Effect of maternal factors on nutritional status of 1-5-year-old children in urban slum population

Cultural and Contextual Drivers of Triple Burden of Malnutrition among Children in India

This study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-2021), the study identifies risk factors and assesses their contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% were overweight, and 66% were anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At the macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran's I: stunting-0.53, overweight-0.41, and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.

Impact of low birth weight and breastfeeding practices on the nutritional status of children aged 2 to 5 years in the slums

Malnutrition among children in developing countries is a major public health problem, especially in India. Inappropriate feeding practices, in combination with other causes such as infection and food shortage, may be responsible for 1/3rd of malnutrition. Moreover, the risk of mortality is inversely related to children's height-for-age and weight-for-height. The aim: To assess the nutritional status of children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati and to determine the impact of low birth weight, breastfeeding practices and other related factors on the nutritional status of the above study population. Materials and methods: This is a community-based observational cross-sectional study conducted among 282 children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati. Socio-demographic data, Birth history, breastfeeding practices and anthropometric measurements were noted in the study questionnaire. Nutritional status was determined using HAZ, WHZ and WAZ scores of WHO child growth standards. Data was entered and analyzed using IBM SPSS Statistics 26 version to test for association between categorical variables, and a p-value < 0.05 was considered statistically significant. Results: A total of 282 school children with mean age of 39.9 (+10.4) months participated in the study, of which 132 (46.8 %) were boys and 150 (53.2 %) were girls. This study observed exclusive breastfeeding in 193 (68.4 %) children. Prevalence of stunting, wasting and being underweight were 22 %, 12.4 % and 23.8 %, respectively. A statistically significant association was found between stunting (p=0.006) and underweight (p=0.001) with low birth weight children. Conclusions: The present study revealed a high prevalence of malnutrition, especially stunting, a common outcome of long-term malnutrition among young children. Low birth weight and inappropriate breastfeeding practices result in long-term adverse consequences on the nutrition of preschool children, which should be prevented through appropriate strategies.

Prevalence and determinants of nutritional status among women and children in Pakistan

Background

Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalences of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.

Methods

The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012–13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.

Results

A higher proportion of children in rural areas were severely stunted (19.6% vs. 12.5%), severe wasted (2.4% vs. 2.2%), and severe underweight (9.4% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.5%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.3% vs. 19.0%) than rural women. The odds of severe stunting (OR = 0.24; C.I. = 0.15–0.37), severe underweight (OR = 0.11; C.I. = 0.05–0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR = 3.7; C.I. = 2.47–5.54) and Obese (RRR = 4.35; C.I. = 2.67–7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.

Conclusion

This study has highlighted determinants associated with maternal and child nutritional status, whereby the child’s nutritional status was measured by stunting, wasting, and underweight, and BMI measured the mother’s nutritional status. The main risk factors for a child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women’s age, educational status, rural residence, and household wealth. Poor households should be provided special attention to improve the nutritional status among women and children in poor households.

Greater male vulnerability to stunting? Evaluating sex differences in growth, pathways and biocultural mechanisms

CONTEXT

Child stunting has increasingly become the focus of large-scale global health efforts with the inclusion of stunting eradication as one of the Sustainable Development Goals of the United Nations. Child sex has been identified as a biological risk factor for stunting, and sex-specific approaches to stunting prevention have been proposed.

OBJECTIVE

This paper examines four pathways, developmental sensitivity, energetics, caretaking and measurement, proposed to contribute to sex differences in linear growth faltering and stunting risk.

METHODS

Anthropological, public health and clinical literature on sex differences in stunting and the mechanisms contributing to variability across contexts are reviewed.

RESULTS

The direction of sex differences in stunting prevalence varies across countries and between households. Sex differences in growth trajectories and immune function beginning prenatally place boys at greater risk of infection and undernutrition, but these biological differences are interpreted by parents and within household contexts that are shaped by social and cultural norms which, in turn, influence care and feeding practices.

CONCLUSION

A perspective that incorporates an examination of the social and environmental factors shaping child growth in specific contexts is needed to understand sex-based vulnerability to stunting and to develop context-appropriate interventions.

Trends and Determinants of Underweight among Children under Five Years in Ethiopia: Further Analysis with Ethiopian Demographic and Health Survey 2005-2016-Multivariate Decomposition Analysis

Background

Underweight is one of the paramount major worldwide health problems, and it traces a big number of populations from infancy to old age. This study aimed to analyze the trends and predictors of change in underweight among children under five years in Ethiopia.

