Environmental Risk Factors Associated with Child Stunting: A Systematic Review of the Literature

Effect of pesticide exposure on stunting incidence: a systematic review and meta-analysis

As an endocrine disruptor chemical, pesticide exposure may affect the regulation of growth hormones such as insulin-like growth factor-1 (IGF-1). A few current studies to date have noted that long-term pesticide exposure disrupted IGF-1, a potential risk of stunting in children. This study aims to evaluate studies to date of the effect of pesticide exposure on stunting incidence. This systematic review and meta-analysis adhered to the PRISMA (Pre-ferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The PubMed and EBSCO databases were searched for relevant articles without publication restrictions. This review aimed to include reviews, randomized controlled trials (RCT), and cohort, case-control, and cross-sectional studies, which provide actual exposure types of pesticides with stunting measurement by height-age z score. A screening, extraction, and synthesis were conducted, leading to a consensus for reaching mutual agreement. The analysis was performed using Microsoft Excel 2017 for the screening and extraction, Revman version 5.4 software for the meta-analysis, and OpenMEE software for the meta-regression. Of the 13 studies subjected to the qualitative analysis, 6 were eligible for inclusion in the meta-analysis: 2 reviews, 2 RCTs, 2 cohorts, 2 case-control, and 5 cross-sectional studies. Exposure to organophosphate and pyrethroid pesticides was not associated with stunting (P=0.78; odds ratio [OR], 1.11; 95% confidence interval [CI], 0.65-1.88). Heterogeneity existed for 79% of the meta-analysis (P≤0.000; z=-5.37; 95% CI, -0.034 to -0.016), and the meta-regression identified age as the causative covariate. Pesticide exposure, regardless of type, is not associated with stunting in children.

Assessing groundwater quality and its association with child undernutrition in India

BACKGROUND AND OBJECTIVES

Groundwater contamination poses a significant health challenge in India, particularly impacting children. Despite its importance, limited research has explored the nexus between groundwater quality and child nutrition outcomes. This study addresses this gap, examining the association between groundwater quality and child undernutrition, offering pertinent insights for policymakers.

DATA AND METHODS

The study uses data from the fifth round of the National Family Health Survey (NFHS) and the Central Groundwater Board (CGWB) to analyze the association between groundwater quality and child nutritional status. The groundwater quality data were collected by nationwide monitoring stations programmed by CGWB, and the child undernutrition data were obtained from the NFHS-5, 2019-21. The analysis included descriptive and logistic regression model. The study also considers various demographic and socio-economic factors as potential moderators of the relationship between groundwater quality and child undernutrition.

FINDINGS

Significant variation in groundwater quality was observed across India, with numerous regions displaying poor performance. Approximately 26.53 % of geographical areas were deemed unfit for consuming groundwater. Environmental factors such as high temperatures, low precipitation, and arid, alluvial, laterite-type soils are linked to poorer groundwater quality. Unfit-for-consumption groundwater quality increased the odds of undernutrition, revealing a 35 %, 38 %, and 11 % higher likelihood of stunting, underweight, and wasting in children, with higher pH, Magnesium, Sulphate, Nitrate, Total Dissolved Solids, and Arsenic, levels associated with increased odds of stunting, underweight, and wasting. Higher temperatures (>25 °C), high elevations (>1000 m), and proximity to cultivated or industrial areas all contribute to heightened risks of child undernutrition. Children consuming groundwater, lacking access to improved toilets, or living in rural areas are more likely to be undernourished, while females, higher-income households, and those consuming dairy, vegetables, and fruits daily exhibit lower odds of undernutrition.

POLICY IMPLICATIONS

Policy implications highlight the urgent need for investment in piped water supply systems. Additionally, focused efforts are required to monitor and improve groundwater quality in regions with poor water quality. Policies should emphasize safe sanitation practices and enhance public awareness about the critical role of safe drinking water in improving child health.

Spatial Machine Learning for Exploring the Variability in Low Height-For-Age From Socioeconomic, Agroecological, and Climate Features in the Northern Province of Rwanda

Childhood stunting is a serious public health concern in Rwanda. Although stunting causes have been documented, we still lack a more in-depth understanding of their local factors at a more detailed geographic level. We cross-sectionally examined 615 height-for-age prevalence observations in the Northern Province of Rwanda, linked with their related covariates, to explore the spatial heterogeneity in the low height-for-age prevalence by fitting linear and non-linear spatial regression models and explainable machine learning. Specifically, complemented with generalized additive models, we fitted the ordinary least squares (OLS), a standard geographically weighted regression (GWR), and multiscale geographically weighted regression (MGWR) models to characterize the imbalanced distribution of stunting risk factors and uncover the nonlinear effect of significant predictors, explaining the height-for-age variations. The results reveal that 27% of the children measured were stunted, and that likelihood was found to be higher in the districts of Musanze, Gakenke, and Gicumbi. The local MGWR model outperformed the ordinary GWR and OLS, with coefficients of determination of 0.89, 0.84, and 0.25, respectively. At specific ranges, the study shows that height-for-age decreases with an increase in the number of days a child was left alone, elevation, and rainfall. In contrast, land surface temperature is positively associated with height-for-age. However, variables like the normalized difference vegetation index, slope, soil fertility, and urbanicity exhibited bell-shaped and U-shaped non-linear associations with the height-for-age prevalence. Identifying areas with the highest rates of stunting will help determine the most effective measures for reducing the burden of undernutrition.

Factors influencing stunted growth in children: A study in Bandung regency focusing on a deworming program

The prevalence of neglected tropical diseases, specifically those caused by soil-transmitted helminths (STHs) and other parasites that infest the intestine as part of their life cycle, remains a problem in Indonesia. We assessed the effects of deworming programs and socioeconomic and ecological factors on the incidence rate of infections with STHs and other parasites in an urban area of the Bandung Regency. We recruited 361 children with stunted growth who met the inclusion criteria, and 48 of those children were at high risk of STH infection. The study was conducted between September 2020 and September 2021. We collected possible socioeconomic factors influencing the incidence rate of infections. We found the incidence rate of STH infections among the children with stunted growth to be 3.6%. We confirmed infections with Cyclospora and Cryptosporidium after a Ziehl-Nieelsen stool smear examination in two of the 48 children at risk of infection. We found 43.75% of the children had short stature and weight below the normal limits, while stunting and severe stunting were associated with Ascaris lumbricoides infection (44.70%, p = 0.035). Parents of children with stunted and severely stunted growth were more likely to have a low education level, lack knowledge about deworming program, and to be earning a low income. The mother's occupation had a particularly strong influence on the severity of the stunting (89.58%, p = 0.012). Our results show that deworming programs can affect the growth and development of children and that socioeconomic and ecological factors also play a role.

The role of national nutrition programs on stunting reduction in Rwanda using machine learning classifiers: a retrospective study

BACKGROUND

In Rwanda, the prevalence of childhood stunting has slightly decreased over the past five years, from 38% in 2015 to about 33% in 2020. It is evident whether Rwanda's multi-sectorial approach to reducing child stunting is consistent with the available scientific knowledge. The study was to examine the benefits of national nutrition programs on stunting reduction under two years in Rwanda using machine learning classifiers.

METHODS

Data from the Rwanda DHS 2015-2020, MEIS and LODA household survey were used. By evaluating the best method for predicting the stunting reduction status of children under two years old, the five machine learning algorithms were modelled: Support Vector Machine, Logistic Regression, K-Near Neighbor, Random Forest, and Decision Tree. The study estimated the hazard ratio for the Cox Proportional Hazard Model and drew the Kaplan-Meier curve to compare the survivor risk of being stunted between program beneficiaries and non-beneficiaries. Logistic regression was used to identify the nutrition programs related to stunting reduction. Precision, recall, F1 score, accuracy, and Area under the Curve (AUC) are the metrics that were used to evaluate each classifier's performance to find the best one.

RESULTS

Based on the provided data, the study revealed that the early childhood development (ECD) program (p-value = 0.041), nutrition sensitive direct support (NSDS) program (p-value = 0.03), ubudehe category (p-value = 0.000), toilet facility (p-value = 0.000), antenatal care (ANC) 4 visits (p-value = 0.002), fortified blended food (FBF) program (p-value = 0.038) and vaccination (p-value = 0.04) were found to be significant predictors of stunting reduction among under two children in Rwanda. Additionally, beneficiaries of early childhood development (p  < .0001), nutrition sensitive direct support (p = 0.0055), antenatal care (p = 0.0343), Fortified Blended Food (p = 0.0136) and vaccination (p = 0.0355) had a lower risk of stunting than non-beneficiaries. Finally, Random Forest performed better than other classifiers, with precision scores of 83.7%, recall scores of 90.7%, F1 scores of 87.1%, accuracy scores of 83.9%, and AUC scores of 82.4%.

