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Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition 2024; 122:112390. [PMID: 38458063 DOI: 10.1016/j.nut.2024.112390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Concurrent wasting and stunting (WaSt) in a child is a health problem that leads to detrimental effects. However, to our knowledge, there is limited research regarding the prevalence and determinants of WaSt, including in Indonesia. The aim of this study was to analyze the prevalence and determinants of WaSt in children 6 to 23 mo of age. METHODS This cross-sectional study was conducted with data sets from the Indonesia Nutritional Status Survey (INSS). Data was collected between January and December 2021. About 15 641 children, ages 23 mo, were included. A χ2 analysis examined the association between the dependent and independent variables. A multivariate test analyzed the risk for the independent variable to the dependent, seen through the adjusted odds ratio (aOR). RESULTS The prevalence of WaSt was 2.4%. Higher odds for WaSt were seen in the following: • Boys: 2.15 times (95% confidence interval [CI], 1.72-2.68); • Children ages 12 to 23 mo 3.15 times (95% CI, 2.33-4.25); • Those with low birth weight 3.11 times (95% CI, 2.33-4.15) • Those with small birth size: 2 times (95% CI, 1.59-2.54) • Babies born from mothers >35 y of age: 1.5 times (95% CI, 1.19-1.89); • Children who experienced infection: 1.43 times (95% CI, 1.16-1.76); • Children not using the Integrated Health and Nutrition Services (Posyandu): 1.17 times (95% CI; 1.29-2.27); • Children from middle- income families:2.54 times higher odds (95% CI, 1.75-3.7); and • Children from rural areas: 1.37 times (95% CI, 1.1-1.71). CONCLUSION WaSt is associated with multiple factors in Indonesia. Hence, policymakers need to address this problem comprehensively.
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Affiliation(s)
- Lidya Alwina Jokhu
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ahmad Syauqy
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
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Bourdon C, Diallo AH, Mohammad Sayeem Bin Shahid AS, Khan MA, Saleem AF, Singa BO, Gnoumou BS, Tigoi C, Otieno CA, Oduol CO, Lancioni CL, Manyasi C, McGrath CJ, Maronga C, Lwanga C, Brals D, Ahmed D, Mondal D, Denno DM, Mangale DI, Chimwezi E, Mbale E, Mupere E, Salauddin Mamun GM, Ouédraogo I, Berkley JA, Njunge JM, Njirammadzi J, Mukisa J, Thitiri J, Walson JL, Jemutai J, Tickell KD, Shahrin L, Mallewa M, Hossain MI, Chisti MJ, Timbwa M, Mburu M, Ngari MM, Ngao N, Aber P, Harawa PP, Sukhtankar P, Bandsma RH, Bamouni RM, Molyneux S, Mwaringa S, Shaima SN, Ali SA, Afsana SM, Banu S, Ahmed T, Voskuijl WP, Kazi Z. Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort. EClinicalMedicine 2024; 70:102530. [PMID: 38510373 PMCID: PMC10950691 DOI: 10.1016/j.eclinm.2024.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
Background Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. Methods We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates. Findings We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36, -0.19]) and MW (-0.23 [-0.34, -0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions. Interpretation Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support. Funding Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813.
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Affiliation(s)
- Celine Bourdon
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Abdoulaye Hama Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Public Health, Centre Muraz Research Institute, Bobo-Dioulasso, Burkina Faso
| | | | - Md Alfazal Khan
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ali Faisal Saleem
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Caroline Tigoi
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | | | | | - Christine J. McGrath
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Christopher Maronga
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christopher Lwanga
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Daniella Brals
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dilruba Ahmed
- Clinical Microbiology and Immunology Laboratory, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dinesh Mondal
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donna M. Denno
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Emmanuel Chimwezi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gazi Md Salauddin Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Issaka Ouédraogo
- Department of Pediatrics, Banfora Referral Regional Hospital, Banfora, Burkina Faso
| | - James A. Berkley
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - James M. Njunge
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jenala Njirammadzi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John Mukisa
- Department of Immunology and Department of Molecular Biology Makerere University College of Health Sciences, Kampala, Uganda
| | - Johnstone Thitiri
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Judd L. Walson
- Departments of International Health and Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Julie Jemutai
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kirkby D. Tickell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lubaba Shahrin
- Hospitals, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Macpherson Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Md Iqbal Hossain
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Molline Timbwa
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Mburu
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses M. Ngari
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Narshion Ngao
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peace Aber
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Philliness Prisca Harawa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Priya Sukhtankar
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert H.J. Bandsma
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Health Systems and Research Ethics Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shalton Mwaringa
- Clinical Research Department, KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syeda Momena Afsana
- Clinical Biochemistry Laboratory, Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Office of Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Wieger P. Voskuijl
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Amsterdam UMC, Location University of Amsterdam, Amsterdam Institute for Global Child Health, Emma Children’s Hospital, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC, Location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9, Amsterdam, the Netherlands
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Wu L, Wang J, Lu Y, Huang Y, Zhang X, Ma D, Xiao Y, Cao F. Association of intimate partner violence with offspring growth in 32 low- and middle-income countries: a population-based cross-sectional study. Arch Womens Ment Health 2024; 27:179-190. [PMID: 37947903 DOI: 10.1007/s00737-023-01387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother-child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence.
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Affiliation(s)
- Liuliu Wu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Juan Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, Hangzhou, 311121, People's Republic of China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, 310058, People's Republic of China
| | - Yan'e Lu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Yongqi Huang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Xuan Zhang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Dandan Ma
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Yiping Xiao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China.
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Abstract
OBJECTIVE To describe the scenario of child undernutrition in Brazil and its determinants. DATA SOURCE Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. DATA SYNTHESIS Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). CONCLUSION Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.
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Affiliation(s)
| | | | - Ana Lydia Sawaya
- Centro de Recuperação e Educação Nutricional, São Paulo, SP, Brazil
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Penteado MP, Grandi C, Rodrigues LDS, Cardoso VC. Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort. J Pediatr (Rio J) 2024:S0021-7557(24)00007-X. [PMID: 38346677 DOI: 10.1016/j.jped.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. METHOD This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. RESULTS 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. CONCLUSIONS Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.
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Affiliation(s)
- Marina Papa Penteado
- Universidade de São Paulo (USP), Hospital das Clínicas de Ribeirão Preto (HCRP), HC Criança, Ribeirão Preto, SP, Brazil.
| | - Carlos Grandi
- Sociedade Argentina de Pediatria, Comissão de Pesquisa, Buenos Aires, Argentina
| | | | - Viviane Cunha Cardoso
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Puericultura e Pediatria, Ribeirão Preto, SP, Brazil
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Gebreegziabher T, Sidibe S. Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018. Public Health Nutr 2024; 27:e58. [PMID: 38311339 PMCID: PMC10882532 DOI: 10.1017/s1368980024000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali. DESIGN Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018. SETTING Urban and rural areas of Mali. PARTICIPANTS A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months). RESULTS In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group. CONCLUSIONS This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.
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Affiliation(s)
- Tafere Gebreegziabher
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA98926, USA
| | - Saran Sidibe
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA98926, USA
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Grace N, Mbabazi E, Mukunya D, Tumuhamye J, Okechi H, Wegoye E, Olupot-Olupot P, Matovu JK, Hopp L, Napyo A. High burden of wasting among children under-five with hydrocephalus receiving care at CURE children's hospital in Uganda: a cross-sectional study. BMC Nutr 2024; 10:14. [PMID: 38233952 PMCID: PMC10795367 DOI: 10.1186/s40795-024-00819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Hydrocephalus is one of the most common neurological disabilities presenting in children. Although there are limited studies on its association with wasting, neurological comorbidities such as dysphagia have been associated with an increased risk of wasting in children. In this study, we aimed to determine the prevalence and factors associated with wasting in children less than five years with hydrocephalus. METHODS We conducted a cross-sectional study at various satellite clinics of CURE Children's Hospital in Uganda between September and November 2021. Children with hydrocephalus were identified at the outpatient departments of the satellite clinics of the Cure Children's Hospital and these include Mbale, Gulu, Lira, Jinja and Katalemwa. A structured questionnaire was used to collect information on several variables including (1) for the mother: socio-demographic characteristics, partner support, and wealth index (2) for the child: socio-demographic characteristics, clinical symptoms, feeding difficulties and neural comorbidity. Anthropometric measurements were also taken and these included the mid-upper arm circumference. Data were analysed using Stata version 14. We estimated adjusted odds ratios and their corresponding 95% confidence intervals while relying on multivariable logistic regression models. RESULTS The prevalence of wasting among children with hydrocephalus was 23.2% (n = 89/384) (95%CI: 19 - 27.7%). Their mean age was 19.5 months (SD 16.8). Most of the children were below 12 months (47.9%) and were male (57.5%). The factors associated with wasting among children with hydrocephalus included: having; difficulty in chewing and swallowing (AOR = 2.6, (95%CI:1.05-3.94), a poor appetite (AOR = 1.74, (95%CI: 1.31-2.32), difficulty in breathing (AOR = 1.9, (95%CI: 1.18-3.16), chocking on food (AOR = 1.42, (95%CI:1.1-1.9) and attending the Mbale satellite clinic (AOR = 2.1 (95% CI 1.19-3.7). Children under 5 years of age with hydrocephalus that were born to women whose highest level of education was 7 to 10 years of formal schooling (AOR = 0.32, 95%CI: (0.12-0.87) were less likely to be wasted. CONCLUSIONS AND RECOMMENDATIONS The prevalence of wasting among children with hydrocephalus was high. The factors associated with wasting were mainly feeding challenges. We recommend that children with hydrocephalus should be given greater attention regarding their nutrition especially those with various forms of feeding difficulties. The caregivers of children with hydrocephalus should receive counseling on nutrition and on the best modalities to rely on while feeding their children.
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Affiliation(s)
- Naula Grace
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Edith Mbabazi
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Josephine Tumuhamye
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Humphrey Okechi
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - Emmanuel Wegoye
- Department of Medicine and Research, Cure Children's Hospital, Mbale, Uganda
| | - Peter Olupot-Olupot
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Mbale Clinical Research Institute, Mbale, Uganda
| | - Joseph Kb Matovu
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Leah Hopp
- Department of Community Health, Akisyon a Yesu Presbyterian Clinic, Nakaale, Karamoja, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda.
- Department of Nursing Sciences, School of Medicine, Kabale University, Kabale, Uganda.
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Saleem J, Zakar R, Butt MS, Aadil RM, Ali Z, Bukhari GMJ, Ishaq M, Fischer F. Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan. BMC Public Health 2024; 24:167. [PMID: 38216908 PMCID: PMC10787446 DOI: 10.1186/s12889-024-17701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Malnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan. METHODS A multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children's anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio. RESULTS This study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five. CONCLUSION This study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Rana Muhammad Aadil
- National Institute of Food Sciences and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Zulfiqar Ali
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan
| | | | - Muhammad Ishaq
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité- Universitätsmedizin Berlin, Berlin, Germany.
