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Mardani RAD, Wu WR, Hajri Z, Thoyibah Z, Yolanda H, Huang HC. Effect of a Nutritional Education Program on Children's Undernutrition in Indonesia: A Randomized Controlled Trial. J Pediatr Health Care 2024; 38:552-563. [PMID: 38613537 DOI: 10.1016/j.pedhc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION To assess effects of a nutritional education program on improving mothers' undernutrition knowledge, self-efficacy, and complementary feeding practices, and reducing undernutrition in children aged <2 years. METHOD A randomized controlled trial was conducted at a community healthcare center in Indonesia. The intervention group participated in a 4-week nutritional education program; the control group received standard care (n = 80; 1:1 ratio). Measurements consisted of mothers' knowledge of undernutrition, self-efficacy, and complementary feeding practices, and children's anthropometric indicators. RESULTS Intervention group mothers improved their understanding of undernutrition, self-efficacy, and complementary feeding practices compared to the control group. Additionally, children in the intervention group exhibited increased mean Z-scores for stunting, wasting, and being underweight at 12 and 24 weeks following the intervention. DISCUSSION Healthcare professionals can regularly provide nutritional education programs related to managing undernutrition and complementary feeding practices for mothers with children aged <2 years to prevent and improve undernutrition.
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kitaw TA, Tilahun BD, Abate BB, Haile RN. Minimum acceptable diet and its predictors among children aged 6-23 months in Ethiopia. A multilevel cloglog regression analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13647. [PMID: 38530126 PMCID: PMC11168368 DOI: 10.1111/mcn.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/10/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log-log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6-23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log-log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p-value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90-12.15) of the children meet the minimum acceptable diet. Child aged (18-23 month) (AOR = 1.78, 95CI:1.14-2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51-5.15), number of children three and above [(AOR = 0.78,95CI: 0.53-0.94], institutional delivery [AOR = 1.77,95CI: 1.11-3.11], having postnatal-check-up [AOR = 2.33,95CI: 1.59-3.41] and high community poverty level (AOR = 0.49,95CI: 0.29-0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check-ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children.
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Affiliation(s)
| | | | - Biruk Beletew Abate
- Department of Nursing, College of Health ScienceWoldia UniversityWoldiaEthiopia
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health ScienceWoldia UniversityWoldiaEthiopia
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Kitaw TA, Abate BB, Derese Tilahun B, Haile RN. Geospatial pattern of level of minimum acceptable diet and its determinants among children aged 6-23 months in Ethiopia. Spatial and multiscale geographically weighted regression analysis. Front Public Health 2024; 12:1348755. [PMID: 38962777 PMCID: PMC11221355 DOI: 10.3389/fpubh.2024.1348755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/17/2024] [Indexed: 07/05/2024] Open
Abstract
Background Despite prior progress and the proven benefits of optimal feeding practices, improving child dietary intake in developing countries like Ethiopia remains challenging. In Ethiopia, over 89% of children fail to meet the minimum acceptable diet. Understanding the geographical disparity and determinants of minimum acceptable diet can enhance child feeding practices, promoting optimal child growth. Methods Spatial and multiscale geographically weighted regression analysis was conducted among 1,427 weighted sample children aged 6-23 months. ArcGIS Pro and SatScan version 9.6 were used to map the visual presentation of geographical distribution failed to achieve the minimum acceptable diet. A multiscale geographically weighted regression analysis was done to identify significant determinants of level of minimum acceptable diet. The statistical significance was declared at P-value <0.05. Results Overall, 89.56% (95CI: 87.85-91.10%) of children aged 6-23 months failed to achieve the recommended minimum acceptable diet. Significant spatial clustering was detected in the Somali, Afar regions, and northwestern Ethiopia. Children living in primary clusters were 3.6 times more likely to be unable to achieve the minimum acceptable diet (RR = 3.61, LLR =13.49, p < 0.001). Mother's with no formal education (Mean = 0.043, p-value = 0.000), family size above five (Mean = 0.076, p-value = 0.005), No media access (Mean = 0.059, p-value = 0.030), home delivery (Mean = 0.078, p-value = 0.002), and no postnatal checkup (Mean = 0.131, p-value = 0.000) were found to be spatially significant determinants of Inadequate minimum acceptable diet. Conclusion Level of minimum acceptable diet among children in Ethiopia varies geographically. Therefore, to improve child feeding practices in Ethiopia, it is highly recommended to deploy additional resources to high-need areas and implement programs that enhance women's education, maternal healthcare access, family planning, and media engagement.
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Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Aboagye RG, Donkoh IE, Okyere J, Seidu AA, Ahinkorah BO, Yaya S. Can women empowerment boost dietary diversity among children aged 6-23 months in sub-Saharan Africa? Trop Med Health 2024; 52:39. [PMID: 38835092 DOI: 10.1186/s41182-024-00579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The empowerment of women has implications on the health and dietary needs of children. Using the survey-based women's empowerment index (SWPER), we examined the association between women's empowerment and dietary diversity among children aged 6-23 months in sub-Saharan Africa. METHODS Data from the Demographic and Health Surveys of 21 countries were utilized. Descriptive spatial map was used to present the proportions of dietary diversity among the children. Multilevel binary logistic regression was used to examine the association between SWPER and dietary diversity. RESULTS Overall, 22.35% of children aged 6-23 months had adequate minimum dietary diversity (MDD) in sub-Saharan Africa. The countries with the highest proportions of adequate MDD were Angola, Benin, Madagascar, Rwanda, Sierra Leone, and South Africa. South Africa had the highest proportion of MDD (61.00%), while Liberia reported the least (9.12%). Children born to mothers who had high social independence were more likely to have adequate MDD compared to those with low social independence [aOR = 1.31, 95% CI 1.21, 1.41]. In addition, children born to women with medium [aOR = 1.12; 95% CI 1.03, 1.21] and high decision-making [aOR = 1.25, 95% CI 1.14, 1.37] were more likely to receive MDD than those with low decision-making. CONCLUSIONS Insufficient dietary diversity is evident among children aged 6-23 months in sub-Saharan Africa. MDD in children is influenced by women's empowerment. Policies and interventions promoting women's empowerment can enhance MDD, especially for vulnerable groups in rural and poorer households. It is crucial to leverage media and poverty reduction strategies to improve MDD among children in sub-Saharan African countries.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, K1N 6N5, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Shibeshi AH, Mare KU, Kase BF, Wubshet BZ, Tebeje TM, Asgedom YS, Asmare ZA, Asebe HA, Lombebo AA, Sabo KG, Fente BM, Seifu BL. The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model. PLoS One 2024; 19:e0298647. [PMID: 38771790 PMCID: PMC11108208 DOI: 10.1371/journal.pone.0298647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. OBJECTIVE To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. METHODS The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. RESULTS The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. CONCLUSION Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.
