasan Al Banna
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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21
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Andersen CT, Cain JS, Chaudhery DN, Ghimire M, Higashi H, Tandon A. Assessing public financing for nutrition in Bhutan, Nepal and Sri Lanka. MATERNAL & CHILD NUTRITION 2022; 18:e13320. [PMID: 35307937 DOI: 10.1111/mcn.13320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess public financing for nutrition in Bhutan, Nepal and Sri Lanka to identify limitations of available data and to discuss policy implications. A variant of the Scaling Up Nutrition Movement methodology was used. Budget allocations and expenditures for relevant government ministries during 2012-2018 were identified. Nutrition-related line items were tagged using definitions of nutrition-specific and nutrition-sensitive interventions. Data were aggregated by year and calculated in constant United States dollars (USD). Expenditures by year were presented as a proportion of gross domestic product and general government expenditures. The percent utilization of budget allocations and proportion of funding from central government sources were determined. Per capita expenditures on nutrition-specific interventions varied from USD 1.08-8.76 and for nutrition-sensitive interventions varied from USD 20.22-51.20. Nutrition-specific expenditures as a percent of gross domestic product ranged from 0.08% in Sri Lanka in 2017% to 0.34% in Nepal in 2016. The median utilization rate was 64% for nutrition-specific and 84% for nutrition-sensitive interventions. Nutrition-specific funding financed by the central government was 90.7% in Bhutan and 99.4% in Sri Lanka. This study revealed the need to prioritize and invest in evidence-based interventions, including balancing investments in nutrition-specific versus -sensitive interventions. Challenges in estimation of nutrition expenditures and cross-country comparison were also observed, highlighting the need for appropriate nutrition line item tagging and standardized systems for data collection.
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Affiliation(s)
- Christopher T Andersen
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Jewelwayne S Cain
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Deepika N Chaudhery
- The World Bank, Health, Nutrition, and Population Global Practice, New Delhi, India
| | - Mamata Ghimire
- The World Bank, Health, Nutrition, and Population Global Practice, Kathmandu, Nepal
| | - Hideki Higashi
- The World Bank, Health, Nutrition, and Population Global Practice, Colombo, Sri Lanka
| | - Ajay Tandon
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
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22
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Sadler K, James PT, Bhutta ZA, Briend A, Isanaka S, Mertens A, Myatt M, O'Brien KS, Webb P, Khara T, Wells JC. How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project. J Nutr 2022; 152:2645-2651. [PMID: 35687496 PMCID: PMC9839990 DOI: 10.1093/jn/nxac091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023] Open
Abstract
Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.
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Affiliation(s)
| | | | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada,Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark,Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Epicentre, Paris, France
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | - Mark Myatt
- Emergency Nutrition Network, Kidlington, United Kingdom,Brixton Health, Llwyngwril, Gwynedd, Wales, United Kingdom
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, United Kingdom
| | - Jonathan C Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, United Kingdom
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23
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Maternal Underweight and Its Association with Composite Index of Anthropometric Failure among Children under Two Years of Age with Diarrhea in Bangladesh. Nutrients 2022; 14:nu14091935. [PMID: 35565901 PMCID: PMC9105738 DOI: 10.3390/nu14091935] [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] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/30/2022] [Accepted: 04/30/2022] [Indexed: 01/13/2023] Open
Abstract
Malnutrition in women has been a long-standing public health concern, with serious effects on child survival and development. Maternal body mass index (BMI) is an important maternal nutritional indicator. There are few published studies although child anthropometric failures do not occur in isolation and identifying children with single versus several co-occurring failures can better capture cases of growth failure in combination: stunting, wasting, and underweight. In the context of multiple anthropometric failures, traditional markers used to assess children's nutritional status tend to underestimate overall undernutrition. Using the composite index of anthropometric failure (CIAF), we aimed to assess the association between maternal undernutrition and child undernutrition among children with diarrhea under the age of two and to investigate the correlates. Using 1431 mother-child dyads from the Antibiotic for Children with Diarrhea (ABCD) trial, we extracted children's data at enrollment and on day 90 and day 180 follow-ups. ABCD was a randomized, multi-country, multi-site, double-blind, placebo-controlled clinical trial. The Bangladesh site collected data from July 2017 to July 2019. The outcome variable, CIAF, allows combinations of height-for-age, height-for-weight, and weight-for-age to determine the overall prevalence of undernutrition. The generalized estimating equation was used to explore the correlates of CIAF. After adjusting all the potential covariates, maternal undernutrition status was found to be strongly associated with child undernutrition using the CIAF [aOR: 1.4 (95% CI: 1.0, 1.9), p-value = 0.043] among the children with diarrhea under 2 years old. Maternal higher education had a protective effect on CIAF [aOR: 0.7 (95% CI: 0.5, 0.9), p-value = 0.033]. Our study findings highlight the importance of an integrated approach focusing on maternal nutrition and maternal education could affect a reduction in child undernutrition based on CIAF.