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Kangas ST, Ouédraogo CT, Tounkara M, Ouoluoguem B, Coulibaly IN, Haidara A, Diarra NH, Diassana K, Tausanovitch Z, Ritz C, Wells JC, Briend A, Myatt M, Radin E, Bailey J. Nutritional treatment of children 6-59 months with severely low weight-for-age z-score: a study protocol for a 3-arm randomized controlled trial. Trials 2024; 25:30. [PMID: 38191436 PMCID: PMC10773065 DOI: 10.1186/s13063-023-07890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Admission criteria that treat children with low mid-upper-arm circumference (MUAC), and low weight-for-height z-score (WHZ) are not aligned with the evidence on which children are at risk of mortality. An analysis of community-based cohort data from Senegal found that a combination of weight-for-age (WAZ) and MUAC criteria identified all children at risk of near-term death associated with severe anthropometric deficits. This study will address whether children with WAZ <-3 but MUAC ≥125 mm benefit from therapeutic feeding with ready-to-use therapeutic foods (RUTF) and whether a simplified protocol is non-inferior to the weight-based standard protocol. METHODS This is a prospective individually randomized controlled 3-arm trial conducted in the Nara health district in Mali. Children aged 6-59 months presenting with MUAC ≥125 mm and WAZ <-3 will be randomized to (1) control group receiving no treatment, (2) simplified treatment receiving 1 sachet of RUTF daily until WAZ ≥-3 for 2 visits, (3) standard treatment receiving RUTF according to WHZ category: (a) WHZ <-3 receive 200 kcal/kg/day until WHZ ≥-2 for 2 visits, (b) WHZ ≥-3 but <-2 receive 1 sachet daily until WHZ ≥-2 for 2 visits or (c) WHZ ≥-2 receive no treatment. All children will be followed up first fortnightly for 12 weeks and then monthly until 6 months post-enrolment. The primary endpoint will be measured at 2 months with the primary outcome being WAZ as a continuous measure. Other outcomes include other anthropometric measurements and a secondary endpoint will be observed at 6 months. A total of 1397 children will be recruited including 209 in the control and 594 in both the simplified and standard arms. The sample size should enable us to conclude on the superiority of the simplified treatment compared to no treatment and on the non-inferiority of the simplified treatment versus standard treatment with a margin of non-inferiority of 0.2 WAZ. DISCUSSION This trial aims to generate new evidence on the benefit of treating children with WAZ <-3 but MUAC ≥125 mm in order to guide the choice of admission criteria to malnutrition treatment and build evidence on the most efficient treatment protocol. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov: NCT05248516 on February 21, 2022.
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Affiliation(s)
| | | | - Moctar Tounkara
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Technics and Technologies of Bamako, Bamako, Mali
| | | | | | | | | | | | | | - Christian Ritz
- National Institute of Public Health, Copenhagen, Denmark
| | - Jonathan C Wells
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - André Briend
- Department of International Health, University of Tampere School of Medicine, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Myatt
- Brixton Health, Brixton, UK
- Emergency Nutrition Network, Kidlington, Oxforshire, UK
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Teshome MS, Lema TB, Abessa TG, Mingels S, Granitzer M, Rameckers E, Verbecque E. Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis. J Nutr Sci 2024; 12:e130. [PMID: 38179261 PMCID: PMC10765019 DOI: 10.1017/jns.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between -3 and -2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn-soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.
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Affiliation(s)
- Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
| | - Tefera Belachew Lema
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Sarah Mingels
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven 3000, Belgium
| | - Marita Granitzer
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
| | - Eugene Rameckers
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Evi Verbecque
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, 3590Diepenbeek, Belgium
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11
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Okyere J, Donkoh IE, Seidu AA, Ahinkorah BO, Aboagye RG, Yaya S. Mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. J Health Popul Nutr 2024; 43:1. [PMID: 38167549 PMCID: PMC10759505 DOI: 10.1186/s41043-023-00479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. METHODS Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother-child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child's undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). RESULTS Higher likelihood of OWOBM-SUWC was found among women aged 45-49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC. CONCLUSION Combination of child, maternal, and contextual factors could explain mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6-59 months in Nigeria. BMC Nutr 2024; 10:1. [PMID: 38167375 PMCID: PMC10762859 DOI: 10.1186/s40795-023-00813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Malnutrition has remained a global public health issue, particularly in low- and middle-income countries (LMICs). Researchers have committed to studying malnutrition (especially in children under the age of five) to address the nine malnutrition targets, set by the WHO to be achieved by 2025. This study seeks to evaluate the prevalence, the individual and contextual predictors of malnutrition among children aged 6-59 months across Nigeria and its states. Two separates, independently collected, nationally representative cross-sectional surveys, the National Human Development Report (NHDR 2018) and the 2018 Nigeria Demographic and Health Survey (2018 NDHS) were linked for this study. Spatial map was used to describe the prevalence of malnutrition, a 3-level multivariate multilevel logistic regression models were fitted where children/individuals (at level 1) were nested in communities/clusters (at level 2) and nested in states (at level 3). A weighted sample of 7,770 children 6-59 months were considered in this study. The results showed that an estimated 43.6% of children aged 6-59 months are poorly nourished in Nigeria. The proportions of poorly nourished children were generally highest in the Northern Nigeria. Child's gender, age, birth size, preceding birth order, anaemia status, maternal education, work status, body weight, household wealth status, number of bedrooms were among individual/household predictors of malnutrition. On the community level, being from community with high wealth index, distance to nearest health facilities is no big problem. Regional variations and gender inequality index were the state level predictors of malnutrition among children in Nigeria. This study has shown that two-third of children aged 6-59 months in Nigeria were poorly nourished, an indication of a growing concern of double burden of malnutrition in Nigeria.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK.
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, 912231, Bida, Nigeria.
| | - Stephen J Walters
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Jacques
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, S10 2BP, Sheffield, UK
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Jones-Antwi R, Cunningham SA. Unhealthy weight among young children in the Middle East and North African region. Public Health Nutr 2023; 26:2383-2395. [PMID: 37606074 PMCID: PMC10641650 DOI: 10.1017/s1368980023001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years. DESIGN Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight. SETTING Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen). PARTICIPANTS Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961). RESULTS Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls. CONCLUSION Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.
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Sahiledengle B, Mwanri L, Blumenberg C, Agho KE. Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey. BMC Public Health 2023; 23:2040. [PMID: 37853384 PMCID: PMC10585928 DOI: 10.1186/s12889-023-16907-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia. METHODS The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition. RESULTS The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted. CONCLUSION Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide Campus, SA, 5000, Australia
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Namiiro FB, Batte A, Rujumba J, Nabukeera-Barungi N, Kayom VO, Munabi IG, Serunjogi R, Kiguli S. Nutritional status of young children born with low birthweight in a low resource setting: an observational study. BMC Pediatr 2023; 23:520. [PMID: 37858130 PMCID: PMC10585881 DOI: 10.1186/s12887-023-04356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda. METHODS We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14. RESULTS Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. CONCLUSION Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.
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Affiliation(s)
- Flaviah B Namiiro
- Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda.
| | - Anthony Batte
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Violet O Kayom
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G Munabi
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-John Hopkins University Institute, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Murphy KT, Lynch GS. Impaired skeletal muscle health in Parkinsonian syndromes: clinical implications, mechanisms and potential treatments. J Cachexia Sarcopenia Muscle 2023; 14:1987-2002. [PMID: 37574254 PMCID: PMC10570091 DOI: 10.1002/jcsm.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/27/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
There is increasing evidence that neurodegenerative disorders including the Parkinsonian syndromes are associated with impaired skeletal muscle health, manifesting as wasting and weakness. Many of the movement problems, lack of muscle strength and reduction in quality of life that are characteristic of these syndromes can be attributed to impairments in skeletal muscle health, but this concept has been grossly understudied and represents an important area of unmet clinical need. This review describes the changes in skeletal muscle health in idiopathic Parkinson's disease and in two atypical Parkinsonian syndromes, the most aggressive synucleinopathy multiple system atrophy, and the tauopathy progressive supranuclear palsy. The pathogenesis of the skeletal muscle changes is described, including the contribution of impairments to the central and peripheral nervous system and intrinsic alterations. Pharmacological interventions targeting the underlying molecular mechanisms with therapeutic potential to improve skeletal muscle health in affected patients are also discussed. Although little is known about the mechanisms underlying these conditions, current evidence implicates multiple pathways and processes, highlighting the likely need for combination therapies to protect muscle health and emphasizing the merit of personalized interventions for patients with different physical capacities at different stages of their disease. As muscle fatigue is often experienced by patients prior to diagnosis, the identification and measurement of this symptom and related biomarkers to identify early signs of disease require careful interrogation, especially for multiple system atrophy and progressive supranuclear palsy where diagnosis is often made several years after onset of symptoms and only confirmed post-mortem. We propose a multidisciplinary approach for early diagnosis and implementation of personalized interventions to preserve muscle health and improve quality of life for patients with typical and atypical Parkinsonian syndromes.
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Affiliation(s)
- Kate T. Murphy
- Department of Anatomy and Physiology, Centre for Muscle ResearchThe University of MelbourneMelbourneAustralia
| | - Gordon S. Lynch
- Department of Anatomy and Physiology, Centre for Muscle ResearchThe University of MelbourneMelbourneAustralia
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Pongutta S, Ferguson E, Davey C, Tangcharoensathien V, Limwattananon S, Borghi J, Wong CKH, Lin L. The impact of a complex school nutrition intervention on double burden of malnutrition among Thai primary school children: a 2-year quasi-experiment. Public Health 2023; 224:51-57. [PMID: 37734276 DOI: 10.1016/j.puhe.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/22/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study assessed the impacts of the Dekthai Kamsai programme on overweight/obesity, underweight and stunting among male and female primary school students. STUDY DESIGN A quasi-experiment was conducted in 16 intervention and 19 control schools across Thailand in 2018 and 2019. In total, 896 treated and 1779 control students from grades 1 to 3 were recruited. In intervention schools, a set of multifaceted intervention components were added into school routine practices. Anthropometric outcomes were measured at baseline and at the beginning and end of every school term. METHODS Propensity score matching with linear and Poisson difference-in-difference analyses were used to adjust for the non-randomisation and to analyse the intervention's effects over time. RESULTS Compared with controls, the increases in mean BMI-for-age Z-score (BAZ) and the incidence rate of overweight/obesity were lower in the intervention schools at the 3rd, 4th and 8th measurements and the 3rd measurement, respectively. The decrease in mean height-for-age Z-score (HAZ) was lower at the 4th measurement. The decrease in the incidence rate of wasting was lower at the 5th, 7th and 8th measurements. The favourable impacts on BAZ and HAZ were found in both sexes, while the favourable impact on overweight/obesity and unfavourable impact on wasting were found in girls. CONCLUSIONS This intervention might be effective in reducing BAZ, overweight/obesity, poor height gain, but not wasting. These findings highlight the benefits of a multifaceted school nutrition intervention and a need to incorporate tailor-made interventions for wasting to comprehensively address the double burden of malnutrition.