Method

The data for this study were accessed from three Ethiopian Demographic and Health Survey data sets 2005, 2011, and 2016. The trend was examined separately for the periods 2005–2011, 2005–2016, and 2011–2016. Multivariate decomposition analysis of change in underweight was employed to answer the major research question of this study. The technique employed the output from the logistic regression model to parcel out the observed difference in underweight into components, and STATA 14 was utilized for data management and analysis.

Result

Perceiving the overall trend, the rate of underweight was decreased from 38% in 2005 to 24% in 2016. The decomposition analysis results revealed that, about 12.60% of declines in underweight have been explained by the difference in population characteristics or endowments (E) over the study period. The size of the child at birth, husband's education, women's education, and household wealth index contributed significantly to the compositional decline in underweight.

Conclusion

The magnitude of underweight among children under five years indicates a remarkable decline over the last ten years in Ethiopia. In this study, two-twelfth of the overall decrease in underweight among children under five years over the decade was due to the difference in characteristics between 2005 and 2016. Continuing to educate the population and boost the population's economy is needed on the government side in Ethiopia.

Morbidity profile of under-5 slum dwellers of Amritsar city: A descriptive cross-sectional study

Context:

Children living in slums are deprived from basic necessities. Unhygienic environment and deficient nutrition hinder their growth and make them more prone to infectious diseases.

Aims:

To study morbidity profile of under-5 children and determine social epidemiological factors associated with it.

Settings and Design:

A descriptive cross-sectional study in urban slums of district Amritsar.

Methods and Material:

In total, 400 households each from four slums (1600 in total) were randomly selected. One to one interview with mother of each under 5 was conducted and information was recorded on pretested performa. Height and weight with haemoglobin estimation was done for each child.

Statistical Analysis Used:

Descriptive statistics (frequencies and proportions) and univariate logistic regression was applied to determine factors associated with under nutrition.

Results:

Out of 1136 under-5, 50, 45 and 8% were stunted, underweight and wasted. Severe malnutrition was seen among 23%. In total, 79% had anaemia. About 69% suffered from one or more infectious disease in last 3 months. Anaemia, birth order >2, lower socio-economic status and suffering from any infectious disease in last 3 months were associated with malnutrition.

Conclusions:

Severe malnutrition and anaemia was high among under-5 of urban slums and 69% suffered from infectious disease in last 3 months emphasizing on addressal of health needs of under-5 residing in urban slums.

Determinants of stunting among children under 2 years in urban informal settlements in Mumbai, India: evidence from a household census

BACKGROUND

There is limited evidence on the determinants of childhood stunting across urban India or specifically in slum settlements. This study aims to assess the extent of stunting among children under 2 years of age and examine its determinants in informal settlements of Mumbai.

METHODS

Data were collected in 2014-2015 in a post intervention census of a cluster randomized controlled trial to improve the health of women and children. Census covered 40 slum settlements of around 600 households each. A total of 3578 children were included in the study. Mixed effects logistic regression models were used to identify factors associated with stunting.

RESULTS

The prevalence of stunting among children aged 0-23 months was 38%. In the adjusted model, higher maternal education (AOR 0.59; 95% CI 0.42, 0.82), birth interval of at least 2 years (AOR 0.71; 95% CI 0.58, 0.87) and intended conception of the child (AOR 0.80; 95% CI 0.64, 0.99) were associated with lower odds of stunting. Maternal exposure to physical violence (AOR 1.83; 95% CI 1.21, 2.77) was associated with higher odds of being stunted. A child aged 18-23 months had 5.04 times greater odds (95% CI 3.91, 6.5) of being stunted than a child less than 6 months of age. Male child had higher odds of being stunted (AOR 1.33; 95% CI 1.14, 1.54).

CONCLUSIONS

Our findings support a multidimensional aetiology for stunting. The results of the study emphasize the importance of women's status and decision-making power in urban India, along with access to and uptake of family planning and services to provide support for survivors of domestic violence. Ultimately, a multilateral effort is needed to ensure the success of nutrition-specific interventions by focusing on the underlying health and social status of women living in urban slums.

TRIAL REGISTRATION

ISRCTN Register: ISRCTN56183183 , and Clinical Trials Registry of India: CTRI/2012/09/003004.

Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study

BACKGROUND

Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India.

METHODS

A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas.

