Household Food Insecurity as a Predictor of Stunted Children and Overweight/Obese Mothers (SCOWT) in Urban Indonesia

Double Burden of Malnutrition and Its Associated Factors in Urbanized Indigenous Peoples (Orang Asli) of Peninsular Malaysia

Double burden of malnutrition (DBM) is a global public health concern. This study determined the prevalence of DBM and its associated factors among 451 indigenous households in an urbanized state of Malaysia. Mothers and children were measured for weight and height/length. Mothers were interviewed for socio-demographics and diets of mothers and children. Prevalence of DBM (overweight/obese mother and underweight/stunted child) was 28.8%. Food insecurity, maternal height (<150 cm) and energy intake (>recommendation), child's age (≥24 months) and energy intake ( Collapse

Key Words

• Double burden of malnutrition
• indigenous peoples
• maternal height, food insecurity, energy intake

Collapse

MESH Headings

• Humans
• Malaysia/epidemiology
• Female
• Malnutrition/epidemiology
• Indigenous Peoples
• Child, Preschool
• Male
• Adult
• Prevalence
• Infant
• Food Insecurity
• Urban Population
• Urbanization
• Thinness/ethnology
• Thinness/epidemiology
• Young Adult
• Energy Intake
• Mothers
• Diet
• Adolescent
• Cross-Sectional Studies
• Overweight/ethnology
• Overweight/epidemiology
• Child
• Obesity/ethnology

Collapse

Grants Collapse

Affiliation(s)

Zalilah Mohd Shariff Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
Rozalina Ismail Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
Nurul Husna Mohd Shukri Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia

Collapse

Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.

Exploring Factors Associated with Stunting in 6-Month-Old Children: A Population-Based Cohort Study in Sulawesi, Indonesia

Stunting in children under the age of two is a significant global concern, particularly in low- and middle-income countries like Indonesia. Intervention efforts often come too late as many of the underlying causal factors have already occurred earlier. While antenatal multiple micronutrient supplements (MMS) have demonstrated positive effects on pregnancy outcomes, their impact on infant growth in the first six months remains inadequately explored in epidemiological studies. This study aims to identify factors associated with stunting at six months in infants whose mothers received MMS. A population-based cohort study was conducted in four subdistricts of Banggai, Indonesia. Pregnant women were recruited in their third trimester and followed up until their children were six months of age. Validated questionnaires were employed to gather data on social determinants of health and diet, and standardised methods were utilised for anthropometric measurements. Stunting was determined based on the WHO child growth standards. The analysis comprised data from 152 mother-child pairs. The prevalence of stunting during early infancy (first two months) was 18.4%, which decreased to 15.8% in later infancy (at six months). Factors such as small-for-gestational-age (AOR = 11.29; 2.73-46.66), preterm birth (AOR = 6.33; 1.25-31.97), short birth length (AOR = 4.31; 1.11-16.78), maternal mid-upper arm circumference (MUAC) below 23.5 cm, and female infants (AOR = 3.27; 95%CI: 1.04-10.27) were associated with stunting at six months. This study highlights that stunting in the first six months is present at birth, with small-for-gestational-age (SGA) as a strong predictor. In addition, there was a trend to improved growth (-0.30 [-0.79 to 0.18]) in infants born to mothers who received MMS supplementation pre-pregnancy rather than during pregnancy, although it was not statistically significant.

Exploring the double burden of malnutrition at the household level in the Philippines: Analysis of National Nutrition Survey data

BACKGROUND

In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking.

METHODS

Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM.

RESULTS

The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age.

CONCLUSIONS

The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.

Effectiveness of Positive Deviance Approach to Reduce Malnutrition among under Five Children: A Systematic Review and Meta-Analysis of Interventional Studies

The high malnutrition rate in children under five makes this problem one of the public health problems. Various efforts have been made to reduce malnutrition in children under five, one of which is the implementation of community programs with a positive deviance approach which is considered an effective way because the solution to the problem comes from the local community. Thus, we conducted a systematic review and meta-analysis to determine the effect of interventions with a positive deviance approach to reducing under-five children's malnutrition. Systematic searches were conducted using the following journal databases: Science Direct, Pubmed, Proquest, SAGE journal, Web of Science, and Scopus. The article was included if using an intervention design. Data analysis used Review Manager 5.4 software, random effect model, outcome mean of difference, and 95% confidence interval. There were no significant differences between the intervention and control groups on the length for age z-scores (LAZ), weight for age z-scores (WAZ), and weight for height z-scores (WHZ) indicators. There was an increase in LAZ, WAZ, and WHZ scores in the intervention group, with a greater z-score than in the control group. In conclusion, interventions with the positive deviance approach can be used as an alternative to improving the nutritional status of under-five children. However, further research is needed to determine the effective duration of interventions in improving the nutritional status of children.

