An Investigation of the Prevalence and Causes of Malnutrition in Iran: a Review Article and Meta-analysis

Association of healthy eating index and anthropometric indices among primary school girls in southeast of Iran: a cross-sectional study

BACKGROUND

The school-age period is marked by substantial advancements in physical and cognitive development, highlighting the importance of assessing the diet quality and its impact on body weight and height. The main objective of this study was to evaluate the association between diet quality and selected anthropometric indices of primary school girls in southeast of Iran using the healthy eating index-2015 (HEI-2015).

METHODS

This cross-sectional study involved 330 students aged 6-12 years from 10 primary schools in Kerman City. Standard protocols and a dish-based food frequency questionnaire were employed to evaluate anthropometric indices and dietary intake. The HEI-2015 was utilized to assess the quality of participants' diets, with a total score ranging from zero to 100, based on thirteen food score components.

RESULTS

In the present study, older participants had higher HEI scores (p = 0.02). Additionally, participants in the highest tertile of HEI score had greaterodds of being overweight (OR: 2.13; CI = 1.17-3.85, P = 0.011) and had higher intakes of whole fruits, total fruits including fruit juice, whole grains, total protein foods, seafood and plant proteins, greens, and beans (p < 0.05). However, no significant association was found between HEI score and other anthropometric indices, obesity, and thinness.

CONCLUSIONS

The study found no significant association between HEI scores and the likelihood of being thin or obese. However, children with the highest HEI scores were more likely to beoverweight. Therefore, it is recommended to implement health programs for primary school girls in Kerman to improve their eating habits and reduce the risk of overweight and obesity.

Designing and Evaluating a Nutrition Recommender System for Improving Food Security in a Developing Country

BACKGROUND

Due to the increased price of foods in recent years and the diminished food security in Iran, nutrition recommender systems can suggest the most suitable and affordable foods and diets to users based on their health status and food preferences. Objective: The present study aimed to design and evaluate a recommender system to suggest healthy and affordable meals and provide a tele-nutrition consulting service.

METHODS

This applied three-phase study was conducted in 2020. In the first stage, the food items' daily prices were extracted from credible sources, and accordingly, meals were placed in three price categories. After conducting a systematic review of similar systems, the requirements and data elements were specified and confirmed by 10 nutritionists and 10 health information management and medical informatics experts. In the second phase, the software was designed and developed based on the findings. In the third phase, system usability was evaluated by four experts based on Nielsen's heuristic evaluation.

RESULTS

Initially, 72 meals complying with nutritional principles were placed in three price categories. Following a literature review and expert survey, 31 data elements were specified for the system, and the experts confirmed system requirements. Based on the information collected in the previous stage, the Web-based software TanSa in the Persian language was designed, developed, and presented on a unique domain. During the evaluation, the mean severity of the problems associated with Nielsen's 10 principles was 1.2, which is regarded as minor.

CONCLUSION

To promote food security, the designed system recommends healthy, nutritional, and affordable meals to individuals and households based on user characteristics.

Street Children in Iran: What Are Their Living and Working Conditions? Findings from a Survey in Six Major Cities

Street children are among the most marginalized children, globally, who experience severe violations of their rights and face multiple deprivations. This study aimed to describe street children's characteristics and working conditions in Iran.

METHOD

This cross-sectional rapid survey was conducted from March to May 2017 in six major cities in Iran. The sample group consisted of Iranian and non-Iranian girls and boys, aged 10 to 18, who worked on the streets for at least one month prior to the survey. Time-location based sampling was used. A total of 856 Children were randomly selected from 464 venues, including corners of streets, parks, metro gates, bus stations, shopping malls, and shopping centers frequented by street children.