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Affiliation(s)
- Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Betel Zelalem Wubshet
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Amzat J, Aminu K, Matankari B, Ismail A, Almu B, Kanmodi KK. Sociocultural context of exclusive breastfeeding in Africa: A narrative review. Health Sci Rep 2024; 7:e2115. [PMID: 38742092 PMCID: PMC11089088 DOI: 10.1002/hsr2.2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
Background and Aims Although exclusive breastfeeding (EBF) has many benefits, it is not commonly practiced in several countries as a result of context-specific challenges. EBF practice is thus a global health discourse because over 200 million children suffer from malnutrition despite the abundance of human milk. The risk of starvation remains very high among African children with less than 40% of them exclusively breastfed. In Africa, the adoption or nonadherence to EBF is a sociocultural issue. Hence, this narrative review examined the sociocultural context of EBF in the region. Methods PubMed, Google Scholar, and Scopus were searched using keywords related to EBF and Africa. Relevant data from selected studies were synthesized narratively and reported using a structured narrative format. Results EBF is strongly rooted in every culture and is a culturally determined behavior. Some believe that colostrum is dirty and harmful to newborns and, thus, needs to be purified. Despite the belief that human milk is the best food for babies, mothers often complement human milk with other foods right from birth because of perceived lactation inadequacy. Most African mothers believe in prelacteal feeding to help cleanse the infant's gastrointestinal tract for digestion, quench thirst, flush the bladder and help the mother to rest after childbirth before breastfeeding (BF) is initiated. The role of significant others was equally found important in the decision and duration of BF. The availability of family support (especially from grandmothers and husbands) reportedly encouraged EBF in Africa. The duration and exclusivity of BF in Africa are negatively associated with demographic variables like young age, low level of education, being unmarried, low income, out of employment, and parity (first-time mother). Conclusion While there have been some efforts and policies to improve EBF, it is important to consider context-specific challenges and sociocultural factors. There is a need for more deliberate efforts to encourage mothers through the implementation of effective best practices concerning EBF in Africa.
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Affiliation(s)
- Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
- Department of SociologyUniversity of JohannesburgJohannesburgSouth Africa
| | - Kafayat Aminu
- Centre for Child and Adolescent Mental HealthUniversity College HospitalIbadanNigeria
| | | | - Abbas Ismail
- Department of SociologyUmaru Musa Yar'adua UniversityKatsinaNigeria
| | - Bello Almu
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
| | - Kehinde Kazeem Kanmodi
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of DentistryUniversity of RwandaKigaliRwanda
- Cephas Health Research Initiative IncIbadanNigeria
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Kanmodi KK, Amzat J, Aminu K. Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review. Health Sci Rep 2024; 7:e2078. [PMID: 38690007 PMCID: PMC11058263 DOI: 10.1002/hsr2.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Aims One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY. Methods/Literature Search Strategy Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review. Results The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY. Conclusion The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- School of DentistryUniversity of RwandaKigaliRwanda
- Child Health and Wellbeing (CHAW) ProgramCephas Health Research Initiative IncIbadanNigeria
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
| | - Kafayat Aminu
- Center for Child and Adolescent Mental HealthUniversity College HospitalIbadanNigeria
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Wubetie BY, Tsunekawa A, Haregeweyn N, Tsubo M, Nigussie Z, Meshesha TM, Abe T. Analysis of Malnutrition among Children under Five Years across Contrasting Agroecosystems of Northwest Ethiopia: Application of Structural Equation Modeling. Nutrients 2024; 16:1208. [PMID: 38674898 PMCID: PMC11054005 DOI: 10.3390/nu16081208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Child malnutrition remains a public health challenge in developing countries, but a comprehensive understanding of its burden and its determinants in specific local contexts is generally lacking. This study examined the prevalence of malnutrition and its determinants among children aged <5 years across contrasting agroecosystems in northwest Ethiopia. A community-based cross-sectional study involving 400 respondents was employed. Data were collected through semi-structured questionnaires and anthropometric measurements, complemented with focus group discussions and key informant interviews. The direct and indirect effects of the determinants of malnutrition were examined using structural equation modeling (SEM). The overall prevalence of child malnutrition, measured using the Composite Index of Anthropometric Failure, was 49%, with notable variation across agroecosystems (from 36.1% [midland with red soil] to 59% [lowland and valley fragmented]). Disease experience had significant positive direct effects on malnutrition. Dietary intake had negative and significant total (direct and indirect) effects on malnutrition, partially mediated through disease experience. Serial mediation in SEM analysis revealed significant indirect relationships between malnutrition and food security, feeding and care practices, household environment, health services, maternal diet, maternal empowerment, household wealth, and nutrition-sensitive agricultural practices. In conclusion, child malnutrition was highly prevalent and higher among children in the lowland and valley fragmented agroecosystem, characterized by unfavorable agro-climatic conditions, lower wealth status, poor health services access, and higher disease (particularly malaria) exposure. This study demonstrates the dynamics and multifaceted nature of malnutrition, highlighting the importance of considering geographical differences when planning interventions for childhood malnutrition and its determinants.