Household food insecurity and hunger status in Debre Berhan town, Central Ethiopia: Community-based cross-sectional study

Background

Food security occurs when all people have physical, social, and economic access to sufficient, safe, and nutritious food that fits their dietary needs and food preferences for an active and healthy life at all times. There is limited evidence on this topic and not well studied in Ethiopia.

Objective

This study aimed to investigate food insecurity and hunger status among households (HHs) in Debre Berhan town, Ethiopia.

Methods

A community-based cross-sectional study was undertaken from 1 January 2017 to 30 January 2017. A simple random sampling technique was used to enroll 395 HHs for the study. An interviewer-administered, structured, and pretested questionnaire was used to collect data through a face-to-face interview. The household food security and hunger status were assessed by using the Household Food Insecurity Access Scale and the Household Hunger Scale, respectively. Data were entered and cleaned using Epiata 3.1 and exported to SPSS software version 20 for statistical analysis. Logistic regression was fitted, and an odds ratio with a 95% confidence interval (CI) and a value of p of less than 0.05 were used to identify factors associated with food insecurity.

Results

A total of 377 HHs participated in the study with a response rate of 95.4%. The proportion of households with food insecurity was 32.4%, among which mild, moderate, and severe food insecurity accounted for 10.3, 18.8, and 3.2%, respectively. The mean score of the Household Food Insecurity Access Scale was 1.88 ± 3.5. Hunger occurred among 3.2% of households. The mean score of the Household Hunger Scale was 2.17 ± 1.03. Husband or male cohabitant's occupation (AOR = 2.68; 95% CI: 1.31-5.48) and wife or female cohabitant's literacy (AOR = 3.10; 95% CI: 1.01- 9.55) were the only factors associated with HH food insecurity.

Conclusion

HH food insecurity and hunger in Debre Berhan town were unacceptably high, which can hamper achieving national targets for food security, nutrition, and health. Intensified efforts are further needed to accelerate the decline in food insecurity and hunger prevalence. Therefore, interventions need to target self-employed merchants in small businesses and women who are uneducated.

Maternal and Child Health handbook and under-6 child overweight in greater Jakarta, Indonesia: a cross-sectional web-based survey

BACKGROUND

In Indonesia, the double burden of child overnutrition and undernutrition is a public health concern. The nationally distributed Maternal and Child Health (MCH) handbook provides child nutrition information to caregivers. We aimed to find mothers' information sources regarding child nutrition, including the internet and the MCH handbook, and to explore the association between overweight and use of the MCH handbook.

METHOD

A cross-sectional web-based survey was conducted among mothers with children under 6 years old in Greater Jakarta during 2019. Bivariate and multivariate logistic regression examined the association between child nutrition status and use of the MCH handbook.

RESULTS

Data were collected from 233 children. Overweight, underweight, wasting, and stunting were identified in 36.4%, 22.6%, 26.8%, and 37.6%, respectively. 62.5% of mothers used the MCH handbook, and 88.2% used the internet via a mobile phone. Significantly more cases of overweight were observed among children whose mothers used the MCH handbook (adjusted OR [aOR]: 5.829; 95% Confidential Interval [CI]: 1.618-20.999) whereas no relationship was observed between MCH handbook use and child undernutrition. Significant associations with child overweight were found for mother's education (tertiary) (aOR: 0.294; 95%CI: 0.098-0.885), employment type (fulltime) (aOR: 0.185; 95%CI: 0.061-0.562), watching television (more than 1 h) (aOR: 4.387; 95%CI: 1.648-11.678) and recognition of child overweight by mother (yes) (aOR: 3.405; 95%CI: 1.05-11.03).

CONCLUSION

These results indicate the need to support mothers of children exhibiting overnutrition and undernutrition. The MCH handbook should be modified to address this issue.

Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia

In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The dominant factors that caused stunting in this study were the children’s age of 24−35 months (OR = 2.08, 95% CI: 1.12−3.86), mothers with low education (OR = 1.57, 95% CI: 1.18−2.08), and children living in rural areas (OR = 1.39, 95% CI: 1.01−1.91). The highest prevalence of stunting was in the group of children aged 12−23 months (45.2%). To prevent child stunting, the government must intervene for mothers with low education and those living in rural areas. Intervention includes intensive socialization about improving nutritional status during pregnancy and practicing complementary feeding and breastfeeding habits until the child is 24 months old.

Comparing level of food insecurity between households with and without home gardening practices in Zege, Amhara region, North West Ethiopia: Community based study

BACKGROUND

Globally, close to 1 billion people suffer from hunger and food insecurity. Evidence showed that prevalence of household food insecurity in Ethiopia is ranged from 25.5%-75.8%. Home gardening is one way to alleviate food insecurity. Hence, the study aimed to determine level of food insecurity and its associated factors between home gardening and non-home gardening household in Zegie, North west Ethiopia.

METHODS

Community-based study was conducted from February 10th-March 10th/2020. A total of 648 samples were included. First, 2142 total households who have 6-59 months of age children in the area identified and registered. Then, households categorized in to home garden practicing (1433) and non-home garden practicing (709). The calculated sample size, 324 for each group were selected using simple random sampling technique.

RESULTS

The overall prevalence of food insecurity was 38.1% (95% CI: 34.29-42.11%). Food insecurity was significantly higher in non-home gardening groups than their counter parts 45.5% (95% CI: 39.80-51.20%). Having primary education and above (AO = 1.89, 95% CI: 1.25-2.86%), wealth index; 2nd quantile (AOR = 0.44, 95% CI: 0.25-0.85%), 3rd quantile (AOR = 0.32, 95% CI: 0.17-0.62%) and 4th quantile (AOR = 0.27, 95% CI: 0.15-0.54%), dietary diversity (AOR = 1.83, 95% CI: 1.15-2.92%) and home garden practices (AOR = 1.57, 95% CI: 1.06-2.32%) were variables significantly associated with food insecurity.

CONCLUSION

Food insecurity in non-home garden practicing households is higher than practicing households. The local agriculture sector needs to emphasis and empowered households on home gardening practices to realize food security.

Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review

BACKGROUND

The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting.

METHODS

This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020.

RESULTS

Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity.

CONCLUSIONS

This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

Predictor of Obese Mothers and Stunted Children in the Same Roof: A Population-Based Study in the Urban Poor Setting Indonesia

Stunting leads to the poor cognitive development, increases the risk of child mortality, and elevates the risk of non-communicable diseases. This study aimed to determine the magnitude of double burden of malnutrition (DBM) in the urban poor setting in Indonesia and investigate its predictors. This was a cross-sectional study involving 436 mothers proportionally chosen from 16 integrated health posts in Surabaya, Indonesia. The households were categorized into the two groups based on the body mass index (BMI) of mother and the height-for-age z-score (HAZ) of child; households without DBM and household with DBM. Energy, carbohydrate, protein, and fat intake were obtained using 24-h food recall and socioeconomic status was measured using a structured questionnaire. Data on socioeconomic status were educational level of mother and occupation, household income, and food expenditure. The prevalence of household with DBM was 27.5%; 12.4% pair stunted children and normal weight mother; 45.6% pair of overweight/obese mother and normal height children. The logistic regression analysis showed significant differences in the education level and occupation of mother, protein intake of the children, and fat intake of the mother between households with and without DBM. This study offers an important insight to improve the knowledge of mother related to the protein intake of children to reduce stunting risk and fat intake of mother to prevent over-nutrition.

Food insecurity status and determinants among Urban Productive Safety Net Program beneficiary households in Addis Ababa, Ethiopia

Background

Measuring household food insecurity in specific geographic areas provides vital information that enables appropriate and effective intervention measures to be taken. To that end, this study aimed to assess the prevalence of food insecurity and associated factors among Urban Productive Safety Net Program (UPSNP) beneficiary households in Addis Ababa, Ethiopia’s capital city.