RESULTS

Findings showed that 90% of participants were boys, 60% were between 10 and 14 years old, almost 50% attended school, 12% were illiterate, and 32% had quit school. Children of Afghan nationality comprised 54% of the study participants, and the rest were Iranian. Of all participants, 85% resided with family or relatives. Most children (75.5%) worked more than 5 h daily, and vending (71.2%) and waste picking (16.1%) were common activities. Street children suffered, mainly, from harsh weather (22.7%), insults and beatings of everyday people (21%), starvation (20.7%), and police repression (15.4%). More than half of the study participants were not involved in intervention programs, and just 7% of them had attended any health education programs.

CONCLUSION

Street children reported little to no service use, which may contribute to poor health. Street children require immediate attention to improve their wellbeing. Decision-makers and academicians should collaborate on intervention development research to design appropriate health and social interventions targeted at street children.

Evaluation of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old

Background

Considering the destructive effects of malnutrition on the growth, development, and health of children and the importance of identifying the factors affecting it, the present study aimed to investigate the status of anthropometric indices and their relationship with maternal nutritional literacy and selected socio-economic and demographic variables among children under 5 years old.

Methods

This cross-sectional study was conducted on 405 mothers with children under 5 years old in Urmia, Iran. The data collection tool consisted of two parts. The first part was the demographic and socio-economic information of mother and child and the second part was the Evaluation Instrument of Nutrition Literacy on Adults; EINLA.

Results

There was statistically significant relationship between maternal nutritional literacy with weight-for-age, height-for-age, and weight-for-height indices; between weight-for-age index with maternal education, gestational weight gain, and mean weight, as well as mean height of the mother; between weight-for-age and weight-for-height indices with child gender, type of milk consumed, status of starting complementary foods, and history of acute respiratory infection, as well as diarrhea; and finally between height-for-age with family income status.

Conclusions

It is suggested that mothers with low nutritional literacy, mothers whose gestational weight gain was not normal, children whose family income is low, boy child, children with a history of disease, children who consume powdered milk and children who have not started complementary foods at the right time be given priority when designing and implementing educational interventions to enhance nutritional status and anthropometric indices of children.

The Analysis of Trends of Preschool Child Stunting, Wasting and Overweight in the Eastern Mediterranean Region: Still More Effort Needed to Reach Global Targets 2025

BACKGROUND

This study was undertaken to analyze and compare Eastern Mediterranean (EM) countries in achievement of WHO nutrition global targets for children growth indicators by 2025.

METHODS

A total of 108 national surveys from 20 countries in EM region were analyzed to estimate the prevalence of stunting and wasting and 93 surveys to estimate the prevalence of overweight/obesity in children. These data were obtained from national surveys included in the WHO Global Database on Child Growth and Malnutrition.

RESULTS

In EM region, the prevalence of childhood stunting was estimated to have a 38% decline from 2000 (34.7%) to 2025 (21.2%). Only three countries in EM region (Iran and Jordan, Saudi Arabia) were anticipated to achieve the expected WHO target by 2025. From 2000 to 2020, the prevalence of wasting decreased from 6.9 to 5.3. Six countries were presumed to achieve the expected WHO target by 2025. Nine countries will presumably have overweight rates >5% (Djibouti, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Syrian Arab Republic and Tunisia) in 2025 whereas five countries will have overweight rates above 10% (Egypt, Libya, Morocco, Syrian Arab Republic and Tunisia).

CONCLUSION

Despite descending trends of child stunting and wasting and a secular trend of child obesity in EM region, it is expected that WHO targets will not be achieved by 2025. A diverse socio-economic condition in EM countries necessitates different action plans. International determination, political commitment and, above all, involvement of the families are needed to achieve 2025 targets for child stunting, wasting and overweight/obesity.

Improvement in Anthropometric Measurements of Malnourished Children by Means of Complementary Food and Nutritional Education in Fars Province, Iran: A Community-Based Intervention

Background

Childhood malnutrition could have adverse impacts on the growth of child and eventually on fertility and general economic growth, and still, this issue remains a worldwide priority and a concern. This study aimed to evaluate the effectiveness of the national nutritional interventions program on the improvement and nutritional status of malnourished children children aged 6–59 months.

