Child Malnutrition in Pakistan: Evidence from Literature

Concordance of weight status between mothers and children: a secondary analysis of the Pakistan Demographic and health survey VII

BACKGROUND

Familial concordance of weight status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. There is a dearth of published data for concordance of weight status within Pakistani households.

METHODS

We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data from 2017-18. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child's weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years and 2 to 5 years).

RESULTS

In all children under-five and in children 2 to 5 years, maternal BMI was positively associated with child's WHZ. For all children under-five, children of normal weight, overweight, and obese women had WHZ scores that were 0.21 [95% CI (confidence interval): 0.04, 0.37], 0.43 [95% CI: 0.25, 0.62], and 0.51 [95% CI: 0.30, 0.71] units higher than children of underweight women, respectively. For children ages 2 to 5, children of normal weight, overweight, and obese women had WHZ scores that were 0.26 [95% CI: 0.08, 0.44), 0.50 [95% CI: 0.30, 0.71), and 0.61 [95% CI: 0.37, 0.84] units higher than children of underweight women, respectively. There was no association between maternal BMI and child WHZ for children under-two.

CONCLUSIONS

The findings indicate that the weight status of mother's is positively associated with that of their children, particularly after age 2. These associations further strengthen the call for research regarding interventions and policies aimed at healthy weight promotion among mothers and their children collectively, rather than focusing on individuals in isolation.

Malnutrition among Children under Age Five in Panama: Results of the ENSPA 2019

Background: Malnutrition has important short- and long-term consequences in children under age five. Malnutrition encompasses undernutrition, overnutrition, and the coexistence of both of them, known as the double burden of malnutrition (DBM). Objective: The aim of this study was to estimate the prevalence of undernutrition, overnutrition, and the DBM among these children at the national level and by living area in Panama. Methods: Data from the National Health Survey of Panama (ENSPA, Spanish acronym), a population-based, cross-sectional study carried out in 2019 were used. Stunting, wasting, overweight, and obesity were defined according to the cut-off points of the World Health Organization Growth Standards. Undernutrition was defined as being stunted only, wasted only or both; overnutrition was defined as being overweight only or obese only; and the DBM was defined as the co-occurence of stunting and overweight/obesity in the same child. Prevalence and general characteristics at the national level and by living area were weighted. Findings: The prevalence of undernutrition was 15.3% (95% confidence interval (CI) 13.4-17.3) at the national level and 36.6% (CI: 30.1-43.5) in indigenous areas. The prevalence of overnutrition was 10.2% (8.2-12.6) at the national level and 11.9% (CI: 8.5-16.3), 8.4% (CI: 6.5-10.7) and 8.7% (CI: 5.2-14.3) in urban, rural and indigenous areas, respectively. The DBM prevalence was 1.4% (CI: 1.0-2.1) at the national level and 2.7% (CI: 1.4-5.1) in indigenous areas. Conclusions: Undernutrition is still the most prevalent malnutrition condition in our country. Panama has the highest prevalence of overnutrition in Central America. The highest prevalence of undernutrition and DBM was found among children living in indigenous areas.

Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan

BACKGROUND

There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan.

METHODS

Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition.

RESULTS

Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting.

CONCLUSIONS

In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.

Exploring the Multifaceted Influences on Childhood Nutritional Status: A Study Conducted in South Punjab, Pakistan

Introduction The double burden of malnutrition (DBM) in Pakistan is a rising concern affecting school-going children, marked by coexisting under- and over-nutrition within the same population. Key influences include shifts in dietary habits, socioeconomic status, and lifestyle changes due to rapid urbanization. With a focus on Multan, Pakistan, the study seeks to assess the proportion of underweight and overweight students while identifying the risk factors and sociodemographic characteristics associated with this incidence. The aim is to guide future health interventions addressing this multidimensional health challenge. Materials and methods This study, adopting a descriptive cross-sectional research design, collected data from female teenage students through interviews and anthropometric measurements. A total of 300 participants were randomly selected from a comprehensive school list representing diverse urban and rural settings. Participants' weight and height were measured to calculate their body mass index (BMI), categorizing them into underweight, normal weight, and overweight groups. The relevant risk factors were collected through an interview questionnaire. Collected data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with the results stratified according to socioeconomic, dietary, and psychosocial factors and compared across different weight categories. Results The study collected data from 300 students, revealing a correlation between socioeconomic status, dietary habits, and BMI. Parental occupation significantly affected nutritional status, with children of laborers primarily falling within normal and underweight categories. Dietary habits like frequency of fast food and milk or dairy consumption showed notable associations with nutritional status. Psychosocial factors such as peer or teacher comments about weight and outdoor sports participation also influenced the students' nutritional status. However, factors like family income, video game hours, and the presence of pets at home did not show significant associations with nutritional status. Conclusions The study illustrates a multi-faceted association between socioeconomic status, dietary habits, and BMI among schoolchildren in Multan, Pakistan, emphasizing the need for comprehensive interventions.

The Impact of Vaccination Status on Anthropometric Indices of Growth Among Children: A Cross-Sectional Study

Background Childhood immunization programs in underdeveloped nations can improve children's growth and nutritional status and prevent growth delays while protecting against infectious diseases and meeting growth norms. This study aimed to assess the impact of vaccination status on the anthropometric indices of children aged 12-18 months at an Expanded Programme on Immunization vaccination center and compare the anthropometric indices of growth in children with complete and incomplete vaccination statuses. Methodology This study was conducted at the rural health center in Kala Shah Kaku, Pakistan, from November 2023 to December 2023. Children aged 12-18 months were enrolled and their vaccination status was recorded. Height and weight were measured using World Health Organization growth charts. The data were analyzed using descriptive statistics and chi-square and Fisher's exact tests. A p-value <0.05 was considered statistically significant. Results The mean age of the 110 children who visited the vaccination site for this study was 16.36 months ± 2.415. There were 28 (25.5%) stunted children. In the study, 17.6 (16%) participants were underweight, and 15.95 (14.5%) were wasted. Of the children, 79% had received all recommended vaccinations. A statistically significant (p < 0.05) association was found between vaccination and nutritional status. Conclusions This study emphasizes the significance of vaccination in promoting child health and nutrition, reducing stunting risk, and ensuring equitable access to vaccination services and comprehensive healthcare interventions. This can help mitigate the malnutrition burden and promote optimal growth, contributing to global health and development goals.

Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia

OBJECTIVE

Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia.

METHODS

To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste.

RESULTS

This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste.

CONCLUSIONS

This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.

Malnutrition in children under five years in a squatter settlement of Karachi: a case-control study

BACKGROUND

Multidimensional factors such as socioeconomic or environmental factors influence malnutrition. Several studies have strongly linked malnutrition to poverty. Some international studies point to the worse nutritional status of urban slum children than rural children. Limited data is available regarding the nutritional status of slum children in Karachi. This study aimed to determine characteristics of malnourished children in an urban squatter settlement in Karachi, Pakistan.

METHODS

A case- control study was carried out at the primary healthcare center of a squatter settlement in Karachi, Pakistan. All children under five years of age visiting the primary healthcare center were recruited consecutively. Cases were defined as children with z scores < -2 SD of WHO reference measurements of WFA, HFA, WFH and OFC. The controls were similar in terms of age group but had z scores between - 2SD and + 2SD. A self- structured risk factor questionnaire that included information about sociodemographic, economic and environmental factors as well as child- related characteristics was researcher administered via face-to-face interviews with the mothers of children. Univariate and multivariate logistic regression analyses were conducted. Crude and adjusted odds ratios were calculated with 95% confidence interval.

RESULTS

A total of 280 participants including 140 cases and 140 controls participated in the study. A larger proportion of the sample originated from individuals with low household income. After adjusting for the confounders, childhood malnutrition was significantly associated with a low education level of father (aOR 4.86, 95% CI 2.23-10.60), a monthly income less than 25,000 PKR (89 USD) per month (aOR 7.13, 95% CI 1.67-30.54), pour pit latrine type of toilet (aOR 4.41, 95% CI 2.67-7.3), less than six months of exclusive breast feeding (aOR 3.578, CI 1.58-8.08), inappropriate weaning age (aOR 3.71, 95% CI 1.53-9).

CONCLUSION

Malnutrition in children under five years of age in the community is associated with low family income, low paternal education, poor toilet facilities, lack of exclusive breastfeeding and inappropriate weaning age. The implementation of poverty reduction programs, sanitation provision at affordable rates, community-based breast feeding and weaning education intervention are urgently required to efficiently improve children's nutritional status.

Improving nutritional status of children using artificial intelligence-based mobile application postsurgery: randomised controlled trial

Background

Malnutrition is a common problem in children postsurgery especially in low-middle-income countries. Health-based mobile apps play an important role for better nutritional status.

Methods

This is a two-arm randomised controlled trial, which was conducted at a tertiary care hospital, Rawalpindi. The study duration was 6 months from February 2021 to July 2021. The sample size with power of 80% and significance level of 5% was calculated to be 88. The intervention group was given a diet-related mobile app, and the usual care group was handed a pamphlet with diet instructions on discharge.

Findings

The mean weight of all participants was 15 (SD 5.7) kg at the time of discharge. However, at the end of the 8th week, the mean weight of the participants in the usual care group was 16.5 (SD 7.2) kg and that of the intervention group was 17.1 (SD 5) kg. The average calorie consumed by the usual care group was 972 (SD 252) kcal and 1000.75 (SD 210) kcal by the intervention group after 8 weeks of discharge. The average protein consumed by the usual care group was 34.3 (SD 12.5) g and 39 (SD 6.4) g by the intervention group after 8 weeks of discharge.

Interpretation

This study showed strength for the future of scalable modern technology for self-nutrition monitoring. There was a slight increase in the weight and nutritional intake of both groups.

Trial registration number

NCT04782635.

Comparison of renal growth in breast fed and artificial fed infants: a cross-sectional study

INTRODUCTION

Renal growth in infancy determines renal function in adulthood and can easily be assessed via infant renal volume. Renal growth is influenced by many endogenous and exogenous factors among which nutrition is of prime importance. Worldwide, infants get their nutrition either from breast milk or formula, both of which have controversial roles in kidney growth and development.

METHODS

A cross-sectional study was done on healthy infants in the Pediatric Nephrology Department of Mayo Hospital, Lahore. These infants were either breastfed or artificially fed and their kidney volumes were noted to determine any significant difference in kidney size. Both informed and written consent was taken before data collection and the data was analyzed using SPSS version 26.

RESULTS

Out of 80 infants included in our study, 55% were male and 45% were female. The mean age was 8.9 months and the mean weight was 7.6 kg. The mean total kidney volume was 45.38 cm³ and the mean relative kidney volume was 6.12 cm³/kg. No statistical difference in relative renal volume was found between breastfed and artificially fed infants.

CONCLUSION

The present study aimed to compare the renal volume and thus renal growth in breastfed versus formula-fed infants. No statistical significance was found in relative renal volume between breastfed and artificially fed infants.

Concordance of weight status between mothers and children: A secondary analysis of the Pakistan Demographic and Health Survey VII

Familial concordance of nutritional status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. Little published data exist for concordance of nutritional status within Pakistani households. We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data. Our analysis included 3465 mother-child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child's weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years and 2 to 5 years). In all children under-five and in children 2 to 5 years, maternal BMI was positively associated with child's WHZ, while there was no association between maternal BMI and child WHZ for children under-two. The findings indicate that the weight status of mother's is positively associated with that of their children. These associations have implications for interventions aimed at healthy weights of families.

