Does Mothers' Awareness of Health and Nutrition Matter? A Case Study of Child Malnutrition in Marginalized Rural Community of Punjab, Pakistan

Effect of a Nutritional Education Program on Children's Undernutrition in Indonesia: A Randomized Controlled Trial

INTRODUCTION

To assess effects of a nutritional education program on improving mothers' undernutrition knowledge, self-efficacy, and complementary feeding practices, and reducing undernutrition in children aged <2 years.

METHOD

A randomized controlled trial was conducted at a community healthcare center in Indonesia. The intervention group participated in a 4-week nutritional education program; the control group received standard care (n = 80; 1:1 ratio). Measurements consisted of mothers' knowledge of undernutrition, self-efficacy, and complementary feeding practices, and children's anthropometric indicators.

RESULTS

Intervention group mothers improved their understanding of undernutrition, self-efficacy, and complementary feeding practices compared to the control group. Additionally, children in the intervention group exhibited increased mean Z-scores for stunting, wasting, and being underweight at 12 and 24 weeks following the intervention.

DISCUSSION

Healthcare professionals can regularly provide nutritional education programs related to managing undernutrition and complementary feeding practices for mothers with children aged <2 years to prevent and improve undernutrition.

Double burden of malnutrition and its associated factors among adolescents in Debre Berhan Regiopolitan City, Ethiopia: a multinomial regression model analysis

Background

The double burden of malnutrition (DBM), contained both undernutrition and overnutrition, is a growing public health concern that presents a significant challenge to the food and nutrition policies of developing nations such as Ethiopia. However, the prevalence and contributing factors of DBM among adolescents in the study area have not been adequately investigated by Ethiopian researchers. Therefore, this study aims to determine the prevalence of DBM and contributing factors among secondary school students in Debre Berhan City, Ethiopia.

Methods

A school-based cross-sectional study was conducted among 742 adolescents aged 10-19 years from October 13, 2022, to November 14, 2022, using a multi-stage sampling method. Data were collected using the online Kobo toolbox tool. A multinomial logistic regression model was used to analyze the data. The data were cleaned and analyzed in R software 4.2.2. Adolescents who had body mass index for age Z score (BAZ) < -2 SD, > +1 SD, and > +2 from the median value were considered thin, overweight, and obese, respectively.

Results

The overall prevalence of DBM was 21.5% (14.8% thinness and 6.7% overweight/obesity). In the multivariable multinomial logistic regression analysis models factors such as age [AOR = 0.79, 95% CL: (0.67, 0.93)], sex [AOR = 3.86, 95% CL: (2.35, 6.32)], school type [AOR 5.03, 95% CL: (2.30, 10.99)], minimum dietary diversity score [AOR = 2.29, 95% CL: (1.27, 4.14)], frequency of meals [AOR = 2.09, 95% CL: (1.13, 3.89)], home gardening practice [AOR = 2.31, 95% CL: (1.44, 3.67)], history of illness [AOR = 0.57, 95% CL: (0.36, 0.93)], and knowledge of nutrition [AOR = 4.96, 95% CL: (1.61, 15.33)] were the significant predictors of either thinness or overweight/obesity (DBM).

Conclusion

More than one-fifth of adolescents were affected by DBM in the study area. This prevalence is higher compared with the national and regional prevalence that found to be a public health concern. Thus, interventions like double-duty interventions should consider the age, sex, school type, minimum dietary diversity score, frequency of meals, home gardening practice, history of illness, and nutritional knowledge of adolescents.

Clinical Trial Registration

clinicaltrial.gov, identifier NCT05574842.

Rural mothers' beliefs and practices about diagnosis, treatment, and management of children health problems: A qualitative study in marginalized Southern Pakistan

Introduction

Appropriate health-seeking beliefs and practices are indispensable for the survival and development of children. In this study, we explore childcare beliefs and practices of rural mothers and analyze the different ways childhood illness is diagnosed and managed in a marginalized rural community in Southern Pakistan.