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24
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Headey DD, Ruel MT. Economic shocks predict increases in child wasting prevalence. Nat Commun 2022; 13:2157. [PMID: 35444216 PMCID: PMC9021262 DOI: 10.1038/s41467-022-29755-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
In low and middle income countries macroeconomic volatility is common, and severe negative economic shocks can substantially increase poverty and food insecurity. Less well understood are the implications of these contractions for child acute malnutrition (wasting), a major risk factor for under-5 mortality. This study explores the nutritional impacts of economic growth shocks over 1990–2018 by linking wasting outcomes collected for 1.256 million children from 52 countries to lagged annual changes in economic growth. Estimates suggest that a 10% annual decline in national income increases moderate/severe wasting prevalence by 14.4–17.8%. An exploration of possible mechanisms suggests negative economic shocks may increase risks of inadequate dietary diversity among children. Applying these results to the latest economic growth estimates for 2020 suggests that COVID-19 could put an additional 9.4 million preschoolers at risk of wasting, net of the effects of preventative policy actions. Economic shocks may lead to food insecurity and therefore acute child malnutrition (wasting). Here, the authors use data from Demographic Health Surveys to estimate impacts of past economic shocks on wasting and project possible effects of shocks related to the COVID-19 pandemic.
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Affiliation(s)
- Derek D Headey
- The International Food Policy Research Institute (IFPRI), Washington, DC, USA.
| | - Marie T Ruel
- The International Food Policy Research Institute (IFPRI), Washington, DC, USA
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25
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Ketema B, Bosha T, Feleke FW. Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis. J Nutr Sci 2022; 11:e28. [PMID: 35573460 PMCID: PMC9066325 DOI: 10.1017/jns.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022] Open
Abstract
Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.
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Key Words
- Bale Robe
- EBF, Exclusive Breastfeeding
- Ethiopia
- HAZ, Height-for-Age Z-score
- Infant and young child
- MAD, Minimum Acceptable Diet
- MDD, Minimum Diet Diversity
- MMF, Minimum Meal Frequency
- MUAC, Mid-upper arm circumference
- MUACAZ, Mid-upper arm circumference-for-age Z-score
- PCA, Principal Component Analysis
- PI, Principal Investigator
- SPSS, Statistical Product and Service Solutions
- Stunting
- UNICEF, United Nations Children's Fund
- Underweight
- WAZ, Weight-for-Age Z-score
- WHO, World Health Organization
- WHZ, Weight-for-Height Z-Score
- Wasting
- sd, Standard Deviation
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Affiliation(s)
- Bezawit Ketema
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Tafese Bosha
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fentaw Wassie Feleke
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
- College of Health Science, Woldia University, P.O. Box 400, Woldia, Ethiopia
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26
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Waghmare H, Chauhan S, Sharma SK. Prevalence and determinants of nutritional status among women and children in Pakistan. BMC Public Health 2022; 22:766. [PMID: 35428254 PMCID: PMC9013048 DOI: 10.1186/s12889-022-13059-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/23/2022] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalences of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.
Methods
The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012–13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.
Results
A higher proportion of children in rural areas were severely stunted (19.6% vs. 12.5%), severe wasted (2.4% vs. 2.2%), and severe underweight (9.4% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.5%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.3% vs. 19.0%) than rural women. The odds of severe stunting (OR = 0.24; C.I. = 0.15–0.37), severe underweight (OR = 0.11; C.I. = 0.05–0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR = 3.7; C.I. = 2.47–5.54) and Obese (RRR = 4.35; C.I. = 2.67–7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.
Conclusion
This study has highlighted determinants associated with maternal and child nutritional status, whereby the child’s nutritional status was measured by stunting, wasting, and underweight, and BMI measured the mother’s nutritional status. The main risk factors for a child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women’s age, educational status, rural residence, and household wealth. Poor households should be provided special attention to improve the nutritional status among women and children in poor households.