Do crop diversity and livestock production improve smallholder intra-household dietary diversity, nutrition and sustainable food production? Empirical evidence from Pakistan

Crop diversification and livestock production is an important strategy to enhance nutrition, sustainable food production, and improve food security, especially at the smallholder household level. However, existing evidences are mixed and there are limited information about the relationship among agriculture crops, household income diversification (HID), and household dietary diversity (HDD) among smallholder farmers in developing country setting like Pakistan. Therefore, this study aims to understand the role of crop diversification (CD) on HDD, nutrition, and sustainable agriculture and food production in the context of smallholder households in Punjab, Pakistan. The study employed ordered probit regression and cross-sectional data from 450 households collected using 24-h recall method. Regression results indicate that crop diversity and intra-household dietary diversity are positively associated across adults, adolescents, and children in all the study districts. Moreover, annual income, key crops grown by the household and family education are also the significant drivers of dietary diversity. Greater travel distance between markets was the most crucial factor in all regions which significantly affect dietary diversity. The overall research findings indicated that crop diversification and livestock production in the selected areas is significantly contributing to improve nutrition and sustainable food production. Therefore this study recommends for promoting crop diversification and livestock production for sustainable agricultural development and improving nutrition in the context of developing countries like Pakistan.

Antioxidant and Antimicrobial Evaluations of Moringa oleifera Lam Leaves Extract and Isolated Compounds

Moringa oleifera, native to India, grows in tropical and subtropical regions around the world and has valuable pharmacological properties such as anti-asthmatic, anti-diabetic, anti-inflammatory, anti-infertility, anti-cancer, anti-microbial, antioxidant, and many more. The purpose of this study was to assess the free radical scavenging ability of two extracts and two pure compounds of M. oleifera Lam (hexane, ethanol, compound E3, and compound Ra) against reactive oxygen species, as well as their reducing power and antimicrobial activities. Bioautography antioxidant assay, 2,2-diphenyl-1-picrylhydrazyl (DPPH), hydrogen peroxide (H₂O₂) free radical scavenging, and iron (iii) (Fe³⁺ to Fe²⁺) chloride reducing power assays were used to assess the extracts' qualitative and quantitative free radical scavenging activities. Furthermore, the extract and the compounds were tested against both Gram-positive and Gram-negative bacterial strains suspended in Mueller-Hinton Broth. The extracts and pure compounds showed noteworthy antioxidant potential, with positive compound bands in the Rf range of 0.05-0.89. DPPH), H₂O₂, and Fe³⁺ to Fe²⁺ reduction assays revealed that ethanol extract has a high antioxidant potential, followed by compound E3, compound Ra, and finally hexane extract. Using regression analysis, the half maximal inhibitory concentration (IC₅₀) values for test and control samples were calculated. Compound Ra and ethanol exhibited high antioxidant activity at concentrations as low as ≈0.28 mg/mL in comparison with n-hexane extract, compound E3, ascorbic acid, and butylated hydroxytoluene standards. The radical scavenging activity of almost all M. oleifera plant extracts against DPPH was observed at 0.28 mg/mL; however, the highest activity was observed at the same concentration for ascorbic acid and butylated hydroxytoluene (BHT) with a low IC₅₀ value of 0.08 mg/mL and compound Ra and ethanol with a low IC₅₀ of 0.4 mg/mL, respectively. The extracts and pure compounds of M. oleifera have little to no antibacterial potential. M. oleifera extracts contain antioxidant agents efficient to alleviate degenerative conditions such as cancer and cardiovascular disease but have little activity against infectious diseases.

Relationship of Functional Constipation and Growth Status: A Systematic Review and Meta-Analysis

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.

Pakistan at the precipice: The looming threat of measles amidst the COVID-19 pandemic

The global focus on curbing the COVID-19 pandemic has reduced the overall immunization rates worldwide. This, coupled with increasing malnutrition and strained healthcare, has increased measles cases and mortality globally. Many countries are thus facing outbreaks, with Afghanistan having reported 372 deaths between January and September 2022. Therefore, Pakistan, a country in a similar economic state and the world's fourth highest reported measles cases in 2022, must take action. Moreover, the current flooded state of Pakistan and the subsequent mass movement of population, deterioration of health services, and worsened living conditions all contribute to put the country at a high risk of potentially devastating Measles outbreaks. With vaccination rates down by 42% since the start of the pandemic and the threat of an outbreak increasing daily, there is only so much time before the situation spirals out of control.

Nutritional status of school children in the South Tongu District, Ghana

Background

Malnutrition is a major public health problem because of the devastating consequences it has on children, their families, and society at large. Our study, therefore, sought to determine the prevalence of undernutrition and overweight/obesity and its associated factors among children aged 6–12 in the South Tongu District, Ghana.

Methods

A school-based cross-sectional study was conducted among 423 school children aged 6–12 years in the South Tongu District of Ghana. A multistage sampling method was employed to recruit the school children for the study. A semi-structured questionnaire was used to collect data from the respondents. We used a dual-purpose (height and weight) measuring scale to obtain the anthropometric data. The World Health Organization’s AnthroPlus software was used to generate the z-scores for determining the nutritional status. Percentages were used to present the results of the prevalence of undernutrition and overweight/obesity among school children. Bivariate and multivariable binary logistic regression were used to examine the factors associated with undernutrition and overweight/obesity among school children. The results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), with their 95% confidence interval (CI). Statistical significance was set at p<0.05. Stata 16.0 was used to perform the analyses.

Results

The overall prevalence of undernutrition and overweight/obesity were 21.5% (CI = 17.7, 25.7) and 24.8% (CI = 20.8, 29.2), respectively. Specifically, the prevalence of stunting, thinness, underweight, overweight, and obesity were 10.4%, 12.1%, 3.8%, 11.1%, and 13.7%, respectively. School children whose household used water from non-portable sources were more likely to be undernourished [AOR = 2.03, 95% CI = 1.13, 3.63]. The odds of overweight/obesity was higher among school children whose mothers had attained formal education [AOR = 2.10, 95% CI = 1.09, 4.06], those who consumed beverages between meals per day [AOR = 1.87, CI = 1.08, 3.24], and those who had adequate dietary diversity score [AOR = 1.65, 95% CI = 1.02, 2.67]. School children aged 10–12 were less likely to be overweight/obese [AOR = 0.58, 95% CI = 0.35, 0.94] compared to those aged 6–9.