Methods

Using purposive sampling, in-depth interviews are conducted to obtain qualitative data from 20 illiterate and rural mothers in addition to 15 healthcare providers in the district Rajanpur of South Punjab.

Results and discussion

The findings reveal that rural mothers' access to healthcare and therapeutic programs is impeded due to geographical isolation, structural inequalities, poverty, and illiteracy. Consequently, evil eyes, witchcraft, and spirits are recognized as potential threats to children's health and nutrition. Therefore, the treatment of childhood morbidity and malnutrition is mostly performed with folk, domestic, herbal, magico-religious remedies, and spiritual healing methods. The current study also highlights that many low-income and rural mothers tend to normalize childhood illness when they become unable to advocate for their children's health and nutrition. Besides improving low-income mothers' access to healthcare facilities, health education and risk communication at the field level through field health staff could be most effective for health promotion.

The Effects of Financial Stress and Household Socio-Economic Deprivation on the Malnutrition Statuses of Children under Five during the COVID-19 Lockdown in a Marginalized Region of South Punjab, Pakistan

The lockdown after the COVID-19 pandemic not only caused public health crises and income stress but also put millions at risk of food insecurity and malnutrition across the globe, especially in low and middle-income countries [LMICs]. This study evaluated the effects of financial stress and household socio-economic deprivation on the nutritional status of 1551 children under the age of five during COVID-19 in Pakistan. A self-administered questionnaire was used between November 2020 and April 2021 to collect information on age, height, children's weight, and socio-economic status from 1152 rural households from underdeveloped regions in Punjab, Pakistan. With the help of the proportionate simple random sampling method, this study employed a model (binary logistic regression) to calculate the likelihood of malnourishment. The findings showed that the stunting, underweight, and wasting prevalence rates during COVID-19 were 58.86%, 41.89%, and 8.11%, respectively, in the Bahawalpur region. According to the binary logistic regression analysis, among the household deprivation status (HDS) categories, the risks of childhood malnutrition were lesser in HDS-2 (OR = 0.05, 95% CI: 0. 005-0.879) and HDS-3 (OR = 0.04, 95% CI: 0.008-0.193). Similar to this, within the financial stress index (FSI) categories, the children in homes with medium financial stress had reduced odds of malnutrition (OR = 0.10, 95% CI: 0.018-0.567), and the children in households with low financial stress had reduced risks of malnutrition (OR = 0.006, 95% CI: 0.005-0.061). The proposed research found that stunting and underweight increased by 17.26% and 12.29% during the COVID-19 lockdown in the Bahawalpur region. Additionally, financial stress and socio-economic deprivation strongly affected children's nutritional statuses during the COVID-19 lockdown in the Bahawalpur region of Southern Punjab.

Association between Nutrition Literacy and Bangladeshi Adults' Healthy Eating Behaviors: Evidence from the Nutrition Literacy Study 2021

This study investigated the association between healthy eating behaviors and nutrition literacy in a sample of Bangladeshi adults. A cross-sectional survey was conducted among 400 adults from two districts of Bangladesh (Dhaka and Chattogram). Data were generated by in-person interviews using a structured questionnaire. The Nutrition Literacy Scale and National Dietary Guidelines for Bangladesh were used to assess nutrition literacy and healthy eating behaviors, respectively. Multiple linear regression models were used to observe the association. The mean score for healthy eating behavior was 21.8 (SD = 4.8, Range: 5−33) on a scale of 34. A moderate positive correlation was found between nutrition literacy and healthy eating behavior of participants (r = 0.28, p < 0.001). The adjusted regression model showed that a 1 unit increase in nutrition literacy reflected an increase in the healthy eating behavior score of participants by 0.22 units (β = 0.223, p < 0.001). Findings showed an association between nutrition literacy and eating behaviors in Bangladeshi adults. Future research could be carried out to establish a causal relationship that may help inform the necessity of educational interventions for Bangladeshi adults to assist with meeting national nutrition-related targets.