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27
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Griswold SP, Marshak A, Fitzpatrick M, Lantagne D, Shoenmakers K, Hebie M, Radday A, De Groote H, Mehta S, Gottlieb G, Webb P, Ghosh S. The One Nutrition in Complex Environments (ONCE) study protocol: a cluster-randomized multi-level multi-sectoral intervention to improve nutrition in Uganda. Trials 2022; 23:244. [PMID: 35365180 PMCID: PMC8972632 DOI: 10.1186/s13063-022-06170-7] [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: 07/12/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To implement and measure the effects of a multi-level multi-sectoral social behavior change (SBC) intervention in Agago District of Northern Uganda and to determine the potential for scale-up. Intervention Compare the Nutrition Impact and Positive Practice (NIPP) approach to a NIPP+ approach. The NIPP approach involves nutrition education and SBC, whereas the NIPP+ adds agricultural inputs, training, and tools to support improved farm and water quality practices. The intervention effect will be measured through lower levels of aflatoxin in grain, lower water contamination, and improved knowledge on nutrition and health. Design This is a three-arm cluster-randomized controlled superiority trial (cRCT). The study arms include the following: group 1: NIPP; group 2: NIPP+, and group 3: control. Groups 1 and 2 will receive a 12-week intervention (NIPP or NIPP+) with active monitoring and longitudinal follow-up at 2, 6, and 12 months post-intervention. Additionally, an in-depth process and performance evaluation of each intervention arm will be undertaken using quantitative and qualitative methods. A total of 60 clusters from 5 subcounties of the Agago district will be randomly selected, and 15 households per cluster will be recruited using specific inclusion/exclusion criteria for a total of 900 households (300/arm). Respondents for the qualitative portion will be purposely selected. Analysis We will collect data from all participants at 3 time points: baseline, endline, and 12 months post-intervention. The analysis will utilize intent-to-treat (ITT) using the initial randomization of the treatment arms to determine the overall impact of having the NIPP vs. NIPP+ vs. control. Mixed effects models will be used to determine the role of time-variant and invariant individual household, and community characteristics, as well as measures of exposure and integration on key outcome indicators. A difference-in-difference analysis (baseline/endline, baseline/12 months post-intervention, endline/12 months post-intervention) will also be used to triangulate findings. Trial registration NCT04209569. One Nutrition in Complex Environments (ONCE) Registered 24 December 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06170-7.
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Affiliation(s)
- Stacy P Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Anastasia Marshak
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Merry Fitzpatrick
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | | | | | - Anne Radday
- Feinstein International Center, Tufts University, Boston, MA, USA
| | - Hugo De Groote
- International Maize and Wheat Improvement Centre (CIMMYT), Nairobi, Kenya
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Greg Gottlieb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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28
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Roy A, Hossain MM, Hanif AAM, Khan MSA, Hasan M, Hossaine M, Shamim AA, Ullah MA, Sarkar SK, Rahman SMM, Bulbul MMI, Mitra DK, Mridha MK. Prevalence of Infant and Young Child Feeding Practices and Differences in Estimates of Minimum Dietary Diversity Using 2008 and 2021 Definitions: Evidence from Bangladesh. Curr Dev Nutr 2022; 6:nzac026. [PMID: 35415389 PMCID: PMC8992578 DOI: 10.1093/cdn/nzac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infant and young child feeding (IYCF) practices directly impact the health of <2-y-old children. Minimum dietary diversity (MDD) is an IYCF indicator to assess feeding practices of children aged 6-23 mo. The definition of MDD has recently been updated by the WHO and UNICEF, substituting "≥4 out of 7 food groups" (MDD-7FG) with "≥5 out of 8 food groups" (MDD-8FG). Objectives The goals of this study were to estimate the prevalence of IYCF indicators and identify the implications of the change in the prevalence of MDD at the national and regional levels of Bangladesh. Methods This study used data from the National Food Security and Nutrition Surveillance 2018-2019 round. A total of 1992 children aged 0-23 mo were included in this analysis. IYCF indicators and MDD were calculated according to the WHO-UNICEF guidelines. The difference between the prevalence of MDD-7FG and MDD-8FG is presented as percentage points. Results The prevalence of early initiation of breastfeeding was 43.8%, and exclusive breastfeeding was 56.2%. Approximately 55% of children maintained MDD (MDD-7FG), 48% received minimum meal frequency, and 28% received a minimum acceptable diet. Compared with MDD-7FG, the prevalence of MDD-8FG was lower among 6-23-mo-old children. The difference between MDD prevalence (MDD-8FG vs. MDD-7FG) was high for boys (44.0% vs. 53.2%), children aged 12-23 mo (53.4% vs. 63.4%), in urban areas (30.2% vs. 42.4%), in the Dhaka administrative division (42.0% vs. 56.3%), among uneducated mothers (37.1% vs. 47.1%), in households with ≤4 members (44.3% vs. 55%), and for middle-class households (40.3% vs. 57.6%). Conclusions The new method led to a decrease in the prevalence of MDD in Bangladesh. As the country prepares to implement the new indicator, it is critical to disseminate the new knowledge and its positive implication for improved child feeding and nutrition.
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Affiliation(s)
- Abhijeet Roy
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Abdullah Mohammad Hanif
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Samir Kanti Sarkar
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | - Md Mofijul Islam Bulbul
- National Nutrition Services (NNS), Institute of Public Health Nutrition (IPHN), Dhaka, Bangladesh
| | | | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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29
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Shahid M, Cao Y, Shahzad M, Saheed R, Rauf U, Qureshi MG, Hasnat A, Bibi A, Ahmed F. Socio-Economic and Environmental Determinants of Malnutrition in under Three Children: Evidence from PDHS-2018. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030361. [PMID: 35327732 PMCID: PMC8947569 DOI: 10.3390/children9030361] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan. METHODS Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017-2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition. RESULTS The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers' education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children. CONCLUSION Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan.