CONCLUSION

The early childhood development (ECD) program, receiving the nutrition sensitive direct support (NSDS) program, focusing on households with the lowest wealth quintile (ubudehe category), sanitation facilities, visiting health care providers four times, receiving fortified blended food (FBF), and receiving all necessary vaccines are what determine the stunting reduction under two among the 17 districts of Rwanda. Finally, when compared to other models, Random Forest was shown to be the best machine learning (ML) classifier. Random forest is the best classifier for predicting the stunting reduction status of children under two years old.

Analysis of anthropometric outcomes in Indian children during the COVID-19 pandemic using National Family Health Survey data

BACKGROUND

Disruptions in food, health, and economic systems during the COVID-19 pandemic may have adversely affected child health. There is currently limited research on the potential effects of the COVID-19 pandemic on stunting, wasting, and underweight status of young children.

METHODS

We examine the short-term associations between the pandemic and anthropometric outcomes of under-5 children (n = 232,920) in India, using data from the National Family Health Survey (2019-2021). Children surveyed after March 2020 are considered as the post-COVID group, while those surveyed earlier are considered as pre-COVID. Potential biases arising from differences in socioeconomic characteristics of the two groups are mitigated using propensity score matching methods.

RESULTS

Post-COVID children surveyed in 2020 and 2021 have 1.2% higher underweight rates, 1.2% lower wasting rates, 0.1 lower height-for-age z-scores (HAZ), and 0.04 lower weight-for-height z-scores as compared with matched pre-COVID children. Post-COVID children surveyed in 2020 have 1.6%, 4.6%, and 2.4% higher stunting, underweight, and wasting rates, respectively, and 0.07 lower HAZ, as compared with matched pre-COVID children. Reductions in nutritional status are largest among children from households in the poorest wealth quintiles.

CONCLUSIONS

These findings indicate a trend towards a recovery in child anthropometric outcomes in 2021 after the initial post-pandemic reductions. The resilience of health and food systems to shocks such as COVID-19 should be strengthened while immediate investments are required to decrease child malnutrition and improve broader child health outcomes.

Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey

INTRODUCTION

Undernutrition poses a significant global public health challenge, adversely affecting childhood cognitive and physical development while increasing the risk of disease and mortality. Stunting, characterized by impaired growth and development in children due to insufficient psychological stimulation, frequent infections, and inadequate nutrition, remains a critical issue. Although economic growth alone cannot fully address the prevalence of stunting, there exists a robust correlation between a country's income level and childhood stunting rates. Countries with higher incomes tend to have lower rates of childhood stunting. Notably, while childhood stunting is declining worldwide, it remains persistent in Africa. Consequently, this study aims to assess the prevalence of childhood stunting and its determinants in low- and lower-middle-income African countries.

METHOD

This study conducted a secondary analysis of standard demographic and health surveys in low- and lower-middle-income African countries spanning the period from 2010 to 2022. The analysis included a total sample of 204,214 weighted children under the age of five years. To identify the determinants of stunting, we employed a multilevel mixed-effect model, considering the three levels of variables. The measures of association (fixed effect) were determined using the adjusted odds ratio at a 95% confidence interval. Significance was declared when the association between the outcome variable and the explanatory variable had a p-value less than 0.05.

RESULT

In low and lower-middle-income African countries, 31.28% of children under five years old experience stunting, with a 95% confidence interval ranging from 31.08% to 31.48%. The results from a multilevel mixed-effect analysis revealed that 24 months or more of age of child, male gender, low and high birth weight, low and high maternal BMI, no and low maternal education, low household wealth index, multiple (twin or triplet) births, rural residence, and low income of countries were significantly associated with childhood stunting.

CONCLUSION

Stunting among children under five years of age in low- and lower-middle-income African countries was relatively high. Individual, community, and country-level factors were statistically associated with childhood stunting. Equally importantly, with child, maternal, and community factors of stunting, the income of countries needs to be considered in providing nutritional interventions to mitigate childhood stunting in Africa.

Effectiveness of ERKADUTA model to increase stunting prevention behaviors among mothers with toddlers in Indonesia: A quasi-experiment

Stunting, a persistent nutritional issue arising from prolonged inadequate nutrient intake, poses substantial risks such as heightened morbidity, mortality, and compromised cognitive, psychomotor, and verbal development. In Indonesia, addressing stunting in children under two necessitates urgent community empowerment, given its multifaceted nature. The aim of this study was to assess the effects of an intervention targeting mothers of toddlers, called RT kawal baduta (ERKADUTA) model, a local community-based assistance for babies under two years old. A quasi-experiment using pre-test and post-test with a control group design was conducted. Employing a quantitative analytic approach with 112 respondents, the effectiveness of ERKADUTA model to improve the knowledge, attitude, and practice of stunting prevention among mothers with child under two years old was assessed. ERKADUTA program was run for three months. The Wilcoxon test was used to determine score changes before and after program in both groups, while the Mann-Whitney test was used to analyze the score differences of knowledge, attitude and practice between intervention and control groups. Our data indicated that there were changes in knowledge, attitudes, and practices in preventing stunting in both the intervention and control groups. There are significant differences in knowledge (p<0.001, effect size=-0.855), attitude (p<0.001, effect size=-0.864), and practice score (p<0.001, effect size=-0.924) between the intervention and control groups after the intervention. This study highlights that the ERKADUTA model emerged as a potent catalyst in improving stunting prevention behaviors among mothers with toddlers and this model holds promise for addressing the complexities of stunting in Indonesia.

Statistical modelling of determinants of child stunting using secondary data and Bayesian networks: a UKRI Global Challenges Research Fund (GCRF) Action Against Stunting Hub protocol paper

INTRODUCTION

Several factors have been implicated in child stunting, but the precise determinants, mechanisms of action and causal pathways remain poorly understood. The objective of this study is to explore causal relationships between the various determinants of child stunting.

METHODS AND ANALYSIS

The study will use data compiled from national health surveys in India, Indonesia and Senegal, and reviews of published evidence on determinants of child stunting. The data will be analysed using a causal Bayesian network (BN)-an approach suitable for modelling interdependent networks of causal relationships. The model's structure will be defined in a directed acyclic graph and illustrate causal relationship between the variables (determinants) and outcome (child stunting). Conditional probability distributions will be generated to show the strength of direct causality between variables and outcome. BN will provide evidence of the causal role of the various determinants of child stunning, identify evidence gaps and support in-depth interrogation of the evidence base. Furthermore, the method will support integration of expert opinion/assumptions, allowing for inclusion of the many factors implicated in child stunting. The development of the BN model and its outputs will represent an ideal opportunity for transdisciplinary research on the determinants of stunting.

ETHICS AND DISSEMINATION

Not applicable/no human participants included.

A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health

Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.

Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Stunting is a major public health concern, particularly in low and middle-income countries. Globally, nearly 149 million under-five children are suffering from stunting. Despite it can occur in all age groups, the impact is more severe among children age less than 24 months as this period is critical time of very rapid growth and development. Therefore, this review aimed to determine the pooled prevalence and determinants of stunting among children during this critical period in Ethiopia.

METHODS

The literature search was conducted using international electronic data bases (pumed, Google scholar, CINHAL, Hinari, open Google) and the hand search of reference lists of eligible articles. The presence of heterogeneity between studies was evaluated using Cochrane Q-test and I2 test statistics and sensitivity analysis was also checked. Small study effect was checked through graphical and statistical test. Sub-group analysis was performed to handle heterogeneity.

RESULTS

This study included 14 studies with a total sample size of 8,056 children. The overall pooled estimate of stunting was 35.01(95% CI: 24.73-45.28, I2 = 98.98%) in the country with the highest prevalence in Amhara region. Increased Child's age (OR = 3.83; 95% CI: 2.47-5.18, I2 = 97.76%), no maternal education (OR = 2.90; 95%CI: 1.59-4.20, I2 = 89.73%), no maternal postnatal follow up (OR = 1.81; 95% CI:1.51-2.10) less than four food diversity of the child (OR = 2.24;95%CI; 1.94-2.55,I2 = 21.55%), low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were significant factors of stunting.

CONCLUSION AND RECOMMENDATIONS

The pooled prevalence of stunting among children during their critical time is high. Increased Child's age, no maternal education and no maternal postnatal follow up, less than four food diversity of the child, low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were determinants of stunting. Therefore, providing continuous maternal postnatal follow up, increase awareness of mothers on importance of colostrum and exclusive breast feeding, feeding of children the recommended variety of foods and at large to improve the wealth status of the households are crucial interventions to meet national and international targets of zero stunting in children less than 2 years.