Methods

A community-based cross-sectional study was conducted among 624 UPSNP beneficiary households in nine districts of Addis Ababa from June to July 2019. A multi-stage sampling method was used; study participants were selected using a simple random sampling technique after establishing the proportionally allocated sample size for 9 districts. Data were collected by trained personnel using a pretested, structured questionnaire. The outcome variable was food insecurity as measured by Household Food Insecurity Access Scale (HFIAS), a tool developed by the Food and Nutrition Technical Assistance Scale (FANTA) and validated for developing countries, including Ethiopia. A binary (crude odds ratio [COR]) and multivariable (adjusted odds ratio [AOR]) logistic regression analysis were employed at 95% CI (confidence interval). From the bivariate analysis, factors having a p-value<0.25 were included in the multivariable analysis. From the multivariable analysis, any variable at p-value < 0.05 at 95% CI was declared significantly associated with household food insecurity. Model fitness was also checked using the Hosmer-Lemeshow test with p-value>0.05.

Results

The prevalence of household food insecurity was 77.1% [95%CI:73.8–80.7] during the month prior to the survey. Illiteracy of household head [AOR: 2.56; 95%CI:1.08–6.07], family size of 4 or more [AOR: 1.87, 95%CI:1.08–3.23], high dependency ratio [AOR: 3.95; 95%CI:1.31–11.90], household lack of access to credit [AOR:2.85; 95%CI:1.25–6.49], low household income [AOR: 4.72; 95%CI:2.32–9.60] and medium household income [AOR: 9.78; 95%CI:4.29–22.35] were significantly associated with household food insecurity.

Conclusion

We found that three in four of Addis Ababa’s UPSNP beneficiary households were food-insecure. Implementation of measures to improve household income, minimize the dependency ratio of households, and arrange access to credit services are paramount ways to tackle food insecurity problems in Addis Ababa.

The relationship between dietary intake and stunting among pre-school children in Upper Egypt

OBJECTIVE

Linear growth is controlled by several factors, malnutrition is one of the leading causes of stunted child growth. The objective of this study was to determine the dietary intakes associated with stunting among pre-school children in rural Upper Egypt.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interviewing the children's caregivers in the rural household setting.

PARTICIPANTS

The study included 497 pre-school children aged 2-5 years in rural Upper Egypt. Food intake data were estimated using 24-h recall method. Anthropometric measurements of children were taken and then converted to z-scores for weight-for-age Z-score, height-for-age Z-score and weight-for-height Z-score.

RESULTS

The study included 497 children of which 19·1 % were stunted, 76·3 % did not meet recommended energetic intake and 13·7 % did not meet recommended protein intake and this was significantly higher than non-stunted children. Children who were stunted significantly consumed poultry, eggs and fruits less often than non-stunted children, by regression; male sex (adjusted odds ratio (aOR) = 1·91), mother's age (0·93), lower socio-economic status (SES); and not meeting recommended protein intake (aOR = 2·26) were found to be associated with stunting.

CONCLUSION

Male sex, younger mothers, lower SES and not meeting recommended energy and protein were statistically associated with stunting. Nutrition education messages encouraging adequate and healthy eating are recommended.

Household food insecurity and health in a high-migration area in rural Honduras

Household food insecurity (HFI) is a significant problem in the developing world. Relationships between HFI and nutrition, physical growth, and development have been elucidated; less is known about the non-nutritional impacts among individuals living in rural areas in low-income countries. The aim of this study was to determine if HFI is a risk factor for suboptimal mental health and overall health in rural Honduras. In a population of 24,696 adults with 176 isolated villages in western Honduras, we collected data on household food insecurity and physical and mental health outcome measures. Using logistic regression with and without adjusting for village and household level unobservables invariant across individual respondents, we show that females (OR: 1.11, p <0.01)), indigenous people (OR: 2:00, p < 0.01), and those planning to migrate (OR: 1.24, p <0.01) have higher odds of experiencing food insecurity. The risks of food insecurity and poor health were mitigated among respondents living where they were born and having multi-generations of relatives living in the same village-a measure of the opportunity and availability of social networks. Living in a food insecure compared to a food secure household was associated with 77 percent higher odds of being depressed, 35 percent higher odds of low overall mental health, and 20 percent higher odds for low overall health.

Under-five malnutrition among Palestine refugee children living in camps in Jordan: a mixed-methods study

Background

Jordan hosts the largest Palestine refugee population in the world. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the primary healthcare provider for Palestine refugees. To better inform UNRWA’s health programme, we conducted this study to assess the prevalence and determinants of malnutrition among Palestine refugee children in Jordan and to analyse caregiver perceptions of food insecurity and structural barriers to accessing food.