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Affiliation(s)
- Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
| | - Yang Cao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
- Correspondence: ; Tel.: +86-173-1948-0430
| | - Muhammad Shahzad
- Department of Anthropology, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Rafit Saheed
- School of Public Policy, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Umara Rauf
- Department of Psychology, GC Women University, Sialkot 2021, Pakistan;
| | - Madeeha Gohar Qureshi
- Department of Economics, Pakistan Institute of Development Economics, Islamabad 44000, Pakistan;
| | - Abdullah Hasnat
- Medical and Dental College, Bahria University, Karachi 74400, Pakistan;
| | - Asma Bibi
- Independent Researcher in Applied Psychology, Lahore 54000, Pakistan;
| | - Farooq Ahmed
- Department of Anthropology, Quaid-i-Azam University, Islamabad 44000, Pakistan;
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA
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Sanjeev RK, Nuggehalli Srinivas P, Krishnan B, Basappa YC, Dinesh AS, Ulahannan SK. Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets. Wellcome Open Res 2022; 5:118. [PMID: 35720193 PMCID: PMC9194519 DOI: 10.12688/wellcomeopenres.15934.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The previous round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence at six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of wheat. In multivariable analysis, wasting was positively associated with women’s body mass index and stunting with women’s short stature. Conclusions: Well-designed intervention studies will be required to confirm causal pathways contributing to ecogeographic patterns of child malnutrition. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
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Affiliation(s)
- Rama Krishna Sanjeev
- Pediatrics, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | | | - Bindu Krishnan
- Physiology, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | - Yogish Channa Basappa
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | | | - Sabu K. Ulahannan
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
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Ahmed Hanifi SMM, Menon N, Quisumbing A. The impact of climate change on children's nutritional status in coastal Bangladesh. Soc Sci Med 2022; 294:114704. [PMID: 35030394 DOI: 10.1016/j.socscimed.2022.114704] [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] [Received: 10/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
This paper studies the impact of climate change on the nutritional status of very young children between the ages of 0-3 years by using weather data from the last half century merged with rich information on child, mother, and household characteristics in rural coastal Bangladesh. We evaluate the health consequences of rising temperature and relative humidity and varying rainfall jointly employing alternate functional forms. Leveraging models that control for annual trends and location-specific seasonality, and that allow the impacts of temperature to vary non-parametrically while rainfall and humidity have flexible non-linear forms, we find that temperatures that exceed 25 °C (the "comfortable" benchmark) in the month of birth exert negative effects on children's nutritional status as measured by mid upper arm circumference. Humidity has a positive impact which persists when child, mother and household controls are included. We find that exposure to changing climate in utero also matters. Explanations for these results include consequences of weather fluctuations on the extent of pasture, cropland, and rainfed lands planted with rice and other crops, and on mother's age at first marriage. Our results underline that climate change has real consequences for the health of very young populations in vulnerable areas.
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Affiliation(s)
- S M Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Center for Diarrheal Disease Research, GPO Box 128, Dhaka, 1000, Bangladesh.
| | - Nidhiya Menon
- Department of Economics, MS 021, Brandeis University, Waltham, MA, 02453, USA.
| | - Agnes Quisumbing
- Health, and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC, 20005, USA.
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Thurstans S, Sessions N, Dolan C, Sadler K, Cichon B, Isanaka S, Roberfroid D, Stobaugh H, Webb P, Khara T. The relationship between wasting and stunting in young children: A systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13246. [PMID: 34486229 PMCID: PMC8710094 DOI: 10.1111/mcn.13246] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near-term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z score might effectively identify children at most risk of near-term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.
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Affiliation(s)
- Susan Thurstans
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited KingdomUK
- Emergency Nutrition NetworkOxfordUK
| | | | | | | | | | - Sheila Isanaka
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of ResearchEpicentreParisFrance
| | - Dominique Roberfroid
- Faculty of MedicineUniversity of NamurNamurBelgium
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
| | - Heather Stobaugh
- Action Against Hunger USANew YorkNew YorkUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Patrick Webb
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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Dasgupta S, Roy S, Wheeler D. Explaining regional variations in mother-child health: Additional identified determinants in India and Bangladesh. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Methods for assessing seasonal and annual trends in wasting in Indian surveys (NFHS-3, 4, RSOC & CNNS). PLoS One 2021; 16:e0260301. [PMID: 34807959 PMCID: PMC8608332 DOI: 10.1371/journal.pone.0260301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Wasting in children under-five is a form of acute malnutrition, a predictor of under-five child mortality and of increased risk of future episodes of stunting and/or wasting. In India, national estimates of wasting are high compared to international standards with one in five children found to be wasted. National surveys are complex logistical operations and most often not planned or implemented in a manner to control for seasonality. Collection of survey data across differing months across states introduces seasonal bias. Cross-sectional surveys are not designed to collect data on seasonality, thus special methods are needed to analyse the effect of data collection by month. We developed regression models to estimate the mean weight for height (WHZ), prevalence of wasting for every month of the year for an average year and an overall weighted survey estimates controlling for the socio-demographic variation of data collection across states and populations over time. National level analyses show the mean WHZ starts at its highest in January, falls to the lowest in June/August and returns towards peak at year end. The prevalence of wasting is lowest in January and doubles by June/August. After accounting for seasonal patterns in data collection across surveys, the trends are significantly different and indicate a stagnant period followed by a decline in wasting. To avoid biased estimates, direct comparisons of acute malnutrition across surveys should not be made unless seasonality bias is appropriately addressed in planning, implementation or analysis. Eliminating the seasonal variation in wasting would reduce the prevalence by half and provide guidance towards further reduction in acute malnutrition.
