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Hardjo J, Selene NB. Stunting and Gut Microbiota: A Literature Review. Pediatr Gastroenterol Hepatol Nutr 2024; 27:137-145. [PMID: 38818278 PMCID: PMC11134181 DOI: 10.5223/pghn.2024.27.3.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 06/01/2024] Open
Abstract
Stunting, a condition characterized by impaired growth and development in children, remains a major public health concern worldwide. Over the past decade, emerging evidence has shed light on the potential role of gut microbiota modulation in stunting. Gut microbiota dysbiosis has been linked to impaired nutrient absorption, chronic inflammation, altered short-chain fatty acid production, and perturbed hormonal and signaling pathways, all of which may hinder optimal growth in children. This review aims to provide a comprehensive analysis of existing research exploring the bidirectional relationship between stunting and the gut microbiota. Although stunting can alter the gut microbial community, microbiota dysbiosis may exacerbate it, forming a vicious cycle that sustains the condition. The need for effective preventive and therapeutic strategies targeting the gut microbiota to combat stunting is also discussed. Nutritional interventions, probiotics, and prebiotics are among the most promising approaches to modulate the gut microbiota and potentially ameliorate stunting outcomes. Ultimately, a better understanding of the gut microbiota-stunting nexus is vital for guiding evidence-based interventions that can improve the growth and development trajectory of children worldwide, making substantial strides toward reducing the burden of stunting in vulnerable populations.
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Affiliation(s)
- Jessy Hardjo
- Department of Emergency Medicine, General Hospital Ploso, East Java, Indonesia
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Rivera A, Marín V, Romaní F. Concurrence of anemia and stunting and associated factors among children aged 6 to 59 months in Peru. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002914. [PMID: 38564615 PMCID: PMC10986945 DOI: 10.1371/journal.pgph.0002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Anemia and stunting are two health problems in the child population; therefore, their concurrence needs to be quantified. We estimated the prevalence of concurrent anemia and stunting (CAS) in children aged 6-59 months and identified the factors associated with this condition. The data came from the Demographic and Health Survey of Peru (DHS), 2022. The study design was cross-sectional and included 19,191 children. Height and hemoglobin measurement followed the specifications of National Health Institute of Peru. To reduce error in measures, the anthropometry personnel was training, the quality of measuring equipment was ensuring, and protocolized techniques and procedures was applying. Hemoglobin concentration was measured in capillary blood using the Hemocue model Hb 201+. Stunting was defined as a height-for-age Z-score less than minus two standard deviations (SD) from the median, following the 2006 WHO child growth standard. Anemia was classified into mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), severe (< 7.0 g/dL), and no anemia (11.0 to 14.0 g/dL). We performed a bivariate analysis to evaluate factors associated with CAS. To include variables in the multivariate analysis, we applied a statistical criterion (p < 0.10 in the crude analysis) and an epidemiological criterion. We used a binary logistic hierarchical regression model. The prevalence of CAS was 5.6% (95%CI: 5.2 to 5.9). The modifiable factors associated with higher odds of CAS were: "poorest" (aOR: 3.87, 95%CI: 1.99 to 7.5) and "poorer" (aOR: 2.07, 95%CI: 1.08 to 3.98) wealth quintiles, mother with no formal education or primary (aOR: 2.03, 95%CI: 1.46 to 2. 81), father with no formal education or primary (aOR: 1.55, 95%CI: 1.16 to 2.07), no improved water source (aOR: 1.36, 95%CI: 1.10 to 1.68), no roof with improved material (aOR: 1.49, 95%CI: 1.12 to 1.98) and low birth weight (aOR: 7.31, 95%CI: 4.26 to 12.54). In Peru, five out of every 100 children suffer from anemia and stunting simultaneously; there are modifiable factors that, if addressed, could reduce their prevalence.
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Affiliation(s)
| | - Víctor Marín
- Faculty of Human Medicine, Universidad de Piura, Lima, Peru
| | - Franco Romaní
- Faculty of Human Medicine, Universidad de Piura, Lima, Peru
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Martin SL, Zongrone AA, Craig HC, Litvin K, Fort P, Cooper S, Haller M, Dickin KL. Measuring the intangible resources caregivers need to provide nurturing care during the complementary feeding period: a scoping review in low- and lower-middle-income countries. Public Health Nutr 2024; 27:e78. [PMID: 38223942 DOI: 10.1017/s1368980024000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries. DESIGN We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age. RESULTS We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures. CONCLUSIONS Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.
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Affiliation(s)
- Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, CB 7461, Chapel Hill, NC, 27599-7461, USA
| | | | - Hope C Craig
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, Virginia, USA
| | - Peyton Fort
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Stephanie Cooper
- Global Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mia Haller
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine L Dickin
- USAID Advancing Nutrition, Arlington, Virginia, USA
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Tonui KK, Onyango AC, Ouma C. Seasonality of associations between production of indigenous foods and food security status of mother-child dyads in Kisumu County, Kenya. BMC Nutr 2024; 10:8. [PMID: 38200527 PMCID: PMC10782713 DOI: 10.1186/s40795-024-00820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Food insecurity is a major predicament for rural populations, especially mothers and children, whose livelihoods are often dependent on rain-fed agriculture. Indigenous foods have the potential of mitigating food insecurity as they can thrive in poor agro-ecological conditions. However, the associations between indigenous food production and food security status of mothers and children drawn from rural contexts has not been expansively assessed. Food insecurity evident by high food poverty rates remain high in Kisumu County due to over-reliance on food imports from other counties. The objective of the study was to assess seasonality in associations between production of selected indigenous foods (kidney beans, soya beans, millet, cassava, sweet potatoes, groundnuts, green grams, cow peas, amaranth leaves, spider plant leaves, black night shade leaves, mangoes, guavas, lime, and tamarind) and food security status of mothers and children during planting and harvesting seasons. METHODS We used a longitudinal study design adopting both quantitative and qualitative data collection methods. A structured questionnaire assessed production of selected indigenous foods in the sampled households, Household Food Insecurity Access Scale for mother's food security status and Prevalence of Underweight for children's food security status. Ordinal logistic regression was used to derive odds ratio (OR), which assessed strength of associations between dependent variables (mother's and children's food security status) and independent variables (production of selected indigenous foods). Significance was determined at α ≤ 0.05. RESULTS Results demonstrated that during planting season, production of kidney beans decreased the odds of mothers being severely food insecure by 53% (OR = 0.469, 95% CI = 0.228-0.964, p = 0.039). In the same season, sorghum production demonstrated 3.5 times increase in odds of children being severely food insecure (OR = 3.498, 95% CI = 1.454-8.418, p = 0.005). During harvesting season, production of kidney beans was associated with a 62% reduction in the odds of children being severely food insecure (OR = 0.379, 95% CI = 0.190-0.754, p = 0.006). CONCLUSIONS Production of some of the selected indigenous foods demonstrated significant odds of predicting mother's and children's food security status across both study seasons. An intervention-based study approach that would best establish causal associations of indigenous food production and food security status is recommended.
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Affiliation(s)
- Kenneth Kipngeno Tonui
- School of Public Health and Community Development, Department of Nutrition and Health, Maseno University, 333-40105, Maseno, Kenya.
| | - Agatha Christine Onyango
- School of Public Health and Community Development, Department of Nutrition and Health, Maseno University, 333-40105, Maseno, Kenya
| | - Collins Ouma
- School of Public Health and Community Development, Department of Biomedical Sciences and Technology, Maseno University, 333-40105, Maseno, Kenya
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Goddard FGB, Hunegnaw BM, Luu J, Haneuse SJPA, Zeleke M, Mohammed Y, Bekele C, Tadesse D, Solomon M, Bekele D, Chan GJ. Prevalence, Incidence, and Reversal Pattern of Childhood Stunting From Birth to Age 2 Years in Ethiopia. JAMA Netw Open 2024; 7:e2352856. [PMID: 38265800 PMCID: PMC10809014 DOI: 10.1001/jamanetworkopen.2023.52856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024] Open
Abstract
Importance Although there has been a reduction in stunting (low-height-for-age and low-length-for-age), a proxy of malnutrition, the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to increase awareness and resources to improve the potential for recovery. Objective To estimate the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months. Design, Setting, and Participants This population-based cohort study of the Birhan Maternal and Child Health cohort in North Shewa Zone, Amhara, Ethiopia, was conducted between December 2018 and November 2020. Eligible participants included children aged 0 to 24 months who were enrolled during the study period and had their length measured at least once. Data analysis occurred from Month Year to Month Year. Main Outcomes and Measures The primary outcome of this study was stunting, defined as length-for-age z score (LAZ) at least 2 SDs below the mean. Z scores were also used to determine the prevalence, incidence, and reversal of stunting at each key time point. Growth velocity was determined in centimeters per month between key time points and compared with global World Health Organization (WHO) standards for the same time periods. Heterogeneity was addressed by excluding outliers in sensitivity analyses using modeled growth trajectories for each child. Results A total of 4354 children were enrolled, out of which 3674 (84.4%; 1786 [48.7%] female) had their length measured at least once and were included in this study. The median population-level length was consistently below WHO growth standards from birth to 2 years of age. The observed prevalence of stunting was highest by 2 years of age at 57.4% (95% CI, 54.8%-9 60.0%). Incidence of stunting increased over time and reached 51.0% (95% CI, 45.3%-56.6%) between ages 12 and 24 months. Reversal was 63.5% (95% CI, 54.8%-71.4%) by age 6 months and 45.2% (95% CI, 36.0%-54.8%) by age 2 years. Growth velocity point estimate differences were slowest compared with WHO standards during the neonatal period (-1.4 cm/month for girls and -1.6 cm/month for boys). There was substantial heterogeneity in anthropometric measurements. Conclusions and Relevance The evidence from this cohort study highlights a chronically malnourished population with much of the burden associated with growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia, needs to be addressed.
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Affiliation(s)
- Frederick G. B. Goddard
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bezawit Mesfin Hunegnaw
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jonathan Luu
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Mesfin Zeleke
- HaSET, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yahya Mohammed
- HaSET, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Chalachew Bekele
- HaSET, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Daniel Tadesse
- HaSET, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Meles Solomon
- Maternal, Child and Adolescent health lead executive office, Federal Ministry of Health, Ethiopia
| | - Delayehu Bekele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Obstetrics and Gynecology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Grace J. Chan
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Lye CW, Sivasampu S, Mahmudiono T, Majid HA. A systematic review of the relationship between household food insecurity and childhood undernutrition. J Public Health (Oxf) 2023; 45:e677-e691. [PMID: 37291061 DOI: 10.1093/pubmed/fdad070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/21/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This systematic review aims to investigate the association between household food insecurity (HFIS) and undernutrition in children under 5 years old, thereby informing policymakers on the vital factors needed to be considered in tailoring an effective strategy to tackle childhood undernutrition and ultimately HFIS. METHODS We performed a systematic review that examined household food insecurity among the undernourished under-five children. PubMed, Cochrane, EBSCO Host, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched from 1 January 2012 to 1 April 2022, for relevant articles. Outcome measures were stunting, underweight or wasting. Of the 2779 abstracts screened, 36 studies that fulfilled the inclusion and exclusion criteria were included. A range of tools had been used to measure HFIS, the most common being Household Food Insecurity Access Scale. HFIS has been found to be significantly associated with undernutrition, particularly stunting and underweight. This is observed proportionately across all national income levels. CONCLUSIONS Sustainable and inclusive economic growth, which aims to reduce income, education and gender inequality, should be a key policy goal in the minimizing food insecurity and childhood undernutrition. Multisectoral interventions are needed to address these issues.