Safely managed sanitation practice and childhood stunting among under five years old children in Myanmar

In 2020, 149 million children under the age of five were estimated to be stunted globally. Around half of deaths among children under 5 years of age are related to under-nutrition. Objective of this study is to determine the association between safely managed sanitation and childhood stunting among under-five years old children in Myanmar. This cross-sectional analytical study was conducted in 16 townships across three regions and five states in Myanmar. Multiple logistic regressions analysis was performed to determine the associations. This study found that 327 (27.09%) under-five children were stunted among a total of 1207 children in Myanmar. Children with unsafely managed sanitation were 2.88 times more likely to be stunting compared with children who access to safely managed sanitation services (AOR = 2.88, 95% CI: 2.16 to 3.85; p-value <0.01). Other associated factors for childhood stunting were needs 1-15 minutes for water collection (AOR = 2.07, 95% CI: 1.46 to 2.94; p-value <0.01), 15-60 minutes for water collection times (AOR = 1.55, 95% CI: 1.08 to 2.23; p-value 0.02), improper waste water disposal (AOR = 1.99, 95% CI: 1.47 to 2.70; p-value <0.01), boys children (AOR = 4.49, 95% CI: 3.30 to 6.12; p-value <0.01), did not take vitamin A supplements(AOR = 1.64, 95% CI: 1.22 to 2.20; p-value <0.01), mothers height shorter than 153.4cm (AOR = 1.94, 95% CI: 1.45 to 2.58; p-value <0.01), and the lower minimal diet diversity (AOR = 1.47, 95% CI: 1.08 to 2.01; p-value 0.02). More access to safely managed sanitation facilities, technical sharing for proper waste water disposal, promoting household water supply system, health promotion for children's diet eating pattern, and regular support for Vitamin A supplementation are critical to reduce childhood stunting among children under the age of five in Myanmar.

Stunting and Its Associated Factors among Children Below 5 Years Old on the East Coast of Peninsular Malaysia: Evidence from the National Health and Morbidity Survey

Background

Child malnutrition problems still occur in Malaysia, particularly stunting. This study aimed to determine the proportion of stunting among children below 5 years old and investigate the factors associated with stunting on the East Coast of Peninsular Malaysia.

Methods

This study utilised data from the 2016 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to determine the factors associated with malnutrition among non-stunted and stunted children.

Results

The proportion of stunting among children below 5 years old in this East Coast region was 26.2%. When divided by state, Kelantan had the highest proportion of stunting, followed by Pahang and Terengganu, at 28.8%, 26.2% and 23.4%, respectively. In this study, the factors associated with stunting were children aged 24 months old-59 months old (adjusted odds ratio [aOR]: 1.52; 95% CI: 1.26, 1.83; P < 0.001), male children (aOR: 1.47; 95% CI: 1.23, 1.76; P < 0.001), Orang Asli children (aOR: 2.84; 95% CI: 1.86, 4.32; P < 0.001), children with low birth weight from 1,500 g to 2,499 g (aOR: 1.86; 95% CI: 1.36, 2.55; P < 0.001) and children from households that practice unsanitary waste disposal (aOR: 1.42; 95% CI: 1.16, 1.74; P = 0.001).

Conclusion

Stunting among children under the age of 5 years old on the East Coast of Peninsular Malaysia remains a public health problem. To reduce the prevalence of stunting in this region, intervention programmes should be intensified. Emphasis should be placed on public health programmes that target the associated factors, such as dietary habits, Orang Asli children, low birth weight and unsanitary waste disposal.

A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data

Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.

Effect of applying the health promotion model in stunting prevention and behavior control in Indonesia

BACKGROUND

Stunting is a condition of failure to thrive in children, due to chronic malnutrition and recurrent infections. This study aimed to evaluate the effectiveness of implementing the health promotion model in stunting prevention and control behavior.

MATERIALS AND METHODS

This cross-sectional quantitative analytic study was conducted using a survey method involving 228 mothers of stunted children in Indonesia. Cluster random sampling was used. Data were collected using a questionnaire with a Likert scale, and then, they were analyzed using univariate analysis, multiple linear regression, and pathway analysis to determine the direct and indirect effects.

RESULTS

All respondents were of non-risk age (20-45 years), most had height >150 cm (83.8%), moderate weight (93.4%), multigravida parity (87.3%), middle education (70.2%), unemployed (91.7%), monthly income of less than 1,800,000 rupiahs (89.9%), and exclusive breastfeeding (97.4%). Sanitation, self-efficacy, and social support had a significant effect on stunting prevention and control behavior (P < 0.05). Socioeconomic and sanitation effects through self-efficacy indirectly had a significant positive, while parenting through food or nutritional intake had a significant influence on the stunting incidence (P < 0.05). Variables that had a significant positive effect on stunting prevention and behavior directly were perceived vulnerability, perceived severity, perceived obstacles, self-efficacy, social support, community organizing, and facilitator (P < 0.05). Parenting through the health of diarrhea or acute respiratory infection (ARI) had no significant positive effect on the stunting incidence (P = 0.121).

CONCLUSION

Almost all variables have a significant direct and indirect effect on stunting prevention and control behavior, as well as the stunting incidence, except parenting through the health of diarrhea or ARI.

Low bone mineral density is associated with fatty liver disease and respiratory illness in a pediatric mortality sample

This study finds that fatty liver disease is associated with low bone density in a pediatric mortality sample. Since non-alcoholic fatty liver disease has increased in prevalence over the past few decades among children, a better understanding of the disease's impacts on bone health is of significance to clinicians.

PURPOSE

Chronic illness leads to decreased bone modeling and remodeling. This can be especially problematic during childhood and adolescence, since the majority of an individual's peak bone mass is achieved by the age of 20. In this study, we examine relationships between chronic illness and low bone mineral density (BMD) in a pediatric mortality sample (aged 0.5 to 20.9 years) from New Mexico. We also test whether low BMD is related to decelerated linear growth by examining its relationship to growth stunting and arrest (Harris lines).

METHODS

Hounsfield units (HU), a proxy for trabecular BMD, were obtained at the fourth lumbar vertebra and the femoral neck from postmortem CT scans. Linear regression was used to examine associations between z-standardized HU and age, sex, medical conditions, Harris lines, and growth stunting.

RESULTS

We find that lumbar HU is significantly lower for individuals with fatty liver disease and respiratory illness; femoral HU is significantly lower in individuals with Harris lines.

CONCLUSION

The mechanisms of low BMD in individuals with fatty liver disease and respiratory illness are likely multifactorial and involve vitamin D deficiency (malnutrition, malabsorption), systemic inflammation, and sedentary lifestyles. However, better awareness of this relationship can provide clinicians with the ability to introduce nutritional and behavioral interventions early to mitigate deleterious effects on bone. Harris lines, on the other hand, mark temporary growth cessation due to physiological stress followed by a rapid resumption of growth. Low BMD in these individuals may be due to bone mineralization lagging behind relatively rapid linear growth.

The Nutritional Quality of Food Provision at UK Government-Funded Holiday Clubs: A Cross-Sectional Analysis of Energy and Nutrient Content

A large proportion of children are at risk of food insecurity during school holidays in the UK. The government-funded Holiday Activities and Food (HAF) programme provides free holiday clubs offering at least one healthy meal/day to eligible children and adolescents. This study aims at evaluating the nutritional quality of food provision at HAF holiday clubs, particularly hot/cold and vegetarian/non-vegetarian meals. Menu variants (n = 2759) from 49 HAF holiday clubs were assessed for adherence to School Food Standards (SFS) and their notional compositional quality, which was scored utilising a novel nutrient-based meal quality index. The median adherence to SFS across all available menus was 70% (IQR 59-79%). Overall, hot variants scored statistically higher menu quality scores than cold variants for both 5-11y (92.3 (80.7-102.7) vs. 80.4 (69.3-90.6)) and 11-18y (73.5 (62.5-85.8) vs. 58.9 (50.0-70.7)) criteria. Cold and hot menu variants tended to score differentially for quality sub-components. These findings highlight areas for potential future improvement in HAF holiday club provision with a tendency for food provision to appear less ideal for attendees for those aged 11-18. Ensuring that children from low-income households have access to a healthy diet is crucial to reduce UK health inequalities.

Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: A longitudinal cross-sectional survey in Surkhet District, Nepal

INTRODUCTION

Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour change is challenging but more likely to be realized during epidemics, when health threats are high and the dissemination of information on preventative measures is intense. Our study conducted cross-sectional surveys in Surkhet District Nepal, before and during the Covid-19 pandemic to assess the impact of water safety interventions and hygiene training implemented before and during the pandemic on WASH conditions and practices and to assess the association of these changes with child health.

METHODS

Information on WASH infrastructure, WASH behaviour, nutrition, and child health, including on parasitic infections, was obtained before and during the Covid-19 pandemic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of children including anthropometric measurements, analysis of children's stool, and water quality analysis. The association of changes in WASH factors with changes in child health was analysed using multivariate generalized estimating equations for repeated measures.

RESULTS

Water safety management was significantly improved by the introduction of chlorination to piped water supply systems, which served 40% of households. In addition, the percentage of households using a ceramic water filter increased from 12.2% to 34.8%. Large and significant changes were observed in handwashing behaviour (frequency, use of soap and washing at critical times) and infrastructure: 35% of households constructed a new handwashing station. Kitchen and household hygiene also improved. An additional 22% of households improved the cleanliness of the toilet. The number of houses with a cemented floor increased by 20%. WASH changes were significantly associated with improved child health: the chlorination of piped water supply reduced odds ratios for diarrhoea (OR = 0.36, 95% CI = 0.15-0.88, p = 0.025), respiratory difficulties (OR = 0.39, 95% CI = 0.16-0.92, p = 0.033), fever (OR = 0.42, 95% CI = 0.26-0.71, p = 0.001) and cough (OR = 0.58, 95% CI = 0.36-0.93, p = 0.024), and. The frequency of handwashing with soap was associated with significantly reduced odds ratios for infections with Giardia lamblia (OR = 0.68, 95% CI = 0.50-0.91, p = 0.011), stunting and wasting (OR = 0.75, 95% CI = 0.66-0.92, p = 0.003) and fever (OR = 0.85, 95% CI = 0.75-0.96, p = 0.008),. The presence of a handwashing station at baseline was associated with significantly reduced odds ratios for respiratory difficulties (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004). The construction of a handwashing station between baseline and endline was significantly associated with reduced odds ratios for pale conjunctiva (OR = 0.32, 95% CI = 0.17-0.60, p < 0.001), which is a clinical sign of iron deficiency and anaemia, respiratory difficulties (OR = 0.39, 95% CI = 0.17-0.89, p = 0.026) and cough (OR = 0.44, 95% CI = 0.26-0.76, p = 0.003). Using a clean container for the transport of drinking water was significantly associated with reduced odds ratios for infections with Giardia lamblia (OR = 0.39, 95% CI = 0.16-0.93, p = 0.033) and diarrhoea (OR = 0.48, 95% CI = 0.24-0.96, p = 0.038). Similarly, a cemented floor in the household was significantly associated with reduced odd ratios for diarrhoea (OR = 0.38, 95% CI = 0.16-0.87, p = 0.022) and infections with Giardia lamblia (OR = 0.44, 95% CI = 0.19-1.02, p = 0.056).

CONCLUSION

WASH training and the promotion of preventative measures during the Covid-19 pandemic supported improved water safety management and hygiene behaviour, which resulted in a reduction in infectious diseases among children in the study area.

Food systems determinants of nutritional health and wellbeing in urban informal settlements: A scoping review in LMICs

INTRODUCTION

Increasing food and nutritional inequities are apparent in urban settings across Low- and Middle-Income Countries (LMICs), along with nutrition transition towards ultra-processed diets high in fat, sugar, and salt. In urban informal settlements, characterized by insecurity and inadequate housing and infrastructure, food systems dynamics and their nutritional implications are poorly understood.

OBJECTIVES

This paper explores the food system determinants of food and nutrition security in urban informal settlements in LMICs with the goal of identifying effective approaches and entry points for policy and program.

METHODS

Scoping review. Five databases were screened spanning the period 1995 to 2019. A total of 3748 records were assessed for inclusion based on title and abstract followed by 42 full text reviews. At least two reviewers assessed each record. Twenty-four final publications were included, coded, and synthesized.

RESULTS

Factors influencing food security and nutrition in urban informal settlements can be organized into three interconnected levels. Macro-level factors include globalization, climate change, transnational food corporations, international treaties and regulations, global and national policies such as SDGs, insufficient social aid programs, and formalization or privatization. Meso-level factors include gender norms, inadequate infrastructure and services, insufficient transportation, informal food retailers, weak municipal policies, marketing strategies, and (lack of) employment. Micro-level factors comprise gender roles, cultural expectations, income, social networks, coping strategies, and food (in) security.

CONCLUSIONS

Greater policy attention should focus at the meso-level, with priority investments in services and infrastructure within urban informal settlements. The role and engagement of the informal sector is an important consideration in improving the immediate food environment. Gender is also crucial. Women and girls have a central role in food provisioning but are more vulnerable to various forms of malnutrition. Future research should include context-specific studies in LMIC cities as well as promoting policy change using a participatory and gender transformative approach.

Prevalence and Correlates of Stunting among Children Aged 6-23 Months from Poor Households in Rwanda

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19-23 months (AOR = 4.410, p-value = 0.01), and children aged 13-18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

Is stunting in children under five associated with the state of vegetation in the Democratic Republic of the Congo? Secondary analysis of Demographic Health Survey data and the satellite-derived leaf area index

Background

The prevalence of stunting in the Democratic Republic of the Congo (DRC) is one of the highest globally. However, only a few studies have attempted to measure the association between stunting and vegetation, which is an important food source. The leaf area index (LAI) is an excellent measure for the vegetation state.

Objective

This paper intended to measure the association between the LAI and stunting among children under five years of age in the DRC. Its aim was to better understand the boundary conditions of stunting and explore potential links to climate and environmental change.

Methods

This paper adopts a secondary data analysis approach. We used data on 5241 children from the DRC Demographic Health Survey (DHS) 2013-2014, which was collected from a nationally representative cross-sectional survey. We used the satellite-derived LAI as a measure for the state of vegetation and created a 10-km buffer to extract each DHS cluster centroid's corresponding mean leaf-area value. We used a generalised mixed-effect logistic regression to measure the association between LAI and stunting, adjusting the model for mother's education, occupation and birth interval, as well as child's age and national wealth quintile. A height-for-age Z-score (HAZ) was calculated and classified according to WHO guidelines.

Results

Children in communities surrounded by high LAI values have lower odds of being stunted (OR [odds ratio] = 0.63; 95% CI [confidence interval] = 0.47-0.86) than those exposed to low LAI values. The association still holds when the exposure is analysed as a continuous variable (OR = 0.84; 95% CI = 0.74-0.95).When stratified in rural and urban areas, a significant association was only observed in rural areas (OR = 0.6; 95% CI = 0.39-0.81), but not in urban areas (OR = 0.9; 95% CI = 0.5-0.5). Furthermore, the study showed that these associations were robust to LAI buffer variations under 25 km.

Conclusions

Good vegetation conditions have a protective effect against stunting in children under five years of age. Further advanced study designs are needed to confirm these findings.

Climate change vulnerability, and health of women and children: Evidence from India using district level data

OBJECTIVE

To understand how climate change vulnerability is associated with women and children's health (WCH) at the district level in India.

METHODS

The district-specific climate change vulnerability index was mapped to the district level NFHS-5 data (N = 674). Fractional regression and spatial analyses were performed to examine the strength of association and the presence of geographic clustering.

RESULTS

Bivariate analysis revealed that the levels of WCH indicators were lower in districts with a high vulnerability index than in those with a low vulnerability index. Multivariable analyses suggested that with a 1% increase in the vulnerability index, the proportion of modern contraceptive use was reduced by 0.22, four or more prenatal care visits by 0.14, postnatal care by 0.11, and full immunization by 0.12; whereas wasting and underweight proportions increased by 0.07 and 0.10, respectively. The spatial analysis found that in about 70-118 districts, mostly in eastern India, where climate vulnerability was high the WCH outcomes were also poor.

CONCLUSION

There is a macro-level association between climate change vulnerability and WCH, as districts that had high levels of climate change vulnerability also performed poorly in WCH. There is a need for an integrated approach that considers geography-specific climate change threats to develop health programs.