Conclusion

The study showed a relatively high prevalence of undernutrition and overweight/obesity among school children in the South Tongu District. The identified risk factor(s) for undernutrition was the usage of water from non-potable sources whilst those of overweight/obesity were age (10–12 years), maternal formal education, beverage consumption between meals per day, and adequate dietary diversity. The findings reaffirm that malnutrition is still prevalent among school children. Hence, there is a need for the Ministry of Health, Ghana Education Service, and other Non-Governmental Organizations to pay critical attention to these factors to achieve the Sustainable Development Goal 2, target 2.2. Nutritional behavioural change education should be carried out among parents and school children. School health service activities should be intensified with a special focus on nutritional screening.

A. Effectiveness of Ready-to-Use Therapeutic Food Among Children With Protein-Calorie Malnutrition

Background

Malnutrition develops when there is an inadequacy of one or more than one macronutrient for optimum body functioning. This study was designed to determine the effectiveness of ready-to-use therapeutic food (RUTF) in children with protein-calorie malnutrition (PCM) in terms of weight gain and mid-upper arm circumference (MUAC) improvement.

Methodology

This prospective observational study was done at The Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan from 1^st January 2021 to 31^st December 2021. A total of 159 children of either gender between six and 59 months of age and diagnosed with PCM were included. All children participating in the study were asked to come back for a follow-up every two weeks until they are 12 weeks old. Outcomes were measured in terms of comparison of weight gain and MUAC at baseline and after 12 weeks of RUTF.

Results

Of the 159 children, 94 (59.1%) were female. The mean age was 16.8±9.2 months, and 88 (55.3%) children were aged between six to 12 months. The mean body weight was 6.8±9.7 kg. The mean MUAC was calculated to be 116±9.1 mm. There were 121 (76.1%) children who had severe acute malnutrition. One hundred and thirty-one children completed the planned 12-week of follow-up using RUTF in this study, so they were included in the final analysis. Body weight increased significantly from baseline to 12-weeks after RUTF (6.8±1.7 kg vs. 7.6±1.2kg, p<0.0001). Likewise, MUAC also increased from baseline to 12 weeks after RUTF (116.0±9.1 mm vs. 127.2±8.2 mm, p<0.0001).

Conclusion

The RUTF was found to significantly improve weight gain and MUAC among children aged between six to 60 months with PCM during a period of 12-weeks. Early diagnosis and timely intervention can improve outcomes among children with PCM. Community-based interventions can be aimed to improve the nutritional status of children in a developing country like Pakistan.

Nutritional Demand and Consumption Pattern: A Case Study of Pakistan

Nutrition problems persist over several decades in most developing countries. Poor and vulnerable households in low-income countries do not have sufficient disposable sources to access adequate and diverse diets. This study analyzes the household nutrition consumption patterns in Pakistan at a provincial level. The log-linear Engel’s curve approach is applied using household-level data comprising 16,340 households from the Pakistan Household Integrated Expenditure survey (HIES) between 2018 and 2019. The results of the estimated income and household size elasticities reveal that any variation in the households’ income brings major changes in their diets, whereas an increase in household size, ceteris paribus (impact of all other factors are held constant), increases the demand for all nutritional intakes except thiamine and cholesterol. Furthermore, the estimated income elasticities for the four provinces provided similarities and differences in the nutritional consumption patterns of households. On the basis of income elasticities, we find the same nutrition pattern in Sindh and Baluchistan and a similar nutrition pattern in Khyber Pakhtunkhwa and Punjab. Finally, the estimated income elasticities show poor nutritional consumption patterns in Sindh and Baluchistan as compared to Punjab and Khyber Pakhtunkhwa. Thus, there is a need to generate nutritional policies in each province, and people should make wise nutrient-dense choices from all food commodities groups. Moreover, this study applies a unique approach to estimate the income elasticities for 17 nutrients using household survey data within the same framework of Engel’s curve. The findings of this study have important implications for public policy aiming at malnutrition alleviation and understanding dietary change in Pakistan.

Determinants of Gender Disparity in Nutritional Intake among Children in Pakistan: Evidence from PDHS

The purpose of this study is to analyze early age malnutrition on a gender basis in Pakistan. Pakistan Demographic and Health Survey (PDHS) 2012–2013 data related to households’ characteristics that affect the nutrition of children less than 5 years of age are used for the estimation of results. Gender disparity (measured by girl malnourished in household/boy malnourished in a household) is constructed for the measurement of gender disparity in early age child nutrition. After synthesizing the PDHS data set, 2119 observations are used for regression results of gender disparity. Regression results are analyzed at the level of 5% confidence interval otherwise insignificant. egression results for gender disparity show that households in good socioeconomic status, a greater number of household members, a mother’s higher level of education, mother employment, and the male head of the household, causes a decrease in gender disparity in nutrition intake of children.

Nutritional status and growth centiles using anthropometric measures of school-aged children and adolescents from Multan district

BACKGROUND

Nutritional status among children and adolescents is assessed using growth rates. The aim of this study was to assess age- and gender-specific height, weight, and body mass index (BMI) centiles among children and adolescents relative to World Health Organization (WHO) references.

METHODS

A sample of 1040 school-aged children and adolescents aged 3-18 years from Multan District in Pakistan were selected for the study between January and March 2020. Multistage stratified random sampling was used for sample selection. Centile curves of height, weight, and BMI for age and gender were obtained using the lambda-mu-sigma (LMS) method, and results were compared with WHO 2007 references.

RESULTS

For boys and girls, the average height was 137.37 ± 8.24 and 135.62 ± 9.64 cm, average weight was 36.32 ± 6.84 and 35.21 ± 7.27 kg, and average BMI was 18.44 ± 2.67 and 18.36 ± 2.91, respectively. The height centiles of boys were higher than the WHO reference, and during the prepubertal period (age 8 years or older) the centiles were lower than the WHO reference. The height centiles of girls were higher than the WHO reference, and during the pubertal period (age 10 years or older) the centiles were lower than the WHO reference. The gender-wise BMI centiles were higher compared to the WHO reference.

CONCLUSION

The prevalence of thinness, overweight, and obesity in boys and girls was significantly higher than the WHO reference. The results of this study on centiles are up-to-date and will be used as a standard for comparison.