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Affiliation(s)
- Chuan Way Lye
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hazreen Abdul Majid
- The Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Dorset BH5 2DF, UK
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Walls H, Johnston D, Matita M, Kamwanja T, Smith R, Nanama S. The politics of agricultural policy and nutrition: A case study of Malawi's Farm Input Subsidy Programme (FISP). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002410. [PMID: 37819904 PMCID: PMC10566744 DOI: 10.1371/journal.pgph.0002410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/30/2023] [Indexed: 10/13/2023]
Abstract
The concept of food and nutrition policy has broadened from simply being an aspect of health policy, to policy interventions from across a wide range of sectors, but still with potentially important impact on nutritional outcomes. This wider and more complex conceptualisation involves policy with multiple objectives and stakeholder influences. Thus, it becomes particularly important to understand the dynamics of these policy processes, including policy design and implementation. To add to this literature, we apply the Kaleidoscope Model for understanding policy change in developing country contexts to the case-study of an agricultural input subsidy (AIS) programme in Malawi, the Farm Input Subsidy Programme (FISP), exploring the dynamics of the FISP policy process including nutritional impact. Over a three-month period between 2017 and 2019 we conducted in-depth interviews with key stakeholders at national and district levels, and focus groups with people from rural districts in Malawi. We also undertook a review of literature relating to the political economy of the FISP. We analysed the data thematically, as per the domains of the Kaleidoscope Model. The analysis across the FISP policy process including policy design and implementation highlights how stakeholders' ideas, interests and influence have shaped the evolution of FISP policy including constraints to policy improvement-and the nutritional impacts of this. This approach extends the literature on the tensions, contradictions and challenges in food and nutrition policy by examining the reasons that these occur in Malawi with the FISP. We also add to the political science and policy analysis literature on policy implementation, extending the concept of veto players to include those targeted by the policy. The findings are important for consideration by policymakers and other stakeholders seeking to address malnutrition in rural, food-insecure populations in Malawi and other low-income settings.
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Affiliation(s)
- Helen Walls
- Department of Global Heath and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Deborah Johnston
- Department of Economics, SOAS University of London, London, United Kingdom
| | - Mirriam Matita
- Department of Economics, University of Malawi, Zomba, Malawi
- Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Tayamika Kamwanja
- Department of Economics, University of Malawi, Zomba, Malawi
- School of Business, University of Leicester, Leicester, United Kingdom
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simeon Nanama
- United Nations Children’s Fund (Unicef), Abuja, Nigeria
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Mukanu MM, Thow AM, Delobelle P, Mchiza ZJR. Mapping of food environment policies in Zambia: a qualitative document analysis. BMC Nutr 2023; 9:112. [PMID: 37784146 PMCID: PMC10544488 DOI: 10.1186/s40795-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The food environment in which people exercise food choices significantly impacts their dietary patterns. Policies that limit the availability, affordability, and access to unhealthy food while increasing that of healthier alternatives help build healthy food environments, which are required to address the double burden of malnutrition. This study aimed to assess the availability of food environment policies in Zambia. METHOD We applied a two-step qualitative document analysis to identify policy content relating to healthy food environments from global and Zambia-specific nutrition-related policy documents. In the first step, global policy documents were analyzed to develop a reference point for globally recommended policies for healthy food environments. In the second step, Zambia's nutrition-related policies were analyzed to identify content relating to healthy food environments. The identified policy content was then mapped against the global reference point to identify food environment policy gaps. RESULTS Our analysis of global policy recommendations identified five broad categories of policy provisions: information and education based; regulatory and legislative tools; strategies to promote production and access to healthy food production; social protection-based strategies and guiding principles for governments relating to multisectoral collaboration and governance. Our analysis found that Zambian Government policy documents in the health, agriculture, education, and national planning and development sectors have policy provisions for healthy food environments. While these policy provisions generally covered all five reference categories, we found policy gaps in the regulatory and legislative tools category relative to global recommendations. CONCLUSION Zambia's food environment policy landscape must include globally recommended regulatory and legislative policy measures like restricting the marketing of unhealthy foods and non-alcoholic beverages to children. Nutrition policy reforms are required to facilitate the introduction of regulatory and legislative policy measures that effectively address the double burden of malnutrition in Zambia.
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Affiliation(s)
- Mulenga Mary Mukanu
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, 7700, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, 7505, South Africa
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Asmare AA, Agmas YA. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr 2023; 9:82. [PMID: 37420303 DOI: 10.1186/s40795-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Malnutrition is the main cause of illness and death in children under the age of five. It affects millions of children worldwide, putting their health and future in jeopardy. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHOD The study was carried out in 10 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Zimbabwe, Kenya, Zambia, and Malawi. A weighted total sample of 53,322 children under the age of five was included. Given the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate binary logistic regression model was employed to analyze the relationship between stunting, wasting, and underweight. RESULT The study included 53,322 children, and 34.7%, 14.8%, and 5.1% were stunted, underweight, and wasted, respectively. Almost half of the children (49.8%) were female, and 22.0% lived in urban areas. The estimated odds of children from secondary and higher education mothers being stunted and wasted were 0.987; 95% CI: 0.979 - 0.994 and 0.999; 95% CI: 0.995 - 0.999, respectively, times the estimated odds of children from no education mothers. Children from middle-class families were less likely to be underweight than children from poorer families. CONCLUSION The prevalence of stunting was higher than in the sub-Saharan Africa region, but the prevalence of wasting and underweight was lower. According to the study's findings, undernourishment among young children under the age of five continues to be a significant public health issue in the East African region. Governmental and non-governmental organizations should therefore plan public health participation focusing on paternal education and the poorest households in order to improve the undernutrition status of children under five. Additionally, improving the delivery of healthcare at health facilities, places of residence, children's health education, and drinking water sources are essential for lowering child undernutrition indicators.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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Nemerimana M, Havugarurema S, Nshimyiryo A, Karambizi AC, Kirk CM, Beck K, Gégout C, Anderson T, Bigirumwami O, Ubarijoro JM, Ngamije PK, Miller AC. Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda. PLoS One 2023; 18:e0283504. [PMID: 37418456 PMCID: PMC10328318 DOI: 10.1371/journal.pone.0283504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Stunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age. METHODS This retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ <-3 based on the 2006 WHO child growth standards. Stunting recovery at 24 months of age was defined as the child's LAZ changing from <-2 to > -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother's socio-demographic and clinical characteristics. RESULTS Of the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07-0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16-0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1-0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model. CONCLUSION A substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.
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Affiliation(s)
| | | | | | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Todd Anderson
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Ouaijan K, Hwalla N, Kandala NB, Abi Kharma J, Kabengele Mpinga E. Analysis of predictors of malnutrition in adult hospitalized patients: social determinants and food security. Front Nutr 2023; 10:1149579. [PMID: 37229465 PMCID: PMC10203390 DOI: 10.3389/fnut.2023.1149579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/07/2023] [Indexed: 05/27/2023] Open
Abstract
Background Malnutrition in hospitalized patients is becoming a priority during the patient care process due to its implications for worsening health outcomes. It can be the result of numerous social factors beyond clinical ones. This study aimed to evaluate the link between these various risk factors considered social determinants of health, food security levels, and malnutrition and to identify potential predictors. Methods A cross-sectional observational study was conducted on a random sample of adult patients in five different hospitals in Lebanon. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were interviewed to collect social and economic characteristics and were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status, and (4) source of health coverage. The food security level was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey, targeting both quantity and quality. Results In a random sample of 343 patients, the prevalence of malnutrition according to the GLIM criteria was 35.6%. Patients with low levels of food security, mainly low quality of food, had higher odds of being malnourished (OR = 2.93). Unemployed or retired patients and those who have only completed only elementary school had higher odds of being diagnosed with malnutrition as compared to those who were employed or had university degrees, respectively (OR = 4.11 and OR = 2.33, respectively). Employment status, education level, and type of health coverage were identified as predictors of malnutrition in the multiple regression model. Household location (urban vs. rural) was not associated with malnutrition. Conclusion The social determinants of health identified in our study, mainly the level of education and income level, in addition to food security, were identified as predictors of malnutrition in hospitalized patients. These findings should guide healthcare professionals and national policies to adopt a broader perspective in targeting malnutrition by including social determinants in their nutrition care.
