The double burden of overnutrition and undernutrition in mother-child dyads in Kenya: demographic and health survey data, 2014

The double burden of overnutrition and undernutrition is rapidly becoming a public health concern in low- and middle-income countries. We explored the occurrence of mother-child pairs of over- and undernutrition and the contributing factors using the 2014 Kenya Demographic and Health Survey data. A weighted sample of 7830 mother-child pairs was analysed. The children's nutritional status was determined using the WHO 2006 reference standards while maternal nutritional status was determined with BMI. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. The proportion of overweight and obese mothers was 26 % (18·8 % overweight and 7·2 % obese). The prevalence of child stunting, underweight and wasting was 26·3, 12·8 and 5·1 %, respectively. Out of the overweight/obese mothers (weighted n 2034), 20 % had stunted children, 5·4 % underweight children and 3·1 % wasted children. Overweight/obese mother-stunted child pairs and overweight/obese mother-underweight child pairs were less likely to occur in the rural areas (adjusted OR (aOR) = 0·43; P < 0·01) in comparison with those residing in the urban areas (aOR = 0·54; P = 0·01). Children aged more than 6 months were more likely to be in the double burden dyads compared with children below 6 months of age (P < 0·01). The double burden mother-child dyads were more likely to be observed in wealthier households. Mother-child double burden is a notable public health problem in Kenya. Household wealth and urban residence are determinants of the double burden. There is need for target-specific interventions to simultaneously address child undernutrition and maternal overweight/obesity.

Is there a threshold level of maternal education sufficient to reduce child undernutrition? Evidence from Malawi, Tanzania and Zimbabwe

Background

Maternal education is strongly associated with young child nutrition outcomes. However, the threshold of the level of maternal education that reduces the level of undernutrition in children is not well established. This paper investigates the level of threshold of maternal education that influences child nutrition outcomes using Demographic and Health Survey data from Malawi (2010), Tanzania (2009–10) and Zimbabwe (2005–06).

Methods

The total number of children (weighted sample) was 4,563 in Malawi; 4,821 children in Tanzania; and 3,473 children in Zimbabwe Demographic and Health Surveys. Using three measures of child nutritional status: stunting, wasting and underweight, we employ a survey logistic regression to analyse the influence of various levels of maternal education on child nutrition outcomes.

Results

In Malawi, 45 % of the children were stunted, 42 % in Tanzania and 33 % in Zimbabwe. There were 12 % children underweight in Malawi and Zimbabwe and 16 % in Tanzania.The level of wasting was 6 % of children in Malawi, 5 % in Tanzania and 4 % in Zimbabwe. Stunting was significantly (p values < 0.0001) associated with mother’s educational level in all the three countries. Higher levels of maternal education reduced the odds of child stunting, underweight and wasting in the three countries. The maternal threshold for stunting is more than ten years of schooling. Wasting and underweight have lower threshold levels.

Conclusion

These results imply that the free primary education in the three African countries may not be sufficient and policies to keep girls in school beyond primary school hold more promise of addressing child undernutrition.

Dietary intake of schoolchildren and adolescents in developing countries

School age and adolescence is a dynamic period of growth and development forming a strong foundation for good health and productive adult life. Appropriate dietary intake is critical for forming good eating habits and provides the much needed nutrients for growth, long-term health, cognition and educational achievements. A large proportion of the population globally is in the school age or adolescence, with more than three quarters of these groups living in developing countries. An up-to-date review and discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to provide recent data on patterns of dietary intake, adequacy of nutrient intake and their implications for public health and nutrition issues of concern. This review is based on literature published from 2000 to 2014 on dietary intake of schoolchildren and adolescents aged 6-19 years. A total of 50 studies from 42 countries reporting on dietary intake of schoolchildren and adolescents were included. The dietary intake of schoolchildren and adolescents in developing countries is limited in diversity, mainly comprising plant-based food sources, but with limited intake of fruits and vegetables. There is a low energy intake and insufficient micronutrient intake. At the same time, the available data indicate an emerging trend of consumption of high-energy snacks and beverages, particularly in urban areas. The existence of a negative and positive energy balance in the same population points to the dual burden of malnutrition and highlights the emerging nutrition transition in developing countries. This observation is important for planning public health nutrition approaches that address the concerns of the two ends of the nutrition divide.