Methods

A cross-sectional study was conducted with a randomly selected sample of 405 households, for children under 5 years old in two refugee camps in Jordan, Jerash and Souf. Sociodemographic, food insecurity, diet quality and child anthropometric data were collected. Also, twenty in-depth interviews were conducted with children’s caregivers, along with two focus group discussions with UNRWA staff.

Results

Out of the 367 participants, the prevalence of stunting was 23.8% in Jerash and 20.4% in Souf (p=0.46), and overweight was 18.2% versus 7.1%, respectively (p=0.008). However, high food insecurity in Jerash was 45.7% and 26.5% in Souf (p=0.001), with no significant difference after multivariable adjustment. Qualitative perspectives saw food insecurity and low-quality children’s diets as largely mediated by job and income insecurity, especially marked in Jerash due to the lack of Jordanian citizenship.

Conclusion

We found a moderate-to-high prevalence of stunting and overweight levels among Palestine refugee children, which are three times higher than the 2012 Demographic and Health Survey data for Jordanian non-refugee children. High rates of household food insecurity were closely tied to households’ lack of essential civil and economic rights. We call for international collective efforts to expand economic livelihoods for Palestine refugees and to support UNRWA’s ongoing operations.

Food insecurity and the double burden of malnutrition in Colombian rural households

OBJECTIVE

This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother.

DESIGN

A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child.

SETTING

Rural Colombia.

PARTICIPANTS

Totally, 2·350 mother-child pairs living in the same household.

RESULTS

Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)).

CONCLUSIONS

Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.

Factors associated with undernutrition among children aged between 6-36 months in Semien Bench district, Ethiopia

BACKGROUND

Malnutrition is a term used to refer a condition of both excessive and under-nutrition. Even in the 21st c, it is yet among the major public health challenges that affect the health, growth, and development of millions of children across continents. Studies show that malnutrition during early childhood could result in devastating long-term effects such as poor school performance, weak immune system, and growth and development. Unfortunately, Ethiopia is among the developing countries hard hit by the problem of malnutrition (under-nutrition).

OBJECTIVE

To assess the magnitude of stunting, wasting, and underweight and risk factors associated with them; among Children aged between 6- 36 months.

METHODS

A community-based cross-sectional study design was conducted on 700 study participants from April to May 2020. Nutritional status of children aged between 6-36 months was determined based on the WHO reference population with Z score ≤ -2 SD (HAZ, WHZ and WAZ) was looked upon for stunting, wasting and underweight accordingly. Data were collected through structured and measuring anthropometric of the eligible sample unit. The questionnaire data were first entered into Epi-data and later analyzed following binary and multiple logistic regression analysis procedures with the help of IBM SPSS 26. Adjusted odds ratios, with 95% CI of the association and statistical significance declared at P-values ≤ 0.05 in this study.

RESULTS

In the present study, the response rate of the respondent was 100%. Factors significantly associated with undernutrition: stunting, Mothers who have no formal education (AOR = 2.58, 95% CI; 1.44-4.63), food insecure (AOR = 1.9, 95% CI; 1.23-2.9) and children had no feeding plate (AOR = 1.53, 95% CI; 1.07-2.19).

FOR UNDERWEIGHT

have not individual feeding plate (AOR = 2.39, 95% CI; 1.42-4.03), poor dietary diversity (AOR = 1.82, 95% CI; 1.23-2.69) and food insecurity (AOR = 4.24, 95% CI; 2.68-6.71).We have also identified age between 6-11 months (AOR = 6.81, 95% CI; 2.93-15.79), 12-23 months (AOR = 2.28, 95% CI; 1.03-5.06), food insecure (AOR = 10.34, 95% CI; 5.22-20.45) and poor dietary diversity (AOR = 5.58, 95% CI; 2.36-13.19) as risk factors associated with wasting.

CONCLUSION

This study relived that six variables significantly associate with undernutrition. These are: children have not his/her own feeding plate, household food insecurity, mother who had no formal education, poor dietary diversity and children aged between 6-11months and children age 6-23 months. Based on the findings of this study, the following recommendations are made. First, strategies and programs targeted towards the reduction and prevention of undernutrition among 6-36-month children should be made at all level to improve childhood nutritional status. Second, provide health information to families regarding the importance of separating children's feeding plate. Three, provide nutritional counselling about feeding practice and dietary diversity for mothers who have no formal education.