RESULTS

The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight.

CONCLUSIONS

Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community.

TRIAL REGISTRATION

Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

Factors Responsible for Childhood Malnutrition: A Review of The Literature

Children are the future of any nation. A malnourished child is not only a problem of present-day society, but also an issue for the future. However, approximately one-third of the world’s children are malnourished. Malnourishment can be measured in terms of nutrition and weight. In general, people believe that a lack of money—that is, financial poverty—is the main reason for childhood malnutrition. Nevertheless, most studies addressing this topic report that socio-economic factors are the major cause of childhood malnutrition worldwide. This study analyses how some of these socio-economic factors affect childhood malnutrition and identifies the major steps taken by the authorities of different countries to eliminate these causes. A review of the literature shows that a mother’s knowledge of her children’s health, her education level, and her place of residence are some of the major factors impacting children’s nutrition level. A literature review shows that among all types of malnutrition measurements, stunting indicates the long-term impact of consistent malnutrition most effectively. The governments of several countries as well as international organisations are trying to overcome this problem through the implementation of various programs; however, more thorough intervention is required.

Is child undernutrition associated with antenatal care attendance in Madhya Pradesh, India?

Context

There is a paucity of research investigating the association between antenatal care (ANC) attendance and child undernutrition in Madhya Pradesh, India.

Aim

To determine whether body weight status in children under the age of 5 years is associated with ANC attendance in Madhya Pradesh.

Methods

A cross-sectional study was carried out using data from India's National Family Health Survey (2005-2006). Bodyweight status (an indicator of undernutrition) was determined using weight-for-age. Descriptive statistics and logistic regression were used to estimate prevalence and obtain adjusted odds ratios (AOR) to investigate associations between ANC indicators and weight-for-age.

Results

Majority of children were underweight (55.1%). ANC attendance was inadequate, with only 36.8% of women having four or more visits. None of the ANC indicators were associated with body weight status. Increased child age especially an age of 2 years (AOR 2.29; 1.66-3.15), belonging to a scheduled tribe [ST] (AOR 2.36; CI 1.64-3.39), scheduled caste [SC] (AOR 1.75; CI 1.25-2.45) or other backward caste [OBC] (AOR 1.43; CI 1.08-1.89) were associated with being underweight; a birth weight of ≥2.5 kg was associated with lower relative odds of being underweight (AOR 0.43; CI 0.29-0.64). Mothers who had a normal BMI (AOR 0.66; CI 0.53-0.82) or were overweight (AOR 0.42; CI 0.25-0.69) were less likely to have underweight children.

Conclusions

ANC attendance was not associated with body weight status. Increased child age, low birth weight, poor maternal nutrition status and belonging to SCs, STs or OBCs increased the odds of child undernutrition.

Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors

Background: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions.

Objectives: The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6–8 months in India.

Methods: Survey data on 13,548 infants aged 6–8 months were obtained from the 2015–16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6–8 months in India.

Results: The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0–23.7%) and 10.0% (95% CI: 9.0–11.0%) among infants aged 6–8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09–1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01–1.45) among infants aged 6–8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting.

Conclusion: Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6–8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.

Determinants of nutritional status among children under age 5 in Ethiopia: further analysis of the 2016 Ethiopia demographic and health survey

Background

The aim of this study was to examine the determinants of nutritional status among children under age 5 (0–59 months) in Ethiopia. Child malnutrition is an underlying cause of almost half (45%) of child deaths, particularly in low socioeconomic communities of developing countries. In Ethiopia, the prevalence of stunting decreased from 47% in 2005 to 39% in 2016, but the prevalence of wasting changed little over the same time period (from 11 to 10%). Despite improvements in reducing the prevalence of malnutrition, the current rate of progress is not fast enough to reach the World Health Organization global target for reducing malnutrition 40% by 2025.

Methods

This study used data from the 2016 Ethiopia Demographic and Heath Survey (EDHS). The analysis used stunting and wasting as dependent variables, while the independent variables were characteristics of children, mothers, and households. Logistic regression was used to analyze the determinants of nutritional status among children. Bivariate analysis was also used to analyze the association between the dependent and independent variables.

Results

Study results show that child’s age, sex, and perceived birth weight, mother’s educational status, body mass index (BMI), and maternal stature, region, wealth quintile, type of toilet facility, and type of cooking fuel had significant associations with stunting. Child’s age, sex, and perceived birth weight, mother’s BMI, and residence and region showed significant associations with wasting. The study found that child, maternal, and household characteristics were significantly associated with stunting and wasting among children under age 5.