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Affiliation(s)
- Biruk Yazie Wubetie
- The United Graduate School of Agricultural Sciences, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
- College of Agriculture and Environmental Sciences, Bahir Dar University, Bahir Dar P.O. Box 5501, Ethiopia
| | - Atsushi Tsunekawa
- Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Nigussie Haregeweyn
- International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Mitsuru Tsubo
- Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Zerihun Nigussie
- College of Agriculture and Environmental Sciences, Bahir Dar University, Bahir Dar P.O. Box 5501, Ethiopia
| | - Taye Minichil Meshesha
- The United Graduate School of Agricultural Sciences, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
- School of Civil and Water Resources Engineering, Debre Markos Institute of Technology, Debre Markos University, Debre Markos P.O. Box 269, Ethiopia
| | - Takeshi Abe
- International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
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Atosona A, Mohammed JA, Issahaku H, Saani K, Addae HY, Azupogo F. Maternal employment status and child age are positive determinants of minimum dietary diversity among children aged 6-23 months in Sagnarigu municipality, Ghana: a cross-sectional study. BMC Nutr 2024; 10:57. [PMID: 38622652 PMCID: PMC11020657 DOI: 10.1186/s40795-024-00865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Intake of a diversified diet is key to the prevention of malnutrition among children as it results in improved intake of energy and micronutrients, which are deemed critical for better nutritional status of children. This study assessed minimum dietary diversity (MDD) and its determinants among children aged 6-23 months in the Sagnarigu Municipality of Ghana. METHODS This was an analytical cross-sectional study, carried out in the Sagnarigu Municipality, Ghana and involved 369 mother-child pairs selected through a systematic random sampling. A semi-structured questionnaire was used to obtain respondents' socio-demographic characteristics, feeding practices, nutritional knowledge and anthropometry. MDD was assessed using a repeated 24-hour dietary recall method. Chi-square/Fisher exact test and binary logistic regression analysis were used to determine the factors associated with MDD. RESULTS The study found that 24.9% of the children were between the ages of 6-8 months and 75.1% were between the ages of 9-23 months. About 64.2% of the children met the MDD. Children of mothers who were self-employed were approximately 2 times more likely to meet the MDD as compared to children of mothers who were unemployed [Adjusted Odd Ratio (AOR): 1.93, 95% CI (1.13-3.31), P = 0.017]. Also, children aged 9-23 months were approximately 14 times more likely to meet MDD as compared to younger children aged 6-8 months [AOR: 13.98, 95% CI (7.54-25.91), P < 0.001]. CONCLUSION Our study suggests that maternal empowerment may have positive effects on improving the MDD of infants and young children.
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Affiliation(s)
- Ambrose Atosona
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
| | - Jawahir Abukari Mohammed
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Huzaifa Issahaku
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Khadija Saani
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | | | - Fusta Azupogo
- Faculty of Agriculture, Department of Family and Consumer Sciences, Food and Consumer Sciences, University for Development Studies, Tamale, Ghana
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Angula M, Ishola A, Tjiurutue M, Chigonga N, Sulyok M, Krska R, Ezekiel CN, Misihairabgwi J. Association of food consumption patterns and nutritional status of children under 5 years from rural households in Northern regions, Namibia. BMC Nutr 2024; 10:51. [PMID: 38500224 PMCID: PMC10949813 DOI: 10.1186/s40795-024-00833-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Many developing countries, Namibia included, have a high prevalence of malnutrition among children, especially in rural subsistence farming areas where inadequate food supply is common. Poor diets in children under 5 years may result in negative health impacts. This study determined the association of food consumption patterns and nutritional status of children under 5 years from rural households in Oshana and Oshikoto regions in Namibia. METHOD Employing a cross-sectional descriptive design, 377 children under 5 years participated in this study using purposive sampling. Validated dietary diversity and food frequency questionnaires were used to obtain information on demographic characteristics, commonly consumed food per week, and meal frequencies for the recruited children. Anthropometric measurements were obtained to assess nutritional status of children using Emergency Nutrition Assessment (ENA) software. Descriptive and inferential statistics were computed using the IBM® SPSS® Statistics (Statistical Package for Social Sciences) version 27. RESULTS Staple foods, mostly grains, roots and tubers, along with flesh foods, legumes and nuts were commonly consumed. Vitamin A-rich fruits and vegetables were solely consumed in Oshana region (10.7%) and not in Oshikoto. Oshana exhibited a lower dietary diversity score (4±1 SD) compared to Oshikoto (5±1 SD). The prevalence of adequate feeding practices varied, with Oshana having 38.8% meeting minimum milk feeding frequency (MMFF), 55.6% minimum dietary diversity (MDD), 69.8% minimum meal frequency (MMF), and 27% minimum acceptable diet (MAD). In Oshikoto, these figures were lower at 2%, 7%, 32%, and 0.5%, respectively. Stunting, underweight, wasting, and overweight were also documented, with slight differences between the two regions. The study did not find association between nutritional status and MMFF, MDD and MAD. However, significant associations were found between specific food types, amount of food, breastfeeding length, MMF and malnutrition indicators in both regions (p<0.05). CONCLUSION Most study participants consumed locally available staple foods. Stunting, underweight, and wasting were prevalent among children in the two regions which were significantly associated to the amount of food consumed, MMF and/ some food types. Improving food environments and eliminating access barriers to diversified diets can mitigate high prevalence of malnutrition among rural children.