Family Household Characteristics and Stunting: An Update Scoping Review

Stunting remains a public health concern in developing countries. Factors related to stunting have been categorized using various frameworks. Family plays an important role in providing nutrients for children; however, no review specifies this aspect for identifying family characteristics related to stunting. This study aimed to identify family household characteristics related to stunting among children aged less than 5 years. A scoping review was undertaken with sources from PubMed, CINAHL, and Scopus, using the keywords "family characteristics" AND "growth". Inclusion criteria were (1) correlational study; (2) published between 2018 and 31 July 2022; (3) families with children under the age of 5 years; and (4) independent variable any measure of stunting factors from family and household factors. Of 376 articles, only 20 met the inclusion criteria of the study. The family household characteristics included individual factors (sex age, history of diarrhea, and birthplace), family factors (family headship, primary caregiver/mother, social-cultural orientation, and family system factors), and environmental factors. Various child variables, family factors, and environmental factors (the type of home, floor type, water access, source of drinking water, and household electricity) were identified as being associated with stunting. Therefore, these factors should be evaluated to prevent and control stunting, and they should be incorporated into health programs targeting stunting.

Determining factors of child linear growth from the viewpoint of Bronfenbrenner's Bioecological Theory

OBJECTIVE

To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory.

DATA SOURCES

Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators.

SUMMARY OF FINDINGS

According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes.

CONCLUSION

Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.

Prenatal Mercury Exposure and Infant Weight Trajectories in a UK Observational Birth Cohort

Mercury is highly toxic metal found in trace quantities in common foods. There is concern that exposure during pregnancy could impair infant development. Epidemiological evidence is mixed, but few studies have examined postnatal growth. Differences in nutrition, exposures, and the living environment after birth may make it easier to detect a negative impact from mercury toxicity on infant growth. This study includes 544 mother-child pairs from the Avon Longitudinal Study of Parents and Children. Blood mercury was measured in early pregnancy and infant weight at 10 intervals between 4 and 61 months. Mixed-effect models were used to estimate the change in infant weight associated with prenatal mercury exposure. The estimated difference in monthly weight gain was -0.02 kg per 1 standard deviation increase in Hg (95% confidence intervals: -0.10 to 0.06 kg). When restricted to the 10th decile of Hg, the association with weight at each age level was consistently negative but with wide confidence intervals. The lack of evidence for an association may indicate that at Hg levels in this cohort (median 1.9 µg/L) there is minimal biological impact, and the effect is too small to be either clinically relevant or detectable.

Prenatal Exposure to Ambient PM2.5 and Early Childhood Growth Impairment Risk in East Africa

Height for age is an important and widely used population-level indicator of children's health. Morbidity trends show that stunting in young children is a significant public health concern. Recent studies point to environmental factors as an understudied area of child growth failure in Africa. Data on child measurements of height-for-age and confounders were obtained from fifteen waves of the Demographic and Health Surveys (DHS) for six countries in East Africa. Monthly ambient PM_2.5 concentration data was retrieved from the Atmospheric Composition Analysis Group (ACAG) global surface PM_2.5 estimates and spatially integrated with DHS data. Generalized additive models with linear and logistic regression were used to estimate the exposure-response relationship between prenatal PM_2.5 and height-for-age and stunting among children under five in East Africa (EA). Fully adjusted models showed that for each 10 µg/m³ increase in PM_2.5 concentration there is a 0.069 (CI: 0.097, 0.041) standard deviation decrease in height-for-age and 9% higher odds of being stunted. Our study identified ambient PM_2.5 as an environmental risk factor for lower height-for-age among young children in EA. This underscores the need to address emissions of harmful air pollutants in EA as adverse health effects are attributable to ambient PM_2.5 air pollution.

Exposure to household air pollution from solid cookfuels and childhood stunting: a population-based, cross-sectional study of half a million children in low- and middle-income countries

BACKGROUND

Household air pollution from the incomplete combustion of solid cookfuels in low- and middle-income countries (LMICs) has been largely ignored as a potentially important correlate of stunting. Our objective was to examine the association between solid cookfuel use and stunting in children aged <5 y.

METHODS

We used data from 59 LMICs' population-based cross-sectional demographic and health surveys; 557 098 children aged <5 y were included in our analytical sample. Multilevel logistic regression was used to examine the association between exposure to solid cookfuel use and childhood stunting, adjusting for child sex, age, maternal education and number of children living in the household. We explored the association across key subgroups.

RESULTS

Solid cookfuel use was associated with child stunting (adjusted OR 1.58, 95% CI 1.55 to 1.61). Children living in households using solid cookfuels were more likely to be stunted if they lived in rural areas, the poorest households, had a mother who smoked tobacco or were from the Americas.

CONCLUSIONS

Focused strategies to reduce solid cookfuel exposure might contribute to reductions in childhood stunting in LMICs. Trial evidence to assess the effect of reducing solid cookfuel exposure on childhood stunting is urgently needed.

Child stunting and associated risk factors in selected food-insecure areas in Rwanda: an analytical cross-sectional study

Introduction

stunting rates among the under-five children are generally high in Rwanda. They are unexpectedly lower than the national average stunting rate in some districts where poverty rates are the highest in the country. This study aimed to ascertain the key factors that protect children from stunting in these poorest areas, where stunting rates are lower than expected.

Methods

we analysed cross-sectional data from 2019/2020 Rwanda Demographic and Health Survey (RDHS) for 477 under-five children from Karongi, Rulindo, Nyanza, and Gisagara districts. Univariate and bivariate statistical analyses were used to find out the factors to retain for multivariable analysis. We obtained the key risk factors of child stunting through a multivariable binary logistic regression analysis.

Results

the child stunting rate in the study districts was 30 percent, which is three percent lower than the national average rate. Child stunting was negatively associated with a birth weight of at least 2.5 kg (AOR = 0.393, 95% CI: 0.180 - 0.856), a high household economic status (AOR = 0.506, 95%CI: 0.273 - 0.937), urban residence (AOR = 0.467; 95% CI: 0.222 - 0.984), and health insurance coverage (AOR = 0.418; 95% CI: 0.228 -0.767). Children aged one year and above, as well as female-headed households, were associated with at least three times and two times greater odds of child stunting than children aged below 12 months and those from male-headed households respectively.

Conclusion

the nutritional performance of children in the study districts is substantially driven by the high uptake of health insurance, which fosters increased access to healthcare services. To address child-stunting gaps in low-income areas in Rwanda, child nutrition programs should improve the utilization of healthcare services, and leverage the potential high effect of nutrition education, especially during pregnancy and lactation.

Patterns of Socioeconomic Inequities in SDGs Relating to Children's Well-Being in Thailand and Policy Implications

Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children's wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women's health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people.

Transportation moderation in agricultural sector sustainability - a robust global perspective

The agriculture sector creates nearly a quarter of the total GHG emissions globally as production and transportation activities in the agriculture sector mostly use fossil fuels, creating carbon emissions. In this regard, it is highly important to study the environmental sustainability of agriculture sector growth by using the theory of environmental Kuznets curve (EKC). Furthermore, this research study is aimed to assess the moderation role of transportation competitiveness in determining the carbon emissions of transportation sector by using agriculture sector value addition. The study uses panel quantile regression technique for data analysis of 121 countries by covering time period from 2008 to 2018. The study results validated the agricultural EKC across four different quantile groups based on carbon emissions of transport sector. The moderation of transportation competitiveness is observed in changing the turning point and flattening of agricultural EKC indicating the early achievement of maturity. The quality of institutions and planned increase of population can help reduce carbon emissions of transportation sector. The moderation of transportation competitiveness implicates the importance of planning and efficiently operating the transportation sector to mitigate carbon emissions.

A review of rural and peri-urban sanitation infrastructure in South-East Asia and the Western Pacific: Highlighting regional inequalities and limited data

Rural and peri-urban communities in developing countries rely on sanitation systems which are often unsafely managed. One of the major barriers to assess safely managed sanitation is a lack of data about the existing sanitation infrastructure and levels of containment safety. The aim was to review rural and peri-urban on-site sanitation studies in order to understand different infrastructure types, associated management practices and any impacts on human health. The scope was limited to South-East Asia and Western Pacific regions in order to better identify regional inequalities. Among the 155 reviewed articles, 73 studies (47%) linked sanitation infrastructure to poor human health. Nearly all articles reported latrine ownership (n = 149, 96%) while sanitation infrastructure types were covered less frequently (n = 104, 67%). In particular, there was a lack of published literature describing back-end characteristics (dimension and materials) (n = 12, 8%) and/or management practices (n = 4, 3%). This stems from a limited application of research methodologies that characterise sanitation infrastructure and faecal sludge management (containment, emptying and on-site treatment). Inequality between regions was prevalent with three quarters of the studies on latrine back-end infrastructure from Bangladesh and India in South-East Asia. A strategic research approach is needed to address the current knowledge gaps regarding sanitation infrastructure and safe faecal sludge management.