Prevalence and determinants of wasting of under-5 children in Bangladesh: Quantile regression approach

BACKGROUND

Wasting is perhaps one of the signs of malnutrition that has been linked to the deaths of children suffering from malnutrition. As a result, understanding its correlations and drivers is critical. Using quantile regression analysis, this research aims to contribute to the discussion on under-5 malnutrition by analyzing the predictors of wasting in Bangladesh.

METHODS AND MATERIALS

The dataset was extracted from the 2017-18 Bangladesh demographic and health survey (BDHS) data. The weight-for-height (WHZ) z-score based anthropometric indicator was used in the study as the target variable. The weighted sample constitutes 8,334 children of under-5 years. However, after cleaning the missing values, the analysis is based on 8,321 children. Sequential quantile regression was used for finding the contributing factors.

RESULTS

The findings of this study depict that the prevalence of wasting in children is about 8 percent and only approximately one percent of children are severely wasted in Bangladesh. Age, mother's BMI, and parental educational qualification, are all major factors of the WHZ score of a child. The coefficient of the female child increased from 0.1 to 0.2 quantiles before dropping to 0.75 quantile. For a child aged up to three years, the coefficients have a declining tendency up to the 0.5 quantile, then an increasing trend. Children who come from the richest households had 16.3%, 3.6%, and 15.7% higher WHZ scores respectively than children come from the poorest households suggesting that the risk of severe wasting in children under the age of five was lower in children from the wealthiest families than in children from the poorest families. The long-term malnutrition indicator (wasting) will be influenced by the presence of various childhood infections and vaccinations. Furthermore, a family's economic position is a key determinant in influencing a child's WHZ score.

CONCLUSIONS

It is concluded that socioeconomic characteristics are correlated with the wasting status of a child. Maternal characteristics also played an important role to reduce the burden of malnutrition. Thus, maternal nutritional awareness might reduce the risk of malnutrition in children. Moreover, the findings disclose that to enrich the nutritional status of children along with achieving Sustainable Development Goal (SDG)-3 by 2030, a collaborative approach should necessarily be taken by the government of Bangladesh, and non-governmental organizations (NGOs) at the community level in Bangladesh.

The uptake of key Essential Nutrition Action (ENA) messages and its predictors among mothers of children aged 6-24 months in Southern Ethiopia, 2021: A community-based crossectional study

BACKGROUND

Essential nutrition action(ENA) is a framework for managing advocacy, establishing a foundation, and implementing a comprehensive package of preventive nutritional activities. Essential Nutrition Actions study studies provide current information on each nutrition action, allowing health systems to focus more on nutrition, which is critical in tackling the "double burden" of malnutrition: underweight and overweight. Hence, this study aimed at assessing the level of ENA practice and its predictors among mothers of children aged 6 to 24 months in southern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from May 1 to 30, 2021 among randomly selected 633 mothers of children aged 6-24 months. A multi-stage sampling technique was used to access study participants. Data were collected by using a pretested, structured interviewer-administered questionnaire. To identify predictors of ENA practice, bivariable and multivariable logistic regression were used. The strength of the association was measured using an adjusted odds ratio with 95 percent confidence intervals. The statistical significance was declared at a p-value less than 0.05.

RESULTS

A total of 624 participants took part in the study, with a response rate of 98.6%. The uptake of key ENA messages among mothers was measured using 27 items, and it was found to be 47.4% (95% CI: 43.8, 51.4). Complementary feeding was the commonest ENA message practiced by 66.7% of respondents, while prevention of iodine deficiency disorder was practiced by only 33.7% of respondents. Variables namely, mother's education level of college and above [AOR: 3.90, 95% CI: 1.79, 8.51], institutional delivery [AOR: 2.75, 95% CI: 1.17,6.49], having PNC service [AOR: 2.95, 95% CI: 1.91, 4.57], being knowledgeable on ENA message [AOR: 2.37, 95% CI: 1.81, 3.26] and being a model household [AOR: 3.83,95% CI: 2.58, 5.69] were positively associated with a good uptake of key ENA messages. On the other hand, primiparity [AOR: 0.32, 95% CI: 0.21,0.56] was identified as a negative predictor.

