Nutrition Assessment of Under-Five Children in Sudan: Tracking the Achievement of the Global Nutrition Targets

Capturing growth indices on the road to health booklets in clinics in Free State, South Africa

Background

Growth monitoring plays an essential role in the development of young children. Anthropometric indices are of utmost importance for healthcare professionals to identify children at risk of inadequate growth and malnutrition.

Aim

This study aimed to assess the capturing of the growth indices in the Road to Health Booklets (RTHB) in clinics.

Setting

The study was carried out in Mangaung Metropolitan municipal clinics in the Free State province, South Africa.

Methods

A descriptive quantitative study was conducted using a checklist to audit 264 RTHBs. Descriptive statistics were used to analyse data.

Results

The findings showed that birth weight was recorded in most 99% (n = 262) of the RTHBs. The mid-upper arm circumference (MUAC) was not recorded in 58% (n = 153) of the cases during the last visit. Weight-for-Age (WfA) was routinely plotted in 91% (n = 241) of the RTHB. The length or Height-for-Age (LHfA) was plotted in 38% (n = 99) of the RTHB and Weight-for-Length or height (WfLH) was plotted in 31% (n = 81) of the RTHB.

Conclusion

The results demonstrated that certain anthropometric measures including MUAC, length, or height were absent from the records of the RTHB. Consequently, RTHB may not be effectively used as a means of evaluating nutritional status, affecting early detection of malnutrition in children.

Contribution

The research makes a valuable addition to the existing body of knowledge for monitoring growth and measurement of anthropometric indices in the RTHB, as well as the appropriate execution of these practices.

Food and Power in Protracted Crisis: How Systems and Institutions Influence Livelihoods, Food Security, and Nutrition

This article examines how systems and institutions influence the distribution of resources in society and, as such, affect livelihoods, food security, and nutrition. It draws on research on the political economy of food, and the governance effects of food aid practices, conducted in Sudan and Somalia and on the role of a social approach to nutrition in situations of famine and mass starvation. This article argues first for the importance of examining political structures as basic causes of malnutrition as they influence whether and how institutions function (in relation to land, markets, employment, aid, or justice). Second, this article illustrates how, in situations of crisis, the manipulation of institutions can create power for some and vulnerability to malnutrition in others. Third, it argues that a focus on treatment of malnutrition and behavior (hygiene and feeding practices) has drawn attention away from systems and institutions and feeds into discrimination as a basic cause.

A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa

Undernutrition (stunting, wasting and underweight) among children remains a public health concern in North Africa, especially following recent conflicts in the region. Therefore, this paper systematically reviews and meta-analyses the prevalence of undernutrition among children under five in North Africa to determine whether efforts to reduce undernutrition are on track to achieving the Sustainable Development Goals (SDGs) by 2030. Eligible studies published between 1st January 2006 and 10th April 2022 were searched for, using five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest and CINAHL). The JBI critical appraisal tool was used, and a meta-analysis was conducted using the 'metaprop' command in STATA, to estimate the prevalence of each undernutrition indicator in the seven North African countries (Egypt, Sudan, Libya, Algeria, Tunisia, Morocco, and Western Sahara). Due to the significant heterogeneity among studies (I2 >50%), a random effect model and sensitivity analysis were conducted to examine the effect of outliers. Out of 1592 initially identified, 27 met the selection criteria. The prevalence of stunting, wasting and being underweight were 23.5%, 7.9% and 12.9%, respectively. Significant variations between the countries with the highest rates of stunting and wasting were reported in Sudan (36%, 14.1%), Egypt (23.7%, 7.5%), Libya (23.1%, 5.9%), and Morocco (19.9%, 5.1%). Sudan also had the highest prevalence of underweight (24.6%), followed by Egypt (7%), Morocco (6.1%), and Libya (4.3%) with more than one in ten children in Algeria and Tunisia having stunted growth. In conclusion, undernutrition is widespread in the North African region, particularly in Sudan, Egypt, Libya, and Morocco, making it challenging to meet the SDGs by 2030. Nutrition monitoring and evaluation in these countries is highly recommended.

