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

Association between wasting and inadequate breastfeeding practices among infants under six months in SNNPR and Somali regions of Ethiopia: A multilevel cross-sectional study

BACKGROUND

Wasting is a severe threat to children's survival and development. Attaining optimal breastfeeding practices for infants under six months of age remains a significant challenge in low-income countries. This study assessed the association between wasting and breastfeeding practices among infants under six months of age in the SNNPR and Somali regions of Ethiopia.

METHODS

The study used data from a large feasibility study conducted in the SNNPR and Somali regions of Ethiopia, from August-September 2021. This study involved 895 infants under six months of age with their mothers. The Poisson regression model with robust variance estimation was used to produce adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs).

RESULTS

The prevalence of wasting was 16.5% (95% CI: 14.2, 19.2) among infants under six months of age. Non-exclusive breastfeeding (APR = 1.50; 95% CI:1.02, 2.21), delayed initiation of breastfeeding (APR = 1.52; CI:1.00, 2.30), being male infants (APR = 1.50; 95% CI:1.09, 2.07), and mothers who attained primary level (APR = 0.62; 95% CI: 0.40, 0.95) or secondary level education (APR = 0.30; 95% CI: 0.09, 0.99) were independently associated with wasting in the multivariable analysis.

CONCLUSION

This study indicates a high prevalence of wasting among infants under six months of age. Non-exclusive breastfeeding and delayed initiation of breastfeeding were the modifiable factors significantly linked to infant wasting. Strengthening breastfeeding promotion and support may help reduce wasting in infants under six months.

Exploring under-five child malnutrition in Bangladesh: analysis using the Extended Composite Index of Anthropometric Failure (ECIAF)

OBJECTIVE

The current study is an attempt to explore under-five child malnutrition in a low-income population setting using the Extended Composite Index of Anthropometric Failure (ECIAF).

DESIGN

Data from the Bangladesh Demographic and Health Survey 2017-2018 were analysed. Malnutrition using ECIAF was estimated using stunting, wasting underweight and overweight. Multilevel logistic regression models identified factors associated with malnutrition. Geospatial analysis was conducted using R programming.

SETTING

Bangladesh.

PARTICIPANTS

Children under 5 years of age.

RESULTS

In Bangladesh, as indicated by the ECIAF, approximately 40·8 % (95 % CI: 39·7, 41·9) of children under five experience malnutrition, whereas about 3·3 % (95 % CI: 2·9, 3·7) were overweight. Children of parents with no formal education (56·3 %, 95 % CI: 50·8, 61·8), underweight mothers (53·4 %, 95 % CI: 50·4, 56·3), belonging to the lowest socio-economic strata (50·6 %, 95 % CI: 48·3, 53·0), residing in rural areas (43·3 %, 95 % CI: 41·9, 44·6) and aged below 3 years (47·7 %, 95 % CI: 45·2, 50·2) demonstrated a greater age- and sex-adjusted prevalence of malnutrition. The Sylhet division (Eastern region) exhibited a higher prevalence of malnutrition (> 55·0 %). Mothers with no formal education (adjusted OR (AOR): 1·51, 95 % CI: 1·08, 2·10), underweight mother (AOR: 1·54, 95 % CI: 1·03, 1·83), poorest socio-economic status (AOR: 2·14, 95 % CI: 1·64, 2·81), children aged 24-35 months (AOR: 2·37, 95 % CI: 1·97, 2·85) and fourth and above birth order children (AOR: 1·41, 95 % CI: 1·16, 1·72) were identified key factors associated with childhood malnutrition while adjusting community- and household-level variations.

CONCLUSIONS

In Bangladesh, two out of five children were malnourished, and one in thirty-five children was overweight. Continuous monitoring of the ECIAF over time would facilitate tracking changes in the prevalence of different forms of malnutrition, helping to plan interventions and assess the effectiveness of interventions aimed at addressing both undernutrition and overweight.

The prevalence of malnutrition in children under 6 in Southern Iran from 2018 to 2023: a population-based study authors

BACKGROUND

Malnutrition, wasting, and obesity among children under 6 years old pose a serious global health concern, increasing the risk of various infectious and non-infectious diseases. Therefore, regular monitoring of these conditions is crucial. This study aimed to evaluate the prevalence of malnutrition in children under 6 years of age from 2018 to 2023.