CONCLUSION

The overall practice of key Essential nutrition action messages in the study area was low as compared to studies. Stakeholders must step up their efforts to improve and hasten the utilization of maternal and child health services, especially institutional delivery and Postnatal care by focusing on uneducated women to promote compliance to key ENA messages. Furthermore, health workers need to focus on awareness-raising and model household creation.

Mothers’ Perceived Susceptibility and Severity of Maternal Behavior in Stunting Prevention

BACKGROUND: Nutritional problem is still a significant public health issue worldwide, and Indonesia is not exempted. Stunting is the failure of a child to grow to the proper height of their age due to unbalance nutritional intake (more calories and less protein) when they are still in the womb, baby, and toddlers. The mother’s lack of awareness about the susceptibility and severity of the stunting is the contributing factor. AIM: Purpose of this study is to investigate mothers’ perceived susceptibility and severity toward stunting and their association with mothers’ behavior to prevent stunting. METHODS: It is a quantitative study using an analytical observation design with a cross-sectional approach. This population is 120 mothers with under 5 years of children in East Surabaya Health Center, Indonesia. They were all taken as research samples. The independent variables are perceived susceptibility and severity of stunting, whereas stunting prevention is the dependent variable. The Likert scale is used to develop a questionnaire as a data collection tool. The logistic regression test was carried out to identify mothers’ perceived susceptibility and severity level to protect their children from stunting. RESULTS: The study found that mothers generally have a good perception of the susceptibility and severity of stunting. The logistic regression test shows that the value of significant = 0.000 for the susceptible variable and significant = 0.003 for the severity factor. CONCLUSION: The study concluded that the strong association between mothers’ perception of susceptibility and severity of stunting affects their stunting prevention behavior. SUGGESTION: The study advises mothers to improve their awareness of the danger of stunting and take necessary action to prevent it. Health promotion efforts should focus on empowering and enhancing the participation of mothers to take pre-emptive steps to prevent stunting.

Comparison of Different Nutritional Screening Approaches and the Determinants of Malnutrition in Under-Five Children in a Marginalized District of Punjab Province, Pakistan

Objectives: This research measures the occurrence of malnutrition amongst under-five children in the Rahimyar Khan district of Southern Punjab in Pakistan. Employing different anthropometric measurement approaches such as (1) conventional indices (HAZ, WAZ, and WHZ), (2) CIAF, (3) BMI-for-age, and (4) MUAC, we compare their estimated results and examine the relationship between socioeconomic determinants and different anthropometric indicators. Methods: The study employs a proportional purposive random sampling method to collect data from 384 rural households in the community-based study using a self-administered survey and following the Lady Health Workers (LHWs) registered records. The nutritional status of 517 under-five children is measured with references to WHO (2009) child growth standards. Furthermore, the investigation used the model of binary logistic regression to measure the impact of socioeconomic factors on child malnutrition. Results: Compared with other approaches, the CIAF identifies more malnourished children (63%). The results of binary logistic regression illustrate that all the explanatory variables indicate a more significant empirical association with CIAF than conventional indices, BMI-for-age, and MUAC. Conclusion: CIAF is a more reliable tool for assessing child nutrition because it not only demonstrates more accurate estimates of malnutrition but also recognizes children with multiple anthropometric failures.

Distance to Healthcare Facility and Lady Health Workers’ Visits Reduce Malnutrition in under Five Children: A Case Study of a Disadvantaged Rural District in Pakistan