Conclusion

These findings imply that a multi-sectorial and multidimensional approach is important to address malnutrition in Ethiopia. The education sector should promote reduction of cultural and gender barriers that contribute to childhood malnutrition. The health sector should encourage positive behaviors toward childcare and infant feeding practices. More should be done to help households adopt improved types of toilet facilities and modern types of cooking fuels.

Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study

Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.

Effects of individual, household and community characteristics on child nutritional status in the slums of urban Bangladesh

Background

Bangladesh urban population is expected to overtake rural population by 2040, and a significant part of the increase will be in slums. Wide disparities between urban slums and the rest of the country can potentially push country indicators off track unless the specific health and nutrition needs of the expanding slum communities are addressed. The study aims at describing the individual, household and community determinants of undernutrition status among children living in major urban strata, viz. City Corporation slums and non-slums, in order to understand the major drivers of childhood undernutrition in urban slum settings.

Methods

Data are derived from Bangladesh Urban Health Survey conducted in 2013. This survey is a large-scale, nationally representative of urban areas, household survey designed specifically to provide health and nutrition status of women and children in urban Bangladesh.

Results

Data showed that 50% of under-5 children in slums are stunted and 43% are underweight, whereas for non-slums these rates are 33 and 26% respectively. In terms of severity, proportion of under-5 children living in slums severely underweight or stunted are nearly double than the children living in non-slums. Logistic analyses indicate that mother’s education, child’s age, and household’s socio-economic status significantly affects stunting and underweight levels among children living in the urban slums. Logistic models also indicate that all individual-level characteristics, except exposure to mass media and mother’s working outside home, significantly affect undernutrition levels among children living on non-slums. Among the household- and community-level characteristics, only household’s socioeconomic status remains significant for the non-slums.

Conclusions

Poor nutritional status is a major concern in slum areas, particularly as this group is expected to grow rapidly in the next few years. The situation calls for specially designed and well targeted interventions that take into account that many of the mothers are poorer and less educated, which affects their ability to provide care to their children.

Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study

Background

Nutritional status differs between infants and young children living in slum and non-slum conditions—infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums.

Methods

This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted.

Results

Feeding practices for infants and young children in families with working mothers are broadly determined by mothers’ occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors.

Conclusion

The results suggest a trade-off between mothers’ work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes.

Trends and determinants of inequities in childhood stunting in Bangladesh from 1996/7 to 2014

BACKGROUND

We explore long-term trends and determinants of socioeconomic inequities in chronic childhood undernutrition measured by stunting among under-five children in Bangladesh. Given that one in three children remain stunted in Bangladesh, the socioeconomic mapping of stunting prevalence may be critical in designing public policies and interventions to eradicate childhood undernutrition.

METHODS

Six rounds of Bangladesh Demographic and Health Survey data are utilized, spanning the period 1996/97 to 2014. Using recognized measures of absolute and relative inequality (namely, absolute and relative difference, concentration curve and index), we quantify trends, and decompose changes in the concentration index to identify factors that best explain observed dynamics.

RESULTS

Despite remarkable improvements in average nutritional status over the last two decades, socio-economic inequalities have persisted, and according to some measures, even worsened. For example, expressed as rate-ratios, the relative inequality in under-five stunting increased by 56% and the concentration index more than doubled between 1996/97 and 2014. Decomposition analyses find that wealth and maternal factors such as mothers' schooling and short stature are major contributors to observed socio-economic inequalities in child undernutrition and their changes over time.

CONCLUSIONS

Reflecting on recent success around socioeconomic and gender equity in child mortality, and the weak legacy of nutrition policy in Bangladesh, we suggest that nutrition programming energies be focused specifically on the most disadvantaged and applied at scale to close socioeconomic gaps in stunting prevalence.

Food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County, Kenya

BACKGROUND

HIV and AIDS affect most the productive people, leading to reduced capacity to either produce food or generate income. Children under-fives are the most vulnerable group in the affected households. There exists minimal information on food security status and its effect on nutritional status of children under-fives in households affected by HIV and AIDS. The aim of this study was to assess food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County.