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
- * E-mail:
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Chanie ES, Dagne Z, Jimma MS, Eyayu T, Nebiyu S, Wondifraw EB, GebreEyesus FA, Yemata GA, Melkie A. The effect of timely initiation of complementary feeding and vitamin A supplementation on acute malnutrition among children aged 6-59 months attending Hamusit Health Centre, Northwest Ethiopia, 2021: A cross-sectional study. Heliyon 2021; 7:e08449. [PMID: 34901501 PMCID: PMC8637469 DOI: 10.1016/j.heliyon.2021.e08449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/03/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Acute malnutrition is a nutritional deficiency that results either from inadequate energy or protein intake. It is more prevalent in low- and middle-income countries. Even though efforts have been carried out at the global and national level, the burden is still intolerable and it attracts the attention of the government and researchers. Hence, this study aims to assess the magnitude of acute malnutrition and its associated factors among under-five children who attended Hamusit Health Centre from 1st September to 30th January 2021. MATERIALS AND METHODS This institution-based cross-sectional study was conducted from 1st September to 30th January on 404 randomly selected under-five children who visited the health centre. Samples were selected using a simple random sampling technique, and the data were obtained using a pre-tested standardized questionnaire. For data entry and analysis, Epi-info 7 and SPSS 21 applications were used, respectively. Bivariable and multivariable binary logistic regression were used to identify associated factors at a 95% confidence interval. Significance was considered at p-value<0.05. RESULTS The present research involved a total of 404 children aged 6-59 months. The magnitude of acute malnutrition in this study was 14.4%. Children aged 6-23 months [AOR: 2.92; 95%CI (1.46, 5.85)], vitamin A supplementation [AOR: 0.49; 95%CI (0.25, 0.95)], not timely initiation of complementary feeding [AOR: 2.02; 95%CI (1.06, 3.82)] and children with diarrhea prior to two weeks of the survey [AOR: 2.47; 95% CI (1.28, 4.87)] were significantly associated with acute malnutrition. CONCLUSION A significant number of children aged 6-59 months were affected by acute malnutrition. Younger children, vitamin A supplementation, not timely initiation of complementary feeding, and children with diarrhoea were other factors associated with acute malnutrition.
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Affiliation(s)
| | | | | | - Tahir Eyayu
- Debre Tabor University, Debre Tabor, Ethiopia
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Ricardo LIC, Gatica-Domínguez G, Crochemore-Silva I, Neves PAR, Dos Santos Vaz J, Barros AJD, Victora CG. Age patterns in overweight and wasting prevalence of under 5-year-old children from low- and middle-income countries. Int J Obes (Lond) 2021; 45:2419-2424. [PMID: 34294871 PMCID: PMC8528694 DOI: 10.1038/s41366-021-00911-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe how overweight and wasting prevalence varies with age among children under 5 years in low- and middle-income countries (LMICs). METHODS We used data from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Overweight and wasting prevalence were defined as the proportions of children presenting mean weight for length/height (WHZ) more than 2 standard deviations above or below 2 standard deviations from the median value of the 2006 WHO standards, respectively. Descriptive analyses include national estimates of child overweight and wasting prevalence, mean, and standard deviations of WHZ stratified by age in years. National results were pooled using the population of children aged under 5 years in each country as weight. Fractional polynomials were used to compare mean WHZ with both overweight and wasting prevalence. RESULTS Ninety national surveys from LMICs carried out between 2010 and 2019 were included. The overall prevalence of overweight declined with age from 6.3% for infants (aged 0-11 months) to 3.0% in 4 years olds (p = 0.03). In all age groups, lower prevalence was observed in low-income compared to upper-middle-income countries. Wasting was also more frequent among infants, with a slight decrease between the first and second year of life, and little variation thereafter. Lower-middle-income countries showed the highest wasting prevalence in all age groups. On the other hand, mean WHZ was stable over the first 5 years of life, but the median standard deviation for WHZ decreased from 1.39 in infants to 1.09 in 4-year-old children (p < 0.001). For any given value of WHZ, both overweight and wasting prevalence were higher in infants than in older children. CONCLUSION The higher values of WHZ standard deviations in infants suggest that declining prevalence in overweight and wasting by age may be possibly due to measurement error or rapid crossing of growth channels by infants.