This study accesses the impact of lady health worker (LHWs) visits in the community and distance to a healthcare facility on the nutritional status of under-five children. Additionally, it explores the perceptions and attitudes of the community about the performance of LHWs. A self-administered instrument was applied to gather data on different parameters, such as children’s height, age, weight, and socioeconomic status from 384 rural households in a marginalized district of Punjab province with the help of a purposive random sampling technique. The binary logistic regression model was employed for the computation of the probability of malnutrition. The prevalences of stunting, underweight children, and wasting in the district were 34.8%, 46.1%, and 15.5%, respectively. The logistic results illustrate that those households in which LHW visits occur regularly within 15 days (OR = 0.28 with 95% CI: 0.09–0.82) have a lower probability of malnutrition prevalence among their children. The distance to the health facility shows that the odds of malnutrition were higher from 3–4 Kilometers (Km) (OR = 2.61, 95% CI: 0.85–8.14), and odds were also higher for the ≥5 km category (OR = 2.88, 95% CI: 0.94–8.82). Children from richer families had lower chances of being malnourished (OR = 0.28, 95% CI: 0.07–1.14). Furthermore, the respondents show a positive attitude towards LHWs. They have given the first rank to their performance being beneficial to mothers and childcare, especially on checkups and safe deliveries, while they have shown negative responses and given lower ranks to their performance due to irregular visits (6th rank) and poor community awareness (7th rank). We conclude that LHWs’ regular visits to targeted households and less distance to healthcare facilities reduce the malnutrition risk in under-five children.

Key Challenges to Optimal Therapeutic Coverage and Maternal Utilization of CMAM Program in Rural Southern Pakistan: A Qualitative Exploratory Study

Severe Acute Malnutrition (SAM) is a serious public health problem in many low- and middle-income countries (LMICs). Therapeutic programs are often considered the most effective solution to this problem. However, multiple social and structural factors challenge the social inclusion, sustainability, and effectiveness of such programs. In this article, we aim to explore how poor and remote households face structural inequities and social exclusion in accessing nutrition-specific programs in Pakistan. The study specifically highlights significant reasons for the low coverage of the Community Management of Acute Malnutrition (CMAM) program in one of the most marginalized districts of south Punjab. Qualitative data are collected using in-depth interviews and FGDs with mothers and health and nutrition officials. The study reveals that mothers’ access to the program is restricted by multiple structural, logistical, social, and behavioral causes. At the district level, certain populations are served, while illiterate, and poor mothers with lower cultural capital from rural and remote areas are neglected. The lack of funding for nutrition causes the deprioritization of nutrition by the health bureaucracy. The subsequent work burden on Lady Health Workers (LHWs) and the lack of proper training of field staff impact the screening of SAM cases. Moreover, medical corruption in the distribution of therapeutic food, long distances, traveling or staying difficulties, the lack of social capital, and the stigmatization of mothers are other prominent difficulties. The study concludes that nutrition governance in Pakistan must address these critical challenges so that optimal therapeutic coverage can be achieved.

Determinants of Infant Young Child Feeding Among Mothers of Malnourished Children in South Punjab, Pakistan: A Qualitative Study

Inadequate feeding is one of the most critical underlying determinants of child malnutrition. In this study, we explore infant young child feeding (IYCF) and deconstruct breastfeeding barriers in mothers of severely malnourished children in one of the most marginalized districts of Punjab province of Pakistan. Using purposive sampling, 20 lactating mothers are recruited for open-ended semi-structured interviews. Results reveal that barriers to immediate and exclusive breastfeeding include the introduction of pre-lacteal, butter, and cow or formula milk by mothers and grandmothers. Birthing difficulties and ritualizing prelacteal to transfer religion and culture cause the delay of early initiation of breastmilk. The colostrum is also discarded based on its weird physical look. Moreover, household circumstances, limited diet, extra workload, and mental stress associated with marital relationships are other significant barriers. Mothers perceive their breastmilk as thin, impotent, and of bad quality and often complain against breastmilk insufficiency due to general weakness. Furthermore, poor mothers reduce breastfeeding when the fertility burden is high, especially if a female baby is in their womb. Alternatively, outer milk is recommended but washing bottles with detergents often becomes frequent. In conclusion, immediacy, exclusivity, frequency, and duration of breastfeeding are circumscribed owing to multiple social, cultural, and economic causes. Therefore, a holistic approach combining cultural and structural causes might be more relevant for successful IYCF practices in marginalized communities of Pakistan.