METHOD

This cross-sectional study was conducted on children under 6 years old who were referred to the urban and rural health centres in south Iran for routine health care. The researchers extracted the data from the health electronic records (SIB system) from 2018 to 2023.

RESULTS

This study showed the average prevalence of overweight and obesity is 20%, underweight and severe underweight is 4.9%, wasting and severe wasting is 7.4%, and stunted and severe shortness is 3.8%, 2018-2023. The average annual percentage change of severe wasting was 8.9% (95% CI 0.1% to 18.6%), underweight and severely underweight 5.7% (1.4-10.3) during the study years. The decreasing trend of stunted, particularly severe stunted, - 1.1% (- 0.7-5.2), the probability of overweight - 1.6% (95% CI - 4.7-1.5), and obesity - 1.1% (95% CI - 7-5.2) was seen.

CONCLUSION

This study revealed a higher prevalence of overweight and obesity than previously reported, although the annual percentage change remained relatively stable. In contrast, a significant increase in underweight and wasting was observed over the past 5 years. Consequently, healthcare managers and policymakers should prioritize interventions to address these trends.

Wasting coexisting with underweight and stunting among children aged 6‒59 months hospitalised in Garissa County Referral Hospital, Kenya

Management of undernourished children depends only on wasting yet it can coexist with underweight and/or stunting. Among children admitted to hospital with acute illness, we determined the proportion with wasting coexisting with underweight and/or stunting and their risk factors. A retrospective review of hospital records of children 6‒59 months old admitted at Garissa County referral hospital, Kenya, from January 2017 to December 2019 was conducted. Using World Health Organization 2006 growth standards, undernutrition were defined: wasting as Weight-for-height Z-score < -2, stunting Height-for-age Z-score < -2 and underweight Weight-for-age Z-score < -2. We studied wasting coexisting with underweight and/or stunting. Among 624 children recruited, 347 (56%) were males and 511 (82%) <24 months old. Diarrhoea 210 (34%) and pallor/anaemia 310 (50%) were the most frequent admission diagnosis. HIV infection was present among 8 (1.3%) children. Wasting, underweight and stunting were present among 595 (95%), 518 (83%) and 176 (28%) children respectively. 161 (26%), 506 (81%) and 161 (26%) children had wasting coexisting with stunting, underweight and both stunting and underweight respectively. In the multivariable regression, diarrhoea was positively associated with wasting coexisting with stunting (adjusted risk ratio [aRR = 2.96] [95% CI = 2.06‒4.23]) and anaemia with wasting coexisting with underweight (aRR = 1.23) (95% CI = 1.03‒1.47). Overall, 343 (55%) children were discharged alive, 67 (11%) absconded from the wards, 164 (26%) were transferred to another hospital and 50 (8.0%) died before discharge. The risk of inpatient death was 10.3%, 7.9%, 8.4% and 6.8% among children not wasted, wasted only, wasted & underweight, and wasted and underweight and stunted respectively (Chi-square p = 0.60). The study reports an unacceptably high levels of undernourishment, including coexisting forms of undernutrition among hospitalised children. This highlights a public health priority for current nutrition therapeutic care and need of continuity of care among those children discharged alive in the community-based management of acute malnutrition programmes.

Determinants of stunting among under-five children: Evidence from Cambodian Demographic and Health Survey 2021-2022

BACKGROUND

Epidemiological and nutritional modifications are causing an increase in stunting in many low- and middle-income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under-five children in Cambodia.

METHODS

A secondary dataset consisting of 3268 under-five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)-2021/2022 dataset. The Chi-square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting.

RESULTS

Findings revealed that about 21% of under-five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520-0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under-five stunting is significantly influenced by factors such as the child's age, size at birth, mother's age at first birth, mother's body mass index (BMI), father's educational status, cooking fuel, and wealth index.

CONCLUSIONS

It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under-five children in Cambodia.

Prevalence and associated factors of coexisting forms of malnutrition in children under 5 years age in a rural area of Cameroon

BACKGROUND

Malnutrition of children under 5 years of age is persistent in Cameroon principally in rural areas. Moreover, there is limited knowledge of coexisting forms of malnutrition (CFM) among children of this age. Therefore, the aim of this study was to assess the prevalence of CFM in a cohort of children under 5 years and to identify the associated factors.