Mapping wasted children using data from the Ethiopia Demographic and Health Surveys between 2000 and 2019: A bayesian geospatial analysis

OBJECTIVES

Undernutrition, particularly wasting, is continuing to be a major challenge in developing countries like Ethiopia. However, data on the geographic variations over time are limited. We aimed to investigate the spatiotemporal variation of wasting in Ethiopia using two decades of Ethiopia Demographic and Health Surveys data, from 2000 to 2019.

METHODS

Trend and geospatial regression analysis using a bayesian framework were used to predict wasting in Ethiopia among children aged <5 y. The primary outcomes (wasting) were obtained from the Ethiopia Demographic and Health Surveys conducted between 2000 and 2019. Covariates were accessed from different publicly available credible sources at a high resolution. The spatial binomial regression model through the bayesian framework was fitted to identify drivers of wasting among children in Ethiopia.

RESULTS

The overall national prevalence of wasting among children aged <5 y in Ethiopia was 11.9% in 2000, 11.1% in 2005, 10.2% in 2011, 12.3% in 2016, and 9.4% in 2019, with substantial spatial variation across subnational and local levels over time. Spatial clustering of wasting was observed in eastern Ethiopia (Afar and Somali regions). Altitude (mean regression coefficient = -0.38; 95% credible interval, -0.69 to -0.07) and population density (mean regression coefficient = -0.02; 95% credible interval, -0.03 to -0.01) were negatively associated with wasting, whereas distance to health facilities (mean regression coefficient = 0.13; 95% credible interval, 0.03-0.23) was positively associated with wasting.

CONCLUSIONS

The reduction in the national prevalence of wasting among children was not as expected. Spatial clustering of wasting was observed in the northern, northeastern, eastern, and western parts of Ethiopia. Spatial clustering of wasting was associated with altitude, precipitation, population density, distance to health facilities, travel time to the nearest cities, and distance to a water body. Early screening and treatment of wasted children should be strengthened. Furthermore, outreach community awareness, especially in rural parts of the country, should be recommended through community health extension workers.

Implementation of community-based management of severe acute malnutrition in conflict affected regions: a case of South Kordofan, Sudan

Malnutrition is the major cause of mortality and morbidity globally with undernutrition contributing about 45% of all deaths of under five children. Besides the direct effects of protracted conflicts, the macroeconomic crisis that has greatly increased the national inflation rate hence devastating the purchasing power, the COVID-19 outbreak, flooding, and the Desert Locusts have contributed to a food security emergency. Besides being among the most under resourced states, South Kordofan has experienced years of conflict resulting in displacement of people and extensive infrastructure destruction with high rates of malnutrition. The state currently has 230 health facilities and out of these, only 140 are providing outpatient therapeutic programme centres with 28.6% (40) of these being operated by the state ministry of health and the rest by the international non-governmental organizations. Limited resources leading to donor dependence, limited accessibility due to insecurity and floods, poor referral system and gaps in continuity of care, lack of operational and implementation research data and limited integration of management of malnutrition in other health services have negatively affected effective implementation. Ensuring effective and efficient community based management of acute malnutrition, implementation needs action beyond the health sector with a multi-sectoral and integration approach. Federal and state development frameworks should ensure a comprehensive multi-sectoral nutrition policy with strong political commitment and allocation of adequate resources to ensure integrated and quality implementation.

Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape

BACKGROUND

With increasing global rates of overweight, obesity and non-communicable diseases (NCDs) along with undernutrition and micronutrient deficiencies, the Eastern Mediterranean Region (EMR) is no exception. This review focuses on specific nutrition parameters among under five years children, namely ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods and malnutrition.

METHODOLOGY

PubMed, Google Scholar, United Nations International Children's Emergency Fund (UNICEF) databases, World Health Organization (WHO) databases, the World Bank databases and the Global Nutrition Report databases were explored between 10 January and 6 June 2022, to review the nutrition situation among under five years children in the EMR.