METHODS

A cross-sectional analytical design was used. A formula by Fisher was used to calculate the desired sample size of 286. Systematic random sampling was used to select the children from a list of identified households affected by HIV. A questionnaire was used to collect data. Focus group discussion (FGD) guides were used to collect qualitative data. Nutri-survey software was used for analysis of nutrient intake while ENA for SMART software for nutritional status. Data were analyzed using SPSS computer software for frequency and means. Qualitative data was coded and summarized to capture the emerging themes

RESULTS AND DISCUSSION

Results show that HIV affected the occupation of people with majority being casual laborers (37.3 %), thus affecting the engagement in high income generating activities. Pearson correlation coefficient showed a significant relationship between dietary diversity score and energy intake (r = 0.54 p = 0.044) and intake of vitamin A, iron, and zinc (p < 0.05). A significant relationship was also noted on energy intake and nutritional status (r = 0.78 p = 0.038). Results from FGD noted that HIV status affected the occupation due to stigma and frequent episodes of illness. The main source of food was purchasing (52.7 %). With majority (54.1 %) of the households earning a monthly income less than US$ 65, and most of the income (25.7 %) being used for medication, there was food insecurity as indicated by a mean household dietary diversity score of 3.4 ± 0.2. This together with less number of meals per day (3.26 ± 0.07 SD) led to consumption of inadequate nutrients by 11.4, 73.9, 67.7, and 49.2 % for energy, vitamin A, iron, and zinc, respectively. This resulted to poor nutritional status noted by a prevalence of 9.9 % in wasting. Stunting and underweight was 17.5 and 5.5 %, respectively. Qualitative data shows that the stigma due to HIV affected the occupation and ability to earn income.

CONCLUSIONS

The research recommends a food-based intervention program among the already malnourished children.

Interventions to tackle malnutrition and its risk factors in children living in slums: a scoping review

CONTEXT

Children living in slums are at high risk of being malnourished. There are no published reviews on existing interventions promoting better nutrition for children living in slums and the risk factors for children's malnutrition. Improved understanding of the risk factors for malnutrition in slums communities and the impact of interventions on children's health can provide guidance to practitioners and decision-makers. The present review is designed to provide this information.

METHODS

The search included 30 electronic bibliographic databases and relevant eligible studies published up to December 2013.

RESULTS

The search located 1512 citations. Full text relevance screening was conducted on 226 studies and on abstracts for 16 studies. The final 58 unique studies included 22 on interventions and 38 on risk. All of the interventions were nutrition-specific, with nutritional intervention being the most dominant type. Seventy-three per cent of the interventions were assessed effective.

CONCLUSION

The findings stressed the gaps in knowledge in terms of quality assessment and programmatic recommendations to identify children who are the most at risk of malnutrition to appropriately target interventions. Finally, the review helped to inform a systematic review (Cochrane Systematic review protocol 2015) that will examine the impact of interventions on outcome measures.

Effect of women’s migration on urban children’s health in India

Purpose

– In India, the number of migrants to urban areas is increasing over time. Unlike in earlier years where male migration was prominent, recent trend shows an increasing trend of female and family migration. As migration and health status are highly correlated, the nature of relationship deserves greater attention from researchers. Although literature on internal migration in India is abundant, little attention is given to the research on the effect of migration on the health status of children. The paper aims to discuss these issues.

Design/methodology/approach

– The present paper, based on National Family Health Survey 3 data, examines the health status of migrant and non-migrant children in the urban areas of India.

Findings

– Distribution according to social and demographic characteristics is disadvantageous for urban children who are born to migrant women. As seen from various child health indicators, urban children’s health in general and the health situation of migrant women’s children in particular leaves much to be desired. Pattern of migration tends to have an impact on child health in urban areas; children of women who migrate from rural areas are in an adverse position. Duration of migration has a negative influence on health status of urban children. Overall, it was found that migration status of mothers has an independent effect on child health outcomes; children of migrant mothers have a lower health status.

Originality/value

– This paper fulfills the need to study the health status of migrant and non-migrant children in the urban areas of India.

Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey

Background

Stunting is one of the main public health problems in Tanzania. It is caused mainly by malnutrition among children aged less than 5 years. Identifying the determinants of stunting and severe stunting among such children would help public health planners to reshape and redesign new interventions to reduce this health hazard. This study aimed to identify factors associated with stunting and severe stunting among children aged less than five years in Tanzania.

Methods

The sample is made up of 7324 children aged 0-59 months, from the Tanzania Demographic and Health Surveys 2010. Analysis in this study was restricted to children who lived with the respondent (women aged 15-49 years). Stunting and severe stunting were examined against a set of individual-, household- and community-level factors using simple and multiple logistic regression analyses.