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Affiliation(s)
- S Pongutta
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand; London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - E Ferguson
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK
| | - C Davey
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - V Tangcharoensathien
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - S Limwattananon
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - J Borghi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - C K H Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
| | - L Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Feyisa BB, Dabu GT. Determinant of under nutrition among under five children in Ambo town during covid 19 pandemic in 2020. A community-based cross-sectional study. BMC Nutr 2023; 9:103. [PMID: 37715228 PMCID: PMC10504691 DOI: 10.1186/s40795-023-00762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/03/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND About 8 to 44% of all child mortality in Africa is associated with undernutrition. To alleviate this problem, it is necessary to determine the magnitude and determinants of undernutrition during Covid 19 pandemic. However, there is scarce evidence in an urban setting like Ambo town. Therefore, this study assessed the magnitude and factors associated with undernutrition among under-five children in Ambo town, west Ethiopia. METHODS AND PATIENTS A community-based cross-sectional study was conducted in Ambo town from March 01-30, 2020. The child and mother/caregiver socio-demographic characteristics, child illness and health care utilization, and child feeding practice-related data were collected using the standardized tool adopted from similar studies conducted in Ethiopia. Anthropometric measurements of the child were made using a calibrated scale. A systematic sampling technique was employed to select 363 mothers/caregivers of the child as a source of data. Nutritional status indices were generated using ENASMART software. After testing for collinearity, variables with a p-value < 0.25 in binary logistic regression were interred to backward multiple logistic regressions at a level of significance of p < 0.05. RESULTS A total of 363 participants were included in this study providing a 100% response rate and providing the following result. The mean (+ SD) age of children was 28.85 (+ 14.17) months and that of mothers/caregivers was 28.12 + 48 years. This study found 16.00%, 25.30%, and 19.00% of the study participants were underweight, wasted, and stunted respectively. Decisions making on major food purchases, who usually care for the child, the age at which the child starts complimentary food, late introduction of complementary food were positively associated with wasting. Diarrhea, birth weight, child age, age at which the child starts complimentary food, consumption of milk and milk product, and who usually care for the child were significantly associated with being underweight. Consumption of milk and milk products, household food security level, and birth weight were independent determinants of stunting. CONCLUSION This study identified a high prevalence of undernutrition, especially wasting. Childbirth weight, age, diarrhea, feeding practice, household (HH) food security, Decision making on major food purchases, late introduction of complementary food were found to be the potential determinants of undernutrition. Thus there should be an effort to improve the nutritional status of children in the study area by focusing on these factors.
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Affiliation(s)
- Beshadu Bedada Feyisa
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia.
| | - Getu Taresa Dabu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, PO box 19, Ambo, Ethiopia
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Gaffan N, Kpozehouen A, Degbey C, Ahanhanzo YG, Paraïso MN. Effects of the level of household access to water, sanitation and hygiene on the nutritional status of children under five, Benin. BMC Nutr 2023; 9:95. [PMID: 37528455 PMCID: PMC10391820 DOI: 10.1186/s40795-023-00751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Whether or not the Water, Sanitation and Hygiene (WASH) conditions in which children under five live determine their nutritional status is still under discussion. The work aimed to study the effects of household WASH conditions to which children under five are exposed on their nutritional status in Benin. METHODS The study utilized a cross-sectional design and consisted of secondary analyses using datasets from the fifth Demographic and Health Survey (DHS-V) conducted in Benin. Stunting, wasting and underweight were the dependent variables. The WASH conditions in which children live were evaluated in the immediate environment, i.e., at the level of their households. After describing the study variables, the relationships between the dependent variables and the exposures were checked using multivariate logistic regression. Data analysis was performed with Stata 15 and took into account the survey's sampling design. RESULTS The prevalence of stunting, wasting and underweight was 31.15% (95% CI = 29.90-32.42), 4.79% (95% CI = 4.33-5.31) and 15.82% (95% CI = 14.92-16.76), respectively. The stunting odds were 1.35 (95% CI = 1.15-1.59) and 1.27 (95% CI = 1.01-1.59) times higher for children from households with no water and sanitation services, respectively, compared to children living in households with basic water and sanitation services. Children under five from households with no hygiene facilities and using limited hygiene services had 1.31 (95% CI = 1.05-1.63) and 1.35 (95% CI = 1.10-1.67) times the odds of being stunted, respectively, compared to children covered by basic hygiene facilities. There is no evidence of a significant relationship between household access to WASH and wasting in children under five. The odds of being underweight were 1.33 (95% CI = 1.02-1.72) times higher among children under five from households with limited hygiene facilities than among children from households with basic hygiene facilities. CONCLUSION Interventions to fight malnutrition in children under five should include a WASH dimension.
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Affiliation(s)
- Nicolas Gaffan
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin.
| | - Alphonse Kpozehouen
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Cyriaque Degbey
- Department of Environmental Health, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
- University Hospital Hygiene Clinic, National Hospital and University Centre Hubert Koutoukou Maga, Cotonou, Benin
| | - Yolaine Glele Ahanhanzo
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Moussiliou Noël Paraïso
- Department of Health Promotion, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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21
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Asmare AA, Agmas YA. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr 2023; 9:82. [PMID: 37420303 DOI: 10.1186/s40795-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Malnutrition is the main cause of illness and death in children under the age of five. It affects millions of children worldwide, putting their health and future in jeopardy. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHOD The study was carried out in 10 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Zimbabwe, Kenya, Zambia, and Malawi. A weighted total sample of 53,322 children under the age of five was included. Given the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate binary logistic regression model was employed to analyze the relationship between stunting, wasting, and underweight. RESULT The study included 53,322 children, and 34.7%, 14.8%, and 5.1% were stunted, underweight, and wasted, respectively. Almost half of the children (49.8%) were female, and 22.0% lived in urban areas. The estimated odds of children from secondary and higher education mothers being stunted and wasted were 0.987; 95% CI: 0.979 - 0.994 and 0.999; 95% CI: 0.995 - 0.999, respectively, times the estimated odds of children from no education mothers. Children from middle-class families were less likely to be underweight than children from poorer families. CONCLUSION The prevalence of stunting was higher than in the sub-Saharan Africa region, but the prevalence of wasting and underweight was lower. According to the study's findings, undernourishment among young children under the age of five continues to be a significant public health issue in the East African region. Governmental and non-governmental organizations should therefore plan public health participation focusing on paternal education and the poorest households in order to improve the undernutrition status of children under five. Additionally, improving the delivery of healthcare at health facilities, places of residence, children's health education, and drinking water sources are essential for lowering child undernutrition indicators.
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Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
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Fouad HM, Yousef A, Afifi A, Ghandour AA, Elshahawy A, Elkhawass A, Hawees H, Shaheen E, Alaaeldin M, Kamal M, Bastawy S, Rabie S, Wissa F, Shalaby S. Prevalence of malnutrition & anemia in preschool children; a single center study. Ital J Pediatr 2023; 49:75. [PMID: 37322509 DOI: 10.1186/s13052-023-01476-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Malnutrition including undernutrition, overnutrition, and micronutrient deficiencies are considerable problems worldwide, with variable burdens among different communities. Its complications include physical and cognitive impairment, with the probability of irreversible lifelong consequences. We aimed to assess the prevalence of undernutrition, overweight, obesity, and anemia in preschoolers, being a risk group for developmental adverse events. METHODS We recruited 505 healthy preschool children, with a male: female ratio of 1.05:1. Children with chronic diseases were excluded. We used anthropometry and complete blood count to screen for malnutrition and anemia. RESULTS The mean age of the study group was 3.8 ± 1.4 years (1.02-7). The screening results were average in 228 (45.1%) children, while 277 (54.9%) children had either abnormal anthropometry, anemia, or both. We observed undernutrition in 48 (9.5%) children; among them, 33 (6.6%) were underweight, 33 (6.6%) wasted, and 15 (3%) were stunted, with no significant difference between children aged below or above five. We identified overnutrition in 125 (24.8%); 43 (8.5%) were overweight, 12 (2.4%) were obese, and 70 (13.9%) had a high body mass index Z score, not qualifying the definition of overweight. Anemia was diagnosed in 141 (27.9%) children and was significantly more frequent among older children without gender discrimination. About 10% (50 children) had both anemia and abnormal anthropometry. The frequency of abnormal anthropometry was comparable between children with anemia and those with normal hemoglobin. CONCLUSION Malnutrition and anemia in preschoolers are still a heavy burden affecting about half of our study group, with an upward trend towards the overnutrition side. Anemia is still a moderate public health problem in preschoolers.
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Affiliation(s)
- Hanan Mina Fouad
- Pediatrics Department, Helwan University, Cairo, Egypt.
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt.
| | - Aly Yousef
- Pediatrics Department, Helwan University, Cairo, Egypt
| | - Ahmed Afifi
- Pediatrics Department, Helwan University, Cairo, Egypt
| | - Ahmed A Ghandour
- Community, Environmental and Occupational Medicine Department, Helwan University, Cairo, Egypt
| | - Amira Elshahawy
- Pediatric Department, the National Nutrition Institute, General Organization of Teaching Hospitals, Ministry of Health, Cairo, Egypt
| | | | - Hazem Hawees
- Intern in Helwan University Hospital, Cairo, Egypt
| | - Eman Shaheen
- Clinical and chemical Pathology Department, Helwan University, Cairo, Egypt
| | | | - Mostafa Kamal
- Clinical and chemical Pathology Department, Helwan University, Cairo, Egypt
| | - Samah Bastawy
- Clinical and chemical Pathology Department, Helwan University, Cairo, Egypt
| | - Samah Rabie
- Psychiatry Department, Helwan University, Cairo, Egypt
| | - Farah Wissa
- Intern in Helwan University Hospital, Cairo, Egypt
| | - Sherine Shalaby
- Pediatrics Department, Helwan University, Cairo, Egypt
- Pediatrics Department, Suez Canal University, Ismailia, Egypt
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23
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Kerr HL, Krumm K, Lee I(I, Anderson B, Christiani A, Strait L, Breckheimer BA, Irwin B, Jiang A(S, Rybachok A, Chen A, Caeiro L, Dacek E, Hall DB, Kostyla CH, Hales LM, Soliman TM, Garcia JM. EXT418, a novel long-acting ghrelin, mitigates Lewis lung carcinoma induced cachexia in mice. J Cachexia Sarcopenia Muscle 2023; 14:1337-1348. [PMID: 36942661 PMCID: PMC10235874 DOI: 10.1002/jcsm.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Ghrelin is a potential therapy for cachexia due to its orexigenic properties and anabolic effects on muscle and fat. However, its clinical use is limited by the short half-life of active (acylated) ghrelin (~11 min in humans). EXT418 is a novel long-acting, constitutively active ghrelin analog created by covalently linking it to a vitamin D derivative. Here, we evaluated the effects and mechanisms of action of EXT418 on Lewis lung carcinoma (LLC)-induced cachexia in mice. METHODS Male C57BL/6J mice (5- to 7-month-old) were implanted with 1 × 106 heat-killed (HK) or live LLC cells. When the tumour was palpable, mice were injected with vehicle (T + V) or EXT418 daily (T + 418 Daily, 0.25 mg/kg/day) or every other day (T + 418 EOD, 0.5 mg/kg/EOD) for up to 14 days, whereas HK-treated mice were given vehicle (HK + V). Subsets of T + 418 Daily or EOD-treated mice were pair-fed to the T + V group. Body composition and grip strength were evaluated before tumour implantation and at the end of the experiment. Molecular markers were probed in muscles upon termination. RESULTS In tumour-bearing mice, administration of EXT418 daily or EOD partially prevented weight loss (T + V vs. T + 418 Daily, P = 0.030; and vs. T + 418 EOD, P = 0.020). Similar effects were observed in whole body fat and lean body mass. Grip strength in tumour-bearing mice was improved by EXT418 daily (P = 0.010) or EOD (P = 0.008) administration compared with vehicle-treated mice. These effects of EXT418 on weight and grip strength were partially independent of food intake. EXT418 daily administration also improved type IIA (P = 0.015), IIB (P = 0.037) and IIX (P = 0.050) fibre cross-sectional area (CSA) in tibialis anterior (TA) and EXT418 EOD improved CSA of IIB fibres in red gastrocnemius (GAS; P = 0.005). In skeletal muscles, tumour-induced increases in atrogenes Fbxo32 and Trim63 were ameliorated by EXT418 treatments (TA and GAS/plantaris, PL), which were independent of food intake. EXT418 administration decreased expression of the mitophagy marker Bnip3 (GAS/PL; P ≤ 0.010). Similar effects of EXT418 EOD were observed in p62 (GAS/PL; P = 0.039). In addition, EXT418 treatments ameliorated the tumour-induced elevation in muscle Il6 transcript levels (TA and GAS/PL), independently of food intake. Il-6 transcript levels in adipose tissue and circulating IL-10 were elevated in response to the tumour but these increases were not significant with EXT418 administration. Tumour mass was not altered by EXT418. CONCLUSIONS EXT418 mitigates LLC-induced cachexia by attenuating skeletal muscle inflammation, proteolysis, and mitophagy, without affecting tumour mass and partially independent of food intake.