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Affiliation(s)
- Maria Angula
- Department of Human, Biological, and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia.
| | - Anthony Ishola
- Department of Pharmaceutical Sciences, School of Pharmacy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia
| | - Muvari Tjiurutue
- Department of Biochemistry, Microbiology and Biotechnology, School of Science, University of Namibia, Windhoek, Namibia
| | | | - Michael Sulyok
- Department of Agrobiotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, University of Natural Resources and Life Sciences, Vienna, Konrad Lorenz Str. 20, Tulln, A-3430, Austria
| | - Rudolf Krska
- Department of Agrobiotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, University of Natural Resources and Life Sciences, Vienna, Konrad Lorenz Str. 20, Tulln, A-3430, Austria
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, United Kingdom
| | - Chibundu N Ezekiel
- Department of Agrobiotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, University of Natural Resources and Life Sciences, Vienna, Konrad Lorenz Str. 20, Tulln, A-3430, Austria
| | - Jane Misihairabgwi
- Department of Human, Biological, and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
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Birhanu F, Yitbarek K, Atlantis E, Woldie M, Bobo F. Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005-2016. PLoS One 2024; 19:e0295810. [PMID: 38215079 PMCID: PMC10786372 DOI: 10.1371/journal.pone.0295810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/29/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016. METHOD We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI). RESULT A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P<0.01), 9.5 percentage points for underweight (33.2% to23.7%, P<0.01), and 2.1 percentage points for wasting (12.2% to10.1%, P<0.01). There was persistent and statistically evidence of wealth inequality in stunting, underweight, and wasting (concentration indeces of -0.2 to -0.04, all P values <0.05). Stunting, underweight, and wasting variables were associated with male sex of the child (RR 0.94, 0.95, 0.85, all P-values <0.01) recent diarrhea (RR 1.18, 1.27, 1.37, all P-values <0.01), secondary education status of the mother (RR 0.66, 0.57, 0.61, all P-values < 0.057), increasing wealth index (richest) (RR 0.73, 0.70, 0.50, all P-values < 0.05), and having no toilet facility (RR 1.16, 1.22, 1.18, all P-values < 0.05). CONCLUSION Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Southwest Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Firew Bobo
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6-59 months in Nigeria. BMC Nutr 2024; 10:1. [PMID: 38167375 PMCID: PMC10762859 DOI: 10.1186/s40795-023-00813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Malnutrition has remained a global public health issue, particularly in low- and middle-income countries (LMICs). Researchers have committed to studying malnutrition (especially in children under the age of five) to address the nine malnutrition targets, set by the WHO to be achieved by 2025. This study seeks to evaluate the prevalence, the individual and contextual predictors of malnutrition among children aged 6-59 months across Nigeria and its states. Two separates, independently collected, nationally representative cross-sectional surveys, the National Human Development Report (NHDR 2018) and the 2018 Nigeria Demographic and Health Survey (2018 NDHS) were linked for this study. Spatial map was used to describe the prevalence of malnutrition, a 3-level multivariate multilevel logistic regression models were fitted where children/individuals (at level 1) were nested in communities/clusters (at level 2) and nested in states (at level 3). A weighted sample of 7,770 children 6-59 months were considered in this study. The results showed that an estimated 43.6% of children aged 6-59 months are poorly nourished in Nigeria. The proportions of poorly nourished children were generally highest in the Northern Nigeria. Child's gender, age, birth size, preceding birth order, anaemia status, maternal education, work status, body weight, household wealth status, number of bedrooms were among individual/household predictors of malnutrition. On the community level, being from community with high wealth index, distance to nearest health facilities is no big problem. Regional variations and gender inequality index were the state level predictors of malnutrition among children in Nigeria. This study has shown that two-third of children aged 6-59 months in Nigeria were poorly nourished, an indication of a growing concern of double burden of malnutrition in Nigeria.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK.
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, 912231, Bida, Nigeria.
| | - Stephen J Walters
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Jacques
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, S10 2BP, Sheffield, UK
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Yu Y, Liu C, Chen K, Li S. Parental migration and children's dietary diversity at home: Evidence from rural China. PLoS One 2023; 18:e0291041. [PMID: 38060621 PMCID: PMC10703207 DOI: 10.1371/journal.pone.0291041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/21/2023] [Indexed: 12/18/2023] Open
Abstract
There is a growing literature documenting the link between parental migration and children's health. However, few studies have explained the underlying mechanism of this observed relationship. This paper examines the effect of parental migration on children's health through dietary diversity, using survey data collected in a less developed prefecture in South Central China in 2018. To overcome the potential endogeneity of parental migration, we instrument parental migration with the proportion of households with migrated labor force at the village level, and find that parental migration reduces children's dietary diversity at home. Moreover, we provide suggestive evidence that the reduction in dietary diversity may attribute to significant negative separation effects whereas minimal positive income effects in migrant-sending households. This study highlights the negative effects of labor migration on the next generation's nutrition. In those developing countries with a high prevalence of labor migration, policies that facilitate access to dietary diversity of those left-behind children are warranted.