RESULTS

The regional average prevalence of ever breastfed, exclusive breastfeeding, mixed milk feeding, continued breastfeeding, bottle feeding, introduction of solid, semi-solid, or soft foods was estimated at 84.3%, 30.9%, 42.9%, 41.5%, 32.1% and 69.3%, respectively. Iran, Iraq, Libya and Palestine have seen a decline over time in the prevalence of exclusive breastfeeding. Lebanon, Egypt, Kuwait and Saudi Arabia reported early introduction of infant formula. Moreover, Lebanon, Pakistan, Saudi Arabia and United Arab Emirates were seen to introduce food early to the child, at between 4-6 months of age. The estimated weighted regional averages for stunting, wasting and underweight were 20.3%, 8.9% and 13.1%, respectively. Of concern is the increasing prevalence of stunting in Libya. As for overweight and obesity, the average prevalence was reported to be 8.9% and 3%, respectively. Lebanon, Libya, Kuwait and Palestine showed an increased trend throughout this time.

CONCLUSIONS

In this review, the suboptimal infant and young child feeding patterns and the twofold incidence of malnutrition in the EMR are highlighted and we urge the prioritizing of measures to improve children's nutrition.

Development and optimization of NIRS prediction models for simultaneous multi-trait assessment in diverse cowpea germplasm

Cowpea (Vigna unguiculata (L.) Walp.) is one such legume that can facilitate achieving sustainable nutrition and climate change goals. Assessing nutritional traits conventionally can be laborious and time-consuming. NIRS is a technique used to rapidly determine biochemical parameters for large germplasm. NIRS prediction models were developed to assess protein, starch, TDF, phenols, and phytic acid based on MPLS regression. Higher RSQ_external values such as 0.903, 0.997, 0.901, 0.706, and 0.955 were obtained for protein, starch, TDF, phenols, and phytic acid respectively. Models for all the traits displayed RPD values of >2.5 except phenols and low SEP indicating the excellent prediction of models. For all the traits worked, p-value ≥ 0.05 implied the accuracy and reliability score >0.8 (except phenol) ensured the applicability of the models. These prediction models will facilitate high throughput screening of large cowpea germplasm in a non-destructive way and the selection of desirable chemotypes in any genetic background with huge application in cowpea crop improvement programs across the world.

Correlates of Sub-Optimal Feeding Practices among under-5 Children amid Escalating Crises in Lebanon: A National Representative Cross-Sectional Study

Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother-child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant's feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children's practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03-22.17)) and husband's support (aOR = 3.07, 95% CI (1.9-4.92)) were associated with increased breastfeeding odds. However, mother's occupation (aOR = 0.18, 95% CI (0.55-0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37-3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35-0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32-0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.

Effectiveness of a Nutrition Education Program in Improving Mothers’ Knowledge and Feeding Practices of Infants and Young Children in Sudan

Objective: To assess the effect of a designed nutrition education program (NEP) on maternal Knowledge and practices  Methods: A control two groups quasi-experimental pre- and post-experimental were adopted. Data were collected through personal interviews of two groups using a validated questionnaire. The nutrition education program was conducted in three phases. Phase one was the pre-evaluation; phase two was the program's implementation, and phase three entailed post-evaluation of the program. Results: The results supported the efficient role of the NEP intervention in raising mothers ' Knowledge and practices towards nutritional care of children under two years in Sennar Locality. No statistically significant differences were found between the two groups with the controlled variable, mother age, mother education, mother occupation, husband occupation, No of children less than five years, family size, and infant age. This indicates that the two groups were homogenous. No significant difference between the two groups in mothers' Knowledge and practices before applying the NEP. The results showed the effectiveness of the NEP in developing experimental group mother's Knowledge and practices, comparing post-test with pre-test in favor of post-test to be statistically significant. NEP has a  greater effect in developing mother's awareness post-test measuring and developing mother's Knowledge and practices comparing post-test with pre-test. Conclusions and Implications: It can be concluded that nutrition education intervention demonstrated its effectiveness in maternal Knowledge and practices. The study provided valuable baseline information to develop appropriate training courses and nutrition education programs to raise maternal Knowledge and practices towards infants and young children's nutrition.  