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Affiliation(s)
- Haiming L. Kerr
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Kora Krumm
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Ian (In‐gi) Lee
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Barbara Anderson
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Anthony Christiani
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Lena Strait
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Beatrice A. Breckheimer
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Brynn Irwin
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Alice (Siyi) Jiang
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Artur Rybachok
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Amanda Chen
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Lucas Caeiro
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | - Elizabeth Dacek
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
| | | | - Caroline H. Kostyla
- Extend Biosciences, Inc.St. NewtonMassachusettsUSA
- Present address:
Atalanta TherapeuticsBostonMassachusettsUSA
| | | | | | - Jose M. Garcia
- Geriatric Research, Education and Clinical CenterVeterans Affairs Puget Sound Health Care SystemSeattleWashingtonUSA
- Department of Medicine, Division of Gerontology and Geriatric MedicineUniversity of Washington School of MedicineWashingtonSeattleUSA
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24
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Briend A, Myatt M, Berkley JA, Black RE, Boyd E, Garenne M, Lelijveld N, Isanaka S, McDonald CM, Mwangwome M, O’Brien KS, Schwinger C, Stobaugh H, Taneja S, West KP, Khara T. Prognostic value of different anthropometric indices over different measurement intervals to predict mortality in 6-59-month-old children. Public Health Nutr 2023; 26:1210-1221. [PMID: 36722310 PMCID: PMC10346023 DOI: 10.1017/s1368980023000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/18/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z-score (WHZ) and weight-for-age Z-score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children. DESIGN Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations. SETTING Community-based, prospective studies from twelve countries in Africa and Asia. PARTICIPANTS Children aged 6-59 months living in the study areas. RESULTS For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0·001), 48 % (95 % CI (9·4, 87)) for WHZ < -3 (P < 0·01) and 28 % (95 % CI (7·6, 42)) for WAZ < -3 (P < 0·005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16·4 % (95 % CI (12·0, 20·9)) compared with 3·5 % (95 % CI (0·4, 6·5)) for MUAC < 115 mm alone. CONCLUSIONS Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions.
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Affiliation(s)
- André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958, Frederiksberg, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Arvo building, Arvo Ylpön katu 34, FIN-33014Tampere, Finland
| | - Mark Myatt
- Brixton Health, Cilfach Greigiog, Fford Celynin, Llwyngwril, Gwynedd, UK
- Emergency Nutrition Network, Kidlington, OX, UK
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin Boyd
- USAID, Bureau for Humanitarian Assistance, Washington, DC, USA
- Tufts University, Boston, MA, USA
| | - Michel Garenne
- IRD, UMI Résiliences, Paris, France
- FERDI, Université d’Auvergne, Clermont-Ferrand, France
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christine M McDonald
- Departments of Pediatrics, and Epidemiology and Biostatistics, University of California, San Francisco, Oakland, CA, USA
| | - Martha Mwangwome
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast (CGMRC), Kilifi, Kenya
| | - Kieran S O’Brien
- Department of Ophthalmology, University of California, Francis I. Proctor Foundation, San Francisco, CA, USA
| | - Catherine Schwinger
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Heather Stobaugh
- Tufts University, Boston, MA, USA
- Action Against Hunger USA, New York, NY, USA
| | - Sunita Taneja
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, OX, UK
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Darko BA, Owusu-Asenso CM, Addo-Osafo K, Appiah-Lawson E, Afrane YA, Tette EMA. Malaria, gastrointestinal parasite infection and nutritional status among febrile children In Accra, Ghana. Res Sq 2023:rs.3.rs-2891006. [PMID: 37214835 PMCID: PMC10197738 DOI: 10.21203/rs.3.rs-2891006/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction Malaria and intestinal parasite infection are common in developing countries. These Parasites causes anaemia and malnutrition mostly in children. For this reason, it is important to study these infections and their effects in order to monitor interventions to control them. This study aims to determine prevalence of malaria and intestinal parasite infections and their association with nutritional status among febrile children in Accra, Ghana. Methods The study was conducted among febrile children aged 6 months to 5 years attending three health facilities in Accra from May to October, 2022. A total of 315 children were selected for the study. Anthropometric measurement was done for each participant. Blood and stool samples were collected for investigation. Thick and thin blood smears stained with 10% Giemsa were prepared and examined for Plasmodium parasite using microscopy. Stool samples were processed using direct wet mount and formalin-ether concentration method and examined for intestinal parasites using microscopy. Haemoglobin concentration was measured using automatic haematology analyzer. Results A total of 24% (76/315) were positive for malaria. Plasmodium falciparum accounted for 77.6% (59/76) of parasitaemia, whereas Plasmodium malariae was 22.4% (17/76). Prevalence of intestinal parasite infection was 10.7% (34/315). Giardia lamblia accounted for 17/315 (5.3%) of the entire children, followed by Ascaris lumbricoides 8/315 (2.5%), Hookworm 6/315 (1.9%) and Trichuris trichiura 3/315 (0.9%). A total of 15/315 (5%) of the participants had co-infection of malaria and intestinal parasite infection. Prevalence of anaemia, malnutrition, stunting, wasting and underweight were (72%), (30.7%), (16.2%), (24.4%) and (57.1%) respectively. Malaria was significantly associated with anaemia (p = 0.000) and underweight (p = 0.013). Ascaris lumbricoides was significantly associated with wasting (p = 0.010). Giardia lamblia was significantly association with malnutrition (p = 0.000) and Stunting (p = 0.000), whereas Hookworm was found to be significantly associated with anaemia (p = 0.021). Conclusion Prevalence of IPI in this study was less than previously reported, most likely due to regular deworming of most of the children. However, Malaria and intestinal parasitic infection were significantly associated with anaemia and malnutrition including wasting, stunting, and underweight.
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Affiliation(s)
| | | | | | | | - Yaw Asare Afrane
- Department of Medical Microbiology, University of Ghana Medical School
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Atalell KA, Dessie MT, Wubneh CA. Mapping wasted children using data from the Ethiopia Demographic and Health Surveys between 2000 and 2019: A bayesian geospatial analysis. Nutrition 2023; 108:111940. [PMID: 36682270 DOI: 10.1016/j.nut.2022.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Undernutrition, particularly wasting, is continuing to be a major challenge in developing countries like Ethiopia. However, data on the geographic variations over time are limited. We aimed to investigate the spatiotemporal variation of wasting in Ethiopia using two decades of Ethiopia Demographic and Health Surveys data, from 2000 to 2019. METHODS Trend and geospatial regression analysis using a bayesian framework were used to predict wasting in Ethiopia among children aged <5 y. The primary outcomes (wasting) were obtained from the Ethiopia Demographic and Health Surveys conducted between 2000 and 2019. Covariates were accessed from different publicly available credible sources at a high resolution. The spatial binomial regression model through the bayesian framework was fitted to identify drivers of wasting among children in Ethiopia. RESULTS The overall national prevalence of wasting among children aged <5 y in Ethiopia was 11.9% in 2000, 11.1% in 2005, 10.2% in 2011, 12.3% in 2016, and 9.4% in 2019, with substantial spatial variation across subnational and local levels over time. Spatial clustering of wasting was observed in eastern Ethiopia (Afar and Somali regions). Altitude (mean regression coefficient = -0.38; 95% credible interval, -0.69 to -0.07) and population density (mean regression coefficient = -0.02; 95% credible interval, -0.03 to -0.01) were negatively associated with wasting, whereas distance to health facilities (mean regression coefficient = 0.13; 95% credible interval, 0.03-0.23) was positively associated with wasting. CONCLUSIONS The reduction in the national prevalence of wasting among children was not as expected. Spatial clustering of wasting was observed in the northern, northeastern, eastern, and western parts of Ethiopia. Spatial clustering of wasting was associated with altitude, precipitation, population density, distance to health facilities, travel time to the nearest cities, and distance to a water body. Early screening and treatment of wasted children should be strengthened. Furthermore, outreach community awareness, especially in rural parts of the country, should be recommended through community health extension workers.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Childhood Acute Illness and Nutrition (CHAIN) Network. Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach. EClinicalMedicine 2023; 57:101838. [PMID: 36825237 DOI: 10.1016/j.eclinm.2023.101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine learning to characterise mortality in the 30-days following admission and the 180-days after discharge from nine hospitals in low and middle-income countries (LMIC). METHODS A cohort of 3101 children aged 2-24 months were recruited at admission to hospital for any acute illness in Bangladesh (Dhaka and Matlab Hospitals), Pakistan (Civil Hospital Karachi), Kenya (Kilifi, Mbagathi, and Migori Hospitals), Uganda (Mulago Hospital), Malawi (Queen Elizabeth Central Hospital), and Burkina Faso (Banfora Hospital) from November 2016 to January 2019. To record mortality, children were observed during their hospitalisation and for 180 days post-discharge. Extreme gradient boosted models of death within 30 days of admission and mortality in the 180 days following discharge were built. Clusters of mortality sharing similar characteristics were identified from the models using Shapley additive values with spectral clustering. FINDINGS Anthropometric and laboratory parameters were the most influential predictors of both 30-day and post-discharge mortality. No WHO/IMCI syndromes were among the 25 most influential mortality predictors of mortality. For 30-day mortality, two lower-risk clusters (N = 1915, 61%) included children with higher-than-average anthropometry (1% died, 95% CI: 0-2), and children without signs of severe illness (3% died, 95% CI: 2-4%). The two highest risk 30-day mortality clusters (N = 118, 4%) were characterised by high urea and creatinine (70% died, 95% CI: 62-82%); and nutritional oedema with low platelets and reduced consciousness (97% died, 95% CI: 92-100%). For post-discharge mortality risk, two low-risk clusters (N = 1753, 61%) were defined by higher-than-average anthropometry (0% died, 95% CI: 0-1%), and gastroenteritis with lower-than-average anthropometry and without major laboratory abnormalities (0% died, 95% CI: 0-1%). Two highest risk post-discharge clusters (N = 267, 9%) included children leaving against medical advice (30% died, 95% CI: 25-37%), and severely-low anthropometry with signs of illness at discharge (46% died, 95% CI: 34-62%). INTERPRETATION WHO clinical syndromes are not sufficient at predicting risk. Integrating basic laboratory features such as urea, creatinine, red blood cell, lymphocyte and platelet counts into guidelines may strengthen efforts to identify high-risk children during paediatric hospitalisations. FUNDING Bill & Melinda Gates FoundationOPP1131320.