The Analysis of Trends of Preschool Child Stunting, Wasting and Overweight in the Eastern Mediterranean Region: Still More Effort Needed to Reach Global Targets 2025

BACKGROUND

This study was undertaken to analyze and compare Eastern Mediterranean (EM) countries in achievement of WHO nutrition global targets for children growth indicators by 2025.

METHODS

A total of 108 national surveys from 20 countries in EM region were analyzed to estimate the prevalence of stunting and wasting and 93 surveys to estimate the prevalence of overweight/obesity in children. These data were obtained from national surveys included in the WHO Global Database on Child Growth and Malnutrition.

RESULTS

In EM region, the prevalence of childhood stunting was estimated to have a 38% decline from 2000 (34.7%) to 2025 (21.2%). Only three countries in EM region (Iran and Jordan, Saudi Arabia) were anticipated to achieve the expected WHO target by 2025. From 2000 to 2020, the prevalence of wasting decreased from 6.9 to 5.3. Six countries were presumed to achieve the expected WHO target by 2025. Nine countries will presumably have overweight rates >5% (Djibouti, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Syrian Arab Republic and Tunisia) in 2025 whereas five countries will have overweight rates above 10% (Egypt, Libya, Morocco, Syrian Arab Republic and Tunisia).

CONCLUSION

Despite descending trends of child stunting and wasting and a secular trend of child obesity in EM region, it is expected that WHO targets will not be achieved by 2025. A diverse socio-economic condition in EM countries necessitates different action plans. International determination, political commitment and, above all, involvement of the families are needed to achieve 2025 targets for child stunting, wasting and overweight/obesity.

Understanding drivers of stunting reduction in Nigeria from 2003 to 2018: a regression analysis

Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0-59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12571-022-01279-8.

Stunting Prevention and Control Program to Reduce the Prevalence of Stunting: Systematic Review Study

BACKGROUND: Stunting is a condition in which the occurrence of failure to thrive in children as a result of chronic malnutrition so that the child is too short for his age. The prevalence of stunting in children under five in Indonesia is higher than the prevalence of stunting in the world. One of the impacts of stunting is the occurrence of developmental barriers, where if this is not prevented it will have an impact on the less than optimal performance of children in school and the long-term impact can be a decrease in the quality of human resources. AIM: This study aims to systematically identify stunting prevention and control programs to reduce the prevalence of stunting. METHODS: The method used in this study is the Systematic Review (SR). SR is a method that identifies, assesses, and interprets findings on a research topic to answer predetermined research questions. The keywords used to search for articles on electronic databases are ProQuest, Scinapse, PubMed, and Google Search. The keywords used are “stunting,” “parenting,” “parenting AND Stunting,” “stunting prevention,” “stunting prevention,” “stunting in lower and middle income countries,” “stunting and global programs,” and “stunting and Indonesia.” “Stunting and Asia Region” obtained from the ProQuest, Scinapse, PubMed, and Google Search database. RESULTS: Based on the identification results of this study, there are several forms of programs and interventions to prevent and control stunting that have been proven to be successful in reducing the prevalence of stunting, namely: CARING Trial, COWPEA, The Lulun Project, Rang-Din Nutrition Study, Tubaramure, NEO-MOM, Preparing for Life, Integrated Child Development Services, Early childhood caries, Small-Quantity, Lipid-Based Nutrient Supplements, Handwashing With Soap and Total Sanitation and Sanitation Marketing, PROCOMIDA, Community-Based Participatory Nutrition Promotion Program, Promote Children’s Growth and Development, Community-Based Growth Monitoring Including Nutritional Supplementation, Child Development Agents, Lady Health Worker program, ready-to-use supplementary foods, and Supporting Father Involvement, Positive Deviance/Hearth, JiVitA-3. CONCLUSION: From planning, conducting and reporting, it can be concluded that the intervention as an effort to prevent and control stunting had a significant effect between the intervention group and the treatment group and the control group which was only given normal treatment even without any treatment.

Spatiotemporal clustering and correlates of childhood stunting in Ghana: Analysis of the fixed and nonlinear associative effects of socio-demographic and socio-ecological factors

Childhood stunting remains a major public health issue in many low- and middle-income countries. In Ghana, the progress made is insufficient to reach the targets set by the 2025 World Health Assembly and the 2030 United Nations Sustainable Development Goals. Although studies have examined the socio-demographic determinants of childhood stunting, there has not been any systematic study to examine the spatial associative effects of the socio-demographic and socio-ecological factors at the district level, where health programmes are implemented and monitored. Bayesian geo-additive semiparametric regression technique was used to analyse five conservative rounds of Demographic and Health Surveys in Ghana, with socio-ecological covariates derived from the Demographic and Health Survey Program Geospatial Covariate datasets to examine the temporal trends in childhood stunting, the extent of geospatial clustering at the district level and their associative relationships with socio-demographic and socio-ecological factors. The findings show that childhood stunting in Ghana is not spatially randomly distributed but clustered. Clustering of high childhood stunting was observed amongst districts in the Upper West, Upper East, Northern, North East, Savannah, and Western North regions, whilst clustering of low childhood stunting was observed in districts in the Greater Accra, Volta, Bono and the Eastern regions. Whist socio-demographic factors were predominantly associated with clustering of districts with high childhood stunting, the socio-ecological factors were mainly associated with clustering of districts with low childhood stunting. The socio-ecological factors identified to have a nonlinear associative effect with childhood stunting were Insecticide Treated Net (ITN) coverage, nightlight composite, travel time to a main settlement and population density. The findings suggest that targeted interventions at the district level are essential to reducing childhood stunting in Ghana.

Bayesian geostatistical modelling of stunting in Rwanda: risk factors and spatially explicit residual stunting burden

Background

Stunting remains a significant public health issue in Rwanda and its prevalence exhibits considerable geographical variation. We apply Bayesian geostatistical modelling to study the spatial pattern of stunting in children less than five years considering anthropometric, socioeconomic and demographic risk factors in Rwanda. In addition, we predict the spatial residuals effects to quantify the burden of stunting not accounted for by our geostatistical model.

Methods

We used the data from the 2015 Rwanda Demographic and Health Survey. We fitted two spatial logistic models with similar structures, only differentiated by the inclusion or exclusion of spatially structured random effects.

Results

The risk factors of stunting identified in the geostatistical model were being male (OR = 1.32, 95% CI: 1.16, 1.47), lower birthweight (kg) (OR = 0.96, 95% CI: 0.95, 0.97), non-exclusive breastfeeding (OR = 1.24, 95% CI: 1.04, 1.45), occurrence of diarrhoea in the last two weeks (OR = 1.18, 95% CI: 1.02, 1.37), a lower proportion of mothers with overweight (BMI ≥ 25) (OR = 0.82, 95% CI: 0.71, 0.95), a higher proportion of mothers with no or only primary education (OR = 1.14, 95% CI: 0.99, 1.36). Also, a higher probability of living in a house with poor flooring material (OR = 1.22, 95% CI: 1.06, 1.41), reliance on a non-improved water source (OR = 1.13, 95% CI: 1.00, 1.27), and a low wealth index were identified as risk factors of stunting. Mapping of the spatial residuals effects showed that, in particular, the Northern and Western regions, followed by the Southern region of Rwanda, still exhibit a higher risk of stunting even after accounting for all the covariates in the spatial model.

Conclusions

Further studies are needed to identify the still unknown spatially explicit factors associated with higher risk of stunting. Finally, given the spatial heterogeneity of stunting, interventions to reduce stunting should be geographically targeted.

Aquatic Animal Foods for Nutrition Security and Child Health

BACKGROUND

Aquatic animal source foods (AASF) can provide vital nutrients and bioactive factors essential for human health, yet disparities in consumption patterns prevail globally. Limited evidence exists for the implications of AASF access on child health outcomes.

OBJECTIVE

This study aimed to examine global AASF intakes longitudinally in association with critical nutrient intakes and childhood stunting and anemia.

METHODS

The analysis draws from compiled longitudinal country data (1993-2013) based on a constructed conceptual framework encompassing social and ecological factors that influence fish consumption and human health. Longitudinal generalized linear models were used to estimate the association of apparent AASF intake on country-level nutrient availability (docosahexaenoic acid [DHA], choline, vitamin B₁₂, iron, and zinc) and prevalence of undernourishment, child stunting, and child anemia.

RESULTS

Across 175 countries, the median per capita daily apparent intake of all AASF was 37.87 g, with marginally significant differences observed between countries with low (46.65 g) versus high child mortality (23.50 g). The combined category of all AASF was significantly associated with increased total apparent intakes of DHA, choline, and vitamin B₁₂ and reduced child stunting. Finfish (pelagic and demersal) and crustaceans inversely correlated with child stunting, while apparent intakes of mollusks and crustaceans were associated with reduced child anemia.