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Affiliation(s)
- Yanying Yu
- China Academy for Rural Development, Zhejiang University, Hangzhou, China
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Kevin Chen
- China Academy for Rural Development, Zhejiang University, Hangzhou, China
- International Food Policy Research Institute, East and Central Asia Office, Beijing, China
| | - Shaoping Li
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
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Hossain MI, Kabir S, Zinia FA. Gender disparity in minimum dietary diversity failure among currently breastfed children aged 6-23 months in Bangladesh: evidence from Bangladesh Multiple Indicator Cluster Survey, 2019. J Nutr Sci 2023; 12:e107. [PMID: 37964976 PMCID: PMC10641693 DOI: 10.1017/jns.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/03/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Research on children's dietary diversity plays a crucial role in designing effective health interventions. Thus, this study aimed to identify the factors contributing to minimum dietary diversity failure (MDDF) among male and female children aged 6-23 months in Bangladesh. The data for this study was obtained from the Bangladesh Multiple Indicator Cluster Survey, 2019, which included children currently breastfed within a specific age range. Multivariable binary logistic regression was employed to assess the strength and significance of the association. The findings revealed that approximately 59⋅4 % of children in Bangladesh experienced MDDF, with 57⋅8 % of male children and 61 % of female children affected. Proportion test uncovered a significant gender disparity (χ2=6⋅58, P-value = 0⋅01) among children aged 6-23 months. However, the multivariable binary logistic regression analysis revealed that both male and female children shared common risk factors for MDDF, which included child age, maternal educational status, wealth status, number of antenatal care visits, and division. In our study, we observed varied spatial patterns in minimal dietary diversity. Sherpur, Netrokona, Sunamganj, and Sylhet districts showed the highest failure rates. Notably, all are flood-affected areas, impacting food availability and diversity. For targeted regional development programmes, district mapping results may offer valuable insights to policymakers, especially in areas with a high prevalence of dietary diversity failure. By understanding these risk factors, policymakers and stakeholders can implement targeted strategies to improve dietary diversity among children, promoting better health and well-being for the young population in Bangladesh.
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Affiliation(s)
- Md. Ismail Hossain
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh
| | - Samia Kabir
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
| | - Faozia Afia Zinia
- Department of Statistics, Jagannath University, Dhaka 1100, Bangladesh
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Lacerda EMDA, Bertoni N, Alves-Santos NH, Carneiro LBV, Schincaglia RM, Boccolini CS, Castro IRRD, Anjos LAD, Berti TL, Kac G, Rodrigues Farias D, de Freitas MB, Normando P, Andrade PG. Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age. CAD SAUDE PUBLICA 2023; 39:e00081422. [PMID: 37878864 PMCID: PMC10599228 DOI: 10.1590/0102-311xen081422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 10/27/2023] Open
Abstract
The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.
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Affiliation(s)
| | - Neilane Bertoni
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Nadya Helena Alves-Santos
- Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Belém, Brasil
| | | | | | - Cristiano Siqueira Boccolini
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Talita Lelis Berti
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Gilberto Kac
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Seid A, Dugassa Fufa D, Weldeyohannes M, Tadesse Z, Fenta SL, Bitew ZW, Dessie G. Inadequate dietary diversity during pregnancy increases the risk of maternal anemia and low birth weight in Africa: A systematic review and meta-analysis. Food Sci Nutr 2023; 11:3706-3717. [PMID: 37457158 PMCID: PMC10345738 DOI: 10.1002/fsn3.3388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023] Open
Abstract
Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa. A systematic review of observational studies published between January 2000 and April 2022 was undertaken using the Google Scholar, PubMed, and CINAHL databases. The PRISMA checklist was followed to present the results. Microsoft Excel was used to abstract the data. STATA version 17 was used to analyze the data, and a random-effects meta-analysis model was applied to compute the pooled estimates. The study was registered in PROSPERO with protocol number CRD42022320873. A total of 22 publications with 9,696 participants were included in the final meta-analysis. The pooled adjusted odds ratio (AOR) for inadequate dietary diversity and maternal anemia was 2.15 (95% CI, 1.66-2.65), while that for low birth weight was 2.04 (95% CI, 1.46-2.63). The highest pooled estimate of maternal anemia was reported in Cameroon (AOR = 9.8, 95% CI: 1.68-17.92), followed by Ethiopia (AOR = 2.6, 95% CI: 1.95-3.25). Similarly, the pooled estimates of low birth weight were highest in Cameroon (AOR = 3.04, 95% CI: 1.19-4.88) and Ethiopia (AOR = 1.8, 95% CI: 1.29-2.39). In Africa, pregnant mothers with inadequate dietary diversity are two times more likely to develop anemia and low birth weight. Social protection policies that prioritize pregnant women, maternal nutrition promotion in the community, and dietary counseling during antenatal care visits, using national food-based dietary guidelines, should be strengthened.
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Affiliation(s)
- Awole Seid
- Department of Adult Health NursingCollege of Medicine and Health Sciences, Bahir Dar UniversityBahir DarEthiopia
- Center for Food Sciences and NutritionAddis Ababa UniversityAddis AbabaEthiopia
| | - Desta Dugassa Fufa
- Center for Food Sciences and NutritionAddis Ababa UniversityAddis AbabaEthiopia
- Haramaya Institute of Technology, Haramaya UniversityDire DawaEthiopia
| | | | - Zuriyash Tadesse
- Department of Nutrition and DieteticsMekelle UniversityMekelleEthiopia
| | - Selamawit Lake Fenta
- Department of MidwiferyCollege of Medicine and Health Sciences, Bahir Dar UniversityBahir DarEthiopia
| | - Zebenay Workneh Bitew
- Center for Food Sciences and NutritionAddis Ababa UniversityAddis AbabaEthiopia
- St. Paul Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | - Getenet Dessie
- Department of Adult Health NursingCollege of Medicine and Health Sciences, Bahir Dar UniversityBahir DarEthiopia
- National Center for Epidemiology and Population HealthAustralian National University, College of Health and MedicineAustralian Capital TerritoryCanberraAustralia
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Akanbonga S, Hasan T, Chowdhury U, Kaiser A, Akter Bonny F, Lim IE, Mahmud I. Infant and young child feeding practices and associated socioeconomic and demographic factors among children aged 6-23 months in Ghana: Findings from Ghana Multiple Indicator Cluster Survey, 2017-2018. PLoS One 2023; 18:e0286055. [PMID: 37294773 PMCID: PMC10256209 DOI: 10.1371/journal.pone.0286055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms. OBJECTIVE This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6-23 months in Ghana. METHOD We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017-18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver's self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses. FINDINGS Among 2,585 IYC aged 6-23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD. CONCLUSION We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6-23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity.