Prevalence, Trends, and Socioeconomic Determinants of Coexisting Forms of Malnutrition Amongst Children under Five Years of Age in Pakistan

In Pakistan, malnutrition is a chronic issue. Concerns regarding coexisting forms of malnutrition (CFM) in an individual child are emerging, as children suffering from CFM have a 4 to 12-fold higher risk of death compared with healthy children. This study assessed the prevalence, trends, and socioeconomic determinants of various types of CFM using Pakistan Demographic and Health Survey (PDHS) datasets. Data from children aged 0-5 years old, with complete height and weight information, and valid anthropometry, from all regions of Pakistan (except residents of Azad Jammu Kashmir (AJK) and Federally Administered Tribal Areas (FATA), and non-de jure residents), were included. The prevalence of CFM was 30.6% in 2012-2013 and 21.5% in 2017-2018 PDHS. Both PDHSs reported a significantly higher prevalence of CFM in Sindh and Baluchistan compared with other regions of Pakistan. Improved socioeconomic status significantly reduced the odds of various types of CFM, except the coexistence of underweight with wasting. The high prevalence of CFM in Pakistan can be averted by multisectoral collaboration and by integrating nutrition-sensitive and nutrition-specific interventions.

Assessment of macronutrients consumption in the diet of adolescent school children in four seasons: a longitudinal study from an urban city in Pakistan

BACKGROUND

A healthy diet in the adolescence period is essential for physical, mental, and immunological development. We aimed to assess macronutrient consumption in the diet of adolescent school children using 24 h recalls in four seasons of the year.

METHOD

This was a longitudinal study conducted from February 2014 to June 2015. The study population included 155 school children aged 7-14 years from an urban school in Karachi. 24HR recall was conducted on 4 random days of the 4 main seasons. A food composition table was developed where the weight, calories, carbohydrate, fat, and protein content of the food items were listed. Macronutrients quantification was calculated by using proportional weight from the food composition table. Food groups were also assigned to each food item including vegetables, fruits, grains, protein foods, dairy products, and oils.

RESULTS

A total of 155 adolescent children aged between 7 and 14 years were approached. Out of the 155 preadolescents and adolescents, 150 (96.7%) agreed to participate. The mean (SD) age of the children was 11.31 (1.6) years, and 59% of all the children were males. Overall mean (SD) daily intake for all seasons was 195.31 (86.87) grams of carbohydrates, 94.77 (71.87) grams of proteins, and 55.87 (30.79) grams of fats. Carbohydrates formed 48.16%, protein 21.92%, and fat 29.93% of the total caloric intake. The mean (SD) daily caloric intake was 1517 (644) grams. Overall, the highest source of calories was from carbohydrate 781 (347) Kilocalories (Kcal), followed by fat 502 (277) Kcal and protein 379 (287). The Carbohydrate intake in 24 h was highest in the autumn; 212.81 (85.37), and there was a significant difference in carbohydrate intake in all seasons (p value 0.003). Consumption of discretionary food group was high (31.3%), and consumption of fruits and vegetables was low (29%).

CONCLUSION

The study reports a suboptimal caloric intake of fewer than 2000 cal/day among the adolescents from school. The highest source of calories was from carbohydrates.The highest consumption of food was in autumn and the least in summer. Fruits and vegetable intake was low, and discretionary food intake was high.

Prevalence of undernutrition and potential risk factors among children below five years of age in Somali region, Ethiopia: evidence from 2016 Ethiopian demographic and health survey

BACKGROUND

Childhood under-nutrition is far-reaching in low and middle-income nations. Undernutrition is one of the major open wellbeing concerns among newborn children and youthful children in Ethiopia. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Somali Region, Ethiopia.

METHODS

The data for this study was extricated from the Ethiopian Demographic and Health Survey (EDHS) 2016. The data collected from 1339 children born 5 years before was considered within the analysis. A multivariable binary logistic regression analysis was utilized at a 5% level of significance to decide the individual and community-level variables related to childhood malnutrition.

RESULTS

The prevalence of stunting, underweight and wasting were 27.4, 28.7 and 22.7%, respectively. About 16.1% of children were both stunted and underweight; the extent of both being underweight and wasted was 11.7%, the prevalence of both stunted and wasted children was 5.5%, and all three malnutrition conditions were 4.7% children. Among the variables considered in this study, age of the child in months, type of birth, anemia level, size of child at birth, sex of the child, mothers' BMI and sources of drinking water were significantly related to stunting, underweight and wasting in Somali Region.

CONCLUSIONS

The prevalence of stunting, underweight and wasting was relatively high. Undernutrition is one of the major open wellbeing concerns among children in Somali region. The impact of these variables ought to be considered to develop strategies for decreasing the lack of healthy sustenance due to undernutrition in the study areas. Hence, intercession should be centered on making strides for the under-nutrition determinant variables of the children to be solid, to improve the child's wholesome status, and decrease child mortality quickly.

Barriers to Access of Healthcare Services for Rural Women-Applying Gender Lens on TB in a Rural District of Sindh, Pakistan

Background: Women in the rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for the disease of tuberculosis (TB). This study was conducted to assess the general understanding of TB and for women’s access to healthcare, as a first step towards implementation of a gender responsive TB program in Tando Allahyar, a rural district of Pakistan. Methods: A total of 36 participants were interviewed for the study. The focus group discussion guide comprised of questions on: (1) family/household dynamics, (2) community norms, (3) healthcare systems, (4) women’s access to healthcare, (5) TB Awareness, and (6) women’s access to TB Care. Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access healthcare for women, which is even higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. Conclusion: Significant barriers are faced by women in accessing TB care in rural districts of Pakistan. Program implementers in high burden countries should shift towards improved gender-responsive TB programming.