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Toma TM, Andargie KT, Alula RA, Kebede BM, Gujo MM. Factors associated with wasting and stunting among children aged 06-59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study. BMC Nutr 2023; 9:34. [PMID: 36829183 DOI: 10.1186/s40795-023-00683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Child undernutrition is a major public health problem in Ethiopia despite different nutrition-specific and sensitive interventions implemented by the government. However, evidence regarding the burden and responsible factors is limited in the South Ari district. Hence, this study aimed to assess factors associated with wasting and stunting among children aged 06-59 months in the South Ari district, Southern Ethiopia, 2021. METHODS A community-based cross-sectional study was conducted from March 11 to April 11, 2021, among 717 households with at least one child aged 06-59 months. Anthropometric measurements were taken using standard procedures and were converted to height for age Z score and weight-for-height using WHO Anthro software Version 3.2.2. Data were checked and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25.0. Binary logistic regression analysis was fitted to identify predictors of wasting and stunting. A p-value < 0.05 was used to declare statistical significance. RESULT The prevalence of wasting and stunting among children aged 06-59 months in the district was 9.1% (95% CI: 7.07%, 11.41%) and 59.97% (95% CI: 56.28%, 63.58%), respectively. Family size (8 and above) (AOR = 3.03, 95% CI: 1.31, 7.03), family size (5 to 7) (AOR = 2.05, 95% CI: 1.11, 3.81), poor and medium wealth index (AOR = 3.69, 95% CI: 1.65, 8.26) and (AOR = 2.29, 95% CI: 1.01, 5.16), insufficient maternal knowledge on child feeding practice (AOR = 2.58, 95% CI: 1.31, 5.07), presence of diarrhea in the past two weeks (AOR = 2.05, 95% CI: 1.10, 3.85), non-exclusive breastfeeding (AOR = 2.65, 95% CI: 1.51, 4.65), and birth interval of < 24 months (AOR = 4.49, 95% CI: 2.40, 8.37) were factors significantly associated with wasting. Whereas, children in the age group of 24-59 months (AOR = 2.24, 95% CI: 1.58, 3.16), non-exclusive breastfeeding (AOR = 1.81, 95% CI: 1.24, 2.65), birth interval of fewer than 24 months (AOR = 1.54, 95% CI: 1.11, 2.14), sub-optimal child dietary diversity score (AOR = 1.59, 95% CI: 1.14, 2.22), being a non-beneficiary of productive safety-net program (AOR = 1.91, 95% CI: 1.24, 2.95), and household food insecurity (AOR = 2.60, 95% CI: 1.86, 3.64) were factors significantly associated with stunting. CONCLUSIONS Wasting and stunting were found to be key public health problems in the South Ari District. Hence, further interventions should consider strategies to enhance household food security and integration of productive safety net programs with primary health care services. Rigorous work is required in advocating and strengthening the provision of family planning services, child care, and integrated management of common childhood illnesses. Moreover, behavioral change communication is highly demanded to improve child feeding practices.
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Khara T, Myatt M, Sadler K, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald C, Mertens A, Mwangome M, O’Brien K, Stobaugh H, Taneja S, West KP, Briend A. Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts. Public Health Nutr 2023; 26:1-17. [PMID: 36734049 PMCID: PMC10131149 DOI: 10.1017/s136898002300023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. DESIGN A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled. SETTING Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread. PARTICIPANTS Children aged 6 to 59 months. RESULTS Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC < 115 mm or WAZ < -3) and (WAZ < -3) had the highest informedness in predicting mortality. A combined case definition (MUAC < 115 mm or WAZ < -3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ < -3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC < 115 mm or WAZ < -3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC < 115 mm alone. CONCLUSIONS A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
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Affiliation(s)
- Tanya Khara
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Mark Myatt
- Brixton Health, Llwyngwril, Gwynedd, Wales, UK
| | - Kate Sadler
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université libre de Bruxelles
| | - James A Berkley
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Erin Boyd
- USAID/Bureau of Humanitarian Assistance, USA
| | - Michel Garenne
- IRD, UMI Résiliences, Paris, France
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
- FERDI, Université d’Auvergne, Clermont-Ferrand, France
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Epicentre, Paris, France
| | - Natasha Lelijveld
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Christine McDonald
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Nutrition, University of California, Davis, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | | | - Kieran O’Brien
- The F.I. Proctor Foundation, University of San Francisco, San Francisco, USA
| | - Heather Stobaugh
- Action Against Hunger USA, New York, NY, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sunita Taneja
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - André Briend
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Fredericksberg, Denmark
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Woeltje MM, Evanoff AB, Helmink BA, Culbertson DL, Maleta KM, Manary MJ, Trehan I. Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: analysis of operational data. Public Health Nutr 2023; 26:246-55. [PMID: 34915944 DOI: 10.1017/S1368980021004894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. DESIGN Review of operational acute malnutrition treatment records. SETTING Twenty-one outpatient therapeutic feeding clinics in rural Malawi. PARTICIPANTS Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials. RESULTS A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75·4 %) achieved nutritional recovery; in comparison, 56 (75·7 %) of those with severe acute malnutrition 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81·3 %) recovered; in comparison, 241 (85·2 %) of those aged 6-9 months recovered. CONCLUSIONS In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.
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Vatsa R, Ghimire U, Sapkota S, Subedi RK. Spatial distribution of stunting and wasting in 6-59 months children in Nepal: analysis using a Bayesian distributional bivariate probit model. J Nutr Sci 2023; 12:e25. [PMID: 36843979 DOI: 10.1017/jns.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/10/2023] [Indexed: 02/25/2023] Open
Abstract
The combined burden of stunting and wasting in children under five years is a serious public health concern. The present study aimed to estimate the joint burden of stunting and wasting among children aged 6-59 months and explore its spatial variation across Nepal. The 2016 Nepal Demographic and Health Survey data was used to study acute and chronic childhood malnutrition. A Bayesian distributional bivariate probit geoadditive model was designed to study the linear association and geographical variation of stunting and wasting among 6-59 months, children. Child-related factors such as low birth weight, fever in the last 2 weeks preceding the survey and fourth or greater birth order were associated with a higher likelihood of stunting. The likelihood of a child being stunted was significantly less in the wealthiest households, having improved toilet facilities, and if mothers were overweight. Children from severely food insecure households were significantly more likely, and children from poorer households were significantly less likely to suffer both acute and chronic malnutrition simultaneously. Results from spatial effect showed that children from Lumbini and Karnali had a higher burden of stunting, and the likelihood that achild would have been wasted was significantly higher in Madhesh and Province 1. Immediate nutritional efforts are vital in low-income and severely food insecure households to lessen the risk of stunting and wasting in under children. Disproportionate geographic variations in stunting and wasting warrant sub-regional-specific nutrition intervention to achieve nutrition targets and reduce the burden of childhood malnutrition across the country.
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Acharyya S, Acharyya K. A Cohort Study Comparing the Growth and Neurodevelopmental Outcome of Babies Conceived by Assisted Reproductive Technology with Those of Naturally Conceived Babies from Birth till 24 Months. Indian J Pediatr 2023; 90:16-21. [PMID: 35460463 DOI: 10.1007/s12098-021-04065-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare the growth and neurodevelopmental outcome of term, singleton babies conceived by assisted reproduction with those of naturally conceived babies. METHODS A cohort study evaluating the growth delay in terms of proportion of babies with wasting (W/L < -2SD) at 6, 12 and 24 mo follow-up. Developmental delay was defined as either motor or mental developmental quotient < 70 in DASII. RESULTS Amongst the 128 artificially conceived babies, at 6 and 12 mo, the proportions of babies with wasting (21.1% and 17.2%), motor (7.03%, 6.3%), and mental developmental delays (5.5% and 3.9%) were significantly higher (p < 0.05) compared to the naturally conceived babies (10.94%, 8.6%, 1.6%, 0.8%, 0.8% and 0%, respectively). However, at 24 mo, the difference in outcomes were not statistically significant (p > 0.05). CONCLUSION The growth and neurodevelopment of artificially conceived babies may be delayed in early infancy but they normalize to catch up with their naturally conceived peers by 24 mo.
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Ravindra H, Sreevalsan-Nair J. A Methodology for Integrating Population Health Surveys Using Spatial Statistics and Visualizations for Cross-Sectional Analysis. SN Comput Sci 2023; 4:224. [PMID: 36844505 PMCID: PMC9942654 DOI: 10.1007/s42979-022-01652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/21/2022] [Indexed: 02/23/2023]
Abstract
Large-scale population surveys are beneficial in gathering information on the performance indicators of public well-being, including health and socio-economic standing. However, conducting national population surveys for low and middle-income countries (LMIC) with high population density comes at a high economic cost. To conduct surveys at low-cost and efficiently, multiple surveys with different, but focused, goals are implemented through various organizations in a decentralized manner. Some of the surveys tend to overlap in outcomes with spatial, temporal or both scopes. Mining data jointly from surveys with significant overlap gives new insights while preserving their autonomy. We propose a three-step workflow for integrating surveys using spatial analytic workflow supported by visualizations. We implement the workflow on a case study using two recent population health surveys in India to study malnutrition in children under-five. Our case study focuses on finding hotspots and coldspots for malnutrition, specifically undernutrition, by integrating the outcomes of both surveys. Malnutrition in children under-five is a pertinent global public health problem that is widely prevalent in India. Our work shows that such an integrated analysis is beneficial alongside independent analyses of such existing national surveys to find new insights into national health indicators.