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Affiliation(s)
- Krystel Ouaijan
- Department of Clinical Nutrition, Saint George Hospital University Medical Center, Beirut, Lebanon
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Joelle Abi Kharma
- Faculty of Arts and Sciences, Lebanese American University, Beirut, Lebanon
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Woldeyohannes M, Girma M, Petros A, Hussen A, Samuel A, Dinssa DA, Challa F, Laillou A, Chitekwe S, Baye K, Noor R, Donze AS, Tollera G, Dangiso MH, Tadesse L, Zelalem M, Tessema M. Ethiopia National Food and Nutrition Survey to inform the Ethiopian National Food and Nutrition Strategy: a study protocol. BMJ Open 2023; 13:e067641. [PMID: 37185190 PMCID: PMC10151871 DOI: 10.1136/bmjopen-2022-067641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Ethiopia has made significant progress in reducing malnutrition in the past two decades. Despite such improvements, a substantial segment of the country's population remains chronically undernourished and suffers from micronutrient deficiencies and from increasing diet-related non-communicable diseases such as diabetes, hypertension and cancer. This survey aims to assess anthropometric status, dietary intake and micronutrient status of Ethiopian children, women and adolescent girls. The study will also assess coverage of direct and indirect nutrition-related interventions and map agricultural soil nutrients. The survey will serve as a baseline for the recently developed Ethiopian Food System Transformation Plan and will inform the implementation of the National Food and Nutrition Strategy. METHODS AND ANALYSIS As a population-based, cross-sectional survey, the study will collect data from the 10 regions and 2 city administrations of Ethiopia. The study population will be women of reproductive age, children aged 0-59 months, school-aged children and adolescent girls. A total of 16 596 households will be surveyed, allowing the generation of national and regional estimates. A two-stage stratified cluster sampling procedure will be used to select households. In the first stage, 639 enumeration areas (EAs) will be selected using probability-proportional-to-size allocation. In the second stage, 26 eligible households will be selected within each EA using systematic random selection. Primary outcomes include coverage of direct and indirect nutrition interventions, infant and young child feeding (IYCF) practices, food insecurity, dietary intakes, mental health, anthropometric status, micronutrient status and soil nutrient status. ETHICS AND DISSEMINATION The protocol was fully reviewed and approved by the Institutional Review Board of the Ethiopian Public Health Institute (protocol no: EPHI-IRB-317-2020). The study is based on voluntary participation and written informed consent is required from study participants. The findings will be disseminated via forums and conferences and will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Meseret Woldeyohannes
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Meron Girma
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemnesh Petros
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemayehu Hussen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Aregash Samuel
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Danial Abera Dinssa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Feyissa Challa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | - Kaleab Baye
- Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Getachew Tollera
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Mesay Hailu Dangiso
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Lia Tadesse
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
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Ikoona EN, Toure MA, Njenga A, Namulemo L, Kaluya R, Kamara K, Oyat FWD, Aloyo J, Kitara DL. Prevalence and factors associated with underweight among 15-49-year-old women in Sierra Leone: a secondary data analysis of Sierra Leone demographic health survey of 2019. BMC Womens Health 2023; 23:192. [PMID: 37085835 PMCID: PMC10122406 DOI: 10.1186/s12905-023-02358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Women are at higher risks of being underweight than men due to biological, socio-economic, and cultural factors. Underweight women have high risks of poor obstetric outcomes. We aimed to determine the prevalence and factors associated with being underweight among women of reproductive age (15-49 years) in Sierra Leone. METHODS We used Sierra Leone Demographic and Health Survey (2019-SLDHS) data of 7,514 women aged 15 to 49 years, excluding pregnant, post-natal, lactating, and post-menopausal women. A multistage stratified sampling approach was used to select study participants, and data was collected using validated questionnaires. A multivariable logistic regression analysis was used to determine factors associated with underweight among 15-49-year-old women in Sierra Leone. Ethical approval for the study was obtained. RESULTS The prevalence of underweight was 6.7% (502/7,514). Underweight was likely among age-group of 15-24 years, AOR = 2.50,95%CI:2.39-2.60;p < 0.001 compared to 25-34 year age-group and likely among women with parity of one to four, AOR = 1.48,95%CI:1.08-2.03;p = 0.015 compared to women who never gave birth. Underweight was unlikely among women who did not listen to radios AOR = 0.67,95%CI:0.55-0.83;p < 0.001 compared to those who did; women from the north AOR = 0.73,95%CI:0.56-0.96;p = 0.026 compared to the east, and not married women AOR = 0.59,95%CI:0.47-0.76;p < 0.001 compared to married. All household wealth indices were not significantly associated with underweight. CONCLUSION The prevalence of underweight among women in the reproductive age (15-49 years) in Sierra Leone was 6.7% and it is lower compared to global and most sub-Saharan African data. Factors associated with underweight were 15-24-year age-group, and parity of one to four. Being underweight was unlikely among women who did not listen to radios, women from the north and not married. All household wealth indices were not significantly associated with underweight. Even though household wealth indices were not significantly associated with being underweight, most underweight women 68.7% (345/502) were in the poorest, poorer, and middle household wealth indices. The need to address socio-economic determinants of underweight among women (aged 15-49 years) due to household poverty is a priority in Sierra Leone.
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Affiliation(s)
| | | | - Amon Njenga
- ICAP at Columbia University, Freetown, Sierra Leone
| | - Lucy Namulemo
- Foothills Community Based Interventions, Monticello, KY, USA
- Lindsey Wilson College, School of Professional Counseling, Kentucky, USA
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Ronald Kaluya
- Uganda Counseling and Support Services, Kampala, Uganda
| | - Kassim Kamara
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Free Town, Sierra Leone
| | | | - Judith Aloyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda
- Rhites-N, Acholi, Gulu City, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu City, Uganda.
- Department of Surgery, Harvard University and Faculty at Gulu University, Faculty of Medicine, P.0. Box 166, Gulu City, Uganda.
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Gholmie Y, Lee AR, Satherley RM, Schebendach J, Zybert P, Green PHR, Lebwohl B, Wolf R. Maladaptive Food Attitudes and Behaviors in Individuals with Celiac Disease and Their Association with Quality of Life. Dig Dis Sci 2023:10.1007/s10620-023-07912-6. [PMID: 37024737 PMCID: PMC10079145 DOI: 10.1007/s10620-023-07912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The only treatment for celiac disease (CeD) is strict lifelong adherence to a gluten-free diet (GFD). In some individuals the demands of a GFD may contribute to maladaptive eating attitudes and behaviors that impair quality of life (QOL). The Celiac Disease Food Attitudes and Behaviors (CD-FAB) is an easily administered and scored 11-item tool querying potentially maladaptive food attitudes and behaviors resulting from beliefs around gluten exposures and food safety. OBJECTIVES To assess the usefulness of the CD-FAB in establishing the presence of maladaptive food attitudes and behaviors among adults with CeD and to explore the relationship between these attitudes and behaviors and other factors including QOL, anxiety, depression, CeD symptoms and personality traits. METHODS The study is a cross-sectional pilot of 50 adults (mean age 29.6 years) with biopsy-proven CeD who followed a GFD for at least one year and had no self-reported eating disorder diagnosis. High scores on the CD-FAB tool suggest higher disordered eating attitudes and beliefs. RESULTS Compared to lower scores (mean 20.2), higher (worse) CD-FAB scores (mean 54.5) were positively associated with recency of diagnosis, number of CeD-related gastrointestinal symptoms, and the personality trait of neuroticism. Higher CD-FAB scores were statistically and clinically significantly associated with diminished QOL (p < 0.001). The relationship with anxiety and depression was less clear but trended in the expected direction. CONCLUSION The CD-FAB may be a useful tool for dietitians who wish to monitor maladaptive food attitudes and behaviors among their CeD patients, especially in the first-year post-diagnosis.
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Affiliation(s)
- Yara Gholmie
- Program in Nutrition, Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Anne R Lee
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
| | - Rose-Marie Satherley
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Janet Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Patricia Zybert
- Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 934, Harkness Pavilion, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th St., New York, NY, 10032, USA
| | - Randi Wolf
- Program in Nutrition, Department of Health & Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
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Chacha S, Hui J, Yuxin T, Wang Z, Ali S, Mbonile N, Msumari M, Msuya N, Malimu E, Revocatus B, Maokola W, Mtali G, Simon V, Dang S. Epidemiological profile of malnutrition status and spatial distribution of children and adolescents living with HIV/AIDS in Tanzania. Trop Med Int Health 2023; 28:203-214. [PMID: 36617637 DOI: 10.1111/tmi.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the prevalence of malnutrition status, analyse the association between malnutrition status and individual-level factors, and explore the spatial variation among children and adolescents living with HIV/AIDS in Tanzania. METHODS The study is based on large-scale baseline routine data from the National AIDS Control Programme on people living with HIV from January 2016 to December 2021 in mainland Tanzania. 70,102 children and adolescents aged 5-19 years receiving active antiretroviral therapy were included in the analysis. Nutritional status of participants was assessed by anthropometric measurement. Pearson's Chi-square test was used to describe the association between individual-level factors with all malnutrition outcomes and spatial analysis was used to investigate spatial distribution of malnutrition. The excess risk of malnutrition for each region was calculated while Anselin Local Moran's I and Getis-Ord statistical tools were used to identify significant hot spots regions of malnutrition. RESULTS The mean age of participants was 11.1 (SD 4.7) years, with 71.7% in the 5-14-year age group and 58.4% being girls. 39.2% were attending care and treatment clinics services at hospital level with public ownership. 53.4% started using ARV at age 5-14 years and 55.5% had already switched to second- or third-line ARV with 61.1% using ARV for less than 3 years. 51.2% were in WHO HIV clinical stage III or IV. The prevalence of malnutrition was 36.0% for stunting, 28.9% for underweight, 13.0% for wasting, and 48.0% for anthropometric failure. Individual-level factors which accounted for a higher proportion of malnutrition based on anthropometric failure were male sex (56.3%), age 5-14 years (50.0%), being unmarried (52.9%), being on second- or third-line ARV treatment (51.4%), ART initiation at age 5-14 years (55.7%), ARV for more than 3 years (49.4%), and stage IV of WHO HIV clinical status (57.8%). There were regional hot spots (p < 0.05): the prevalence rate and excess risk of malnutrition for stunting and anthropometric failure were highest in the southern highlands regions, for underweight in the central regions, and for wasting in the northern regions. CONCLUSIONS Children and adolescents living with HIV/AIDS in Tanzania suffer from poor nutritional status. Malnutrition does not occur arbitrarily, and the regions identified as hot spots should be given priority for nutritional intervention. Effective nutritional interventions for children living with HIV/AIDS should incorporate multiple approaches by considering unique geographical factors.
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Affiliation(s)
- Samuel Chacha
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Jing Hui
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Teng Yuxin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Ziping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Saumu Ali
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Nicolaus Mbonile
- Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Mary Msumari
- Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Ndovera Msuya
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Malimu
- Global Fund, Ministry of Health, Dodoma, Tanzania.,Department of Parasitology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Baraka Revocatus
- Department of Data and Statistics, Bugando Medical Centre, Mwanza, Tanzania.,National AIDS Control Program, Ministry of Health, Dodoma, Tanzania
| | - Werner Maokola
- National AIDS Control Program, Ministry of Health, Dodoma, Tanzania
| | - Godwin Mtali
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Victor Simon
- Global Health Program, HJFMRI, U.S. Military HIV Research Program, Rukwa, Tanzania
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
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Ahmed SM, Brintz BJ, Pavlinac PB, Shahrin L, Huq S, Levine AC, Nelson EJ, Platts-Mills JA, Kotloff KL, Leung DT. Derivation and external validation of clinical prediction rules identifying children at risk of linear growth faltering. eLife 2023; 12:78491. [PMID: 36607225 PMCID: PMC9833824 DOI: 10.7554/elife.78491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023] Open
Abstract
Background Nearly 150 million children under-5 years of age were stunted in 2020. We aimed to develop a clinical prediction rule (CPR) to identify children likely to experience additional stunting following acute diarrhea, to enable targeted approaches to prevent this irreversible outcome. Methods We used clinical and demographic data from the Global Enteric Multicenter Study (GEMS) to build predictive models of linear growth faltering (decrease of ≥0.5 or ≥1.0 in height-for-age z-score [HAZ] at 60-day follow-up) in children ≤59 months presenting with moderate-to-severe diarrhea, and community controls, in Africa and Asia. We screened variables using random forests, and assessed predictive performance with random forest regression and logistic regression using fivefold cross-validation. We used the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study to (1) re-derive, and (2) externally validate our GEMS-derived CPR. Results Of 7639 children in GEMS, 1744 (22.8%) experienced severe growth faltering (≥0.5 decrease in HAZ). In MAL-ED, we analyzed 5683 diarrhea episodes from 1322 children, of which 961 (16.9%) episodes experienced severe growth faltering. Top predictors of growth faltering in GEMS were: age, HAZ at enrollment, respiratory rate, temperature, and number of people living in the household. The maximum area under the curve (AUC) was 0.75 (95% confidence interval [CI]: 0.75, 0.75) with 20 predictors, while 2 predictors yielded an AUC of 0.71 (95% CI: 0.71, 0.72). Results were similar in the MAL-ED re-derivation. A 2-variable CPR derived from children 0-23 months in GEMS had an AUC = 0.63 (95% CI: 0.62, 0.65), and AUC = 0.68 (95% CI: 0.63, 0.74) when externally validated in MAL-ED. Conclusions Our findings indicate that use of prediction rules could help identify children at risk of poor outcomes after an episode of diarrheal illness. They may also be generalizable to all children, regardless of diarrhea status. Funding This work was supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award NIH T32AI055434 and by the National Institute of Allergy and Infectious Diseases (R01AI135114).