Results

The prevalence of stunting and severe stunting were 35.5 % [95 % Confidence interval (CI): 33.3-37.7] and 14.4 % (95 % CI: 12.9-16.1) for children aged 0-23 months and 41.6 % (95 % CI: 39.8-43.3) and 16.1 % (95 % CI: 14.8-17.5) for children aged 0-59 months, respectively. Multivariable analyses showed that the most consistent significant risk factors for stunted and severely-stunted children aged 0-23 and 0-59 months were: mothers with no schooling, male children, babies perceived to be of small or average size at birth by their mothers and unsafe sources of drinking water [adjusted odds ratio (AOR) for stunted children aged 0-23 months = 1.37; 95 % CI: (1.07, 1.75)]; [AOR for severely stunted children aged 0-23 months = 1.50; 95 % CI: (1.05, 2.14)], [AOR for stunted children aged 0-59 months = 1.42; 95 % CI: (1.13, 1.79)] and [AOR for severely stunted children aged 0-59 months = 1.26; 95 % CI: (1.09, 1.46)].

Conclusions

Community-based interventions are needed to reduce the occurrence of stunting and severe stunting in Tanzania. These interventions should target mothers with low levels of education, male children, small- or average-size babies and households with unsafe drinking water.

Factors Associated with Underweight among Children of Former-Kamaiyas in Nepal

Background: Bonded labor was a tradition in Nepal since the 16th century. In 2002, the Government of Nepal freed Kamaiyas and gave the newly freed individuals support for basic living. Many children of former-Kamaiyas live below subsistence level and are vulnerable to undernutrition. The aim of this study was to identify the factors associated with underweight among the children of former-Kamaiyas.

Methods: We conducted the community based cross-sectional study from June to December, 2012. Face-to-face interviews were conducted using semi-structured questionnaires with randomly selected mothers of 280 children under 5 years of age from former-Kamaiya families residing in Banke district. We also measured the weight and height of the children. Undernutrition was defined according to the World Health Organization child growth standards. Factors associated with underweight were examined using a Chi-square test followed by multiple logistic regression.

Results: Out of 280 children, 116 (41.4%) were underweight (≤2 SD weight-for-age), 156 (55.7%) were stunted (≤2 SD height-for-age), and 52 (18.6%) were wasted (≤2 SD weight-for-height). Females were more likely to be underweight than males [adjusted odds ratio (aOR) = 1.696, 95% confidence interval (CI) = 1.026–2.804]. Children were less likely to be underweight if they were having daily bath (aOR = 0.532; 95% CI = 0.314–0.899) or if their mothers were ≥24 years of age (aOR = 0.440; 95% CI = 0.266–0.727).

Conclusion: The proportion of underweight, stunting, and wasting was more than the national average among the children of former-Kamaiyas. Female children were more likely to be underweight whereas children who were being bathed daily and with mothers whose age was ≥24 years were less likely to be underweight.

Determinants of stunting and severe stunting among under-fives: evidence from the 2011 Nepal Demographic and Health Survey

Background

Stunting remains a major public health concern in Nepal as it increases the risk of illness, irreversible body damage and mortality in children. Public health planners can reshape and redesign new interventions to reduce stunting and severe stunting among children aged less than 5 years in this country by examining their determinants. Hence, this study identifies factors associated with stunting and severe stunting among children aged less than five years in Nepal.

Methods

The sample is made up of 2380 children aged 0 to 59 months with complete anthropometric measurements from the 2011 Nepal Demographic and Health Survey (NDHS). Simple and multiple logistic regression analyses were used to examine stunting and severe stunting against a set of variables.

Results

The prevalences of stunting and severe stunting were 26.3% [95% confidence Interval (CI): 22.8, 30.1] and 10.2% (95%CI: 7.9, 13.1) for children aged 0–23 months, respectively, and 40.6 (95%CI: 37.3, 43.2) and 15.9% (95%CI: 13.9, 18.3) for those aged 0–59 months, respectively. After adjusting for potential confounding factors, multivariable analyses showed that the most consistent significant risk factors for stunted and severely stunted children aged 0–23 and 0–59 months were household wealth index (poorest household), perceived size of baby (small babies) and breastfeeding for more than 12 months (adjusted odds ratio (AOR) for stunted children aged 0–23 months = 2.60 [95% CI: (1.87, 4.02)]; AOR for severely stunted children aged 0–23 months = 2.87 [95% CI: (1.54, 5.34)]; AOR for stunted children aged 0–59 months = 3.54 [95% CI: (2.41, 5.19)] and AOR for severely stunted children aged 0–59 months = 4.15 [95% CI: (2.45, 6.93)].

Conclusions

This study suggests that poorest households and prolonged breastfeeding (more than 12 months) led to increased risk of stunting and severe stunting among Nepalese children. However, community-based education intervention are needed to reduce preventable deaths triggered by malnutrition in Nepal and should target children born to mothers of low socioeconomic status.

Prevalence of malnutrition among pre-school children in South-east Nigeria

BACKGROUND

Malnutrition can be defined as a state of nutrition where the weight for age, height for age and weight for height indices are below -2 Z-score of the NCHS reference. It has posed a great economic burden to the developing world.

OBJECTIVES

The objective of this study is to assess the prevalence of malnutrition among pre-school children in Abakiliki in Ebonyi state of Nigeria.

METHODS

This is a cross-sectional studies that assess the prevalence of malnutrition and associated factors among children aged 1-5 years attending nursery and primary schools. Nutritional assessment was done using anthropometry and clinical examination.

RESULTS

A total of 616 children aged one to 5 years were enrolled into this study. Three hundred and sixty-seven (59.6%) were males while 249 (40.4%) were females. Sixty of the 616 children (9.7%) had acute malnutrition based on WHZ-score. Moderate acute malnutrition (MAM) was present in 33 children (5.3%) while 27 (4.4%) had severe acute malnutrition.

CONCLUSIONS

The prevalence of global and severe acute malnutrition using z-score is 9.7% and 4.4% respectively while that of stunting is 9.9% with a male preponderance.

Nutritional status of young children in Mumbai slums: a follow-up anthropometric study

Background

Chronic childhood malnutrition remains common in India. As part of an initiative to improve maternal and child health in urban slums, we collected anthropometric data from a sample of children followed up from birth. We described the proportions of underweight, stunting, and wasting in young children, and examined their relationships with age.

Methods

We used two linked datasets: one based on institutional birth weight records for 17 318 infants, collected prospectively, and one based on follow-up of a subsample of 1941 children under five, collected in early 2010.

Results

Mean birth weight was 2736 g (SD 530 g), with a low birth weight (<2500 g) proportion of 22%. 21% of infants had low weight for age standard deviation (z) scores at birth (<−2 SD). At follow-up, 35% of young children had low weight for age, 17% low weight for height, and 47% low height for age. Downward change in weight for age was greater in children who had been born with higher z scores.

Discussion

Our data support the idea that much of growth faltering was explained by faltering in height for age, rather than by wasting. Stunting appeared to be established early and the subsequent decline in height for age was limited. Our findings suggest a focus on a younger age-group than the children over the age of three who are prioritized by existing support systems.

Funding

The trial during which the birth weight data were collected was funded by the ICICI Foundation for Inclusive Growth (Centre for Child Health and Nutrition), and The Wellcome Trust (081052/Z/06/Z). Subsequent collection, analysis and development of the manuscript was funded by a Wellcome Trust Strategic Award: Population Science of Maternal and Child Survival (085417ma/Z/08/Z). D Osrin is funded by The Wellcome Trust (091561/Z/10/Z).

Prevalence of undernutrition, its determinants, and seasonal variation among tribal preschool children of Odisha state, India

A community-based cross-sectional study was undertaken in the tribal areas of Odisha state, India, covering 1951 preschool children to assess their nutritional status in terms of underweight, stunting, and wasting; its correlates; and seasonal variation in nutritional status. χ(2) Test, one-way analysis of variance, and unadjusted and adjusted odds ratios were used for data analysis. The prevalence of underweight, stunting, and wasting was 58%, 65%, and 20%, respectively. The risk of underweight and stunting was, respectively, 1.9 and 2.4 times higher among children of illiterate mothers, whereas underweight and wasting was 1.4 times higher among children who had morbidities during the preceding fortnight. The prevalence of undernutrition was significantly (P < .01) higher during monsoon as compared with winter season. Undernutrition is an important public health problem and is associated with literacy of mother, morbidity, and season. Thus, improving socioeconomic condition, literacy, and sanitation along with insuring food security during monsoon season might improve nutritional status.