CONCLUSIONS

This study uniquely showed that AASF were associated with improved child health outcomes and the critical nutrients necessary for growth, development, and maintaining health throughout the life course. Policies should ensure increased access to AASF across food systems and within sustainable healthy diets globally.

Evolution of Lactase Persistence: Turbo-Charging Adaptation in Growth Under the Selective Pressure of Maternal Mortality?

The emergence of the capacity to digest milk in some populations represents a landmark in human evolution, linking genetic change with a component of niche construction, namely dairying. Alleles promoting continued activity of the enzyme lactase through the life-course (lactase persistence) evolved in several global regions within the last 7,000 years. In some European regions, these alleles underwent rapid selection and must have profoundly affected fertility or mortality. Elsewhere, alleles spread more locally. However, the functional benefits underlying the rapid spread of lactase persistence remain unclear. Here, we set out the hypothesis that lactase persistence promoted skeletal growth, thereby offering a generic rapid solution to childbirth complications arising from exposure to ecological change, or to new environments through migration. Since reduced maternal growth and greater neonatal size both increase the risk of obstructed labour, any ecological exposure impacting these traits may increase maternal mortality risk. Over many generations, maternal skeletal dimensions could adapt to new ecological conditions through genetic change. However, this adaptive strategy would fail if ecological change was rapid, including through migration into new niches. We propose that the combination of consuming milk and lactase persistence could have reduced maternal mortality by promoting growth of the pelvis after weaning, while high calcium intake would reduce risk of pelvic deformities. Our conceptual framework provides locally relevant hypotheses to explain selection for lactase persistence in different global regions. For any given diet and individual genotype, the combination of lactase persistence and milk consumption would divert more energy to skeletal growth, either increasing pelvic dimensions or buffering them from worsening ecological conditions. The emergence of lactase persistence among dairying populations could have helped early European farmers adapt rapidly to northern latitudes, East African pastoralists adapt to sudden climate shifts to drier environments, and Near Eastern populations counteract secular declines in height associated with early agriculture. In each case, we assume that lactase persistence accelerated the timescale over which maternal skeletal dimensions could change, thus promoting both maternal and offspring survival. Where lactase persistence did not emerge, birth weight was constrained at lower levels, and this contributes to contemporary variability in diabetes risk.

Peranan Pilar Tujuan Pembangunan Berkelanjutan Terhadap Penanganan Gizi Kurang di Provinsi Jawa Barat (The Role Of Pillar Sustainable Development Goals Relate to Tackling Undernutrition in West Java Province)

ABSTRAKLatar belakang: Penghapusan malnutrisi dalam segala bentuknya, khususnya gizi kurang (stunting dan underweight) adalah suatu keharusan untuk alasan kesehatan, etika, politik, sosial dan ekonomi. Komitmen Tujuan Pembangunan Berkelanjutan (TPB) dipertimbangkan untuk dapat diarahkan kepada tindakan dan akuntabilitas untuk dapat menangani  penyebab langsung dan tidak langsung dari segala bentuk malnutrisi.Tujuan: Menganalisis peranan Tujuan Pembangunan Berkelanjutan terhadap penanganan gizi kurang (stunting dan underweight) dan menyusun pemodelan hubungan keduanya.Metode: Penelitian menggunakan data sekunder. Unit analisis 27 kabupaten/kota di Provinsi Jawa Barat selama tahun 2016-2017, dengan total 54 unit. Variabel dependen penelitian ini adalah gizi kurang (stunting dan underweight) pada anak usia 0-59 bulan, sedangkan variabel independennya yaitu pilar sosial, pilar ekonomi dan pilar lingkungan. Data penelitian diolah menggunakan pendekatan Partial Least Square-Structural Equation Model (PLS-SEM)Hasil: Pencapaian pilar lingkungan dapat mendorong peningkatan capaian pilar sosial dan ekonomi sehingga secara langsung dan tidak lansung mampu menurunkan prevalensi gizi kurang dengan total 5,09%. Pencapaian pilar sosial dapat secara langsung meningkatkan pencapaian pilar ekonomi sehingga secara langsung maupun tidak langsung dapat menurunkan prevalensi gizi kurang dengan total 3,65%. Peningkatan pencapaian pilar ekonomi dapat secara langsung menurukan prevalensi gizi kurang sebesar 3.86%. Semua hubungan signifikan dengan t-statistik > 1,96 (α=0,05).Kesimpulan: Penurunan masalah gizi kurang (stunting (TB/U) dan underweight (BB/U)) pada anak usia 0-59 bulan dapat dipengaruhi oleh pencapaian indikator di masing-masing pilar TPB. Kombinasi pilar sosial, lingkungan dan ekonomi dalam penanganan masalah gizi secara bersama-sama menunjukkan penurunan prevalensi gizi kurang yang cenderung lebih tinggi dibandingkan hanya melalui pencapaian indikator pada satu/dua pilar TPB. ABSTRACTBackground: Tackling malnutrition in all its forms, especially undernutrition (stunting, underweight) is a necessity related to health, ethical, political, social and economic reasons. Commitment to the post-2015 framework, Sustainable Development Goals (SDGs) is considered to be directed towards action and accountability to be able to address the direct and indirect causes of all forms of malnutrition.Objectives: To analyze the role of SDGs indicators in tackling undernutrition (stunting dan underweight) and to determine the undernutrition and SDGs modelling in West Java province.Methods: This study used secondary data. The unit analysis was 27 districts of West Java Province during 2016-2017, with a total 54 units. The dependent variable was undernutrition (stunting nd underweight) in children aged 0-59 months. The independent variables were the pillars of social development, the pillars of environmental development and the pillars of economic development. The data were analyzed using Partial Least-square-structural Equation Modeling (PLS-SEM).Results: The achievement of environmental pillars can encourage increased achievement of social and economic pillars so it can direct and directly decrease the prevalence of undernutrition with a total of 5.09%. The improvement of social pillar can directly increase the achievement of economic pillars so that directly and indirectly can decrease the prevalence of undernutrition with total by 3.65%. The achievement of economic pillars can directly decrease the prevalence of undernutrition 3.86%. All the results were significant with t-statistic > 1.96 (α = 0.05).Conclusion: Reduced undernutrition (stunting and underweight) in children aged 0-59 months can be influenced by the achievement of indicators in each pillars of SDGs. The combination of social, environmental and economic pillars in tackling malnutrition shows a higher decrease in undernutrition’s prevalence than only through the achievement of indicators in one or two pillars of SDGs.

Greater male vulnerability to stunting? Evaluating sex differences in growth, pathways and biocultural mechanisms

CONTEXT

Child stunting has increasingly become the focus of large-scale global health efforts with the inclusion of stunting eradication as one of the Sustainable Development Goals of the United Nations. Child sex has been identified as a biological risk factor for stunting, and sex-specific approaches to stunting prevention have been proposed.

OBJECTIVE

This paper examines four pathways, developmental sensitivity, energetics, caretaking and measurement, proposed to contribute to sex differences in linear growth faltering and stunting risk.

METHODS

Anthropological, public health and clinical literature on sex differences in stunting and the mechanisms contributing to variability across contexts are reviewed.

RESULTS

The direction of sex differences in stunting prevalence varies across countries and between households. Sex differences in growth trajectories and immune function beginning prenatally place boys at greater risk of infection and undernutrition, but these biological differences are interpreted by parents and within household contexts that are shaped by social and cultural norms which, in turn, influence care and feeding practices.

CONCLUSION

A perspective that incorporates an examination of the social and environmental factors shaping child growth in specific contexts is needed to understand sex-based vulnerability to stunting and to develop context-appropriate interventions.

Access to Water and Sanitation Infrastructures for Primary Schoolchildren in the South-Central Part of Côte d'Ivoire

In rural settings of Côte d'Ivoire, access to water, sanitation, and hygiene (WASH) at schools is often lacking. The purpose of this study was to assess the availability, quality, and use of WASH infrastructure in schools in the south-central part of Côte d'Ivoire, and to determine the hygiene practices of schoolchildren. A cross-sectional study was conducted in 20 primary schools with (n = 10) or without (n = 10) direct access to drinking water. The survey was comprised of a questionnaire directed at schoolchildren aged 8-17 years, an assessment of the WASH infrastructure, and the testing of drinking water samples for Escherichia coli and total coliforms. Overall, 771 schoolchildren were enrolled in the study. One out of four children (24.9%) reported that they used available toilets. Among those children not using toilets, more than half (57.5%) reported that they practised open defecation. Drinking water infrastructure was limited in most schools because of poor storage tanks, the low flow of water, or broken wells. All drinking water samples (n = 18) tested positive for total coliforms and 15 (83.3%) tested positive for E. coli. The lack of WASH infrastructures in primary schools in the south-central part of Côte d'Ivoire, in combination with poor hygiene practices, might govern disease transmission and absenteeism at school, especially among females.

