Association of Infant and Child Feeding Index with Undernutrition in Children Aged 6-59 Months: A Cross-Sectional Study in the Maldives

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study

OBJECTIVE

We aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers.

METHODS

We selected 614 preschoolers (2-6 years) who had one day of 24-h dietary recall data from the 2013-2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants' outpatient and emergency medical service utilization were obtained for 2013-2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases.

RESULTS

After adjustment for confounding factors, children aged 2-3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69-0.83) and 16% (95% CI 0.77-0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4-6 years in the T2 group exhibited 15% (95% CI 0.80-0.91) and 11% (95% CI 0.82-0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group.

CONCLUSIONS

TCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

Determinants of Diarrhea Among Children Aged 1 to 6 Years in Flood-Affected Areas of Pakistan: A Cross-Sectional Study

Frequent floods can contribute to the spread of various diseases and complications, some of which may result in diarrhea, especially among children. The current study aimed to find the determinants of diarrhea among children aged 1-6 years in flood-affected areas in Khyber Pakhtunkhwa, Pakistan. A cross-sectional study was conducted in flood-affected districts. Data regarding sociodemographic information related to diarrhea and anthropometric data were collected through a validated questionnaire. Logistic regression was used to find the determinants of diarrhea. In the presence of diarrhea, the prevalences found of stunting, wasting, and being underweight were 75.2%, 76.5%, and 74.1%, respectively, which is higher than those in children without diarrhea (stunting, 24.8%; wasting, 23.5%; and being underweight, 25.9%). In bivariate regression, children aged 2-4 years (odds ratio [OR] = 1.65, P < 0.05), large family size (OR = 7.46, P < 0.01), low income (OR = 2.55, < 0.001), bathing in ponds (OR = 3.05, P < 0.05), drinking of untreated water (OR = 3, P < 0.05), flooding (OR = 1.8, P < 0.05), children living in mud houses (OR = 1.5, P < 0.05), and usage of utensils without lids (OR = 1.96, P < 0.001) were significantly associated with occurrence of diarrhea. In multivariate regression, the identified risk factors (P < 0.05) for diarrhea in flood-affected areas included illiterate mothers, flooding, large family size, households without livestock, poor water quality, untreated water, and lack of toilet facilities. In conclusion, addressing the determinants of diarrhea identified in this study is crucial for mitigating the impact of frequent floods on children in flood-affected areas. Moreover, the higher prevalence of malnutrition underscores the urgent need for comprehensive strategies and proper water, sanitation, and hygiene programs to reduce the occurrence and determinants of diarrhea.

Predictive Utility of Composite Child Feeding Indices (CCFIs) for Child Nutritional Status: Comparative Analyses for the Most Suitable Formula for Constructing an Optimum CCFI

Composite child feeding indices (CCFIs) developed from various relevant measures of dietary intake by infants and young children have several potential applications in nutritional epidemiological studies for the development and deployment of precise public health nutrition interventions against child undernutrition. The predictive utility of some CCFIs (computed from varying formulation components) for child nutritional status (stunting, wasting, and underweight) were compared. The purpose of the study was to identify the most suitable among them for possible standardization, validation, and adoption by nutritional health researchers. Using cluster sampling, data from 581 mother–child pairs were collected. Multivariable regression analyses were applied to the data obtained through a community-based analytical cross-sectional survey design. Three of the CCFIs were found to be significantly associated with only wasting (WHZ) from the linear regression models after adjusting for potential confounders and/or correlates. None of the CCFIs (whether in the continuous nor categorical form) was consistently predictive of all three measures of child nutritional status, after controlling for potential confounders and/or correlates, irrespective of the choice of regression method. CCFI 5 was constructed using a dimension reduction technique—namely principal component analysis (PCA)—as the most optimal summary index in terms of predictiveness for child wasting status, validity, and reliability (Cronbach’s α = 0.80) that captured relevant dimensions of optimal child food intake. The dimension reduction approach that was used in constructing CCFI 5 is recommended for standardization, validation, and possible adoption for wider applicability across heterogeneous population settings as an optimum CCFI usable for nutritional epidemiological studies among children under five years.

Preparedness to Combat Determinants of Underweight-Based Child Malnutrition in Flood-Affected Areas of Pakistan

Aims. Floods badly impact the food and nutrition security in developing countries. The role of the government and the impact of floods on the underweight status of children in the affected areas is not clear. We aimed to find the determinants of underweight in flood-affected areas of Khyber Pakhtunkhwa, Pakistan. Methods. We used a multistage sampling technique and selected 656 households during in the flood-affected areas of Pakistan. Data were collected in the three most affected districts. A validated questionnaire was used to find socioeconomic and demographic information, hygiene, and sanitation information. We used logistic regression to find the determinants of underweight, controlling for confounders. Results. The prevalence of global malnutrition based on underweight was 25.2%. The prevalence of underweight was higher in young age mothers (40.6%), younger age children (71.4%), large family size (28.4%), joint family (27%), and no toilet facility (28.9%). District Nowshera was at high risk of underweight based undernutrition, followed by district Charsadda compared to children belonging to Dera Ismail Khan. The significant risk factor that causes underweight was child lower age ( $p<0.01$ ), young age of mothers ( $p<0.01$ ), children access to unimproved water sources ( $p<0.01$ ), and location (districts) due to environmental and constant flood consequences ( $p<0.01$ ). Conclusion. In conclusion, risk factors of underweight should be appropriately targeted in the flood-hit areas of Pakistan. Governments should preallocate budgetary resources and enhance the emergency preparedness levels to facilitate the communities with flooding incidents and their aftermath in the shape of child underweight-based malnutrition.

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan

Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent's anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

Infant and Child Feeding Index and nutritional status of children aged 6 to 24 months in a Metropolitan city

Background:

The nutritional status of children is influenced by feeding practices. Infant and Child Feeding Index (ICFI) is an age-specific composite index to assess the feeding practices of children.

Objectives:

To determine the association between ICFI and the nutritional status of children aged 6 to 24 months. To find whether ICFI has value as a tool for detecting poor nutritional status. To determine the association of ICFI and nutritional status with sociodemographic and other factors.

Methods:

A cross-sectional study was conducted in the urban field practice area of a tertiary care institute among 149 children aged 6 to 24 months and their mothers. Data on feeding practices were obtained and ICFI scores were calculated. The weight and length of the children were measured and Z scores (WAZ, LAZ, and WLZ) were calculated. A Chi-square test was used to find the association between the categorical variables.

Results:

We found no association between ICFI and any of the three nutritional indicators such as WAZ, LAZ, and WLZ. The sensitivity of the ICFI was low for detecting underweight (10.0%), stunting (29.4%), and wasting (11.1%). ICFI was significantly associated with the growth monitoring of children and mothers' education. WAZ was significantly associated with mother's education and socioeconomic class.

Conclusions:

There is no association between ICFI and the nutritional status of children. ICFI has limited value in detecting the poor nutritional status of children in this urban setting. Maternal education and growth monitoring of children play an important role in infant and child feeding practices.