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Affiliation(s)
- Sharia M Ahmed
- Division of Infectious Diseases, University of Utah School of MedicineSalt lake CityUnited States
| | - Ben J Brintz
- Division of Epidemiology, University of Utah School of MedicineSalt Lake CityUnited States
| | - Patricia B Pavlinac
- Department of Global Health, Global Center for Integrated Health of Women, Adolescents and Children (Global WACh), University of WashingtonSeattleUnited States
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | - Sayeeda Huq
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown UniversityProvidenceUnited States
| | - Eric J Nelson
- Department of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of FloridaGainesvilleUnited States
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of VirginiaCharlottesvilleUnited States
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development, University of Maryland School of MedicineBaltimoreUnited States
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of MedicineSalt lake CityUnited States,Division of Microbiology & Immunology, University of Utah School of MedicineSalt Lake CityUnited States
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Ngassa AB, Meriki HD, Mbanga CM, Nzefa LD, Mbhenyane X, Tambe AB. Key predictors of undernutrition among children 6-59 months in the Buea Health District of the Southwest region of Cameroon: a cross sectional community-based survey. BMC Nutr 2022; 8:148. [PMID: 36514089 PMCID: PMC9745983 DOI: 10.1186/s40795-022-00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the 2018 Demographic and Health Survey, undernutrition remains a public health problem among Cameroonian children under-five. This varies across the country, greatest in areas with ongoing humanitarian crisis, such as the Southwest region. However, data on the burden of undernutrition in the Southwest region is sparse. This study aimed to assess the prevalence and predictors of undernutrition among children under-five in the Buea health district of the Southwest region of Cameroon. METHODS This was a community based cross-sectional study of 321 children under-five/caretaker pairs, surveyed from households selected using multistage randomized sampling. Data were collected by trained data collectors, with the aid of a structured, pre-tested questionnaire that captured information on sociodemographic characteristics, food security, dietary diversity and anthropometric measurements. The weight, height/length and mid upper arm circumference (MUAC) were measured using standardized instruments. Stunting, Wasting and Underweight of children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. Data was analysed using SPSS version 27.0. Predictors of malnutrition were obtained using multivariate logistic regression, adjusting for potential confounders. RESULTS Overall, 31.8% (102/321) of the children were undernourished (26.5% stunted, 1.6% underweight, 3.7% wasted). Drinking water from inappropriate sources (OR: 2.32, 95% CI: 1.30-4.15) and a Dietary Diversity Score < 4 (OR: 2.59, 95%CI: 1.46-4.61) were independently associated with increased risk of stunting. Children of the male sex were more likely to be wasted than females (OR: 5.34, 95%CI: 1.09-26.14). CONCLUSION Childhood undernutrition, particularly stunting is common in the Buea Health District. Risk factors of undernutrition identified are potentially modifiable, highlighting the need for nutrition specific and sensitive interventions to improve dietary diversity, and the need to improve access to safe drinking water, and educate caretakers on the importance of clean potable water, good sanitation and hygiene for the proper growth and development of their children.
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Affiliation(s)
- Andinwoh Betterdel Ngassa
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon
| | - Henry Dilonga Meriki
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon
| | - Clarence Mvalo Mbanga
- Clinton Health Access Innitiative, Cameroon office, 3rd Floor, Y-Building Rue 1775 Nouvelle Route Bastos, Yaounde, Cameroon
| | - Léonie Dapi Nzefa
- grid.8148.50000 0001 2174 3522Department of Social Work, Faculty of Social Sciences, Linnaeus University, Växjö, Sweden
| | - Xikombiso Mbhenyane
- grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town, South Africa
| | - Ayuk Betrand Tambe
- grid.29273.3d0000 0001 2288 3199Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 063, Buea, Cameroon ,grid.11956.3a0000 0001 2214 904XDivision of Human Nutrition, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town, South Africa
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Aziz N, Liu T, Yang S, Zukiewicz-Sobczak W. Causal relationship between health insurance and overall health status of children: Insights from Pakistan. Front Public Health 2022; 10:934007. [PMID: 36568764 PMCID: PMC9768499 DOI: 10.3389/fpubh.2022.934007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
Evaluating the impact of health insurance always remains a methodologically challenging endeavor due to the absence of sample randomization. This paper evaluates the impact of health insurance on the health status of children in Pakistan using the data of the Multiple Indicator Cluster Survey (MICS) for Punjab, Pakistan, from 2017 to 2018. The study adopted the propensity score matching (PSM) method to address the sample selection bias. The sample is matched on potential covariates such as mother characteristics (education level), household head characteristics (gender, age, and education), and other household conditions (such as home dwelling, internet access, wealth index, migration member, number of children residing in the home, as child illness, etc.). The findings revealed that children with insurance have considerably better health than non-insured, at a 1% significance level. The results confirm that health insurance is not a luxury but a need that improves children's overall health. In this regard, governments should enhance and expand programs related to health insurance, especially for children. Health insurance programs will not only help poor people but also improve the overall infrastructure of health services in the country.
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Affiliation(s)
- Noshaba Aziz
- School of Economics, Shandong University of Technology, Zibo, China
| | - Tinghua Liu
- School of Economics, Shandong University of Technology, Zibo, China
| | - Shaoxiong Yang
- College of Economics and Management, Northwest A&F University, Xianyang, China
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Lazarus G, Junaidi MC, Oswari H. Relationship of Functional Constipation and Growth Status: A Systematic Review and Meta-Analysis. J Pediatr Gastroenterol Nutr 2022; 75:702-708. [PMID: 36053122 DOI: 10.1097/mpg.0000000000003600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Functional constipation (FC) and malnutrition are 2 of the most common diseases affecting children worldwide with long-term consequences. We hereby performed a systematic review and meta-analysis to analyze the relationship between these 2 entities. METHODS We searched PubMed, American Academics of Pediatrics (AAP), Cochrane, ClinicalTrials.gov (from inception to December 11, 2021) using "constipation," "growth," and "children" as the keywords. Newcastle-Ottawa Scale was used as the risk of bias assessment tool. Meta-analysis using the random-effects model was done. RESULTS Eighteen studies involving 33,410 children were chosen in this study. Meta-analysis of all the studies showed statistically significant relationship between FC with both overweight/obesity [odds ratio (OR) = 1.75; 95% confidence interval (CI) = 1.11-2.76; P = 0.02], in Asian countries subgroup, and undernutrition (OR = 2.38; 95% CI = 1.43-3.97; P < 0.001) in Asian countries using ROME criteria's subgroup. Normal weight patients were also more prevalent in non-FC patients in Asia (OR = 0.54; 95% CI = 0.38-0.76; P < 0.001). The relationship between FC and short stature is still inconclusive. CONCLUSIONS FC is correlated with the prevalence of both overweight/obesity and undernutrition. Future studies should evaluate the causal relationship and whether FC treatment could help.
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Affiliation(s)
- Glen Lazarus
- From the Gastrohepatology Division, Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Aldridge R. Is the continued existence of diseases of poverty an indictment of our current humanitarian ethos? BMJ Mil Health 2022; 168:441-443. [PMID: 32152208 DOI: 10.1136/bmjmilitary-2020-001413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 11/04/2022]
Abstract
The continued existence of diseases of poverty is one of the great medical moral dilemmas of the 21st century. That this group of largely either preventable or treatable diseases still plagues a great many of the world's poorest citizens is a challenging problem to address. This paper examines diseases of poverty not by looking at the pathogenic diseases themselves but by looking at the 'diseases' of society that lead to the prevalence of such morbidity. 'Diseases' such as lack of infrastructure, lack of nutrition, lack of education, lack of funding and lack of socioeconomic stability. By addressing each of these, in turn, this paper looks to stimulate thought on how society can approach and prevent diseases of poverty in the future.
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Fauziah N, Aviani JK, Agrianfanny YN, Fatimah SN. Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review. Trop Med Infect Dis 2022; 7:371. [PMID: 36422922 PMCID: PMC9697828 DOI: 10.3390/tropicalmed7110371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 09/01/2023] Open
Abstract
Intestinal parasitic infections are common infectious diseases causing many health problems and impaired growth and physical development.. Children under five years old are the most vulnerable to infections, due to their immature immunity and feeding and exploratory behaviours. This systematic review aimed to assess the relationship between intestinal parasitic infections and undernutrition among children under 5 years old. Fifteen studies met the inclusion and exclusion criteria and were classified as high-quality studies. Twelve parasites were reported, including Ascaris lumbricoides, Cryptosporodium spp., Entamoeba histolytica, Enterobius vermicularis, Giardia lamblia, hookworm, Hymenolepis nana, Strongyloides sterocalis, Taenia spp. and Trichuris trichuria. Ascariasis is the most reported infection, with a prevalence ranging from 10.77% in Ethiopia to 57.14% in Malaysia, and is correlated with stunting (OR 2.17 (95% CI 1.14, 4.13), p = 0.02). Giardiasis is the second most reported infection, with a prevalence ranging from 4.43% in Ethiopia to 66.33% in the Central African Republic, and is related to an increased risk of stunting (OR 2.34 (95% CI 1.07, 5.10), p = 0.03)), wasting (OR 2.90 (95% CI 1.12, 7.49, p = 0.03)), and being underweight (OR 1.53 (95% CI 1.02, 2.29, p = 0.04)). The third and fourth most prevalent infections are T. trichiura and hookworm infections. Intestinal parasitic infections can occur very early in life and cause significant growth retardation. It is important to understand the prevalence and effects of infection based on the parasite species in order to implement therapeutic interventions and prevention controls.
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Affiliation(s)
- Nisa Fauziah
- Division of Parasitology, Department of Basic Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Jenifer Kiem Aviani
- Department of Biotechnology, School of Life Science and Technology, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Yukan Niko Agrianfanny
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Siti Nur Fatimah
- Division of Clinical Nutrition, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
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Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Stunting among children aged 24-59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia. Sci Rep 2022; 12:19293. [PMID: 36369357 PMCID: PMC9652362 DOI: 10.1038/s41598-022-23981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24-59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24-59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.