METHODS

A cross-sectional study was conducted in the Health Districts of the locality of Dschang in the West region of Cameroon between June 2021 to November 2021. Data were collected from 200 under-five children of both sexes and an interviewer-administered questionnaire was administered to consented children's mothers/guardians. Malnutrition in children was assessed by WHO growth standards (weight-for-height, weight-for-age, height-for-age and body mass index-for-age). The different CFM were defined by the presence of two autonomous forms of malnutrition in the same child. Logistic regression analyses were done to identify factors associated to different coexisting forms of malnutrition.

RESULTS

The results obtained showed prevalences of 4.20% for the coexistence of underweight with wasting, 7.8% for the coexistence of underweight with stunting and 14.8% for the coexistence of stunting with overweight. Lower maternal age (15-24 years old; OR = 0.09; p = 0.05) and lower education level (primary education, OR = 23.33; p = 0.00) were associated with the coexistence of underweight with wasting. Marital status (single mother, OR = 0.28; p = 0.00) was associated to the coexistence of stunting with overweight/obesity.

CONCLUSION

The findings of this study provide evidence on the coexistence of different forms of malnutrition among children below five years of age in rural area of Cameroon. These finding would guide future research, policies, and programs on the management of malnutrition in rural areas of Cameroon.

Assessing the relationship of maternal short stature with coexisting forms of malnutrition among neonates, infants, and young children of Pakistan

Evidence from previous studies suggests a strong association between pediatric undernutrition and maternal stature. However, there's a scarcity of evidence regarding the relationship between maternal stature and pediatric coexisting forms of malnutrition (CFM). This study examined the prevalence and trends of CFM at the individual, household, and community levels, using data from the Demographic & Health Surveys (DHS) of Pakistan. Furthermore, this study assessed the association between pediatric CFM and short maternal stature while adjusting for multiple covariates. A panel cross-sectional analysis was conducted using data from the 2012-2013 and 2017-2018 Pakistan Demographic & Health Survey (PDHS). We included data from 6194 mother-child dyads aged 15-49 years and 0-59 months, respectively, while excluding data from pregnant mothers and dyads with incomplete anthropometric variables and anthropometric outliers. Across the two survey periods, our findings reveal a significant decline in pediatric malnutrition, including CFM, alongside a concurrent increase in maternal overweight/obesity. Three out of four households had either a malnourished mother, and/or a malnourished child, and/or both. Our study demonstrates that short maternal stature increased the odds of various forms of pediatric undernutrition by two-to-threefolds (p < .041), but we did not find an association with wasting, overweight/obesity, and nutritional paradox. This underscores the heightened vulnerability of children born to short-stature mothers to various forms of pediatric undernutrition. Addressing the high prevalence of pediatric undernutrition among children of short-stature mothers necessitates a comprehensive approach that considers an individual's nutritional status throughout their entire life cycle.

Assessing the relationship of recommended diarrhea case management practices with the nutritional status of children aged between 0 to 59.9 months

Background

Paediatric diarrhoea and malnutrition have a bidirectional relationship, which in turn augments the presence of each other. The diarrhoeal diseases in children can be prevented by using oral rehydration solution (ORS) and oral zinc sulfate. The relationship between paediatric diarrhoea treatment guidelines with the nutritional status is not yet investigated, and this study primarily aims to examine the relationship of recommended diarrhoea case management practices with paediatric undernutrition (wasting, stunting and underweight) among children aged between 0 to 59 months.

Methods

Data from Pakistan Demographic & Health Surveys (PDHS) conducted in 2012-2013 and 2017-2018 were used in this study to investigate the relationship between paediatric diarrhoea treatment adherence with the various forms of paediatric undernutrition. Data from children with complaints of acute watery non-dysenteric diarrhoea was used in this study, whereas data from those children presented with complaints of either dysentery, and/or severe dehydration, and/or incomplete anthropometry were excluded. Children were classified as complete adherent, partial adherent and non-adherent based on ORS and oral zinc sulfate consumption. The relationship of diarrhoea case management practices with different types of nutritional status was assessed using a binomial logistic regression method.

Results

The malnutrition in children with acute non-dysenteric diarrhoea is 54.2% in 2012-2013, which decreased to 48.2% in the succeeding survey of 2017-2018. Only 6.2% (1% in 2012-2013 ~ 10% in 2017-2018) children of Pakistan received appropriate treatment for managing their diarrhoea. However, no relationship between the diarrhoea case management and paediatric undernutrition was observed.