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Affiliation(s)
- Samson Akanbonga
- Department of Nutrition and Dietherapy, Holy Family Hospital, Techiman, Ghana
| | - Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Adrita Kaiser
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Fatema Akter Bonny
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ignitius Ezekiel Lim
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
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Raru TB, Merga BT, Mulatu G, Deressa A, Birhanu A, Negash B, Gamachu M, Regassa LD, Ayana GM, Roba KT. Minimum Dietary Diversity Among Children Aged 6-59 Months in East Africa Countries: A Multilevel Analysis. Int J Public Health 2023; 68:1605807. [PMID: 37325176 PMCID: PMC10267305 DOI: 10.3389/ijph.2023.1605807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: To find out the determinants of minimum dietary diversity (MDD) among under-five children in East Africa based on the 2017 revised indicator. Methods: Secondary data from the demographic and health survey (DHS) of eight countries in East Africa were combined. A total of 27,223 weighted samples of children aged 6-59 months were included. Multi-level logistic regression analysis was employed to identify the determinants of dietary diversity. Results: The magnitude of adequate MDD in East Africa was found to be 10.47% with 95% CI (10.12-10.84) with the lowest and highest magnitude in Ethiopia and Rwanda respectively. Having a mother in the age group of 35-49, having a mother with higher educational attainment, and having a post-natal check-up within 2 months were significant factors in determining adequate MDD. Conclusion: The magnitude of adequate MDD intake among children aged 6-59 months in East Africa is relatively low. Therefore, strengthening interventions focused on improving the economic status of households, the educational status of mothers, and diversified food consumption of children aged 6-59 months should get priority to improve the recommended feeding practice of children.
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Affiliation(s)
- Temam Beshir Raru
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gutema Mulatu
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mulugeta Gamachu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Departments of Public Health, Rift Valley University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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A hybrid ensemble approach to accelerate the classification accuracy for predicting malnutrition among under-five children in sub-Saharan African countries. Nutrition 2023; 108:111947. [PMID: 36641887 DOI: 10.1016/j.nut.2022.111947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The proper intake of nutrients is essential to the growth and maturation of youngsters. In sub-Saharan Africa, 1 in 7 children dies before age 5 y, and more than a third of these deaths are attributed to malnutrition. The main purpose of this study was to develop a majority voting-based hybrid ensemble (MVBHE) learning model to accelerate the prediction accuracy of malnutrition data of under-five children in sub-Saharan Africa. METHODS This study used available under-five nutritional secondary data from the Demographic and Health Surveys performed in sub-Saharan African countries. The research used bagging, boosting, and voting algorithms, such as random forest, decision tree, eXtreme Gradient Boosting, and k-nearest neighbors machine learning methods, to generate the MVBHE model. RESULTS We evaluated the model performances in contrast to each other using different measures, including accuracy, precision, recall, and the F1 score. The results of the experiment showed that the MVBHE model (96%) was better at predicting malnutrition than the random forest (81%), decision tree (60%), eXtreme Gradient Boosting (79%), and k-nearest neighbors (74%). CONCLUSIONS The random forest algorithm demonstrated the highest prediction accuracy (81%) compared with the decision tree, eXtreme Gradient Boosting, and k-nearest neighbors algorithms. The accuracy was then enhanced to 96% using the MVBHE model. The MVBHE model is recommended by the present study as the best way to predict malnutrition in under-five children.
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Ngure FM, Kassim N, Phillips EL, Turner PC. Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania. Curr Dev Nutr 2023; 7:100030. [PMID: 37180082 PMCID: PMC10111587 DOI: 10.1016/j.cdnut.2023.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background Inadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development. Objectives To assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania. Methods Early feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6-18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level. Results The MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations. Conclusions Poor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.
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Affiliation(s)
- Francis M. Ngure
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Neema Kassim
- Department of Food Biotechnology and Nutritional Sciences, School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Erica L. Phillips
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Paul C. Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
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Saha J, Chouhan P, Malik NI, Ghosh T, Das P, Shahid M, Ahmed F, Tang K. Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey. Nutrients 2022; 15:nu15010159. [PMID: 36615816 PMCID: PMC9824371 DOI: 10.3390/nu15010159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Low dietary diversity significantly interplays with children’s growth failure. However, evidence of its crucial role in children’s health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015−2016. A total of 67,278 mother-child pairs of children between the ages of 6−23 months and mothers aged 15−49 years were included in this study. Pearson’s chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (<4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21−1.38), wasted (AOR = 1.29; 95% CI; 1.21−1.38), and underweight (AOR = 1.47; 95% CI; 1.39−1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.
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Affiliation(s)
- Jay Saha
- Department of Geography, University of Gour Banga (UGB), Malda 732103, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga (UGB), Malda 732103, West Bengal, India
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan
| | - Tanmoy Ghosh
- Department of Geography, University of Gour Banga (UGB), Malda 732103, West Bengal, India
| | - Puja Das
- Department of Geography, University of Gour Banga (UGB), Malda 732103, West Bengal, India
| | - Muhammad Shahid
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China
| | - Farooq Ahmed
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China
- Department of Anthropology, Quaid-i-Azam University Islamabad, Islamabad 44000, Pakistan
- Correspondence: (F.A.); (K.T.); Tel.: +86-13-6711-29425 (K.T.)