Iraq Is Moving Forward to Achieve Global Targets in Nutrition

From the 1990s and after 2003, Iraq suffered many difficulties which affected its population negatively in different ways; from embargo to political instabilities, conflicts, and wars, collectively leading to food insecurity especially among the internally displaced people. The Ministry of Health and International Organizations worked collectively to improve the nutritional situation among the most vulnerable groups: children under five, and women in reproductive age. This study aims to review the nutrition situation for Iraq in relation to the Global Nutrition Targets and for Sustainable Development Goals. The data used for comparison was obtained from nationally representative surveys conducted in Iraq from 1996 to 2018, including urban and rural areas for all 18 governorates. Results of these surveys showed a gradual decline in undernutrition indicators for children under five, and an emergence of overweight and obesity, indicating an urgent need for collective action from all sectors and related Ministries regarding malnutrition in its different forms. It also revealed a decline in the prevalence of anemia among the targeted women, but an increase of low birth weight in newborn infants. Exclusive breastfeeding though, is still staggering and in need of urgent action. Iraq is transferring from a generalized state of insecurity to a more secure one, emphasizing the need to strengthen systems for efficient monitoring and evaluation. There is also a need for more recent surveys representing Iraq, as the available data is scant, particularly dietary intake studies within the normal population and internally displaced families in camps or scattered shelters.

Assessment of Micronutrient Situation among Reproductive-Age Women (15-49) and Under-Five Children in Sudan

Background: Micronutrient malnutrition is a form of undernutrition that causes diseases, and this is mainly due to insufficient intake of nutrients in daily foods. The status of micronutrients for people in Sudan remains scarce, and information is limited. The aim of this study is to highlight the status of micronutrients among women of reproductive age (15–49 years of age) and their children in Sudan. Methods: This manuscript is a quantitative descriptive study, based on the data from Sudan Micronutrient Survey (SMS); it is part of the second round of the Simple Spatial Survey Method (S3M II) in Sudan (a total of 93,882 households). Results: The level of consumption of vitamin A-rich foods was found to be moderate at 67.36% for reproductive-age women and low at 23.44% for under-five children. Similarly, consumption rate of vitamin B-rich foods among reproductive-age women was 62.13%, and low for children at 11.02%. The consumption of iron-, calcium-, and zinc-rich foods was moderate among women (66.75%, 47.69%, 69.72%, respectively) and very low in children (12.28%, 17.62%, 14.99%, respectively). The iron deficiency prevalence was 47% in non-pregnant women, 58% in pregnant women, and 54% in children. The prevalence of anemia was 30% in non-pregnant women, 37% in pregnant women, and 48% in children. Generally, urinary iodine concentration was inadequate in lactating and non-pregnant women as well as in pregnant women. Most indicators of micronutrients in Sudan for children and women of reproductive age were highly significant. Sudan needs more efforts to create an enabling environment through legislation, policies, and strategies to strengthen the nutrition-sensitive and specific interventions and improving status of micronutrients among women and children, focusing on food fortification, food supplements, and counseling on micronutrients intake for mothers during antenatal and postnatal services as well as raising community awareness.

Assessment of a Nutrition Education Program designed to Enhance Mothers’ Attitudes on Infants and Young Children feeding in Sudan

Objective: To assess the effect of a designed nutrition education program (NEP) on maternal attitudes.  Methods: A control two groups quasi-experimental pre- and post-experimental were adopted. Data were collected through personal interviews of two groups using a validated questionnaire. The nutrition education program was conducted in three phases. Phase one was the pre-evaluation, phase two was the program’s implementation, and phase three entailed post evaluation of the program. Results: The results supported the efficient role of the NEP intervention in raising mothers’ attitudes towards nutritional care of under two years in Sennar Locality, Sudan. There was no significant difference between the two groups with respect to the controlled variables; mother age, mother education, mother occupation, husband occupation, number of children less than 5 years, family size, and child’s age, which indicates that the two groups were homogenous, i.e., no significant difference between mothers’ attitude of the two groups before applying the NEP. The results showed the effectiveness of the NEP in developing experimental group mother’s attitudes, comparing post-test with pre-test in favor of post-test to be statistically significant. NEP has a huge impact in developing the mother’s awareness post-test, measuring and developing the mother’s attitudes compared to post-test with pre-test. Conclusions and Implications: The nutrition education intervention demonstrated its effectiveness in maternal attitude. The study provided valuable baseline information to develop appropriate training courses and nutrition education programs to raise maternal awareness and attitudes towards infants and young children’s nutrition.