Development and storage stability of chickpea, mung bean, and peanut-based ready-to-use therapeutic food to tackle protein-energy malnutrition

Protein-energy malnutrition (PEM) is most prevalent and affecting a large number of children in Pakistan. Ready-to-use therapeutic food (RUTF) is a tackling strategy to overcome the PEM in Pakistan. The present research was designed to formulate RUTF from different indigenous sources. After conducting some preliminary trials, 14 RUTF formulations were developed by mixing peanut, mung bean, and chickpea alone as well as in various combinations with the addition of sugar, powdered milk, oil, and vitamin-mineral premix. Freshly prepared RUTF was stored at room temperature (20 ± 5°C) and packed in aluminum foil for 90 days to investigate the microbiological analysis (total plate count and mold count), water activity (Aw), peroxide value, and thiobarbituric acid (TBA) value. All the parameters showed significant (p < .05) differences among peanut, chickpea, and mung bean-based RUTF except water activity. The storage days and interaction between treatments and storage days also showed a significant (p < .05) effect on water activity, total plate count, mold count, peroxide value, and TBA of RUTF formulations. The present study revealed that the peanut, chickpea, and mung bean can be used in the formulation of RUTF due to their shelf stability and help to mitigate the PEM in Pakistan.

The future of smallholder farming in developing countries in the face of climate change: a perspective with a focus on Pakistan

The fragile balance in the world’s carbon equilibrium through the discovery of cheap carbon-based fuels in the nineteenth century has led to mass industrialisation and an explosion in the world human population, including that of Pakistan. Farmers worldwide will need to adapt their production systems to accommodate global warming and increased climate extremes resulting from these man-made environmental changes. The focus will need to be on smallholder farmers who generate 53% of the world’s food but who are least equipped to accommodate climate change. The most major limitation will be fresh water supply, no more exemplified than in Pakistan as Himalayan snowfall decreases and peak snow melt comes earlier in spring, limiting irrigation water for summer C4 crops such as corn, millet, sorghum and sugarcane. These are destined to replace the traditional C3 crops of wheat and rice, which will not be as suited to climate change conditions resulting from a projected mean 2°C rise in ambient temperature. Smallholder farmers will need to access superior-quality seed for crop cultivars for both human food and animal forage bred to withstand climatic change. Quantitative genetic selection programs for tropically adapted livestock must be implemented with a major focus on Pakistan’s Nili Ravi and Kundhi buffalo, together with Sahiwal cattle servicing the milk consumption needs of Pakistan’s burgeoning population of 211 million. The quality of forage available for livestock emanating largely from crop residues needs to be improved to meet the country’s greenhouse-gas production targets in line with international expectation. The challenge remains for governments to sustain marketing chains that allow them to be profitable when operating in an increasingly hostile environment. The conservation of soil fertility through increased carbon sequestration will be an important imperative. It is likely that females will play a more important role in directing adaptation in these communities. Successful adjustment will be dependent on effective extension programs working with all sectors of the community including males, females and children from all walks of life in both rural and urban environments. Failure to do so will lead to rapid increases in climate refugee numbers, which the world can ill-afford.

Sanitation ladder and undernutrition among under-five children in Pakistan

While the state of sanitation in Pakistan has improved in the last decade, a significant proportion of its population is still using inadequate sanitation or no toilet facility at all. Open defecation has decreased over the years; however, it has been replaced by poor quality sanitation in rural areas that might still cause diarrhoea and undernutrition. The research regarding inadequate sanitation in Pakistan, especially in terms of the sanitation ladder, remains limited. The present research thus fills this research gap by assessing the impact of different types of sanitation on the prevalence of stunting and underweight (moderate as well as severe) among under-five children in Pakistan using the nationally representative micro survey, Pakistan Demographic and Health Survey (2017-18). The sanitation ladder comprises of piped to sewer (highest level, base) followed by flush to septic tank, flush to pit latrine, other improved, unimproved sanitation, and open defecation. In order to estimate the adjusted and unadjusted odds ratios of the determinants, this research uses logistic regressions are used to estimate adjusted and unadjusted odds ratios of the determinants. We show that toilets connected to piped sewerage network are rare in the rural areas of Pakistan and a large segment of the rural population is still practicing open defecation. The logistic regressions show that piped sewerage network and flush to septic tanks are associated with lowest odds (both adjusted and unadjusted) of stunting and underweight among under-five children. In multivariate regressions, pit latrines are associated with even higher adjusted odds of severe and moderate and severe stunting as well as underweight among under-five children, showing that poor quality pit latrines may bring the source of faecal contamination to the doorstep of the households. Therefore, interventions targeting reduction in open defecation should promote good quality toilets for sustainable long-term improvements in child health.

Prevalence of undernutrition and potential risk factors among children under 5 years of age in Amhara Region, Ethiopia: evidence from 2016 Ethiopian Demographic and Health Survey

More than one-third of deaths during the first 5 years of life are attributed to undernutrition, which are mostly preventable through economic development and public health measures. The present study aimed to explore the potential risk factors of undernutrition among children under 5 years of age in Amhara Region, Ethiopia. Data from the 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 974 children under 5 years of age were involved. A multivariable binary logistic regression analysis was used at a 5 % level of significance to determine the individual- and community-level factors associated with childhood undernutrition. The prevalence of stunting, wasting and underweight was 46⋅3, 9⋅8 and 28⋅4 %, respectively. About 23⋅1 % of children were both stunting and underweight, 7⋅3 % were both underweight and wasting and 4⋅5 % of children had all three conditions. Among the factors considered in the present study, the age of a child in months, birth weight, mother educational level, sex of household head, sources of drinking water and the type of toilet facility were significantly associated with undernutrition in the Amhara Region. Undernutrition among under-five children was one of the public health problems in the Amhara Region. The potential risk factors should be considered to develop strategies for reducing undernutrition in the Amhara Region. Finally, improving the living standards of the children is important to get better health care, to enhance the child's nutritional status and to reduce child mortality.