Factors associated with the double burden of malnutrition at the household level: A scoping review

The double burden of malnutrition (DBM) at the household level has been defined as the coexistence of underweight children and overweight mothers within the same household. The objective of the scoping review was to identify and understand factors associated with DBM. We conducted the scoping review of published, peer-reviewed journal articles in two major databases used in public health research (PubMed and Web of Science). A total of 70 articles met the eligibility criteria. The following factors were identified: mother's age, height, educational level, occupation, food intake, breastfeeding, family income, family size, and urbanization type. Overall, results were heterogeneous. Two scenarios have been identified. The first scenario is those obese women with a job, having a sufficient income, a high educational level, the ability to purchase food, and live either in rural or urban areas. The second scenario is obese women without a job, having an insufficient income, a low educational level, without the ability to purchase food, and live either in rural or urban areas. The DBM at the household level is a complex public health problem. There is a need for target-specific interventions to address child undernutrition and maternal overweight/obesity simultaneously.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran

PURPOSE

Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran.

METHODS

A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression.

RESULTS

A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders.

CONCLUSION

Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.

Stunting Was Associated with Reported Morbidity, Parental Education and Socioeconomic Status in 0.5-12-Year-Old Indonesian Children

Stunting is highly prevalent in Indonesian children. The objective of this study was to identify the associations of stunting with morbidity, parental education and socioeconomic status (SES) in Indonesian children. The study population was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 2236 Indonesian children aged 0.5 to 12 years, who had participated in the SEANUTS, were included in this study. Stunting was defined as height for age Z-score (HAZ) ≤ −2 using WHO criteria and severe stunting as HAZ ≤ −3. Information on morbidity, parental education and family SES were collected by structured questionnaires. ANOVA was used for evaluating differences across groups, with or without correction for confounders. The results showed that the overall prevalence of stunting was 31.4%. HAZ in stunted children was associated with disease incidence, including frequency, parental education and family income. There were no significant differences in HAZ values in stunted children with one or more bouts of infectious, digestive tract or respiratory tract illnesses compared to stunted children with no reported illness. The prevalence of stunting in Indonesian children was high and was strongly associated with child morbidity, parental education and SES.

Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children

BACKGROUND

Child overweight prevalence is increasing globally, but micronutrient deficiencies persist.

OBJECTIVES

We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting.

METHODS

We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao-Scott chi-square test and examined predictors of DBM and its components with logistic regression.

RESULTS

DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%-19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6-23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components.

CONCLUSIONS

Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.

Socio-Ecological Model of Correlates of Double Burden of Malnutrition in Developing Countries: A Narrative Review

(1) Background: The double burden of malnutrition (DBM) is a complex problem involving the coexistence of under- and over-nutrition within the same individual, household or population. This review aimed to discuss the correlates of the double burden of malnutrition through the socio-ecological model (SEM); (2) Methods: The PubMed database was systematically searched for peer-reviewed articles related to the double burden of malnutrition. Information on correlates of the double burden of malnutrition was extracted for analysis and discussion in alignment with the levels of the socio-ecological model.; (3) Results and Discussion: The correlates of the double burden of malnutrition identified from previous literature were: Race/genetics; maternal short stature; breastfeeding status; low maternal education; family size; household food security; household dietary diversity; and rural and urban settings. In the absence of evidence linking factors in a certain level of the SEM and the double burden of malnutrition, we employed correlates of overweight status and obesity to complete this narrative. Potential intervention strategies were proposed in alignment with the targets and settings identified, based on the socio-ecological approach; (4) Conclusions: The double burden of malnutrition is a public health phenomenon associated with a variety of socio-ecological determinants. An integrated approach is needed to address the root causes of malnutrition in all its forms, and at all life stages.