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing 100029, China
- Correspondence: (F.A.); (K.T.); Tel.: +86-13-6711-29425 (K.T.)
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Moga Lencha F, Jebero Zaza Z, Ena Digesa L, Mulatu Ayana T. Minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia, 2021: a cross-sectional study. BMC Public Health 2022; 22:2368. [PMID: 36527009 PMCID: PMC9758836 DOI: 10.1186/s12889-022-14861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor quality diets are the greatest obstacles to survival, growth, development, and learning in children. Dietary diversity is a major problem in developing countries including Ethiopia. For better feeding practices and focused interventions, it is essential to identify dietary diversity in children. In order to draw firm conclusions, previous studies in Ethiopia were unable to get a thorough picture of the dietary diversity among children under the age of five. Therefore, the purpose of this study was to identify minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia. METHODS An institution-based cross-sectional study design was used from February to March, 2021. The sample size of the study was 406. A simple random sampling was used to select the study participants. The minimum dietary diversity of the children was assessed by a standardized dietary assessment tool. The information was gathered using a standardized questionnaire that was administered by an interviewer. The collected data were entered into Epi Data 4.6 then exported to SPSS 26 for analysis. A multivariable logistic regression model was used to identify the independent predictors of the study. The statistical significance level was set at P < 0.05, and the degree of the association was measured using an AOR with a 95% CI. RESULTS A total of 399 participants were involved in this study. Nearly half (52.1%) of the study children met the minimum dietary diversity. The most popular foods were grains, roots, and tubers (79.2%), followed by dairy products (58.1%), vitamin A-rich fruits and vegetables, and grains, roots, and tubers (58.1%). Children whose mothers worked as daily workers had a lower likelihood of meeting the minimal dietary diversity requirement. However, children with separate eating plates from adults, households with food security, low monthly food expenditure, collaborative decision-making on household spending, birth intervals greater than 24 months, and health education on infant and young child feeding were more likely to achieve the minimal dietary diversity requirements. CONCLUSION The proportion of the minimum dietary diversity was higher than in previous studies from Ethiopia. The minimum dietary diversity was higher than in previous studies from Ethiopia. Family planning for birth spacing, nutritional counseling on infant and young child feeding, and parent communication in a child's feeding are critical to improve dietary diversity in a child's feeding.
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Affiliation(s)
- Fikre Moga Lencha
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Zenebe Jebero Zaza
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Lankamo Ena Digesa
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
| | - Tegegn Mulatu Ayana
- grid.442844.a0000 0000 9126 7261College of Medicine and Health Sciences, Arba Minch University, P.O. Box;21, Arba Minch, Ethiopia
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Determinants of undernutrition among young children in Ethiopia. Sci Rep 2022; 12:20945. [PMID: 36470914 PMCID: PMC9722653 DOI: 10.1038/s41598-022-25160-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Ethiopia is one of the countries in sub-Saharan Africa with the highest burden of childhood undernutrition. Despite the high burden of this scourge, little is known about the magnitude and contributing determinants to anthropometric failure among children aged 0-23 months, a period regarded as the best window of opportunity for interventions against undernutrition. This study examined factors associated with undernutrition (stunting, wasting, and underweight) among Ethiopian children aged 0-23 months. This study used a total weighted sample of 2146 children aged 0-23 months from the 2019 Ethiopian Mini Demographic and Health Survey. The data were cleaned and weighted using STATA version 14.0. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. Multilevel mixed-effects logistic regression models adjusted for cluster and survey weights were used. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were estimated. Statistical significance was declared at p < 0.05. The overall weighted prevalence of stunting, wasting, and underweight respectively were 27.21% [95% CI (25.32-29.18)], 7.80% [95% CI (6.71-9.03)], and 16.44% [95% CI (14.90-18.09)] among children aged 0-23 months in Ethiopia. Female children were less likely to be associated with stunting [AOR: 0.68, 95% CI (0.54-0.86)], wasting [AOR: 0.70, 95% CI (0.51, 0.98)], and underweight [AOR: 0.64, 95% CI (0.49, 0.83)] than their male counterparts. Conversely, older children aged 12-17 months [AOR: 2.22, 95% CI (1.52, 3.23)] and 18-23 months [AOR: 4.16, 95% CI (2.75, 6.27)] were significantly at an increased odds of becoming stunted. Similarly, the likelihood of being underweight was higher in older age groups: 6-11 months [AOR: 1.74, 95% CI (1.15, 2.63)], 12-17 months [AOR: 2.13, 95% CI (1.40, 3.24)], and 18-23 months [AOR: 4.08, 95% CI (2.58, 6.44)] compared with the children younger than 6 months. Lower wealth quintile was one of the other significant determinants of stunting and underweight. The study's findings indicated that the most consistent significant risk factors for undernutrition among children aged 0-23 months are: male sex, older age groups and lower wealth quintile. These findings emphasize the importance of strengthening nutrition-specific and sensitive interventions that address the immediate and underlying drivers of childhood undernutrition in early life, as well as targeting low-income households with male children, in order for Ethiopia to meet the Sustainable Development Goals (SDGs) 1,2 and 3 by 2030.
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Masita ED, Amalia R, Rahayu EP, Fernandes AP, Costa AD, Freitas AFDC, Hasina SN. Analysis of Factors that affect Events and Interventions of Stunting through the E-Stunting Android Application. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Based on the Indonesian Toddler Nutrition Status Survey in 2021, it was found that the stunting rate in Indonesia reached 24.4%, which means there were 5.33 million indicated stunting.
Objective: The purpose of this study was to detect the causative factors and effectiveness of stunting interventions in the E stunting application.