Conclusion

This study found did not demonstrate a significant connection of diarrhoea case management strategies with paediatric undernutrition. This highlights the complexity of addressing both diarrhoea and malnutrition in children. Future research should emphasize the identification and resolution of the multifactorial factors, which contribute to paediatric undernutrition, integrating both diarrhoea management and nutritional improvement strategies.

Unraveling the South Asian enigma: concurrent manifestations of child anthropometric failures and their determinants in selected South Asian countries

Malnutrition among children is pervasive in South Asia and there are also reports of overnutrition. To better understand this phenomenon, we need a composite measure. However, the existing measures such as CIAF (Composite Index of Anthropometric Failure) and its revised version have ignored the overnutrition aspect of the phenomenon. This study proposes an extended version of CIAF which also considers overnutrition. This new measure was compared with the existing measures by using data from 1990 to 2018 for three selected South Asian countries including Pakistan, India and Bangladesh. We also examined the effects of socioeconomic and environmental variables on the outcome variable. The results reveal that the new measure (ECIAF) is better at measuring the phenomena. The burden of overall malnutrition has been decreased in the region. However, an increase in the concomitant prevalence of wasting and underweight is observed in both Pakistan and India and stunting and overweight is observed only in India. Besides, political stability, prevalence of undernourishment, anemia in children, mother's education, household size, dependency ratio, air pollution and unimproved sanitation are significantly correlated with childhood malnutrition. The findings also testified to long-run cointegrating relationship among the variables.

Determinants of coexisting forms of undernutrition among under-five children: Evidence from the Bangladesh demographic and health surveys

In many underdeveloped and developing countries, epidemiological and nutritional transitions are leading to an increase in malnutrition, resulting in pediatric diseases and eventually deaths. Therefore, this study intents to determine the important factors of the presence of coexisting forms of malnutrition (CFM), i.e., pediatric undernutrition. This study used the latest Bangladesh Demographic and Health Survey (BDHS)-2017/18 dataset consisting of 7127 under-five children. The logistic regression model has been utilized to gain explicit and in-depth knowledge of the relationship between the presence of pediatric undernutrition with socioeconomic and demographic factors. Findings revealed that about 31%, 22%, and 8% suffered from stunted, underweight, and wasted, respectively. The prevalence of stunted, underweighted, wasted, and CFM among children in the Sylhet division is higher than in any other region. A child of a secondary-level completed mother is 27.6% (OR: 0.724, 95% CI: 0.58-0.90) less likely to suffer from undernutrition than a child of an uneducated mother. The rate of undernutrition of children was less among children of highly educated parents. Age, birth order of the child, twin status, mother's age, body mass index (BMI), working status, parental educational qualification, cooking fuel, toilet facility, region, residence, and wealth index are important for determining the nutritional status of a child. The authors believe that the study findings will be helpful to the policymakers to take proper actions for achieving the sustainable development goal (SDGs) by reducing pediatric undernutrition in Bangladesh by 2030.

Prevalence and factors associated with undernutrition among children under the age of five years in Benin

BACKGROUND

Benin ranks as one of the countries in the world with an alarmingly high prevalence of stunting, wasting, and underweight in children under five years. However, limited studies have examined the factors associated with the prevalence of these undernutrition indicators among children under five years in the country. This study aimed to fill this research gap by examining the prevalence rates and factors associated with stunting, wasting, and underweight among this specific population of interest.

METHODS

This quantitative study utilised data from the most recent Benin Demographic and Health Survey (BDHS) conducted in 2017-18. The survey employed a nationally representative cross-sectional design and utilised a two-stage stratified cluster sampling technique to select participants. The study included a sample of 13,589 children under the age of five years. The main analytical approach employed was binary logistic regression, which was used to explore the associations between undernutrition (the combined outcome variable representing stunting, wasting, and underweight) and various socio-demographic factors.

RESULTS

The combined prevalence of stunting, wasting, and underweight among children under five years in Benin during the 2017-18 survey period was 14.95%. Several factors were significantly associated with these indicators of undernutrition, including female gender (AOR = 0.71, 95% CI = 0.59-0.85), birth weight of 4.1 kg and over (AOR = 0.26, 95% CI = 0.14-0.48), multiple births (AOR = 3.22, 95% CI = 2.11-4.91), and a child's experience of diarrhoea (AOR = 1.76, 95% CI = 1.40-2.20). Furthermore, the prevalence of these undernutrition indicators was higher among children whose mothers had lower levels of education (AOR = 0.82, 95% CI = 0.01-0.42) and were unmarried (AOR = 0.67, 95% CI = 0.49-0.93).