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Affiliation(s)
- Harshitha Ravindra
- Graphics-Visualization-Computing Lab, E-Health Research Center, IIIT Bangalore, 26/C Electronics City, Hosur Road, Bangalore, Karnataka 560100 India
| | - Jaya Sreevalsan-Nair
- Graphics-Visualization-Computing Lab, E-Health Research Center, IIIT Bangalore, 26/C Electronics City, Hosur Road, Bangalore, Karnataka 560100 India
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Ewune HA, Abebe RK, Sisay D, Tesfa GA. Prevalence of wasting and associated factors among children aged 2-5 years, southern Ethiopia: a community-based cross-sectional study. BMC Nutr 2022; 8:160. [PMID: 36585708 PMCID: PMC9805277 DOI: 10.1186/s40795-022-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Wasting (acute malnutrition) is the most serious form of malnutrition for children in the near term. Malnutrition has a variety of causes, all of which are interconnected and hierarchically related. The purpose of this study was to assess the prevalence of wasting and its associated determinants among children under the age of five in the Wonago district, Gedeo zone, southern Ethiopia. METHODS Community based cross-sectional study was conducted from October 1 to 30, 2021 using a systematic random sampling technique. Data were entered using Epidata manager and STATA v.20 software was used for analysis. Descriptive statistics were reported to describe the study population. To identify associated factors of wasting, bivariate and multivariate logistic regression analysis were fitted. Variables having p-value < 0.05 were declared statistically significant predictors of wasting. RESULTS A total of 390 respondents participated with a response rate of 92.6%. The prevalence of wasting among children aged 2-5 years in Wonago district was 36.4% (95% CI: 31.76-41.32). Moderate household food insecurity (AOR = 0.35, 95%CI: 0.14-0.83), history of recurrent illness (AOR = 0.15, 95%CI: 0.26-0.84), and duration of breastfeeding greater than 2 years (AOR = 0.15, 95%CI: 0.26-0.84) were significantly associated with wasting. CONCLUSION Almost one-third of the children were wasted. Household food insecurity, breastfeeding, and recurrent illness were significantly associated with wasting among children aged 24-59 months. It is recommended that interventions be designed with food security, disease prevention, and breastfeeding awareness in mind and put the spotlight on food and nutrition policy to insure children's nutritional status.
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Affiliation(s)
- Helen Ali Ewune
- grid.472268.d0000 0004 1762 2666Human nutrition department, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Reta Kassa Abebe
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Getanew Aschalew Tesfa
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
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Charlotte EE, Ritha Carole MB, Calixthe IP, Jeanne Georgette ME, Patricia E, Iyawa H, Edgar MML, Michael Ngenge B, Gaelle NK, Claudia EBB, Dicka SM, Paul KN, Daniele-Christiane KMK. Describing the growth and nutritional status of sickle cell disease children and adolescents with reference to WHO growth standards in Cameroon. BMC Nutr 2022; 8:154. [PMID: 36575492 PMCID: PMC9793582 DOI: 10.1186/s40795-022-00650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a chronic disease with many complications among which is growth retardation. Here, we described the growth and nutritional status patterns of children with SCD and adolescents living in Douala, Cameroon. METHODS This cross-sectional study took place at the sickle cell treatment center of Douala Laquintinie Hospital from November 2015 to April 2016. The sociodemographic and anthropometric information of each SCD patient was determined, and then used for computing z-score indexes (weight for age, weight for height, body mass index for height, and height for age). The different indexes were used to determine the prevalence of malnutrition forms (stunting, wasting, underweight, and overweight/obesity) and compared to WHO standards by gender and age. RESULTS A total of 208 children and adolescents participated in the study. The mean age was 8 years (±5) and the median age was 7 years. Males accounted for 53.4% of cases, giving a sex ratio of 1:1.1. The proportions of wasting, stunting, underweight, and overweight/obesity in the overall population were 7.1% (n = 15), 9.1% (n = 19), 3.6% (n = 5) and 3.3% (n = 7) respectively. In children under 5, wasting, stunting, underweight, and overweight/obesity were noted in 1.4% (n = 1), 9.5% (n = 7), 1.4% (n = 1), and 5.4% (n = 4) respectively. In patients aged 5 years and above, a proportion of 10.5% (n = 14) was wasted, 9.0% (n = 12) were stunted, 5.9% (n = 4) were underweight and 2.2% (n = 7) were overweight/obese. The growth curve of children under five in our study was superimposable to the WHO standard growth curve. In children older than 5 years, the left shift for stunting was more pronounced for boys compared to girls. CONCLUSION Nine percent of children and adolescents with SCD are stunted. The growth deficit appeared to be higher in patients aged 5 years and above, more particularly in boys than girls. Overweight/obesity was uncommon in our series. More robust research designs and statistical analyses are needed to confirm or refute these findings.
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Affiliation(s)
- Eposse Ekoube Charlotte
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon ,Department of Pediatrics, Hopital Laquintinie Douala, Douala, Cameroon
| | - Mbono Betoko Ritha Carole
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon ,Department of Pediatrics, Hopital Laquintinie Douala, Douala, Cameroon
| | - Ida Penda Calixthe
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Mony Elimbi Jeanne Georgette
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Epee Patricia
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Hassanatou Iyawa
- grid.413096.90000 0001 2107 607XFaculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Mandeng Ma Linwa Edgar
- grid.29273.3d0000 0001 2288 3199Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Budzi Michael Ngenge
- grid.29273.3d0000 0001 2288 3199Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | | | - Koki Ndombo Paul
- grid.412661.60000 0001 2173 8504Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Agabiirwe CN, Dambach P, Methula TC, Phalkey RK. Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review. Environ Health 2022; 21:98. [PMID: 36274126 DOI: 10.1186/s12940-022-00910-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Weather and climate-related disasters, including floods, impact undernutrition through multiple pathways, including food security, inadequate child care practices, and water and sanitation. This review aimed to provide systematic evidence of the impact of floods on undernutrition in children under five years of age in Low and Middle-income countries (LMICs). METHODS We searched PubMed, Web of Science, Embase, MEDLINE, CINAHL and Scopus for peer-reviewed articles. Popline, WHO Library database (WHOLIS), the International Disaster database (EM-DAT), Food and Agriculture Organisation (FAO), UNICEF and Eldis were searched for grey literature articles. Database searches were first conducted in 2016 and updated in 2020. We included English language articles that reported the effect of floods on undernutrition outcomes in children under 5 years of age in LMICs, without limitation to study design and year of publication. The quality of selected studies was assessed using the National Institutes of Health (NIH) tool for Observational Cohort and Cross-Sectional Studies. RESULTS Of the 5701 articles identified, 14 met our inclusion criteria. The review noted stunting as the most frequently reported significant form of undernutrition in flood-affected areas. Severe and recurrent floods showed the greatest impact on undernutrition. Due to weak and limited evidence, the study is inconclusive on the most significant forms within the short-term and intermediate periods following floods. On the other hand, stunting was noted as the most frequently reported significant form of undernutrition in the long-term period following floods. There was generally little evidence of the effect of floods on micronutrient deficiencies. Factors associated with child undernutrition in the flood-affected areas included age, gender, diarrhoea, maternal and paternal education, maternal age, household size, land ownership and socioeconomic status. Overall, the quality of the evidence was fairly weak, with the main challenge lying in the inability of the studies to establish causal pathways for the observed effects. CONCLUSIONS The review suggests clear plans and strategies for preventing and reducing the long-term impact of floods on undernutrition in children under five years. Future research utilising long-term prospective data is indispensable to provide more robust evidence to guide better prevention measures, response decisions and interventions.
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Jisso M, Tesfaye T, Biadgilign S, Tareke AA, Zerfu TA. The role of multi-dimensional women's empowerment in agriculture to improve the nutritional status of under-five children in rural cash crop producing, resource-limited settings of Ethiopia. J Nutr Sci 2022; 11:e92. [PMID: 36337985 DOI: 10.1017/jns.2022.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6-59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P > 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.
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Sahiledengle B, Petrucka P, Kumie A, Mwanri L, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Agho KE. Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach. BMC Public Health 2022; 22:1943. [PMID: 36261797 PMCID: PMC9583486 DOI: 10.1186/s12889-022-14309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. Methods A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. Results The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child’s stool, or improved household flooring and child wasting. Conclusion The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14309-z.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Ababa, Ethiopia
| | - Lillian Mwanri
- Torrens University Australia, Adelaide Campus, 5000, Adelaide, SA, Australia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia
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Fateh HL, Nachvak M, Abdollahzad H, Rezaeian S, Darand M, Bagheri A. Nutritional status of under six years old children in Kalar city, Kurdistan Region, Iraq. BMC Public Health 2022; 22:1668. [PMID: 36056304 PMCID: PMC9438884 DOI: 10.1186/s12889-022-14071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Nutritional problems in children cause major morbidity and mortality in the world. This study aimed to assess the nutritional status of under six years old children in Kalar city, Kurdistan Region, Iraq. METHODS In this longitudinal study, data from 403 Iraqi Kurdish children aged 0-72 months and their mothers were extracted from Health Centre in Kalar city undertaken between 2013 and 2019. The children`s growth data were obtained at birth time, 6, 12, 24, and 72 months. Epi Info was used to classify the children of nutritional status by converting the anthropometric measurements into Z-scores. Data were analyzed using SPSS 25 software. RESULTS The prevalence of overweight and obesity rose from birth to age 6 years old, from 19.6% and 7.4% to 52.2% and 30.5%, respectively. At 24 month, children had the highest rates of being overweight (56.1%) and obesity (34%). At 6 month, the highest prevalence of wasting exists (9.5%). At 6 month boys and girls had the highest frequency of stunting, 17.2% and 7.2% respectively. Considering the association of all characteristic variables and growth data at birth time, only mothers with academic education had children with significantly higher BMI for age compared to illiterate mothers after adjusting for all potential confounders (β: 0.573, 95% CI: 0.105, 1.04, P: 0.017). CONCLUSION The study suggests that some analysed factors that accounted for malnutrition in Kalar city's children are preventable. Therefore, to reduce the burden of malnutrition, community-based education and targeted nutritional interventions are required.