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Affiliation(s)
- Zemichael Gizaw
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.458355.a0000 0004 9341 7904Addis Continental Institute of Public Health, Addis Ababa, Ethiopia ,grid.261331.40000 0001 2285 7943Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH USA
| | - Alemayehu Worku Yalew
- grid.7123.70000 0001 1250 5688School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bikes Destaw Bitew
- grid.59547.3a0000 0000 8539 4635Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jiyoung Lee
- grid.261331.40000 0001 2285 7943Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210 USA ,grid.261331.40000 0001 2285 7943Department of Food Science and Technology, The Ohio State University, Columbus, OH USA
| | - Michael Bisesi
- grid.261331.40000 0001 2285 7943Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210 USA
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Limardi S, Hasanah DM, Utami NMD. Dietary intake and stunting in children aged 6-23 months in rural Sumba, Indonesia. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.341-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background Linear growth retardation in the first two years of life leads to numerous harmful consequences. Lack of diversity in the diet and inadequate amounts of complementary food have been associated with stunted growth in children.
Objective To assess the dietary intake and investigate for associations with stunting among children aged 6-23 months.
Methods This case-control study compared the dietary intake of children aged 6-23 months with and without stunting in the South and West Wewewa subdistricts of Southwest Sumba, East Nusa Tenggara, Indonesia. Complementary food types, dietary diversity, and nutritional intake were assessed and compared between groups. Nutrient intake sufficiency and stunting were analyzed by logistic regression.
Results A total of 200 participants were equally allocated into groups with and without stunting. Only 6% of stunted children received adequate complementary food diversity compared to 14% of non-stunted children (P=0.05). The stunted group had significantly lower consumption of flesh foods (beef, fish, poultry, organ meat, and other kinds of meat) compared to the non-stunted group (7% vs. 16% of subjects, respectively; P<0.05). The median total protein intake was also significantly lower in stunted children compared to non-stunted children [7.72 (IQR 6.46, 11.31) g vs. 10.02 (IQR 6.53, 13.95) g, respectively; P<0.05] although no association was found between protein intake sufficiency and stunting in the multivariate analysis. Only maternal unemployment was positively associated with stunting (OR 2.32; 95%CI 1.26 to 4.26).
Conclusion Overall, most subjects did not receive sufficient amounts of nutrients. Although dietary diversity was not found to be significantly different between those with and without stunting, a significantly lower proportion of stunted children consumed flesh food. The stunted group also received significantly lower protein from their diet although no association was found between nutrient intake sufficiency and stunting. Further studies are needed to longitudinally assess the effects of macronutrient and micronutrient intake sufficiency on linear growth in children.
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How effectively might agricultural input subsidies improve nutrition? A case study of Malawi’s Farm Input Subsidy Programme (FISP). Food Secur 2022. [DOI: 10.1007/s12571-022-01315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhusal UP. Poor and non-poor gap in under-five child nutrition: a case from Nepal using Blinder-Oaxaca decomposition approach. BMC Health Serv Res 2022; 22:1245. [PMID: 36224578 PMCID: PMC9559871 DOI: 10.1186/s12913-022-08643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Many low-and middle-income countries (LMICs) have improved health indicators in the past decades, however, there is a differential in outcomes between socioeconomic groups. Systematic analysis of drivers of child nutrition gap between non-poor and poor groups has a policy relevance in Nepal and other countries to make progress towards universal health coverage (UHC). The objective of this paper was to estimate the mean height-for-age z scores (HAZ) gap between under-five children belonging to non-poor and poor groups, divide the gap into components (endowments, coefficients and interaction), and identify the factors that contributed most to each of the component. METHODS Information about 6277 under-five children was extracted from the most recent nationally representative Nepal Multiple Indicator Cluster Survey (MICS) 2019. HAZ was used to assess nutritional status of children. Wealth index was used to categorize children into non-poor and poor. Mean HAZ gap between groups was decomposed using Blinder-Oaxaca technique into components: endowments (group difference in levels of predictors), coefficients (group difference in effects of predictors), and interaction (group difference due to interaction between levels and effects of predictors). Detailed decomposition was carried out to identify the factors that contributed most to each component. RESULTS There was a significant non-poor and poor gap in nutrition outcome measured in HAZ (0.447; p < 0.001) among under-five children in Nepal. The between-group mean differences in the predictors of study participants (endowments) contributed 0.210 (47%) to the gap. Similarly, the between-group differences in effects of the predictors (coefficients) contributed 0.308 (68.8%) towards the gap. The interaction contributed -0.071 (15.8%) towards minimizing the gap. The predictors/variables that contributed most towards the gap due to (i) endowments were: maternal education, province (Karnali, Sudurpaschim, Madhesh), residence (rural/urban), type of toilet facility and ethnic group (Dalit and Muslim); (ii) coefficients were: number of under-five children in family, ethnic group (Dalit and Muslim), type of toilet facility, maternal age and education. CONCLUSION Decomposition of the child nutrition gap revealed that narrowing the inequality between wealth groups depends not only on improving the level of the predictors (endowments) in the poor group but also on reducing differential effects of the predictors (coefficients).
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Affiliation(s)
- Umesh Prasad Bhusal
- Public Health and Social Protection Professional, Kathmandu, Nepal. .,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
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Modjadji P, Masilela LN, Cele L, Mathibe M, Mphekgwana PM. Evidence of Concurrent Stunting and Obesity among Children under 2 Years from Socio-Economically Disadvantaged Backgrounds in the Era of the Integrated Nutrition Programme in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12501. [PMID: 36231797 PMCID: PMC9564645 DOI: 10.3390/ijerph191912501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
In view of persistent stunting and increasing rates of obesity coexisting among children in the era of the Integrated Nutrition Programme, a cross-sectional study was conducted to determined concurrent stunting and obesity (CSO) and related factors using a random sample of child-mother pairs (n = 400) in Mbombela, South Africa. Sociodemographic data was collected using a validated questionnaire, and stunting (≥2SD) and obesity (>3SD) were assessed through respective length-for-age (LAZ) and body mass index (BAZ) z-scores. Using SPSS 26.0, the mean age of children was 8 (4; 11) months, and poor sociodemographic status was observed, in terms of maternal singlehood (73%), no education or attaining primary education only (21%), being unemployed (79%), living in households with a monthly income below R10,000 (≈$617), and poor sanitation (84%). The z-test for a single proportion showed a significant difference between the prevalence of CSO (41%) and non-CSO (69%). Testing for the two hypotheses using the Chi-square test showed no significant difference of CSO between boys (40%) and girls (41%), while CSO was significantly different and high among children aged 6-11 months (55%), compared to those aged 0-5 months (35%) and ≥12 months (30%). Further analysis using hierarchical logistic regression showed significant associations of CSO with employment (AOR = 0.34; 95%CI: 0.14-0.78), maternal education status (AOR = 0.39; 95%CI: 0.14-1.09) and water access (AOR = 2.47; 95%CI: 1.32; 4.63). Evidence-based and multilevel intervention programs aiming to prevent CSO and addressing stunting, while improving weight status in children with social disadvantages, are necessary.
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Affiliation(s)
- Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Lucy Nomsa Masilela
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Lindiwe Cele
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Mmampedi Mathibe
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Peter Modupi Mphekgwana
- Research Administration and Development, University of Limpopo, Polokwane 0700, South Africa
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Effect of educational intervention based on health belief model on mothers monitoring growth of 6-12 months child with growth disorders. BMC Pediatr 2022; 22:561. [PMID: 36151526 PMCID: PMC9502959 DOI: 10.1186/s12887-022-03593-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternal education is one of the main ways to improve children's nutritional behaviors and development. The purpose of this study is to investigate the effect of educational intervention based on Health Belief Model (HBM) on mothers monitoring growth of 6–12 months child with growth disorders in Ghirokarzin city, Fars Provonce, Iran. Methods This quasi-experimental study was conducted on mothers of 6–12 months children with growth disorders of Ghirokarzin city, Fars province, Iran in 2021–2022. One hundred twenty mothers of 6–12 months child with growth disorders in Ghirokarzin city were selected using random sampling method and were divided into two groups of intervention (60) and control (60). The experimental group received training on the HBM constructs. Both groups completed the questionnaire before and three months after.intervention. A questionnaire beased on Health Belief Model constructs were used to collect information. The data was analyzed with SPSS 22 software using paired t-tests, Chi-square tests, and independent t-tests, with a significance level of 0.05. Results Three months after the educational intervention, the experimental group showed a significant increase in terms of knowledge, HBM constructs, weight of the children and feeding behavior. Conclusion This study showed the educational intervention based on the HBM improved the knowledge and feeding behavior of mothers and improved Growth Disorders of child. Hence, this model can act as a framework for designing and implementing educational interventions for prevention of growth disorders in children.
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Chowdhury MRK, Rahman MS, Billah B, Kabir R, Perera NKP, Kader M. The prevalence and socio-demographic risk factors of coexistence of stunting, wasting, and underweight among children under five years in Bangladesh: a cross-sectional study. BMC Nutr 2022; 8:84. [PMID: 35996184 PMCID: PMC9394024 DOI: 10.1186/s40795-022-00584-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 08/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Childhood stunting, wasting and underweight are significant public health challenges. There is a gap in knowledge of the coexistence of stunting, wasting, and underweight among children under five years (under-5) in Bangladesh. This study aims to (i) describe the prevalence of the coexistence of stunting, wasting, and underweight and ii) examine the risk factors for the coexistence of stunting, wasting, and underweight among children under-5 in Bangladesh. Methods This study included 6,610 and 7,357 under-5 children from Bangladesh Demographic Health Surveys (BDHS) 2014 and 2017/18, respectively. The associations between the coexistence of stunting, wasting, and underweight and independent variables were assessed using the Chi-square test of independence. The effects of associated independent variables were examined using negative binomial regression. Results The prevalence of coexistence of stunting, wasting, and underweight gradually declined from 5.2% in 2014 to 2.7% in 2017/18. Children born with low birth weight ((adjusted incidence rate ratios, aIRR) 2.31, 95% CI 1.64, 3.24)); children of age group 36–47 months (aIRR 2.26, 95% CI 1.67, 3.08); children from socio-economically poorest families (aIRR 2.02, 95% CI 1.36, 2.98); children of mothers with no formal education (aIRR 1.98, 95% CI 1.25, 3.15); and children of underweight mothers (aIRR 1.73, 95% CI 1.44, 2.08) were the most important risk factors. Further, lower incidence among children with the coexistence of stunting, wasting, and underweight was observed in the 2017–18 survey (aIRR 0.59, 95% CI 0.49, 0.70) compared to children in the 2014 survey. Conclusions One out of thirty-five under-5 children was identified to have coexistence of stunting, wasting, and underweight in Bangladesh. The burden of coexistence of stunting, wasting, and underweight was disproportionate among children born with low birth weight, socio-economically poorest, a mother with no formal education, and underweight mothers, indicating the need for individual, household, and societal-level interventions to reduce the consequences of coexistence of stunting, wasting, and underweight. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00584-x.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Md Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, London, United Kingdom
| | - Nirmala K P Perera
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Manzur Kader
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Maria Aspmans gata 30A, 17164, Solna, Stockholm, Sweden.