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Affiliation(s)
- Luiza I C Ricardo
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | | | | | - Paulo A R Neves
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Juliana Dos Santos Vaz
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar Gomes Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Namirembe G, Shrestha R, Mezzano J, Ausman LM, Davis D, Baral K, Ghosh S, Shively G, Webb P. Effective nutrition governance is correlated with better nutrition outcomes in Nepal. BMC Pediatr 2021; 21:434. [PMID: 34615509 PMCID: PMC8493744 DOI: 10.1186/s12887-021-02898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The public health burden of undernutrition remains heavy and widespread, especially in low-income countries like Nepal. While predictors of undernutrition are well documented, few studies have examined the effects of political will and quality of policy or program implementation on child growth. METHODS Data were collected from two nationwide studies in Nepal to determine the relationship between a metric of nutrition 'governance' (the Nutrition Governance Index), derived from interviews with 520 government and non-government officials responsible for policy implementation and anthropometry measured for 6815 children in 5556 households. We employed Generalized Estimating Equation (GEE) and multilevel regression models. RESULTS A higher NGI (more effective nutrition governance) is positively associated with height-for-age as well as weight-for-height in children over 2 years of age compared to younger children (HAZ; β = 0.02, p < 0.004, WHZ; β = 0.01, p < 0.37). Results from the hierarchical model show that a one-point increase in the NGI is significantly associated with a 12% increase in HAZ and a 4% increase in WHZ in older children (> 24 months old). Mothers' education, child's age, BMI and no fever in the past 30 days were also protective of stunting and wasting. Seven percent and 17% of the overall variance in HAZ and WHZ, respectively, are accounted for by variations across the 21 district locations in which sampled households were located. Mean HAZ differs considerably across districts (intercept = 0.116, p < 0.001). CONCLUSIONS These results highlight the importance of effective management of policy-based programming and resource use to bring about nutrition gains on the ground. The NGI explained a non-negligible amount of variation in HAZ and WHZ, which underscores the fundamental role that good governance plays in promoting child nutrition and growth, and the value of seeking to measure it to assist governments in moving policies from paper to practice.
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Affiliation(s)
- Grace Namirembe
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Robin Shrestha
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Julieta Mezzano
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Lynne M Ausman
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Dale Davis
- Helen Keller International, Patan, Nepal
| | - Kedar Baral
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA
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Sanjeev RK, Nuggehalli Srinivas P, Krishnan B, Basappa YC, Dinesh AS, Ulahannan SK. Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets. Wellcome Open Res 2021; 5:118. [DOI: 10.12688/wellcomeopenres.15934.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The last round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence before six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of all crops (except other millets). The analysis was limited by lack of fine-scale data on prevalence of low birth-weight and type of cereal consumed. Conclusions: Better cereal cultivation and consumption data will be needed to confirm causal pathways contributing to potential ecogeographic patterns. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
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Chitekwe S, Torlesse H, Aguayo VM. Nutrition in Nepal: Three decades of commitment to children and women. MATERNAL AND CHILD NUTRITION 2021; 18 Suppl 1:e13229. [PMID: 34523803 PMCID: PMC8770654 DOI: 10.1111/mcn.13229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/20/2022]
Abstract
South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi-Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts.
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Affiliation(s)
- Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Harriet Torlesse
- Nutrition Section, Regional Office for South Asia, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Victor M Aguayo
- Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
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Complex Multilevel Modelling of the Individual, Household and Regional Level Variability in Predictors of Undernutrition among Children Aged 6-59 Months in Ethiopia. Nutrients 2021; 13:nu13093018. [PMID: 34578895 PMCID: PMC8467235 DOI: 10.3390/nu13093018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Worldwide, ten and a half million children under five die every year, with 98% of these deaths in low- and middle-income countries, including Ethiopia. Undernutrition is a serious public health problem in Ethiopia and children are the most affected segments of the population. This study, therefore, sought to investigate the socio-economic, demographic, health and environmental factors associated with undernutrition among children aged 6-59 months in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey. In this study, anthropometric data (height and weight) and other variables of 9461 children were measured. Descriptive statistics and multilevel logistic regression models were fitted. The descriptive results revealed that about 27.5% of the children aged between 6-59 months were undernourished. Place of residence, employment status of the mother, educational status of the mother, the mother's nutritional status, age of the child, birth order of children, source of drinking water, diarrhea and fever among children in the two weeks before the survey were the most important factors associated with undernutrition among children aged 6-59 months in Ethiopia. The findings indicate that it is useful to support health care and food security programs in rural areas to directly address food insecurity and undernutrition problems of the poor and exposed communities in rural parts of the country. The education sector must increase mothers' access to education in all areas to help identify the quality of healthcare and the required attention needed for their children. The health sector should increase their health education programs on the importance of exclusive breastfeeding.
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Mutoro AN, Garcia AL, Kimani-Murage EW, Wright CM. Prevalence and overlap of known undernutrition risk factors in children in Nairobi Kenya. MATERNAL AND CHILD NUTRITION 2021; 18:e13261. [PMID: 34355500 PMCID: PMC8710128 DOI: 10.1111/mcn.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.