Determinants of the Stunting of Children Under Two Years Old in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey

Indonesia is ranked fifth among countries with the highest burden of stunting in children under five. This study aims to examine the determinants of stunting in children aged 0-2 years in Indonesia using data derived from the 2013 Indonesia Basic Health Survey. Twenty potential predictors of stunting, categorized into household and housing characteristics; maternal and paternal characteristics; antenatal care services and child characteristics were analyzed. Multilevel analyses were performed to examine the role of cluster/district/provincial differences, as well as individual/household level characteristics and stunting status. Of 24,657 children analyzed, 33.7% (95%CI: 32.8%-34.7%) were stunted. The odds of stunting increased significantly among children living in households with three or more children under five-years-old (aOR = 1.33, 95%CI: 1.03-1.72), households with five to seven household members (aOR =1.11; 95%CI: 1.03-1.20), children whose mothers during pregnancy attended less than four antenatal care services (aOR = 1.22, 95%CI: 1.08-1.39), boys (aOR = 1.33, 95%CI: 1.22-1.45), children aged 12-23 months (aOR = 1.89; 95%CI: 1.54-2.32), and children who weighed <2500 g at birth (aOR = 2.55; 95%CI: 2.05-3.15). The odds also increased significantly with the reduction of household wealth index. Integrated interventions to address environment, an individual level associated with stunting in Indonesia, from the environment- to individual-level factors are important.

Health issues in a Bangalore slum: findings from a household survey using a mobile screening toolkit in Devarajeevanahalli

Background

Slums are home to nearly one billion people in the world and are expanding at an exponential rate. Devarjeevanahalli is a large notified slum in Bangalore, South India which is characterised by poverty, overcrowding, hazardous living environment and social complexities. The poor living conditions not only affect the health of the people living there but also poses distinctive challenges to conducting health surveys. The purpose of this paper is to report the findings of a household survey that was done to study the health condition of people living in a slum.

Methods

A community-based cross-sectional survey was designed to determine the prevalence of health conditions using a mobile screening toolkit-THULSI (Toolkit for Healthy Urban Life in Slums Initiative). Devarjeevanahalli slum was chosen purposively as it is fairly representative of any slum in a big city in India. Sample size was calculated as 1100 households and demographic parameters at the household level and parameters related to priority health conditions (hypertension, diabetes mellitus, anaemia and malnutrition) at the individual level were studied.

Six zones within the slum were purposively selected and all the contiguous households were selected. The last of the six zones was partially surveyed as the desired sample size was achieved.

Results

A total of 1186 households were surveyed and 3693 people were screened. More than three fourth (70.4%) of the population were below poverty line. Only one third had a regular job and the average daily income was 5.3$ and 2.6$ in men and women respectively. The prevalence of hypertension (35.5%), diabetes (16.6%) and anaemia (70.9%) was high in the screened slum population. Most of the people (56.5% of hypertensives and 34.4% diabetics) were screened for the first time. Almost half of the children under the age of five years were stunted.

Conclusions

Poor income security and huge burden of health issues were reported among adults and children in the household health screening in a large notified slum in South India. Most people were unaware of their disease condition prior to the screening. Relatively simple technological solutions enabled the local health team to screen the slum population despite many challenges.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6756-7) contains supplementary material, which is available to authorized users.

Food insecurity and the risk of undernutrition complications among children and adolescents: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis was performed to examine the association between household food insecurity and the risk of being underweight, stunting, and wasting in children and adolescents.

METHODS

Pertinent studies were identified by searching PubMed, Web of Science, and Scopus databases up to June 2018. A total of 21 studies met the inclusion criteria to be included in the pooled analysis. The risk ratio of 55 173 individuals from 12 different countries were pooled in these studies for our meta-analysis.

RESULTS

It was found that food insecurity increased the risk of stunting (odds ratio [OR] = 1.17; 95% confidence interval [CI]: 1.09-1.25) and underweight (OR = 1.17; 95% CI: 1.01-1.36) but not of wasting (OR = 1.04; 95% CI: 0.96-1.12). Subgroup analysis by age indicated that food insecurity increased the risk of stunting (OR = 1.20; 95% CI: 1.02-1.39) and underweight (OR = 1.34; 95% CI: 1.02-1.77) in children older than 5 y. This association was significant just for stunting risk (OR = 1.14; 95% CI: 1.05-1.23) in children younger than 5 y. Furthermore, among children and adolescents, risk of stunting or being underweight increased by the intensification of the level of food insecurity in food-insecure households. Furthermore, subgroup analysis by country development levels showed that children and adolescents living in developing countries had higher risk of stunting (OR = 1.16; 95% CI: 1.05-1.27).

CONCLUSIONS

Household food insecurity appears to be associated with higher risk of stunting and being underweight among children and adolescents. In addition, the intensification of the level of food insecurity and the increased age of children may increase the risk of stunting or being underweight in food-insecure households. Also, the level of economic development is an important factor in the effects of food insecurity on risk of stunting.