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Habtu M, Agena AG, Umugwaneza M, Mochama M, Munyanshongore C. Effect of integrated nutrition-sensitive and nutrition-specific intervention package on maternal malnutrition among pregnant women in Rwanda. MATERNAL & CHILD NUTRITION 2022; 18:e13367. [PMID: 35538044 PMCID: PMC9218321 DOI: 10.1111/mcn.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 01/10/2023]
Abstract
Maternal undernutrition remains a major public health concern in Rwanda despite significant gains and progress. An integration of nutrition‐specific and nutrition‐sensitive interventions was implemented in five districts of Rwanda to improve maternal and child nutrition. The package included nutrition education and counselling, promotion of agricultural productivity, promotion of financial literacy/economic resilience and provision of Water, Hygiene and Sanitation services. However, there is limited evidence about the effect of such interventions in reducing maternal undernutrition. A postintervention quasi‐experimental study was conducted among pregnant women to determine the effect of the integrated intervention on their nutritional status. It was carried out in two intervention districts, namely Kicukiro and Kayonza, and two control districts, namely Gasabo and Gisagara between November 2020 and June 2021. Five hundred and fifty‐two women were recruited for the intervention arm, while 545 were recruited for the control arm. Maternal undernutrition was defined as either having low mid‐upper arm circumference (<23 cm) during delivery or low body mass index (<18.5 kg/m2) in the first trimester or both. A multivariable logistic regression model was used to assess the effect of the integrated interventions. The prevalence of maternal undernutrition was significantly lower in the intervention group compared with the control group (4.7% vs. 18.2%; p < 0.001). After controlling the potential confounders, the risk of maternal undernutrition was 77.0% lower in the intervention group than in the control group [adjusted odds ratio= 0.23; 95% confidence interval = 0.15–0.36; p < 0.001]. Further studies are therefore recommended to establish causation and inform the potential scale‐up of these interventions nationally in Rwanda. Empirical evidence on the effect of integrated nutrition‐specific and nutrition‐sensitive interventions on maternal undernutrition is limited as existing studies are mainly directed at the effectiveness of nutritional interventions on improving child nutritional status. The results indicated that the integrated nutrition‐specific and nutrition‐sensitive intervention package was significantly associated with low maternal undernutrition. This study adds more evidence to the 2008, 2013 and 2021 Lancet Series regarding the proposed effectiveness of integrated nutrition‐sensitive and nutrition‐specific interventions. Further research should focus on follow‐up randomized controlled trials and the cost‐effectiveness of these integrated nutrition‐specific and nutrition‐sensitive interventions.
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Affiliation(s)
- Michael Habtu
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.,Catholic Relief Services, Kigali, Rwanda.,Department of Public Health, School of Health Sciences, University of Mount Kenya, Kigali, Rwanda
| | | | - Maryse Umugwaneza
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Monica Mochama
- Department of Public Health, School of Health Sciences, University of Mount Kenya, Kigali, Rwanda
| | - Cyprien Munyanshongore
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda
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Di Prima S, Nguyen Dinh D, Reurings DD, Wright EP, Essink D, Broerse JEW. Home-Grown School Feeding: Implementation Lessons From a Pilot in a Poor Ethnic Minority Community in Vietnam. Food Nutr Bull 2022; 43:271-302. [PMID: 35470722 PMCID: PMC9403386 DOI: 10.1177/03795721221088962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Undernutrition threatens the health and future of preschool children in
disadvantaged remote communities. Home-grown school feeding (HGSF) in
nursery schools could positively impact children’s nutrition while creating
multiple benefits for the whole community. However, evidence is lacking on
implementation of HGSF within multi-sectoral programs in remote areas. Objective: This study assessed an HGSF pilot intervention, part of a nutrition-sensitive
agriculture (NSA) program, in a mountain ethnic minority community in
Vietnam. It aimed to identify the changes brought about by the intervention,
in particular diversity of children’s food, food sources, barriers and
facilitators to change, and future challenges and strategies. Methods: Mixed-methods assessment covered school meal diversity, cost, and food
sources but the key focus was on observed changes resulting from the HGSF
intervention and perceived barriers and facilitators to its implementation.
Data were collected mainly through semi-structured interviews (n = 30) and
seven focus group discussions (n = 76). Results: School meals contributed to increasing diversity of food consumed by
children. Above 30% of foods used were home-grown. Respondents reported
increased school attendance; children’s food preferences and hygiene
practices improved as did parents’ caring and feeding practices. Local food
systems became less cash-crop-oriented and more self-reliant, contributing
to household food security and income generation. Social capital increased.
Positive changes were attributed to HGSF and synergy among NSA program
components. Poverty and limited resilience to external shocks threatened
sustainability. Conclusions: Implementing HGSF within an NSA program in a mountainous ethnic minority area
with a high prevalence of undernutrition benefitted children and their
communities.
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Affiliation(s)
- Sabina Di Prima
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Sabina Di Prima and Dai Nguyen Dinh contributed equally to this work and qualify as first authors for this publication
| | - Dai Nguyen Dinh
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Sabina Di Prima and Dai Nguyen Dinh contributed equally to this work and qualify as first authors for this publication
| | | | - E Pamela Wright
- Guelph International Health Consulting, Amsterdam, the Netherlands
| | - Dirk Essink
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Mekonnen TC, Tadesse SE, Dawed YA, Cherie N, Abebe H, Shumye G, Mohammed F, Hussien A. The role of nutrition‐sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study. Health Sci Rep 2022; 5:e524. [PMID: 35284644 PMCID: PMC8893299 DOI: 10.1002/hsr2.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The study aimed to investigate the role of nutrition‐sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia. Methods An adequacy evaluation study was used to see changes between the baseline and end‐line data after following for 1 year. A sample of 170 mother‐child pairs who had a 1‐year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model. Results A total of 170 and 270 mother‐child dyads were interviewed at baseline and end‐line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length‐for‐age Z‐score which changed from −1.18 to −0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction. Conclusions Sustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition‐sensitive agricultural and direct nutrition interventions along with behavioral‐based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.
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Affiliation(s)
- Tefera Chane Mekonnen
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Sisay Eshete Tadesse
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Yeshimebet Ali Dawed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Nigus Cherie
- Reproductive and Family Health Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Hunegnaw Abebe
- Departments of Animal Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Getachew Shumye
- Department of Plant Science College of Agriculture, Wollo University Dessie Ethiopia
| | - Foziya Mohammed
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
| | - Ahmed Hussien
- Nutrition and Dietetics Department School of Public Health, College of Medicine and Health Sciences, Wollo University Dessie Ethiopia
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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Duncan E, Ashton L, Abdulai AR, Sawadogo-Lewis T, King SE, Fraser EDG, Vosti S, Haines J, Knight F, Roberton T. Connecting the food and agriculture sector to nutrition interventions for improved health outcomes. Food Secur 2022; 14:657-675. [PMID: 35126795 PMCID: PMC8804081 DOI: 10.1007/s12571-022-01262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
To achieve the Sustainable Development Goal of zero hunger, multi-sectoral strategies to improve nutrition are necessary. Building towards this goal, the food and agriculture sector must be considered when designing nutritional interventions. Nevertheless, most frameworks designed to guide nutritional interventions do not adequately capture opportunities for integrating nutrition interventions within the food and agriculture sector. This paper aims to highlight how deeply connected the food and agriculture sector is to underlying causes of malnutrition and identify opportunities to better integrate the food and agriculture sector and nutrition in low and middle income countries. In particular, this paper: (1) expands on the UNICEF conceptual framework for undernutrition to integrate the food and agriculture sector and nutrition outcomes, (2) identifies how nutritional outcomes and agriculture are linked in six important ways by defining evidence-based food and agriculture system components within these pathways: as a source of food, as a source of income, through food prices, women’s empowerment, women’s utilization of time, and women’s health and nutritional status, and (3) shows that the food and agriculture sector facilitates interventions through production, processing and consumption, as well as through farmer practices and behavior. Current frameworks used to guide nutrition interventions are designed from a health sector paradigm, leaving agricultural aspects not sufficiently leveraged. This paper concludes by proposing intervention opportunities to rectify the missed opportunities generated by this approach. Program design should consider the ways that the food and agriculture sector is linked to other critical sectors to comprehensively address malnutrition. This framework is designed to help the user to begin to identify intervention sites that may be considered when planning and implementing multi-sectoral nutrition programs.
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Affiliation(s)
- E. Duncan
- University of Guelph, Guelph, ON Canada
| | - L. Ashton
- University of Guelph, Guelph, ON Canada
| | | | | | | | | | - S. Vosti
- University of Guelph, Guelph, ON Canada
| | - J. Haines
- University of Guelph, Guelph, ON Canada
| | - F. Knight
- University of Guelph, Guelph, ON Canada
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Yisak H, Maru I, Abie M, Arage G, Ewunetei A, Azanaw MM, Teshome F. Determinants of undernutrition among older adults in South Gondar Zone, Ethiopia: a community-based study. BMJ Open 2022; 12:e056966. [PMID: 35017256 PMCID: PMC8753413 DOI: 10.1136/bmjopen-2021-056966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess the prevalence and determinants of undernutrition among older adults aged 65 years in the south Gondar Zone, Ethiopia, in 2020. DESIGN A community-based cross-sectional study. SETTING The study was conducted from 1 October to 15 December 2020, in the South Gondar Zone, Ethiopia. Study participants were selected by systematic random sampling. A pretested and structured questionnaire adapted from different literature was used to collect data. Anthropometric measurements were taken following the standard procedure. PARTICIPANTS A total of 290 older adults aged greater than or equal to 65 years of age were included in the study. DATA ANALYSIS Descriptive and summary statistics were employed. Multiple logistic regression was fitted to identify determinants of undernutrition. ORs and their 95% CIs were computed to determine the level of significance. OUTCOME MEASURES Undernutrition was assessed by using Body Mass Index and Mini Nutritional Assessment (MNA) tool. RESULTS The prevalence of undernutrition was 27.6% (95% CI 22.4 to 32.8), and 2.1% (95% CI 0.7 to 3.8) of the study participants were overweight. Based on the MNA tool, 29.7% (95% CI 24.5 to 35.2) of the study participants were undernourished and 61.7% (95% CI 55.5 to 67.2) were at risk of undernourishment. Rural residence adjusted OR (aOR)=10.3 (95% CI 3.6 to 29.4), inability to read and write aOR=3.5 (95% CI 1.6 to 7.6), decrease in food intake aOR=13.5 (95% CI 6.1 to 29.5) and household monthly income of less than US$35.6 aOR=4.3 (95% CI 1.9 to 9.4) were significantly and independently associated with undernutrition. CONCLUSION The level of undernutrition among older adults in the study area was high, making it an important public health burden. The determinants of undernutrition were a place of residence, educational status, food intake and monthly income.