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Affiliation(s)
- Antonina N Mutoro
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Ada L Garcia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Elizabeth W Kimani-Murage
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
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Miyazaki A, Matsui M, Tung R, Taing B, White LV, Iwamoto A, Cox SE. Determinants of growth measurements in rural Cambodian infants: a cross-sectional study. Int Health 2021; 13:49-56. [PMID: 32379305 PMCID: PMC7807240 DOI: 10.1093/inthealth/ihaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
Background Inappropriate feeding and hygiene practices and poor environment are associated with malnutrition. We aimed to investigate the contributions of feeding, hygiene practices and recent illness to the nutritional status of rural Cambodian infants and any sex-specific differences. Methods In a cross-sectional study, nested within an ongoing birth cohort, trained fieldworkers conducted anthropometry and collected information from the main caregiver during home visits. Multivariable linear regression was used to investigate associations with nutritional status as length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ). Results A total of 156 children, 87 (55.8%) male, ages 0–11 months were enrolled. The prevalence of acute malnutrition (WLZ <−2) in males and females was 2.3% (2/87) and 5.8% (4/69), respectively, and 23.0% (20/87) of males and 14.5% (10/69) of females were stunted (LAZ <−2). WLZ but not LAZ decreased with age. WLZ was independently negatively associated with increasing age (β-coefficient −0.14 [95% confidence interval {CI} −0.20 to −0.08], p<0.001), and regular use of feeding bottles (β-coefficient −0.46 [95% CI −0.83 to −0.10], p=0.014), and positively with handwashing with soap (β-coefficient 0.40 [95% CI 0.05 to 0.75), p=0.027). Conclusions The prevalence of acute malnutrition was low, but stunting was prevalent without evidence of a sex difference. Non-linear growth faltering was associated with increasing age and hygiene/feeding practices.
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Affiliation(s)
- Asuka Miyazaki
- School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki University, Nagasaki 852-8523, Japan
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki University, Nagasaki 852-8523, Japan
| | - Rathavy Tung
- National Maternal and Child Health Centre, Ministry of Health, France street, Phnom Penh, Cambodia
| | - Bunsreng Taing
- Kampong Cham Provincial Health Department, Ministry of Health, Preah Kosamak Nearyroth, Kampong Cham, Cambodia
| | - Laura V White
- School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki University, Nagasaki 852-8523, Japan
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Centre for Global Health and Medicine, Toyama 1-12-1, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki University, Nagasaki 852-8523, Japan.,Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki 852-8523, Japan.,London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Mann DM, Swahn MH, McCool S. Undernutrition and malaria among under-five children: findings from the 2018 Nigeria demographic and health survey. Pathog Glob Health 2021; 115:423-433. [PMID: 33944705 DOI: 10.1080/20477724.2021.1916729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Malaria and undernutrition have independently contributed to mortality and morbidity among the under-five population of Nigeria. However, there remains complexity in their association. This study evaluates the association between stunting, underweight, wasting, and malaria among under-five Nigerian children while assessing the effects of sociodemographic factors. Cross-sectional data from the 2018 Nigeria Demographic and Health Survey were used, which included a study population of 12,996 children aged 0-59 months. Stunting (HAZ<-2.0 SD), underweight (WAZ<-2.0 SD), wasting (WHZ<-2.0 SD), malaria test results, and sociodemographic factors were obtained and examined. Logistic regression modeling was used to determine the associations between undernutrition, malaria, and sociodemographic factors. The prevalence of stunting was 37.0%, with 22.0% underweight, 6.9% wasting, and 22.6% tested positive for malaria. Stunting was frequent among 24-35 months old, 12-23 months old were mostly underweight and wasted, and 48-59 months old frequently suffered from malaria. Undernutrition and malaria frequently occurred among males, residents of rural areas, the poorest wealth quintile, and children of mothers with no formal education. The odds of having malaria was 89% higher among under-five stunted children (AOR = 1.89, 95% CI = 1.00,1.40; p-value = <0.0001). However, underweight (AOR = 1.11, 95% CI = 0.91,1.36; p-value = 0.2982) and wasting (AOR = 0.89, 95% CI = 0.67,1.19; p-value = 0.4519) were not significantly associated with malaria. The development of appropriate strategies, especially in rural areas and for less-educated mothers are critical to combat undernutrition and malaria.
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Affiliation(s)
- Daena M Mann
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Monica H Swahn
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Sarah McCool
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014-2018): Analysis of Demographic Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094578. [PMID: 33925898 PMCID: PMC8123503 DOI: 10.3390/ijerph18094578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.