Methods

This community-based intervention study was conducted with 1288 acute and moderately malnourished children aged 6–59 months referred to health centers. Children received combined nutritional education and counseling with the provision of affordable complementary food for 10 months. Anthropometric measurements were assessed monthly according to the standard protocols.

Results

Our results showed the reduction in the risk of malnutrition among children after nutritional interventions for weight-for-height (WHZ) (P < 0.001), height-for-age (HAZ) (P < 0.001), and weight-for-age (WAZ) (P = 0.008). Total malnourished children indicated improvement in HAZ (<-3 SD: OR = 1.10, P = 0.026), WAZ (<-2SD: OR = 1.21, P < 0.001; <-3SD: OR = 1.60, P < 0.001), and WHZ (<-3SD: OR = 1.10, P = 0.030). Controlling potential confounders (socioeconomic status, childrens' birth supine length, and weight) showed a significant amelioration in HAZ (<-2 SD: OR = 6.20, P = 0.020; <-3 SD: OR = 9, P = 0.003) and WAZ (<-2 SD: OR = 5.85, P = 0.010; <-3 SD: OR = 7.50, P = 0.004). In urban areas, significant amelioration was observed in HAZ (<-3 SD: OR = 1.22, P = 0.010) and WAZ (<-2 SD: OR = 1.24, P = 0.003; <-3 SD: OR = 1.64, P < 0.001). In rural, considerable amelioration was observed in WAZ (<-2 SD: OR = 1.20, P = 0.010; <-3 SD: OR = 1.50, P < 0.001) and WHZ (<-3 SD: OR = 1.20, P = 0.020).

Conclusion

Nutritional training and counseling as well as complementary food intervention among the malnourished children significantly improved the nutritional status of children. So community-based intervention is recommended to reduce the malnutrition among children.

Undernutrition among under-five indigenous Mbororo children in the Foumban and Galim health districts of Cameroon: a cross-sectional study

Introduction

despite increasing research interest on Indigenous peoples´ health worldwide, the nutritional status of Indigenous children in Cameroon remains unknown. This study was conducted to assess the prevalence of stunting, wasting, and underweight among under-five Indigenous Mbororo children in the Foumban and Galim health districts of the West Region.

Methods

a cross-sectional study was conducted involving 472 child-caregiver pairs from 16 Mbororo Communities in the Foumban and Galim health districts. Interviewer-administered questionnaires were used for data collection. Anthropometric measurements were collected using standard procedures. Socio-demographic data were analyzed using descriptive statistics. Anthropometric indices: height-for-age, weight-for-height, and weight-for-age - z-scores were analyzed using z-score 06 Stata version 11 and compared with World Health Organization growth reference standards. Ethical approval was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea.

Results

overall prevalence of stunting, wasting and underweight were 55.08% (95% CI: 50.5-59.58), 13.77% (95% CI: 10.65-16.89), and 31.99% (95% CI: 27.76-36.21), respectively. Severe stunting, wasting and underweight were 34.53% (95% CI: 30.22-38.83), 3.18% (95% CI: 1.58-4.76), and 10.59% (95% CI: 7.80-13.37), respectively. Rates of stunting, wasting and underweight for female and male were: 56.88% and 52.71%; 12.38% and 14.72%; and 30.73% and 32.55%, respectively. Stunting, wasting and underweight rates varied with child age.

Conclusion

the prevalence of undernutrition was high, indicating a serious public health problem and the necessity for strategies to ensure the optimal health of the target population.