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Affiliation(s)
- Hiwot Yisak
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ismael Maru
- Department of Medicine, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Abie
- Department of Medicine, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amien Ewunetei
- Department of Pharmacology, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Manners R, Adewopo J, Niyibituronsa M, Remans R, Ghosh A, Schut M, Egoeh SG, Kilwenge R, Fraenzel A. Leveraging Digital Tools and Crowdsourcing Approaches to Generate High-Frequency Data for Diet Quality Monitoring at Population Scale in Rwanda. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2021.804821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diet quality is a critical determinant of human health and increasingly serves as a key indicator for food system sustainability. However, data on diets are limited, scattered, often project-dependent, and current data collection systems do not support high-frequency or consistent data flows. We piloted in Rwanda a data collection system, powered by the principles of citizen science, to acquire high frequency data on diets. The system was deployed through an unstructured supplementary service data platform, where respondents were invited to answer questions regarding their dietary intake. By combining micro-incentives with a normative nudge, 9,726 responses have been crowdsourced over 8 weeks of data collection. The cost per respondent was < $1 (system set-up, maintenance, and a small payment to respondents), with interactions taking <15 min. Exploratory analyses show that >70% of respondents consume tubers and starchy vegetables, leafy vegetables, fruits, legumes, and wholegrains. Women consumed better quality diets than male respondents, revealing a sex-based disparity in diet quality. Similarly, younger respondents (age ≤ 24 years) consumed the lowest quality diets, which may pose significant risks to their health and mental well-being. Middle-income Rwandans were identified to have consumed the highest quality diets. Long-term tracking of diet quality metrics could help flag populations and locations with high probabilities of nutrition insecurity, in turn guiding relevant interventions to mitigate associated health and social risks.
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Sianturi E, Primarti RS, Setiawan AS. A self-reported cross-sectional study on the oral function and the quality of life in children with stunted growth. Front Pediatr 2022; 10:1019143. [PMID: 36683810 PMCID: PMC9850111 DOI: 10.3389/fped.2022.1019143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Failure to catch up with growth in toddlerhood will stunt elementary school children, which continues to cognitive decline and oral motor coordination. Verbal motor skills play an essential role in the oral function of the stomatognathic system, which includes mastication, swallowing, and speech. Therefore, early attention to oral function disorders of the stomatognathic system can avoid complications in children's nutritional status and quality of life. OBJECTIVE The objective of this study was to analyze the correlation of oral function of the stomatognathic system with Oral Health-Related Quality of Life (OHRQoL) in stunting children. METHODS This cross-sectional study correlates with 58 children aged 7-12 years with a history of stunting in toddlerhood from the Pasir Jambu District, Bandung Regency. The oral function of the stomatognathic system was evaluated by Adapted Orofacial Myofunctional Assessment Protocol and OHRQoL with Child Oral Health Impact Profile Short Form (COHIP-SF 19). RESULTS The results were statistically analyzed using Spearman's rank correlation and Kendall's coefficient of concordance correlation tests. The results showed that the research subjects had a significant relationship in each variable and the three variables of the oral function of the stomatognathic system (chewing, swallowing, and speech) with OHRQoL with a p-value <0.05. The study concluded that the oral function of the stomatognathic system (chewing, swallowing, and speech) is related to OHRQoL in children with stunted growth.
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Affiliation(s)
- Eunike Sianturi
- Pediatric Dentistry Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Risti Saptarini Primarti
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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Irenso AA, Chamberlain D, Zheng M, Campbell KJ, Laws R. The Role of Household Structure and Composition in Influencing Complementary Feeding Practices in Ethiopia. Nutrients 2021; 14:nu14010130. [PMID: 35011004 PMCID: PMC8747051 DOI: 10.3390/nu14010130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/03/2023] Open
Abstract
While the household in which a child grows up is considered a critical environment that influences nutrition outcomes, there is little research examining the influence of household composition and structure on complementary feeding practices. This study examined the influence of household structure and composition on complementary feeding practices, using the Ethiopian Demographic and Health Survey (EDHS), 2000 to 2016. The composition variables were calculated from the attributes of household members (alters) and the structure variables from their kinship status. A multilevel mixed-effects regression model, specifying survey rounds as the random effect, was used to examine the association between household structure/composition and the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). The average Marginal Effects (MEs) were calculated to facilitate practical interpretation. Children of caregivers with a higher number of alters (degree), unique number of kinship category (effect size), closely related (constraint), and mixed-age alters (age diversity) seemed to increase the probability of meeting the MDD. Degree and effective size decreased the probability of meeting MMF, while constraint increased it. Overall, this study revealed some associations between household structure and composition and complementary feeding practices. Hence, complementary feeding interventions could be adapted to account for the household structure and composition variations.
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Affiliation(s)
- Asnake Ararsa Irenso
- School of Public Health, Haramaya University, Harar P.O. Box 235, Ethiopia
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
- Correspondence: ; Tel.: +61-416-121-881
| | - Dan Chamberlain
- Centre for Social Impact, University of New South Wales, Kennington, NSW 2052, Australia;
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia; (M.Z.); (K.J.C.); (R.L.)
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Lee AR, Lebwohl B, Lebovits J, Wolf RL, Ciaccio EJ, Green PHR. Factors Associated with Maladaptive Eating Behaviors, Social Anxiety, and Quality of Life in Adults with Celiac Disease. Nutrients 2021; 13:4494. [PMID: 34960046 PMCID: PMC8708489 DOI: 10.3390/nu13124494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 01/05/2023] Open
Abstract
A gluten-free diet (GFD), which is the only treatment for celiac disease (CeD), is challenging and associated with higher levels of anxiety, disordered eating, and lower quality of life (QOL). We examined various demographic and health factors associated with social anxiety, eating attitudes and behaviors, and QOL. Demographics and health characteristics, QOL, eating attitudes and behaviors, and social anxiety of adults with CeD were acquired using validated measures. The mean scores for QOL, SAQ, and CDFAB were compared across various demographic groups using the Z statistical test. The mean QOL score was 57.8, which is in the moderate range. The social anxiety mean scores were high: 78.82, with 9% meeting the clinical cutoff for social anxiety disorder. Those on a GFD for a short duration had significantly higher SAQ scores (worse anxiety), higher CDFAB scores (worse eating attitudes and behavior), and lower QOL scores. Those aged 23-35 years had lower QOL scores (p < 0.003) and higher SAQ scores (p < 0.003). Being single (p < 0.001) and female (p = 0.026) were associated with higher SAQ scores. These findings suggest that the development of targeted interventions to maximize QOL and healthy eating behaviors as well as to minimize anxiety is imperative for some adults with CeD.
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Affiliation(s)
- Anne R. Lee
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Jessica Lebovits
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Randi L. Wolf
- Teachers College, Columbia University, New York, NY 10027, USA;
| | - Edward J. Ciaccio
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
| | - Peter H. R. Green
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY 10032, USA; (B.L.); (J.L.); (E.J.C.); (P.H.R.G.)
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Choudhury N, Siddiqua TJ, Ahmed SMT, Haque MA, Ali M, Dil Farzana F, Naz F, Rahman SS, Faruque ASG, Rahman S, Ahmed T. Iron content of drinking water is associated with anaemia status among children in high groundwater iron areas in Bangladesh. Trop Med Int Health 2021; 27:149-157. [PMID: 34905267 DOI: 10.1111/tmi.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Iron in groundwater provides a good source of absorbable iron for humans and can contribute to optimal iron and haemoglobin (Hb) status among populations. We aimed to examine the relationship between the iron content of groundwater and anaemia status among 12- to 23-month-old children in a rural area of Bangladesh. METHOD A cross-sectional study was conducted in 80 randomly selected unions (the lowest administrative unit) in Sylhet and Moulvibazar districts of Bangladesh. A total of 800 children aged 12-23 months were selected via a systematic random sampling method. The child's age, sex, stunting status, consumption of iron-rich or iron-fortified food, maternal age and maternal body mass index (BMI) and the type of terrain were subjected to multiple logistic regression analysis to observe the independent relationships between groundwater iron content and anaemia in children. RESULTS In total, 50.4% of children were anaemic. The odds of children being anaemic were 1.51-fold higher [OR: 1.51 (95% CI: 1.09, 2.09)] among households consuming water with an iron content <2 mg/L than in households consuming water with an iron content ≥2 mg/L. Childhood stunting, child's sex, child's age and the type of terrain were also significantly associated with anaemia among children. CONCLUSION Groundwater with a high iron concentration was significantly associated with a decreased risk of childhood anaemia. This study provides evidence of the importance of groundwater iron to protect impoverished young children from anaemia.
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Affiliation(s)
- Nuzhat Choudhury
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | | | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | - Mohammad Ali
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Farina Naz
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - A S G Faruque
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
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Chowdhury MRK, Khan HTA, Rashid M, Kabir R, Islam S, Shariful Islam M, Kader M. Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting or underweight) among children under 5 in Bangladesh: a nationally representative cross-sectional study. BMJ Open 2021; 11:e052814. [PMID: 34903543 PMCID: PMC8672009 DOI: 10.1136/bmjopen-2021-052814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh. DESIGN A nationally representative cross-sectional study. SETTING Bangladesh. RESPONDENTS Children age under 5 years of age. OUTCOME MEASURE This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition. STATISTICAL ANALYSIS Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis. RESULTS Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24-35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24-35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father's occupation, children's age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition. CONCLUSION One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father's occupation, children's age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children.
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Affiliation(s)
| | - Hafiz T A Khan
- College of Nursing, Midwifery and Healthcare, University of West London, Brentford, London, UK
| | - Mamunur Rashid
- Department of Public Health and Sports Sciences, University of Gävle, Gavle, Gävleborg, Sweden
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, London, UK
| | - Sazin Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Manzur Kader
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Mburu W, Conroy AL, Cusick SE, Bangirana P, Bond C, Zhao Y, Opoka RO, John CC. The Impact of Undernutrition on Cognition in Children with Severe Malaria and Community Children: A Prospective 2-Year Cohort Study. J Trop Pediatr 2021; 67:6424536. [PMID: 34755192 PMCID: PMC8578678 DOI: 10.1093/tropej/fmab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The frequency of recovery from undernutrition after an episode of severe malaria, and the relationship between undernutrition during severe malaria and clinical and cognitive outcomes are not well characterized. METHODS We evaluated undernutrition and cognition in children in Kampala, Uganda 18 months to 5 years of age with cerebral malaria (CM), severe malarial anemia (SMA) or community children (CC). The Mullen Scales of Early Learning was used to measure cognition. Undernutrition, defined as 2 SDs below median for weight-for-age (underweight), height-for-age (stunting) or weight-for-height (wasting), was compared with mortality, hospital readmission and cognition over 24-month follow-up. RESULTS At enrollment, wasting was more common in CM (16.7%) or SMA (15.9%) than CC (4.7%) (both p < 0.0001), and being underweight was more common in SMA (27.0%) than CC (12.8%; p = 0.001), while prevalence of stunting was similar in all three groups. By 6-month follow-up, prevalence of wasting or being underweight did not differ significantly between children with severe malaria and CC. Undernutrition at enrollment was not associated with mortality or hospital readmission, but children who were underweight or stunted at baseline had lower cognitive z-scores than those who were not {underweight, mean difference [95% confidence interval (CI)] -0.98 (-1.66, -0.31), -0.72 (-1.16, -0.27) and -0.61 (-1.08, -0.13); and stunted, -0.70 (-1.25, -0.15), -0.73 (-1.16, -0.31) and -0.61 (-0.96, -0.27), for CM, SMA and CC, respectively}. CONCLUSION In children with severe malaria, wasting and being underweight return to population levels after treatment. However, being stunted or underweight at enrollment was associated with worse long-term cognition in both CC and children with severe malaria.