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Marshak A, Venkat A, Young H, Naumova EN. How Seasonality of Malnutrition Is Measured and Analyzed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1828. [PMID: 33668508 PMCID: PMC7918225 DOI: 10.3390/ijerph18041828] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Seasonality is a critical source of vulnerability across most human activities and natural processes, including the underlying and immediate drivers of acute malnutrition. However, while there is general agreement that acute malnutrition is highly variable within and across years, the evidence base is limited, resulting in an overreliance on assumptions of seasonal peaks. We review the design and analysis of 24 studies exploring the seasonality of nutrition outcomes in Africa's drylands, providing a summary of approaches and their advantages and disadvantages. Over half of the studies rely on two to four time points within the year and/or the inclusion of time as a categorical variable in the analysis. While such approaches simplify interpretation, they do not correspond to the climatic variability characteristic of drylands or the relationship between climatic variability and human activities. To better ground our understanding of the seasonality of acute malnutrition in a robust evidence base, we offer recommendations for study design and analysis, including drawing on participatory methods to identify community perceptions of seasonality, use of longitudinal data and panel analysis with approaches borrowed from the field of infectious diseases, and linking oscillations in nutrition data with climatic data.
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Affiliation(s)
- Anastasia Marshak
- Feinstein International Center, Tufts University, Boston, MA 02111, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Aishwarya Venkat
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Helen Young
- Feinstein International Center, Tufts University, Boston, MA 02111, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Nasiri-Babadi P, Sadeghian M, Sadeghi O, Siassi F, Dorosty A, Esmaillzadeh A, Pouraram H. The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children. Eat Weight Disord 2021; 26:211-218. [PMID: 31900880 DOI: 10.1007/s40519-019-00834-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/10/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years. METHODS This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated. RESULTS The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91). CONCLUSION The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders. LEVEL OF EVIDENCE Level III, case-control analytic studies.
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Affiliation(s)
- Pegah Nasiri-Babadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Mehdi Sadeghian
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Omid Sadeghi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Siassi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Ahmadreza Dorosty
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
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Nepali S, Simkhada P, Davies IG. Association between wasting and food insecurity among children under five years: findings from Nepal demographic health survey 2016. BMC Public Health 2020; 20:1027. [PMID: 32600372 PMCID: PMC7325295 DOI: 10.1186/s12889-020-09146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics. Methods This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age (n = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals. Results The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72–2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65–1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01–4.19) and Province 2 (AOR 2.45, 95%CI 1.22–4.95) were significantly associated with wasting. Conclusion Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions.
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Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, Garcia-Garcia G, Iyengar A, Sekkarie M, van Biesen W, Ulasi I, Yeates K, Stanifer J. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 2020; 17:15-32. [PMID: 33188362 PMCID: PMC7662029 DOI: 10.1038/s41581-020-00363-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress. Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease. Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment. Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required. The global burden of kidney disease has been relatively underestimated because of a lack of data. Structural violence and the social determinants of health have an important impact on kidney disease risk. Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy. Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. .,Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland.
| | - Ziyad Al-Aly
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.,Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA
| | - Aminu K Bello
- Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Raul G Carlini
- Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Stanifer
- Munson Nephrology, Munson Healthcare, Traverse City, MI, USA
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Yao S, Wang J, Xiao S, Jin X, Xiong M, Peng J, Xu T. Inadequate Nutrition and Associated Factors in Children Aged 6 to 24 Months - 4 Counties, Liangshan Yi Autonomous Prefecture, China, 2018. China CDC Wkly 2020; 2:873-877. [PMID: 34594783 PMCID: PMC8422359 DOI: 10.46234/ccdcw2020.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/27/2020] [Indexed: 11/23/2022] Open
Abstract
What is already known about this topic? Symptoms of malnutrition including anemia, stunting, wasting, and being underweight among children remained one of the major public health problems in poorer areas in China. More research is needed to guide interventions to improve nutrition and health among children in low-income regions. What is added by this report? The prevalences of anemia, stunting, wasting, and being underweight were 51.9%, 25.6%, 14.6%, and 9.5%, respectively, among children aged 6 to 24 months in the poorest areas of Liangshan. Associated factors were gender, age, education level and occupation of mother, breastfeeding, and caregiver knowledge. What are the implications for public health practice? Improving caregiver knowledge of nutrition and child feeding practices is crucial to address malnutrition among children. These findings can help more precisely understand the child health needs in poorer areas in order to develop effective interventions. They also provide evidence-based information to formulate child health promotion strategies in other countries with similar situations.
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Affiliation(s)
- Shiyi Yao
- National Center for Women and Children's Health, China CDC, Beijing, China
| | - Jinpeng Wang
- National Center for Women and Children's Health, China CDC, Beijing, China
| | - Shuyue Xiao
- National Center for Women and Children's Health, China CDC, Beijing, China
| | - Xi Jin
- National Center for Women and Children's Health, China CDC, Beijing, China
| | - Mei Xiong
- Liangshan Maternal and Child Health Care Hospital, Xichang, Sichuan province, China
| | - Jing Peng
- Liangshan Maternal and Child Health Care Hospital, Xichang, Sichuan province, China
| | - Tao Xu
- National Center for Women and Children's Health, China CDC, Beijing, China
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