Methods: The type of the research is quantitative analytic with cross sectional approach using double linear regression analytic test with p = 0.05. The difference test used an unpaired sample test analytic by looking at the difference in mean in the control and treatment groups. The population uses totality sampling with the rule of thumb technique. This research instrument uses a minimum diet diversity questionnaire, diet diversity, parenting model, as well as a questionnaire with a Likert scale and has been through validity and reliability tests.
Results: The results of the determinant coefficient test have a relationship between the independent and dependent variables, while Adjusted R2 = 0.803 which means 80.3% of all variables affect the z score in children, while the difference test result obtained a result of sig 2 tailed = 0.001 and the value of Sig Levene's test for equality variance of 0.44 > 0.001
Conclusion: There is an effect of frequency of eating, number of types of food, eating culture, history of breastfeeding, complementary feeding, perception, knowledge of the z score (stunting events). And E stunting is effective in assessing the causative factors and treatment in cases of infants with stunting
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Harper A, Goudge J, Chirwa E, Rothberg A, Sambu W, Mall S. Dietary diversity, food insecurity and the double burden of malnutrition among children, adolescents and adults in South Africa: Findings from a national survey. Front Public Health 2022; 10:948090. [PMID: 36211708 PMCID: PMC9540989 DOI: 10.3389/fpubh.2022.948090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023] Open
Abstract
Childhood stunting remains a global public health problem. Many stunted children live in the same household as overweight or obese adults (the so-called double burden of malnutrition), evidence that quality as well as quantity of food is important. In recent years, food security measurement has shifted away from anthropometry (e.g., stunting) to experiential measures (e.g., self-reported hunger). However, given the continued problem of stunting, it is important that national surveys identify malnutrition. Objectives To examine the associations between a variety of food security indicators, including dietary diversity, with adult, child (0-4 years) (5-9 years) and adolescent (10-17 years) anthropometry. To estimate the prevalence of double burden households. Methods The study utilized cross-sectional data from the South African National Income Dynamics Survey NIDS (2008). We examined the associations between five food security indicators and anthropometry outcomes. The indicators were adult and child hunger in the household, self-reported household food sufficiency, food expenditure>60% of monthly expenditure and household dietary diversity. Multinomial and logistic regression models were employed to examine the associations with adult BMI categories and children's stunting and BMI. Results The prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8 and 10.4%, respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. Among children <5, child hunger and medium dietary diversity were significantly associated with wasting. None of the food security indicators were associated with stunting in children aged 5-9. Among stunted children, 70.2% lived with an overweight or obese adult. Among adults, increased dietary diversity increased the risk of overweight and obesity. Conclusion Dietary diversity can be used as a proxy for poor nutritional status among children <5 years and adolescents but the relationship between dietary diversity and adult obesity is more complex. Given the double burden of malnutrition in many low- and middle-income countries, indicators of dietary quality remain important. These tools can be further refined to include an extra category for processed foods. Given the relative simplicity to collect this data, national surveys would be improved by its inclusion.
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Affiliation(s)
- Abigail Harper
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa,*Correspondence: Abigail Harper
| | - Jane Goudge
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Esnat Chirwa
- Gender and Health Research Division, The South African Medical Research Council, Johannesburg, South Africa
| | - Alan Rothberg
- School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Winnie Sambu
- School of Economics, The University of Cape Town, Cape Town, South Africa
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
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Birth weight and nutritional status of children under five in sub-Saharan Africa. PLoS One 2022; 17:e0269279. [PMID: 35679306 PMCID: PMC9182265 DOI: 10.1371/journal.pone.0269279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Over the past three decades, undernutrition has become a major cause of morbidity and mortality among children under five years globally. Low birth weight has been identified as a risk factor for child morbidity and mortality, especially among children under five years in sub-Saharan Africa. There is, however, a paucity of empirical literature establishing the association between low birth weight and undernutrition in sub-Saharan Africa. We examined the association between birth weight and nutritional status of children under five in sub-Saharan Africa. Methods Our analyses were performed on a weighted sample of 110,497 children under five years from 32 countries in sub-Saharan Africa. Data were obtained from the Demographic and Health Surveys conducted from 2010 to 2019. We reported the prevalence of low birth weight and nutritional status (stunting, wasting, and underweight) for all the 32 countries using percentages. We used multilevel binary logistic regression to examine the association between birth weight and nutritional status (stunting, wasting, and underweight) of the children, controlling for covariates. The results of the regression analyses were presented using adjusted odds ratios (aOR) with 95% confidence intervals. Statistical significance was set at p<0.05. Results The prevalence of low birth weight was 5.4%, with the highest (13.1%) and lowest (0.9%) reportedin South Africa and Chad, respectively. The pooled prevalence of wasting, underweight, and stunting were 8.1%, 17.0%, and 31.3%, respectively. Niger had the highest prevalence of wasting (21.5%) and underweight (37.1%), whereas Burundi had the highest prevalence of stunting (51.7%). We found that children with low birth weight were more likely to be stunted [aOR = 1.68, 95% CI = 1.58–1.78], underweight [aOR = 1.82, 95% CI = 1.70–1.94], and wasted [aOR = 1.35, 95% CI = 1.20–1.38] after controlling for covariates. Conclusion Our study has demonstrated that low birth weight is a key determinant of undernutrition among children under five in sub-Saharan Africa. Policymakers need to give special attention to improving the nutritional status of children under-five years in sub-Saharan Africa by implementing measures aimed at enhancing the weight of children. To accelerate progress towards the achievement of the Sustainable Development Goal 3.2 target of ending preventable deaths of newborns and under-five by 2030, it is imperative for countries in sub-Saharan Africa to intensify interventions aimed at improving maternal and child nutrition. Specific nutrition interventions such as dietary modification counselling should prioritized.
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