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Affiliation(s)
- Hawal Lateef Fateh
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Nursing Department, Sulaimani Polytechnic University, Kurdistan region, Sulaimani, 460001, Iraq
| | - Mostafa Nachvak
- Department of Nutrition, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Hadi Abdollahzad
- Department of Nutrition, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mina Darand
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Bagheri
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
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Soofi SB, Khan GN, Ariff S, Ihtesham Y, Tanimoune M, Rizvi A, Sajid M, Garzon C, de Pee S, Bhutta ZA. Effectiveness of nutritional supplementation during the first 1000-days of life to reduce child undernutrition: A cluster randomized controlled trial in Pakistan. Lancet Reg Health Southeast Asia 2022; 4:100035. [PMID: 37383995 PMCID: PMC10305932 DOI: 10.1016/j.lansea.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Childhood stunting can start in the womb and continue for two years. Therefore, the first 1000 days of life between a woman's pregnancy and her child's 2nd birthday offer a unique window of opportunity to build healthier and more prosperous futures. Therefore, we aimed to assess the effectiveness of nutritional supplementation during the first 1000-days to reduce the prevalence of stunting in children at 24 months of age. Methods In this cluster randomized controlled trial, we enrolled women during their pregnancy from two rural districts of Sindh, Pakistan. A cluster was one union council with a population of ∼25000 residents. Out of 29 clusters, we randomly allocated 6 clusters to the intervention and control groups each. Pregnant women received a monthly supply of 5 kg (i.e., 165 grams/day) of wheat soya blend plus (WSB+) during pregnancy and the first six months of their lactation period. In addition, their children received lipid-based nutrient supplement - medium-quantity (LNS-MQ) between 6-23 months of age. The primary outcome was a reduction in the prevalence of stunting in children at 24 months of age. Analysis was an intention to treat. The trial is registered on ClinicalTrial.gov, number NCT02422953. Findings Two thousand thirty pregnant women (1017 in the intervention group and 1013 in the control group) were enrolled between August 30, 2014, and May 25, 2016. Monthly follow-ups were conducted between October 1, 2014, and October 25, 2018. At 24 months of age, we captured data from 699 (78%) of 892 live births in the intervention group and 653 (76%) of 853 live births in the control group. There was a significant difference in mean length (49.4 cm vs 48.9 cm, p =0.027), weight (3.1 kg vs 3.0 kg, p =0.013), length for age z-scores (-1.2 vs -1.5, p =0.004) and weight for age z-scores (-1.2 vs -1.5, p =0.015) among infants in the intervention compared to control group. At 24 months of age, a significant difference in the prevalence of stunting (absolute difference, 10.2%, 95% CI 18.2 to 2.3, p =0.017) and underweight (absolute difference, 13.7%, 95% CI 20.3 to 7.0, p =0.001) were observed in the intervention as compared to the control group. The prevalence of wasting was not significantly different between the intervention and control groups (absolute difference, 6.9%, 95% CI 14.1 to 0.3, p =0.057). Interpretation Provision of WSB+ and LNS-MQ during the first 1000-days of life improved child linear growth and reduced stunting in children at 24 months. This study can be scaled-up in similar settings to lower the prevalence of stunting in children under two years of age. Funding World Food Programme, Pakistan.
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Affiliation(s)
- Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz Khan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Arjumand Rizvi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Dwomoh D, Sewor C, Mohammed SA, Annim S, Stranges S, Kandala NB, Amegah AK. Secular trends in low birth weight and child undernutrition in West Africa: evidence from complex nationwide surveys, 1985-2019. Public Health Nutr 2022; 25:2358-70. [PMID: 35039103 DOI: 10.1017/S1368980022000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985-2019 in West Africa (WA). DESIGN Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian-Laird random effect model with the Knapp-Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses. SETTING West Africa. PARTICIPANTS Children aged 0 to 59 months. RESULTS Three distinct periods (1986-1990, 1993-1996 and 1997-2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = -0·20 %; 95 % CI -0·43 %, 0·03 %), log-wasting (β = -0·02 %; 95 % CI -0·02 %, -0·01 %), log-underweight (β = -0·02 %; 95 % CI -0·03 %, -0·01 %) anaemia (β = -0·44; 95 % CI -0·55 %, -0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI -0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985-2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively. CONCLUSIONS Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA.
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Checchi F, Frison S, Warsame A, Abebe KT, Achen J, Ategbo EA, Ayoya MA, Kassim I, Ndiaye B, Nyawo M. Can we predict the burden of acute malnutrition in crisis-affected countries? Findings from Somalia and South Sudan. BMC Nutr 2022; 8:92. [PMID: 36038942 PMCID: PMC9421106 DOI: 10.1186/s40795-022-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sample surveys are the mainstay of surveillance for acute malnutrition in settings affected by crises but are burdensome and have limited geographical coverage due to insecurity and other access issues. As a possible complement to surveys, we explored a statistical approach to predict the prevalent burden of acute malnutrition for small population strata in two crisis-affected countries, Somalia (2014-2018) and South Sudan (2015-2018). METHODS For each country, we sourced datasets generated by humanitarian actors or other entities on insecurity, displacement, food insecurity, access to services, epidemic occurrence and other factors on the causal pathway to malnutrition. We merged these with datasets of sample household anthropometric surveys done at administrative level 3 (district, county) as part of nutritional surveillance, and, for each of several outcomes including binary and continuous indices based on either weight-for-height or middle-upper-arm circumference, fitted and evaluated the predictive performance of generalised linear models and, as an alternative, machine learning random forests. RESULTS We developed models based on 85 ground surveys in Somalia and 175 in South Sudan. Livelihood type, armed conflict intensity, measles incidence, vegetation index and water price were important predictors in Somalia, and livelihood, measles incidence, rainfall and terms of trade (purchasing power) in South Sudan. However, both generalised linear models and random forests had low performance for both binary and continuous anthropometric outcomes. CONCLUSIONS Predictive models had disappointing performance and are not usable for action. The range of data used and their quality probably limited our analysis. The predictive approach remains theoretically attractive and deserves further evaluation with larger datasets across multiple settings.
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Affiliation(s)
- Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Séverine Frison
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdihamid Warsame
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kiross Tefera Abebe
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Jasinta Achen
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Eric Alain Ategbo
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Mohamed Ag Ayoya
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Ismail Kassim
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Biram Ndiaye
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Mara Nyawo
- East and Southern Africa Regional Office, United Nations Children's Fund, Nairobi, Kenya
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King S, D'Mello-Guyett L, Yakowenko E, Riems B, Gallandat K, Mama Chabi S, Mohamud FA, Ayoub K, Olad AH, Aliou B, Marshak A, Trehan I, Cumming O, Stobaugh H. A multi-country, prospective cohort study to measure rate and risk of relapse among children recovered from severe acute malnutrition in Mali, Somalia, and South Sudan: a study protocol. BMC Nutr 2022; 8:90. [PMID: 36002905 PMCID: PMC9404649 DOI: 10.1186/s40795-022-00576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Community-Based Management of Acute Malnutrition (CMAM) model transformed the treatment of severe acute malnutrition (SAM) by shifting treatment from inpatient facilities to the community. Evidence shows that while CMAM programs are effective in the initial recovery from SAM, recovery is not sustained for some children requiring them to receive treatment repeatedly. This indicates a potential gap in the model, yet little evidence is available on the incidence of relapse, the determinants of the phenomena, or its financial implications on program delivery. METHODS This study is a multi-country prospective cohort study following "post-SAM" children (defined as children following anthropometric recovery from SAM through treatment in CMAM) and matched community controls (defined as children not previously experiencing acute malnutrition (AM)) monthly for six months. The aim is to assess the burden and determinants of relapse to SAM. This study design enables the quantification of relapse among post-SAM children, but also to determine the relative risk for, and excess burden of, AM between post-SAM children and their matched community controls. Individual -, household-, and community-level information will be analyzed to identify potential risk-factors for relapse, with a focus on associations between water, sanitation, and hygiene (WASH) related exposures, and post-discharge outcomes. The study combines a microbiological assessment of post-SAM children's drinking water, food, stool via rectal swabs, dried blood spots (DBS), and assess for indicators of enteric pathogens and immune function, to explore different exposures and potential associations with treatment and post-treatment outcomes. DISCUSSION This study is the first of its kind to systematically track children after recovery from SAM in CMAM programs using uniform methods across multiple countries. The design allows the use of results to: 1) facilitate understandings of the burden of relapse; 2) identify risk factors for relapse and 3) elucidate financial costs associated with relapse in CMAM programs. This protocol's publication aims to support similar studies and evaluations of CMAM programs and provides opportunities for comparability of an evidence-based set of indicators for relapse to SAM.
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Affiliation(s)
- Sarah King
- Action Against Hunger, New York, NY, USA
| | - Lauren D'Mello-Guyett
- Environmental Health Group, Department for Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Karin Gallandat
- Environmental Health Group, Department for Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Khamisa Ayoub
- Nutrition Department, Ministry of Health for the Republic of South Sudan, Juba, South Sudan
| | - Ahmed Hersi Olad
- Research Department, Federal Ministry of Health for the Federal Republic of Somalia, Mogadishu, Somalia
| | - Bagayogo Aliou
- Nutrition Sub-Directorate, General Directorate of Health and Public Hygiene, Ministry of Health and Social Development for the Republic of Mali, Bamako, Mali
| | | | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Oliver Cumming
- Environmental Health Group, Department for Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Heather Stobaugh
- Action Against Hunger, New York, NY, USA. .,Tufts University, Boston, MA, USA.
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Shirisha P, Muraleedharan VR, Vaidyanathan G. Wealth related inequality in women and children malnutrition in the state of Chhattisgarh and Tamil Nadu. BMC Nutr 2022; 8:86. [PMID: 35996127 PMCID: PMC9394049 DOI: 10.1186/s40795-022-00580-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Child and maternal malnutrition are the most serious health risks in India, accounting for 15% of the country’s total disease burden. Malnutrition in children can manifest as ‘stunting’ (low height in relation to age) or ‘wasting’ (low weight in relation to height) or both and underweight or obesity among women. Other nutritional indicators show that India lags behind, with high levels of anaemia in women of reproductive age. The study aims to analyse the wealth related inequalities in the nutrition status among women and children of different wealth quintiles in a high focus state (Chhattisgarh; CG) and a non-high focus state (Tamil Nadu; TN) in India. Methods We used National Family Health Survey-3rd (2005–06) & 4th (2015–16) to study the trends and differentials of inequalities in the nutrition status. We have used two summary indices. - absolute inequalities using the slope index of inequality (SII), and relative inequalities using the concentration index (CIX). Results There is reduction in wealth related inequality in nutrition status of women and children from all wealth quintiles between 2005–06 and 2015–16. However the reduction in inequality in some cases such as that of severe stunting among children was accompanied by increase among children from better off households The values of SII and CIX imply that malnutrition except obesity is still concentrated among the poor. The prevalence of anaemia (mild, moderate and severe) has reduced among women and children in the past decade. The converging pattern observed with respect to prevalence of mild and moderate anaemia is not only due to reduction in prevalence of anaemia among women from poor households but an increase in prevalence in rich households. Conclusion Malnutrition remains a major challenge in India, despite encouraging progress in maternal and nutrition outcomes over the last decade. Our study findings indicate the importance of looking at the change in inequalities of nutrition status of women and children of different wealth quintiles sub nationally. Given the country’s rapidly changing malnutrition profile, with progress across several indicators of under nutrition but rapidly rising rates of overweight/obesity, particularly among adults, appropriate strategies needs to be devised to tackle the double burden of malnutrition.