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Affiliation(s)
- Waruiru Mburu
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA,Correspondence: Waruiru Mburu, Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Unit 300, Minneapolis, MN 55454, USA. Tel: 612-624-6368. E-mail: <> and Chandy C. John, Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, 1044 W Walnut Street, R4 402D, Indianapolis, IN 46202, USA. Tel: 317-274-8940. E-mail: <>
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Sarah E Cusick
- Division of Global Pediatrics, Department of Pediatrics, and Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN 55455, USA
| | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Caitlin Bond
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yi Zhao
- Department of Biostatistics, Fairbanks School of Public Health, Indiana University—Purdue University at Indianapolis, Indianapolis, IN 46202, USA
| | - Robert O Opoka
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA,Department of Biostatistics, Fairbanks School of Public Health, Indiana University—Purdue University at Indianapolis, Indianapolis, IN 46202, USA,Correspondence: Waruiru Mburu, Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Unit 300, Minneapolis, MN 55454, USA. Tel: 612-624-6368. E-mail: <> and Chandy C. John, Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, 1044 W Walnut Street, R4 402D, Indianapolis, IN 46202, USA. Tel: 317-274-8940. E-mail: <>
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Moyeda-Carabaza AF, Murimi M. Differences in Factors Contributing to Child Undernutrition between Pastoral and Agro-pastoral Communities in Ethiopia. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1938777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Mary Murimi
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, Texas, USA
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Mank I, Belesova K, Bliefernicht J, Traoré I, Wilkinson P, Danquah I, Sauerborn R. The Impact of Rainfall Variability on Diets and Undernutrition of Young Children in Rural Burkina Faso. Front Public Health 2021; 9:693281. [PMID: 34616704 PMCID: PMC8489680 DOI: 10.3389/fpubh.2021.693281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Climate change and consequent increases in rainfall variability may have negative consequences for the food production of subsistence farmers in West Africa with adverse impacts on nutrition and health. We explored the pathway from rainfall through diet up to child undernutrition for rural Burkina Faso. Methods: The study used data of a dynamic cohort with 1,439 children aged 7-60 months from the Nouna Health and Demographic Surveillance Site (HDSS) for 2017 to 2019. We assessed data on diets, height, weight, household characteristics, and daily precipitation (from 1981 to 2019). Principal component analysis was used to identify distinct child dietary patterns (Dietary Pattern Scores, DPS). These were related to 15 rainfall indicators by area to obtain a precipitation variability score (PVS) through reduced rank regression (RRR). Associations between the PVS and anthropometric measures, height-for-age (HAZ), and weight-for-height (WHZ), were examined using multi-level regression analysis. Results: Stunting (HAZ < -2) and wasting (WHZ < -2) were seen in 24 and 6% of the children. Three main dietary patterns were identified (market-based, vegetable-based, and legume-based diets) and showed mixed evidence for associations with child undernutrition. The RRR-derived PVS explained 14% of the total variance in these DPS. The PVS was characterized by more consecutive dry days during the rainy season, higher cumulative rainfall in July and more extremely wet days. A 1-point increase in the PVS was associated with a reduction of 0.029 (95% CI: -0.06, 0.00, p < 0.05) in HAZ in the unadjusted, and an increase by 0.032 (95% CI: 0.01, 0.06, p < 0.05) in WHZ in the fully adjusted model. Conclusion: Rainfall variability was associated with dietary patterns in young children of a rural population of Burkina Faso. Increased rainfall variability was associated with an increase in chronic undernutrition, but not in acute undernutrition among young children.
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Affiliation(s)
- Isabel Mank
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Kristine Belesova
- Department of Public Health, Environments and Society and Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Jan Bliefernicht
- Institute of Geography, Faculty of Applied Computer Science, University of Augsburg, Augsburg, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna (CRSN), Institut National de Santé Publique, Nouna, Burkina Faso.,Institut Universitaire de Formations Initiale et Continue (IUFIC), Université Thomas Sankara (UTS), Ouagadougou, Burkina Faso
| | - Paul Wilkinson
- Department of Public Health, Environments and Society and Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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Food insecurity and the double burden of malnutrition in Colombian rural households. Public Health Nutr 2021; 24:4417-4429. [PMID: 34218842 DOI: 10.1017/s1368980021002895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother. DESIGN A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child. SETTING Rural Colombia. PARTICIPANTS Totally, 2·350 mother-child pairs living in the same household. RESULTS Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)). CONCLUSIONS Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.
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Wu YH, Moore S, McRae C, Dubé L. Tracing the Single and Combined Contributions of Home-Grown Supply and Health Literacy on Fruit and Vegetable Consumption: An Empirical Exploration in Rural India. Front Public Health 2021; 9:591439. [PMID: 34095042 PMCID: PMC8175893 DOI: 10.3389/fpubh.2021.591439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 01/19/2023] Open
Abstract
Low fruit and vegetable consumption (FVC) remains a global health challenge. Fostering subsistence agriculture through the production and home-grown consumption (HGC) of fruits and vegetables are seen as potential strategies for improving overall FVC, in particular, for developing countries like India. In addition, educational strategies targeting FVC health literacy are also used. Little evidence has documented a connection between these two strategies. We examine the single and combined influence of HGC and health literacy with regard to benefits from fruits and vegetable consumption. Data were collected from 427 rural households in the state of Odisha, India. Three outcomes were examined: FVC, as well as fruit and vegetables separately. Linear and Poisson regression were used to examine the association among home-grown consumption (HGC), FVC health literacy, and the FVC outcomes. Findings show that HGC, but not FVC health literacy, was directly associated with FVC (β = 0.65, SE = 0.10, p = 0.008) and vegetable consumption (β = 0.57, SE = 0.11, p = 0.02). However, both HGC (β = 0.58, SE = 0.05, p < 0.01) and FVC health literacy (β = -0.07, SE = 0.02, p = 0.001) were associated with fruit consumption. In addition, HGC effect is concentrated among participants who reported low FVC health literacy, especially on overall FVC and vegetables alone. Results are discussed in relation to the beneficial role played by HGC in those particularly vulnerable households who perceived little FVC health literacy. Our results provide insights on novel improved FVC consumption across all population segments. Future research should explore the complex interplay between agricultural policies and educational programs in the design of interventions promoting fruit and vegetable production and consumption.
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Affiliation(s)
- Yun-Hsuan Wu
- Department of Public Health, China Medical University, Taichung, Taiwan
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Spencer Moore
- Health and Society Group, Wageningen University and Research, Wageningen, Netherlands
| | - Cameron McRae
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | - Laurette Dubé
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
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Zavala E, King SE, Sawadogo-Lewis T, Roberton T. Leveraging water, sanitation and hygiene for nutrition in low- and middle-income countries: A conceptual framework. MATERNAL AND CHILD NUTRITION 2021; 17:e13202. [PMID: 33988303 PMCID: PMC8189228 DOI: 10.1111/mcn.13202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/25/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022]
Abstract
In low‐ and middle‐income countries (LMICs), access to water, sanitation and hygiene (WASH) is associated with nutritional status including stunting, which affects 144 million children under 5 globally. Despite the consistent epidemiological association between WASH indicators and nutritional status, the provision of WASH interventions alone has not been found to improve child growth in recent randomized control trials. We conducted a literature review to develop a new conceptual framework that highlights what is known about the WASH to nutrition pathways, the limitations of certain interventions and how future WASH could be leveraged to benefit nutritional status in populations. This new conceptual framework will provide policy makers, program implementors and researchers with a visual tool to bring into perspective multiple levels of WASH and how it may effectively influence nutrition while identifying existing gaps in implementation and research.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon E King
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Timothy Roberton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Malnutrition in all its forms by wealth, education and ethnicity in Latin America: who are more affected? Public Health Nutr 2021; 23:s1-s12. [PMID: 32900396 DOI: 10.1017/s136898001900466x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To summarise the findings from this supplemental issue on the distribution of malnutrition (stunting/short stature, anaemia and overweight) by wealth, education and ethnicity within and between ten Latin American countries. DESIGN We retrieved information from each country's article and estimated the average difference in the prevalence of malnutrition between groups. We estimated the associations between countries' malnutrition prevalence and GDP, percentage of women with high education and percentage of non-indigenous ethnicity. SETTING Nationally representative surveys from ten Latin American countries conducted between 2005 and 2017. PARTICIPANTS Children (<5 years), adolescent women (11-19 years) and adult women (20-49 years). RESULTS Socially disadvantaged groups (low wealth, low education and indigenous ethnicity) had on average 15-21 (range across indicators and age groups) percentage points (pp) higher prevalence of stunting/short stature and 3-11 pp higher prevalence of anaemia. For overweight or obesity, adult women with low education had a 17 pp higher prevalence; differences were small among children <5 years, and results varied by country for adolescents by education, and for adults and adolescents by wealth and ethnicity. A moderate and strong correlation (-0·58 and -0·71) was only found between stunting/short stature prevalence and countries' GDP per capita and percentage of non-indigenous households. CONCLUSIONS Overweight was equally distributed among children; findings were mixed for ethnicity and wealth, whereas education was a protective factor among adult women. There is an urgent need to address the deep inequalities in undernutrition and prevent the emerging inequalities in excess weight from developing further.
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Tesema GA, Yeshaw Y, Worku MG, Tessema ZT, Teshale AB. Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis. PLoS One 2021; 16:e0248637. [PMID: 33765094 PMCID: PMC7993805 DOI: 10.1371/journal.pone.0248637] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa. METHODS A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors. RESULTS The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36-48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25-34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting. CONCLUSION The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6-59 Months in the ComPAS Cluster Randomized Controlled Trial. Nutrients 2021; 13:nu13041054. [PMID: 33805040 PMCID: PMC8064102 DOI: 10.3390/nu13041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.
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Alarcón-Guevara S, Peñafiel-Sam J, Chang-Cabanillas S, Pereyra-Elías R. Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015. Child Care Health Dev 2021; 47:228-242. [PMID: 33150967 DOI: 10.1111/cch.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. METHODS Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. RESULTS Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition. CONCLUSIONS There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
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Affiliation(s)
| | | | | | - Reneé Pereyra-Elías
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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