CONCLUSIONS

This present study confirms that undernutrition rates are elevated in Benin and are closely linked to perinatal factors such as birth weights and multiple births, postnatal health conditions including diarrheal episodes, and socio-demographic determinants such as a child's gender, maternal education level, and marital status. Therefore, there is the need to consider specific modifiable factors, such as low birth weight, episodes of child diarrhoea, and maternal education as priority targets for child nutrition interventions in Benin.

Mapping Concurrent Wasting and Stunting Among Children Under Five in India: A Multilevel Analysis

Objectives: The study aims to examine the coexisting forms, patterns, and predictors of concurrent wasting and stunting (WaSt) among children under five in India. Methods: We used data from the National Family Health Survey to understand the trend and association of WaSt among children under five-year-old in India. Univariate analysis and cross-tabulations were performed for WaSt cases. The association was determined using multilevel binary logistic regression and multilevel regression, and the results were provided as adjusted odds ratios (aOR) with 95% confidence intervals at the significance level of p < 0.05. Results: The prevalence of WaSt has decreased from 8.7% in 2005-06 to 5.2 percent in 2019-2020. The proportion of WaSt children grew rapidly from 6 to 18 months, peaked at 19 months (8%), then dropped after 24 months. The prevalence of concurrent wasting and stunting is higher among boys compared to girls. Compared to children of different birth orders, those in the higher birth order are 1.2 times more likely to be WaSt cases (aOR = 1.20, 95% CI = 1.09, 1.33). The education of the mother is strongly correlated with WaSt instances, and children of more educated mothers have a 47% lower chance of being WaSt cases (aOR = 0.63, 95% CI = 0.57, 0.71). Children from wealthy families are 52% less likely to be WaSt cases (aOR = 0.48, 95% CI = 0.43, 0.55). Conclusion: This study emphasizes the importance of concurrent wasting and stunting and its relationship with socioeconomic factors among children under five in India.

Dual burden of individual malnutrition in children 1-4 years: Findings from the Colombian nutritional health survey ENSIN 2015

BACKGROUND

To date there are no studies with estimation of multiple types of double burden of individual malnutrition (DBIM) and evaluation of associated determinants.

OBJECTIVE

To estimate the prevalence and social determinants associated with the double burden of individual malnutrition in children aged 1-4 years.

METHODS

A cross-sectional study was conducted using data from Colombian nutritional heath survey ENSIN 2015. Global DBIM was analysed on the basis of excess weight and the presence of one or more micronutrient deficiencies (vitamin A, D, zinc, or iron) and/or stunting. Specific DBIM pairs were also analysed. Logistic regression was used to evaluate variables associated with DBIM.

RESULTS

The sample consisted of 6807 children. The overall DBIM prevalence was 4%. The prevalence of DBIM in children affected by overweight or obesity was 75%. Male sex was associated with global DBIM (OR 2.19 (1.52-3.16) p = 0.000), indigenous children presented 6 times the DBIM due to stunting (OR 6.17 (1.67-22.7) p = 0.007). Children from the Atlantic (OR 3.95 (1.23-12.61) p = 0.021), central (OR 8.80 (2.38-32.49) p = 0.001) and Pacific (OR 4.19 (1.21-14.49) p = 0.024) regions, had a higher chance of DBIM due to iron deficiency. Children from east region (OR 3.03 (1.12-8.16) p = 0.029) and Bogotá city (OR 4.15 (1.65-12.32) p = 0.004) were associated with DBIM due to vitamin D deficiency.

CONCLUSIONS

Children with overweight or obesity had a high likelihood of presenting micronutrients deficiencies or stunting. Ethnicity, male sex and country region of residence were variables associated with overall DBIM or specific DBIM.

Impact of Drinking Water Source and Sanitation Facility on Malnutrition Prevalence in Children under Three: A Gender-Disaggregated Analysis Using PDHS 2017-18

OBJECTIVES

The proposed research studied the determinants of male and female child malnutrition in Pakistan. More specifically, it observed the role of the sanitation facility and drinking water source as important determinants of malnutrition in a gender analysis.