Mind the gap: What explains the poor-non-poor inequalities in severe wasting among under-five children in low- and middle-income countries? Compositional and structural characteristics

A good understanding of the poor-non-poor gap in childhood development of severe wasting (SW) is a must in tackling the age-long critical challenge to health outcomes of vulnerable children in low- and middle-income countries (LMICs). There is a dearth of information about the factors explaining differentials in wealth inequalities in the distribution of SW in LMICs. This study is aimed at quantifying the contributions of demographic, contextual and proximate factors in explaining the poor-non-poor gap in SW in LMICs. We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in LMICs. The final data consist of 532,680 under-five children nested within 55,823 neighbourhoods from 51 LMICs. Our outcome variable is having SW or not among under-five children. Oaxaca-Blinder decomposition was used to decipher poor-non-poor gap in the determinants of SW. Children from poor households ranged from 37.5% in Egypt to 52.1% in Myanmar. The overall prevalence of SW among children from poor households was 5.3% compared with 4.2% among those from non-poor households. Twenty-one countries had statistically significant pro-poor inequality (i.e. SW concentrated among children from poor households) while only three countries showed statistically significant pro-non-poor inequality. There were variations in the important factors responsible for the wealth inequalities across the countries. The major contributors to wealth inequalities in SW include neighbourhood socioeconomic status, media access, as well as maternal age and education. Socio-economic factors created the widest gaps in the inequalities between the children from poor and non-poor households in developing SW. A potential strategy to alleviate the burden of SW is to reduce wealth inequalities among mothers in the low- and middle-income countries through multi-sectoral and country-specific interventions with considerations for the factors identified in this study.

Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in low- and middle-income countries

BACKGROUND

Low- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, household and neighbourhood characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities.

METHODS

We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p = 0.05.

RESULTS

The proportion of children whose mothers were not educated ranged from 0.1% in Armenia and Kyrgyz Republic to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p < 0.001), Chad(p < 0.001), Comoro(p = 0.047), Burkina Faso(p < 0.001), Ethiopia(p < 0.001), India(p < 0.001), Kenya(p < 0.001), Mozambique(p = 0.012), Namibia(p = 0.001), Nigeria(p < 0.001), Pakistan(p < 0.001), Senegal(p = 0.003), Togo(p = 0.013), and Timor Leste(p < 0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child's age (p < 0.001), child's sex(p < 0.001), maternal age(p = 0.001), household wealth quintile(p = 0.001), mother's access to media(p = 0.001), birth weight(p < 0.001) and neighbourhood socioeconomic status disadvantage(p < 0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.

CONCLUSIONS

SAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.

Severe acute malnutrition among under-5 children in low- and middle-income countries: A hierarchical analysis of associated risk factors

OBJECTIVES

Malnutrition is one of the main reasons for death among children <5 years of age in low- and middle-income countries (LMICs). It accounts for about one-third of preventable deaths among children. Reduction of malnutrition, especially severe acute malnutrition (SAM), is critical, directly or indirectly, to a targeted decrease in child mortality and improvement in maternal health. It would also help achieve sustainable development goal 2 (improvement of nutrition across the board) and sustainable development goal 3 (ensuring healthy lives and well-being promotion for all at all ages). The aim of this study was to develop and test a model of risk factors associated with SAM among under-5 children in LMICs.

METHODS

We used 51 recent demographic and health-surveys, cross-sectional, nationally representative data collected between 2010 and 2018 in LMICs. We used multivariable Bayesian logistic multilevel regression models to analyze the association between individual compositional and contextual risk factors associated with SAM. We analyzed information on 532 680 under-5 children (level 1) nested within 55 823 communities (level 2) from 51 LMICs (level 3).

RESULTS

The prevalence of SAM ranged from 0.1% in both Guatemala and Peru to 9.9% in Timor-Leste. Male children, infants, low birth weight children, children whose mothers had no formal education, those from poorer households, and those with no access to any media were more likely to have SAM. Additionally, children from rural areas, neighborhoods with high illiteracy and high unemployment rates, and those from countries with high intensity of deprivation and high rural population percentage were more likely to have SAM.

CONCLUSION

Individual compositional and contextual factors were significantly associated with SAM. Attainment of sustainable development goals 1, 4, and 10 will automatically contribute to the eradication of SAM, which in turn leads to the attainment of sustainable development goals 2 and 3. These findings underscore the need to revitalize existing policies and implement interventions to rescue and prevent children from having SAM at the individual, community, and societal levels in LMICs.