Risk Factors of Mid-upper Arm Circumference (MUAC) Based Child Malnutrition in the Flood-affected Areas of Pakistan: A Cross-sectional Study

Low- and middle-income countries are usually at high risk of malnutrition. Not only that but the prevalence of malnutrition is much higher. It is important to evaluate the determinants of malnutrition in flood-affected areas of Pakistan. The present study examined the prevalence and risk factors of MUAC-based child malnutrition in flood-hit regions of Khyber Pakhtunkhwa, Pakistan. Multi-stage sampling was employed to select 656 households. Finally, 298 children of 6-59 months were selected. MUAC, an independent anthropometric parameter, was used to investigate the nutritional status of children. An automated logistic regression model was used to identify the risk factors of MUAC-based malnutrition. The prevalence of MUAC-based malnutrition was found 46%, including 40.5% females and 52.1% males. More than 90% of people had improved water quality and soap hand washing facility. Almost 17% of respondents had no toilet facility. Through automated logistic model, child age, maternal age, family size, income level, mother education, water quality, toilet facility were the significant determinants (P < .05) of MUAC-based undernutrition in flood affecting the area. The findings suggest that MUAC-based malnutrition can be minimized in flood-hit areas by targeting the listed risk factors. Community-based awareness programs regarding guidance on nutrition might be a key to reducing malnutrition in the target areas.

Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia.

METHODS

We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I ² test.

RESULTS

A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82).

CONCLUSION

This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.

A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa

Malnutrition is a considerable contributor to child mortality and morbidity. Child malnutrition further affects the country's economic development. Child malnutrition in South Africa is persistent, continuing to be an alarming burden. The nutritional status of kids under the age of five years is a critical indicator of the country's economic condition and health status. An understanding of the influencers of the nutritional status of children can act as a catalyst in combatting all forms of malnutrition. The purpose of this paper was to review selected studies concerning the factors that affect the nutritional status of children in South Africa. Studies were selected from electronic databases, which were PubMed, Google Scholar, Science Direct, Sabinet African Journals, and the University of Zululand library catalog. The keywords that were used to search studies and articles from the selected database were: risk factors, child nutritional status, children under the age of five years, South Africa, malnutrition, underweight, stunted, wasting, and over-nutrition. Studies and surveys published from 2010-2019 that reported on the factors influencing the nutritional status of children under the age of five years were included in this review. Twenty-seven articles met the inclusion criteria of the study. The 27 articles were made up of 21 cross-sectional articles and six longitudinal articles. The finding from this review highlights that there is a lack of studies conducted in urban areas. The results show that the nutritional status of children is affected by several factors. These include household food insecurity, low household income, illiterate caregivers, unemployment, inadequate dietary intake, low birth weight, consumption of monotonous diets, poor caregiver's nutritional knowledge, poor access to water and sanitation, poor weaning practices, age of the caregiver, and demographic characteristics of a child (age and gender). It is critical to have an understanding of the factors that affect the nutritional status of children. Such knowledge can significantly contribute to formulating policies that can enhance nutrition security and the country's economy. Moreover, insights into strategic interventions to eradicate all forms of malnutrition can be made.

Biological sensitivity to context in Pakistani preschoolers: Hair cortisol and family wealth are interactively associated with girls' cognitive skills

Many young children in low- and middle-income countries (LMICs) face heightened risk for experiencing environmental adversity, which is linked with poorer developmental outcomes. Children's stress physiology can shed light on why children are differentially susceptible to adversity. However, no known studies have examined whether links between adversity and children's development are moderated by children's stress physiology in LMICs. The present study revealed significant interactive effects of hair cortisol concentrations, an index of chronic physiological stress regulation, and family wealth on preschoolers' cognitive skills in rural Pakistan. In a sample of 535 4-year-old children (n = 342 girls), we found significant associations between family wealth and direct assessments of verbal intelligence, pre-academic skills, and executive functions only in girls with lower hair cortisol concentrations. Specifically, girls with lower cortisol concentrations displayed greater cognitive skills if they came from relatively wealthier families, but lower cognitive skills if they came from very poor families. There were no significant associations among boys. Results provide evidence of biological sensitivity to context among young girls in a LMIC, perhaps reflecting, in part, sex differences in daily experiences of environmental adversity.

Current Status of Malnutrition and Stunting in Pakistani Children: What Needs to Be Done?

Malnutrition is one of the greatest health challenges that affects about 2 billion people globally. Multiple factors including poverty, food insecurity, maternal health and nutritional status, mother's age at marriage and educational status, low birthweight or small for gestational age (SGA), premature births, suboptimal breastfeeding practices, unhealthy dietary and lifestyle patterns, health and immunization status of children, socioeconomic status of family, environmental and household conditions, together with cultural practices and myths, play vital role in affecting the growth of children at early age. Although child stunting has declined in Pakistan, the reduction rate is only 0.5%, which is very low. This may be due to ineffective or inappropriate intervention programs as they are mostly addressing only one issue at a time and don't use the multi-sector approach to address numerous determinants of stunting. It is therefore important to initiate cost-effective multi-tiered intervention approaches to be implemented at pre-conception, pregnancy and early postpartum stages to prevent the problems of malnutrition and stunting in Pakistani children. This review discusses the etiology of child malnutrition and stunting in Pakistan, role of various determinants of stunting and what type of intervention strategies and approaches should be developed and implemented to deal with these problems. Key teaching pointsMalnutrition is one of the greatest global health challenges.Poverty, food insecurity, socioeconomic status, unhealthy dietary patterns, maternal health and nutritional status, low birthweight, suboptimal breast feeding, environmental conditions, cultural practices and myths, are the main factors for child malnutrition and stunting in Pakistan.The slow reduction rate in child stunting may be due to inappropriate intervention programs.Cost-effective multi-tiered intervention approaches must be implemented at pre-conception, pregnancy and early postpartum stages to prevent child malnutrition and stunting in Pakistan.A holistic approach comprising nutrition and WASH interventions, together with strategies to improve the socioeconomic status be developed and implemented to resolve this dilemma.

Artificial Intelligence-Enabled Predictive Insights for Ameliorating Global Malnutrition: A Human-Centric AI-Thinking Approach

According to the World Health Organization (WHO) and the World Bank, malnutrition is one of the most serious but least-addressed development challenges in the world. Malnutrition refers to the malfunction or imbalance of nutrition, which could be influenced not only by under-nourishment, but also by over-nourishment. The significance of this paper is that it shows how artificial intelligence (AI) can be democratized to enable analysts who are not trained in computer science to also use human-centric explainable-AI to simulate the possible dynamics between malnutrition, health and population indicators in a dataset collected from 180 countries by the World Bank. This AI-based human-centric probabilistic reasoning approach can also be used as a cognitive scaffold to educe (draw out) AI-Thinking in analysts to ask further questions and gain deeper insights. In this study, a rudimentary beginner-friendly AI-based Bayesian predictive modeling approach was used to demonstrate how human-centric probabilistic reasoning could be utilized to analyze the dynamics of global malnutrition and optimize conditions for achieving the best-case scenario. Conditions of the worst-case “Black Swan” scenario were also simulated, and they could be used to inform stakeholders to prevent them from happening. Thus, the nutritional and health status of vulnerable populations could be ameliorated.

Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar

BACKGROUND

The coexistence of overweight mother and stunted child at the same household is a type of Double Burden of Malnutrition at Household Level (DBMHL). This particular public health concern is now emerging at an alarming rate among most of the South Asian and its neighboring lower-and-middle income countries which are going through nutritional transition. This study has examined the prevalence rate and the risk factors of DBMHL along with the socio-economic inequality in DBMHL among Bangladesh, Nepal, Pakistan, and Myanmar.

METHODS

Latest Demographic and Health Survey datasets were used in this study. To identify the significant association of DBMHL with socio-demographic characteristics, a multivariate technique named as logistic regression model, and for measuring socio-economic inequalities in DBMHL prevalence, relative index of inequality (RII) and slope index of inequality (SII) were used.

RESULTS

The prevalence rates of DBMHL were 4.10% (urban: 5.57%, rural: 3.51%), 1.54% (urban: 1.63%, rural: 1.42%), 3.93% (urban: 5.62%, rural: 3.20%), and 5.54% (urban: 6.16%, rural: 5.33%) respectively in Bangladesh, Nepal, Pakistan, and Myanmar. The risk ratios (RR) obtained from RII for Bangladesh, Nepal, Pakistan and Myanmar were 1.25, 1.25, 1.14, and 1.09, respectively, and β coefficient from SII were 0.01, 0.004, 0.005, and 0.006 unit respectively. In addition to not breastfeeding [Bangladesh (AOR: 1.55; 95% CI: 1.11-2.15), Myanmar (AOR: 1.74; 95% CI: 1.02-2.95)], respondent's older age (in Bangladesh, Nepal, and Myanmar), child's older age (in Pakistan and Myanmar), and middle and rich groups of wealth-index (in Bangladesh and Pakistan) were strong risk factors for DBMHL. On the other hand, female child [Nepal (AOR: 0.50; 95% CI: 0.26-0.95), Pakistan (AOR: 0.58; 95% CI: 0.41-0.84)], higher education [in Pakistan], respondent not participated in decision making [in Bangladesh and Nepal] and media access [Nepal (AOR: 0.44; 95% CI: 0.20-0.98)] had negative association with DBMHL.

CONCLUSION

The DBMHL persists in all selected countries, with a higher prevalence in urban areas than in rural areas. In order to control the higher prevalence of DBMHL in urban areas, respective countries need urgent implementation of multisectoral actions through effective policies and empowering local communities.

Prevalence and factors associated with underweight children: a population-based subnational analysis from Pakistan

OBJECTIVES

This study aims to determine the prevalence of and factors associated with underweight children under the age of 5 in Punjab, Pakistan.

DESIGN

We analysed cross-sectional household-level subnationally representative Multiple Indicator Cluster Survey.

SETTINGS

Punjab province, Pakistan.

PARTICIPANTS

24 042 children under 5 years of age.

DATA ANALYSIS

Multilevel multivariate logistic regression analysis.

RESULTS

Prevalence of moderately and severely underweight children was found to be (33.3% and 11.3%, respectively). Multivariate multilevel logistic regression results show that as the child grows older the likelihood of the child being underweight increases significantly (eg, children between 12 and 23 months are one and half times more likely to be underweight, whereas children between the ages of 36 and 47 months are two and a half times more likely to be underweight). Gender was found to be another significant factor contributing to underweight prevalence among children under the age of 5. The likelihood of a girl child being underweight is more than that of a boy child being underweight (OR 0.92, 95% CI 0.8 to 1.0). Similarly, a child whose birth order is three or more is two times more likely to be underweight (OR 1.96, 95% CI 1.5 to 2.5) relative to a child of a lower birth order. Moreover, diarrhoea also significantly increases the likelihood of the child being underweight (OR 1.31, 95% CI 1.1 to 1.5). Child size is another determinant for underweight prevalence among children under 5, for example, a child with a size smaller than average at the time of birth is 2.7 times more likely to be moderately underweight than a child with an average or larger than average size at the time of birth.

CONCLUSION

Rigorous community-based interventions should be developed and executed throughout the province to improve this grave situation of underweight prevalence in Punjab. Mother's education should be uplifted by providing them formal education and providing awareness about the importance of proper nutrition for children.

Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey

BACKGROUND

Childhood malnutrition is a critical public health concern in Pakistan. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012-2013.

METHODS

Sample of 3071 Pakistani children aged 0-59 months from the PDHS 2012-2013, with complete anthropometric measurements were included in the study. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. Uni- and multivariate binary logistic regressions were used to examine the association between selected maternal-socio-demographic and child level variables (such as child sex, age, size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status) and three proxy measures of child nutritional status.

RESULTS

About 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Children whose mothers lived in rural areas (aOR = 0.67, 95%CI 0.48-0.92), were aged ≥18 years at marriage (aOR = 0.76, 95%CI 0.59-0.99) and had visited antenatal clinic more than 3 times during pregnancy (aOR = 0.61, 95%CI 0.38-0.98) were less likely to be stunted. Mother's low educational level (aOR = 2.55, 95%CI 1.26-5.17), short stature (aOR = 2.31, 95%CI 1.34-3.98), child's small size at birth (aOR = 1.67, 95%CI 1.14-2.45) and mother's BMI were significantly associated with child's underweight status. Children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33-9.82).

CONCLUSION

The study suggests that most of the analysed factors that accounted for malnutrition in Pakistani children (such as mother's age at marriage, educational level and mothers' nutritional status) are preventable. Therefore, to reduce the burden of malnutrition interventions that can address these factors are required such as community based education and targeted nutritional interventions.