Social inequalities in the surrounding areas of food deserts and food swamps in a Brazilian metropolis

Background

Food deserts are neighborhoods with little or no access to healthy food, whereas food swamps are neighborhoods where unhealthy food options prevail over healthy ones. The main aims of the current study are to feature and compare the neighborhoods of food deserts and food swamps based on social inequality.

Methods

Ecological study carried out in Belo Horizonte City, Minas Gerais State, Brazil. Information about commercial food establishments derived from two different databases. It was measured by secondary governmental databases, which were virtually conferred in the present study. Census tracts were considered as analysis units and classified as food deserts and food swamps, based on the Brazilian methodology. Take into consideration the density of establishments classified as selling fresh or minimally-processed food, mixed establishments, and establishments selling ultra-processed food. The Brazilian methodology evaluates food deserts by the density of healthy establishments (establishments classified as mostly selling fresh or minimally-processed food and mixed establishments) per 10 thousand inhabitants. And the metric to evaluate food swamps considers the density of unhealthy establishments (establishments mostly selling ultra-processed food) per 10 thousand inhabitants. Information about social inequalities comprised aspects such as income, population count, number of households, number of literate individuals, race, water and energy supply, and garbage collection. The Health Vulnerability Index (HVI) was used as a synthetic social vulnerability indicator.

Results

Neighborhoods of food deserts presented worse essential service availability, lower income per capita, and smaller mean number of literate individuals. Census tracts classified as food swamps presented better socio-demographic conditions than those areas food deserts. Neighborhoods simultaneously classified as food deserts and food swamps presented lower income per capita and were more often observed in census sectors presenting medium and high HVI.

Conclusion

The food environment in Belo Horizonte was featured by the strong presence of food deserts and food swamps. However, the potential influence of these areas on food intake has changed depending on social inequalities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01501-7.

Health effects of climate change: an overview of systematic reviews

OBJECTIVES

We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies' characteristics, climate impacts, health outcomes and key findings.

DESIGN

We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available.

DATA SOURCES

On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science.

ELIGIBILITY CRITERIA

We included systematic reviews that explored at least one health impact of climate change.

DATA EXTRACTION AND SYNTHESIS

We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors' affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies.

RESULTS

We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research.

CONCLUSIONS

Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.

Nutritional Adequacy and Diet Quality Are Associated with Standardized Height-for-Age among U.S. Children

Nutritional status affects linear growth and development. However, studies on the associations between nutritional status, diet quality, and age-standardized height in children are limited. The aim of this study was to assess the relationship between macro- and micronutrient intake and food consumption and height-for-age Z score (HAZ) among US children in the National Health and Nutrition Examination Survey (NHANES). This cross-sectional population-based study included 6116 US children aged 2–18 years. The usual dietary intake of nutrients and food groups was estimated by the multiple source method (MSM) using two-day food consumption data from NHANES 2007–2014. After adjusting for covariates, HAZ was positively associated with intakes of energy, protein, carbohydrate, fat, vitamins A, D, E, B6, and B12, thiamin, riboflavin, niacin, calcium, and iron. Children in the highest tertile of HAZ were less likely to consume lower than the EAR for vitamin E and calcium. Major foods consumed by children with lower HAZ were soft drinks, high-fat milk products, cakes, cookies, pastries, and pies, whereas children with higher HAZ tended to consume low-fat milk products, tea, and low-calorie fruit juice. These findings suggest that adequate nutritional intake, diet quality, and nutrient-dense food are important factors for height in children.

What is normal, healthy growth? Global health, human biology, and parental perspectives

OBJECTIVES

The widespread variation seen in human growth globally stands at odds with the global health perspective that young child growth should not vary across populations if nutritional, environmental and care needs are met. This paper: (1) evaluates the idea that a single standard of "healthy" growth characterizes children under age 5, (2) discusses how variation from this standard is viewed in global health, in human biology and by parents, and (3) explores how views of "normal" growth shape biomedical and parental responses.

METHODS

This paper reviews the anthropological, public health and clinical literature on the nature of child growth and the applicability of World Health Organization Multicenter Growth Reference Study growth standards across contexts.

RESULTS

The considerable variability in child growth across contexts makes it unlikely that any one framework, with issues of sample selection and representativeness, can serve as the model of healthy growth. Global health, human biology and parents differ in the emphasis they place on heredity versus environmental context in understanding this variability, but human biologists and parents tend to view a wider range of growth as "normal." Since both biomedicine and parents base their care decisions on their perceptions of normal, healthy growth, the comparative framework used has important implications for medical treatment and feeding practices.

CONCLUSIONS

A more nuanced approach that incorporates the biology of growth and its association with health outcomes across contexts is critical to identify patterns of healthy growth and to avoid over-reliance on a single standard that may pathologize variability.

Maternal Self-rated Capability Status and Its Association with Under-Five Children Morbidity

Background:

Under-five morbidity is a significant public health concern in developing countries, and maternal intervention remains vital to achieving under-five optimal health.

Objective:

The study examined the influence of maternal self-rated capability status (SCS) on under-five morbidity in Ibadan North Local Government Area (LGA), Oyo State, Nigeria.

Methods:

The study interviewed 683 nursing mothers surveyed from 20 primary healthcare centers (PHCs) from 13th to 27th September 2018 in the LGA of study. We employed logistic regression models to examine the association of 4 domains of maternal SCS on under-five morbidity incidence controlling for the potential confounding effects of maternal, child, and household sociodemographic attributes.

Results:

Under-five children of mothers with poor status in the knowledge of child morbidity, experience-informed action, child morbidity exposure, and childcare vulnerability domains are, respectively, 497%, 323%, 400%, and 318% more likely to be at risk of morbidity than their peers born to mothers with good status. In addition, the odds of morbidity were lower for children born to women with more than 1 under-five children (AOR: 0.49, 95% CI: 0.27, 0.88), while the odds were higher for those from households that are food-insecure (AOR: 3.16, 95% CI: 1.31, 7.65) and dispose of wastes within the compound (AOR: 2.67, 95% CI: 1.31, 5.45) relative to children in the comparative categories.

Conclusion:

Our findings revealed the significance of maternal SCS as a crucial pathway for understanding and reducing under-five morbidity. Community interventions should prioritize empowering nursing mothers with prevention and care information necessary to reduce the under-five morbidity burden at the community level.

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia

BACKGROUND

Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices.

METHODS

A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used.

RESULTS

A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition.

CONCLUSIONS

Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Climate change and child health: a scoping review and an expanded conceptual framework

Climate change can have detrimental effects on child health and wellbeing. Despite the imperative for a fuller understanding of how climate change affects child health and wellbeing, a systematic approach and focus solely on children (aged <18 years) has been lacking. In this Scoping Review, we did a literature search on the impacts of climate change on child health from January, 2000, to June, 2019. The included studies explicitly linked an alteration of an exposure to a risk factor for child health to climate change or climate variability. In total, 2970 original articles, reviews, and other documents were identified, of which 371 were analysed. Employing an expanded framework, our analysis showed that the effects of climate change on child health act through direct and indirect pathways, with implications for determinants of child health as well as morbidity and mortality from a range of diseases. This understanding can be further enhanced by using a broader range of research methods, studying overlooked populations and geographical regions, investigating the costs and benefits of mitigation and adaptation for child health, and considering the position of climate change and child health within the UN Sustainable Development Goals. Present and future generations of children bear and will continue to bear an unacceptably high disease burden from climate change.

Microbiota control of maternal behavior regulates early postnatal growth of offspring

Maternal behavior is necessary for optimal development and growth of offspring. The intestinal microbiota has emerged as a critical regulator of growth and development in the early postnatal period life. Here, we describe the identification of an intestinal Escherichia coli strain that is pathogenic to the maternal-offspring system during the early postnatal stage of life and results in growth stunting of the offspring. However, rather than having a direct pathogenic effect on the infant, we found that this particular E. coli strain was pathogenic to the dams by interfering with the maturation of maternal behavior. This resulted in malnourishment of the pups and impaired insulin-like growth factor 1 (IGF-1) signaling, leading to the consequential stunted growth. Our work provides a new understanding of how the microbiota regulates postnatal growth and an additional variable that must be considered when studying the regulation of maternal behavior.