METHODS

Novel data of 1010 children under three years of age from PDHS 2017-18 were used. A CIAF (Cumulative Index for Anthropometric Failure) was established to assess malnourishment in the children. Discrete-choice logistic methodology was applied in this empirical research to study the likelihood of malnourishment in children.

RESULTS

The logistic regression results depicted that factors such as a child belonging to a deprived area, the status of home wealth, and the education of the mother were common determinants of malnutrition in children. Factors such as a child having diarrhea (OR = 1.55, CI = 0.96-2.50) and the drinking water source (OR = 0.62, CI = 0.37-1.03) were separate prominent predictors of malnutrition in male children whereas the sanitation facility was the main determinant of malnutrition in female children (OR = 0.64, CI = 0.43-0.95).

CONCLUSION

This study concludes that important links exist between the drinking water source and male child malnutrition and between sanitation facilities and female child malnutrition.

Association of Infant Feeding Indicators and Infant Feeding Practices with Coexisting Forms of Malnutrition in Children under Six Months of Age

Breastmilk is the only recommended source of nutrition for infants below six months of age. However, a significant proportion of children are either on supplemental breastfeeding (SBF) or weaned due to the early introduction of solid/semi-solid/soft food and liquids (SSF) before six months of age. There is good evidence that exclusive breastfeeding (EBF) in infants below six months of age protects them from preventable illnesses, including malnutrition. The relationship between infant feeding practices and coexisting forms of malnutrition (CFMs) has not yet been explored. This study examined the association of different feeding indicators (continuation of breastfeeding, predominant feeding, and SSF) and feeding practices (EBF, SBF, and complete weaning) with CFM in infants aged below six months in Pakistan. National and regional datasets for Pakistan from the last ten years were retrieved from the Demographic Health Surveys (DHS) and UNICEF data repositories. In Pakistan, 34.5% of infants have some form of malnutrition. Among malnourished infants, 44.7% (~15.4% of the total sample) had a CFM. Continuation of breastfeeding was observed in more than 85% of infants, but less than a quarter were on EBF, and the rest were either SBF (65.4%) or weaned infants (13.7%). Compared to EBF, complete weaning increased the odds of coexistence of underweight with wasting, and underweight with both wasting and stunting by 1.96 (1.12-3.47) and 2.25 (1.16-4.36), respectively. Overall, breastfed children had lower odds of various forms of CFM (compared to non-breastfed), except for the coexistence of stunting with overweight/obesity. Continuation of any breastfeeding protected infants in Pakistan from various types of CFM during the first six months of life.

Spatial and Machine Learning Approach to Model Childhood Stunting in Pakistan: Role of Socio-Economic and Environmental Factors

This study presents the determinants of childhood stunting as the consequence of child malnutrition. We checked two groups of factors-the socio-economic situation and climate vulnerability-using disaggregated sub-regional data in the spatial context. Data related to the percentage of stunted children in Pakistan for 2017 were retrieved from MICS 2017-18 along with other features. We used three quantitative models: ordinary least squares regression (OLS) to examine the linear relationships among the selected features, spatial regression (SDEM) to identify and capture the spatial spillover effect, and the Extreme Gradient Boosting machine learning algorithm (XGBoost) to analyse the importance of spatial lag and generate predictions. The results showed a high degree of spatial clustering in childhood stunting at the sub-regional level. We found that a 1 percentage point (p.p.) increase in multi-dimensional poverty may translate into a 0.18 p.p. increase in childhood stunting. Furthermore, high climate vulnerability and common marriages before age 15 each exacerbated childhood stunting by another 1 p.p. On the contrary, high female literacy and their high exposure to mass media, together with low climate vulnerability, may reduce childhood stunting. Model diagnostics showed that the SDEM outperformed the OLS model, as AIC_OLS = 766 > AIC_SDEM = 760. Furthermore, XGBoost generated the most accurate predictions in comparison to OLS and SDEM, having the lowest root-mean-square error (RMSE).

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

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

A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children

OBJECTIVE

Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children.

METHODS

A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies.

RESULTS

The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive.

CONCLUSION

Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.

Socio-Economic and Environmental Determinants of Malnutrition in under Three Children: Evidence from PDHS-2018

OBJECTIVES

This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan.

METHODS

Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017-2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition.

RESULTS

The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers' education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children.

CONCLUSION

Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan.