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Delbiso TD, Nigatu YD, Tilahun N. Early childhood development and nutritional status in urban Ethiopia. MATERNAL & CHILD NUTRITION 2024; 20:e13638. [PMID: 38450957 PMCID: PMC11168352 DOI: 10.1111/mcn.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.
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Affiliation(s)
- Tefera Darge Delbiso
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Yakob Desalegn Nigatu
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
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Mbabazi J, Pesu H, Mutumba R, Bromley K, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Correlates of early child development among children with stunting: A cross-sectional study in Uganda. MATERNAL & CHILD NUTRITION 2024; 20:e13619. [PMID: 38291803 PMCID: PMC10981482 DOI: 10.1111/mcn.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024]
Abstract
Many children in low- and middle-income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12-59-month-old children with stunting in a cross-sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23-41] months, 55% of the children resided in rural settings with 21% from female-headed households and 47% of mothers had no schooling. The mean ± standard deviation height-for-age z-score (HAZ) was -3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One-third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14-0.33) and head circumference (0.07, 95% CI: 0.02-0.12) were positive correlates of total MDAT score, whereas weight-for-height z-score (WHZ) was not. Current breastfeeding was associated with 0.41 (95% CI: 0.17-0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95% CI: 0.06-0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Hannah Pesu
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | | | - Christian Ritz
- The National Institute of Public HealthSouthern University of DenmarkCopenhagenDenmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Tampere Center for Child Health ResearchUniversity of TampereTampereFinland
| | - Ezekiel Mupere
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Friis
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Mette F. Olsen
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Infectious DiseasesRigshospitaletCopenhagenDenmark
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Szlamka Z, Ahmed I, Genovesi E, Kinfe M, Hoekstra RA, Hanlon C. Conceptualising the empowerment of caregivers raising children with developmental disabilities in Ethiopia: a qualitative study. BMC Health Serv Res 2023; 23:1420. [PMID: 38102602 PMCID: PMC10722818 DOI: 10.1186/s12913-023-10428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Caregivers of children with developmental disabilities (DDs) in Ethiopia experience stigma and exclusion. Due to limited existing services and substantial barriers to accessing care, they often lack support. Caregiver empowerment could help address injustices that hinder their capacity to support their child as they would like. The aim of this study was to explore the meaning and potential role of empowerment for caregivers raising a child with a DD and how empowerment was situated in relation to other priorities in service development. METHODS This was a qualitative phenomenological study. Semi-structured interviews were conducted in Amharic and English with caregivers of children with a DD (n = 15), clinicians (n = 11), community-based health extension workers (n = 5), representatives of non-governmental organisations working with families with DDs (n = 17), and representatives of local authorities in health, education, and social care (n = 15). Data were analysed thematically. RESULTS Three main themes were developed: "Barriers to exercising caregivers' agency"; "Whose decision is it to initiate empowerment?"; and "Supporting caregivers through support groups". Caregiver capacity to do what they thought was best for their child was undermined by poverty, a sense of hopelessness, experience of domestic abuse and multiple burdens experienced by those who were single mothers. Caregivers were nonetheless active in seeking to bring about change for their children. Caregivers and professionals considered support groups to be instrumental in facilitating empowerment. Participants reflected that caregiver-focused interventions could contribute to increasing caregivers' capacity to exercise their agency. A tension existed between a focus on individualistic notions of empowerment from some professionals compared to a focus on recognising expertise by experience identified as vital by caregivers. Power dynamics in the context of external funding of empowerment programmes could paradoxically disempower. CONCLUSION Caregivers of children with DDs in Ethiopia are disempowered through poverty, stigma, and poor access to information and resources. Shifting power to caregivers and increasing their access to opportunities should be done on their own terms and in response to their prioritised needs.
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Affiliation(s)
- Zsofia Szlamka
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Ikram Ahmed
- Department of Psychiatry, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity-Building, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elisa Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mersha Kinfe
- Department of Psychiatry, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity-Building, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- Department of Health Service and Population Research, Institute of Psychiatry, Centre for Global Mental Health, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity-Building, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
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Ricci H, Faber M, Ricci C, Kruger HS, Malan L, Nakiranda R, Visser M, Smuts CM. Effects of egg as an early complementary food on growth of 6- to 9-month-old infants: a randomised controlled trial. Public Health Nutr 2023; 27:e1. [PMID: 38018158 PMCID: PMC10830362 DOI: 10.1017/s1368980023002604] [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: 10/11/2022] [Revised: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To assess the effect of daily egg consumption for six months on linear growth (primary outcome), weight-for-age, weight-for-length, mid-upper arm circumference-for-age, head circumference-for-age Z-scores, gross motor milestones development, anaemia and iron status (secondary outcomes) in a low socioeconomic community. PARTICIPANTS Infants aged 6 to 9 months living in the peri-urban Jouberton area, in the Matlosana Municipality, South Africa. DESIGN A randomised controlled trial with a parallel design was implemented. Eligible infants were randomly allocated to the intervention (n 250) receiving one egg/day and the control group (n 250) receiving no intervention. The participants were visited weekly to monitor morbidity and gross motor development, with information on adherence collected for the intervention group. Trained assessors took anthropometric measurements, and a blood sample was collected to assess anaemia and iron status. There was blinding of the anthropometric assessors to the groups during measurements and the statistician during the analysis. RESULTS Baseline prevalence of stunting, underweight, wasting, overweight and anaemia was 23·8 %, 9·8 %, 1·2 %, 13·8 % and 29·2 %, respectively, and did not differ between groups. Overall, 230 and 216 participants in the intervention and control groups completed the study, respectively. There was no intervention effect on length-for-age, weight-for-age, weight-for-length Z-scores, gross motor milestone development, anaemia and iron status. CONCLUSIONS Daily egg intake did not affect linear growth, underweight, wasting, motor milestones development, anaemia and iron status. Other interventions are necessary to understand the effect of animal-source food intake on children's growth and development. This trial was registered at https://clinicaltrials.gov/ (NCT05168085).
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Affiliation(s)
- Hannah Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Regina Nakiranda
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Marina Visser
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Masita ED, Amalia R, Rahayu EP, Fernandes AP, Costa AD, Freitas AFDC, Hasina SN. Analysis of Factors that affect Events and Interventions of Stunting through the E-Stunting Android Application. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Based on the Indonesian Toddler Nutrition Status Survey in 2021, it was found that the stunting rate in Indonesia reached 24.4%, which means there were 5.33 million indicated stunting.
Objective: The purpose of this study was to detect the causative factors and effectiveness of stunting interventions in the E stunting application.
Methods: The type of the research is quantitative analytic with cross sectional approach using double linear regression analytic test with p = 0.05. The difference test used an unpaired sample test analytic by looking at the difference in mean in the control and treatment groups. The population uses totality sampling with the rule of thumb technique. This research instrument uses a minimum diet diversity questionnaire, diet diversity, parenting model, as well as a questionnaire with a Likert scale and has been through validity and reliability tests.
Results: The results of the determinant coefficient test have a relationship between the independent and dependent variables, while Adjusted R2 = 0.803 which means 80.3% of all variables affect the z score in children, while the difference test result obtained a result of sig 2 tailed = 0.001 and the value of Sig Levene's test for equality variance of 0.44 > 0.001
Conclusion: There is an effect of frequency of eating, number of types of food, eating culture, history of breastfeeding, complementary feeding, perception, knowledge of the z score (stunting events). And E stunting is effective in assessing the causative factors and treatment in cases of infants with stunting
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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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