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Affiliation(s)
- P Shirisha
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India.
| | - V R Muraleedharan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
| | - Girija Vaidyanathan
- Humanities and Social Sciences Block, Indian Institute of Technology, Madras, India
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Al-Waleedi AA, Bin-Ghouth AS. Malnutrition among hospitalized children 12-59 months of age in Abyan and Lahj Governorates / Yemen. BMC Nutr 2022; 8:78. [PMID: 35962407 PMCID: PMC9373284 DOI: 10.1186/s40795-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The analysis of acute malnutrition in 2018 for the Integrated Phase Classification of Food Security in Yemen shows that high malnutrition rates are present in Abyan governorate (23%) and Lahj governorate (21%). This analysis was community based addressed all children and mostly due to problems related to food intake. The role of diseases was not yet addressed in Yemen. The aim of this study is to assess acute and chronic malnutrition among hospitalized children at 12-59 months of age in Lahj and Abyan governorates in Yemen. METHODOLOGY A cross-sectional, multi-center study is designed. The assessment of the nutritional status was measured by standardized anthropometry of 951 sick children at 12-59 months of age. RESULTS The prevalence of Global acute malnutrition (GAM) among the sick children seeking care in health facilities in Lahj and Abyan is 21%. More specifically; the prevalence of moderate acute malnutrition (MAM) is 15.1% while the prevalence of severe acute malnutrition (SAM) is 6.2%. The prevalence of acute malnutrition (wasting) among the studied sick children in lahj is 23.4% while in Abyan is 19.3%. The prevalence of MAM in Lahj is 17.7% and the prevalence of SAM is 5.7%. The prevalence of acute malnutrition (wasting) in Abyan is 12.6% while the prevalence of SAM in Abyan is 6.7%. The prevalence of acute malnutrition among male children (25.2%) is significantly higher than among female children (17.5%). The prevalence of the chronic malnutrition (Stunting) in the studied sick children is 41.3%; the prevalence of stunting in Lahj is 41% while in Abyan is 41.7%. CONCLUSIONS High acute and chronic malnutrition rates were identified among sick children seeking care in health facilities in lahj and Abyan, and higher than the SPHERE indicators of malnutrition. Boys are more exposed than girls to acute and chronic malnutrition.
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Affiliation(s)
- Ali Ahmed Al-Waleedi
- Department of Public Health and Community Medicine, Faculty of Medicine, University of Aden, Aden, Yemen
| | - Abdulla Salem Bin-Ghouth
- Department of Community Medicine, Hadharamout University College of Medicine (HUCOM), Hadhramout University, 8892, Mukalla, Fwah, Yemen.
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Isanaka S, Tang K, Berthé F, Grais RF, Pandya A. Cost-effectiveness of routine versus indicated antibiotic therapy in the management of severe wasting in children. Cost Eff Resour Alloc 2022; 20:38. [PMID: 35922807 PMCID: PMC9351197 DOI: 10.1186/s12962-022-00374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the outpatient management of severe wasting, routine antibiotic therapy is recommended for all children upon admission regardless of whether clinical signs of infection are present. Indicated antibiotic therapy, where antibiotics are provided only upon presentation of clinical signs of infection, may be considered for its potential to allow for more prudent antibiotic use and greater program coverage, reducing the risk of antibiotic resistance as well as costs and logistical burdens associated with treatment. We therefore conducted a cost-effectiveness analysis to measure the effects of indicated antibiotic therapy compared to routine antibiotic therapy in terms of incremental cost-per-life-year saved in Niger. Methods We used a cohort model to conduct a cost-effectiveness analysis from a healthcare system perspective to project and weigh the lifetime discounted costs and effects of indicated antibiotic therapy compared to routine antibiotic therapy in the treatment of uncomplicated severe wasting in children in Niger. We calculated incremental cost-effectiveness ratios (ICERs) in terms of treatment-related healthcare costs per discounted life-years saved (LYS), and conducted program coverage scenario and sensitivity analyses to assess model uncertainty. Results The ICER for indicated antibiotic therapy compared to routine antibiotic therapy was $8.5/LYS, which is under the cost-effectiveness threshold for Niger. The probability of the indicated strategy being optimal was 76.1% when program coverage was equal to coverage associated with routine therapy but was 100% likely to be optimal in probabilistic sensitivity analysis scenarios where indicated program coverage improved 5 percentage points. Conclusions Indicated antibiotic therapy likely represents a cost-effective strategy, particularly if indicated treatment can result in expanded coverage. With the risk of increasing antibiotic resistance worldwide, antibiotic stewardship and simplified treatment protocols for severe wasting using indicated antibiotic therapy may represent good value for money in some low risk populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00374-z.
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Affiliation(s)
- Sheila Isanaka
- Department of Research, Epicentre, 14-34 avenue Jean Juarès, 75019, Paris, France. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kevin Tang
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rebecca F Grais
- Department of Research, Epicentre, 14-34 avenue Jean Juarès, 75019, Paris, France
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Das S, Baffour B, Richardson A. Prevalence of child undernutrition measures and their spatio-demographic inequalities in Bangladesh: an application of multilevel Bayesian modelling. BMC Public Health 2022; 22:1008. [PMID: 35585516 PMCID: PMC9118603 DOI: 10.1186/s12889-022-13170-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this regard district-representative data were collected in the Bangladesh Multiple Indicator Cluster Survey 2019 for identifying localised disparities. However, district-level estimates of undernutrition indicators - stunting, wasting and underweight - remain largely unexplored. This study aims to estimate district-level prevalence of these indicators as well as to explore their disparities at sub-national (division) and district level spatio-demographic domains cross-classified by children sex, age-groups, and place of residence. Bayesian multilevel models are developed at the sex-age-residence-district level, accounting for cross-sectional, spatial and spatio-demographic variations. The detailed domain-level predictions are aggregated to higher aggregation levels, which results in numerically consistent and reasonable estimates when compared to the design-based direct estimates. Spatio-demographic distributions of undernutrition indicators indicate south-western districts have lower vulnerability to undernutrition than north-eastern districts, and indicate significant inequalities within and between administrative hierarchies, attributable to child age and place of residence. These disparities in undernutrition at both aggregated and disaggregated spatio-demographic domains can aid policymakers in the social inclusion of the most vulnerable to meet the sustainable development goals by 2030.
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Affiliation(s)
- Sumonkanti Das
- School of Demography, Australian National University, Ellery Crescent, Canberra, 2601, ACT, Australia.
| | - Bernard Baffour
- School of Demography, Australian National University, Ellery Crescent, Canberra, 2601, ACT, Australia
| | - Alice Richardson
- Statistical Support Network, Australian National University, Science Road, Canberra, 2601, ACT, Australia
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Grau-Pujol B, Cano J, Marti-Soler H, Casellas A, Giorgi E, Nhacolo A, Saute F, Giné R, Quintó L, Sacoor C, Muñoz J. Neighbors' use of water and sanitation facilities can affect children's health: a cohort study in Mozambique using a spatial approach. BMC Public Health 2022; 22:983. [PMID: 35578273 PMCID: PMC9109333 DOI: 10.1186/s12889-022-13373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 05/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Impact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection - community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children's morbidity and mortality using recorded health data. METHODS We conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012-2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality. RESULTS Household use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition. CONCLUSION Household and neighbors' access to improve water and sanitation can affect children's health. Accounting for household WASH and herd protection in interventions' evaluation could foster stakeholders' investment and improve WASH related diseases control. Distribution of main water and sanitation facilities used during study period.
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Affiliation(s)
- Berta Grau-Pujol
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique ,Mundo Sano Foundation, Buenos Aires, Argentina
| | - Jorge Cano
- grid.463718.f0000 0004 0639 2906Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Helena Marti-Soler
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
| | - Aina Casellas
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona (UB), Casanova 143, 08036 Barcelona, Spain
| | - Emanuele Giorgi
- grid.9835.70000 0000 8190 6402Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW UK
| | - Ariel Nhacolo
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Francisco Saute
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ricard Giné
- grid.454010.40000 0001 1009 1661Stockholm International Water Institute, Stockholm, Sweden
| | - Llorenç Quintó
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jose Muñoz
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
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Rich NE, Phen S, Desai N, Mittal S, Yopp AC, Yang JD, Marrero JA, Iyengar P, Infante RE, Singal AG. Cachexia is Prevalent in Patients With Hepatocellular Carcinoma and Associated With Worse Prognosis. Clin Gastroenterol Hepatol 2022; 20:e1157-e1169. [PMID: 34555519 PMCID: PMC8934317 DOI: 10.1016/j.cgh.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/21/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cancer cachexia is a wasting syndrome associated with functional impairment and reduced survival that impacts up to 50% of patients with gastrointestinal cancers. However, data are limited on the prevalence and clinical significance of cachexia in patients with hepatocellular carcinoma (HCC). METHODS We performed a retrospective cohort study of patients diagnosed with HCC at 2 United States health systems between 2008 and 2018. Patient weights were recorded 6 months prior to and at time of HCC diagnosis. Cachexia was defined as >5% weight loss (or >2% weight loss if body mass index <20 kg/m2), and precachexia was defined as 2% to 5% weight loss. We used multivariable logistic regression models to identify correlates of cachexia and multivariable Cox proportional hazard models to identify factors associated with overall survival. RESULTS Of 604 patients with HCC, 201 (33.3%) had precachexia and 143 (23.7%) had cachexia at diagnosis, including 19.0%, 23.5%, 34.7%, and 34.0% of patients with Barcelona Clinic Liver Cancer stages 0/A, B, C, and D, respectively. Patients with cachexia were less likely to receive HCC treatment (odds ratio, 0.38; 95% confidence interval, 0.21-0.71) and had worse survival than those with precachexia or stable weight (11.3 vs 20.4 vs 23.5 months, respectively; P < .001). Cachexia remained independently associated with worse survival (hazard ratio, 1.43; 95% confidence interval, 1.11-1.84) after adjusting for age, sex, race, ethnicity, Child Pugh class, alpha-fetoprotein, Barcelona Clinic Liver Cancer stage, and HCC treatment. CONCLUSIONS Nearly 1 in 4 patients with HCC present with cachexia, including many with compensated cirrhosis or early stage tumors. The presence of cancer-associated weight loss appears to be an early and independent predictor of worse outcomes in patients with HCC.
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Affiliation(s)
- Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX
| | - Samuel Phen
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX
| | - Nirali Desai
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX
| | - Sukul Mittal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX
| | - Adam C. Yopp
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX,Department of Surgery, UT Southwestern, Dallas TX
| | - Ju Dong Yang
- Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center and Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles CA
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX
| | - Puneeth Iyengar
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX,Department of Radiation Oncology, UT Southwestern, Dallas TX
| | - Rodney E. Infante
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX,Center for Human Nutrition, UT Southwestern, Dallas TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern, Dallas TX
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Ketema B, Bosha T, Feleke FW. Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis. J Nutr Sci 2022; 11:e28. [PMID: 35573460 PMCID: PMC9066325 DOI: 10.1017/jns.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022] Open
Abstract
Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.
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Key Words
- Bale Robe
- EBF, Exclusive Breastfeeding
- Ethiopia
- HAZ, Height-for-Age Z-score
- Infant and young child
- MAD, Minimum Acceptable Diet
- MDD, Minimum Diet Diversity
- MMF, Minimum Meal Frequency
- MUAC, Mid-upper arm circumference
- MUACAZ, Mid-upper arm circumference-for-age Z-score
- PCA, Principal Component Analysis
- PI, Principal Investigator
- SPSS, Statistical Product and Service Solutions
- Stunting
- UNICEF, United Nations Children's Fund
- Underweight
- WAZ, Weight-for-Age Z-score
- WHO, World Health Organization
- WHZ, Weight-for-Height Z-Score
- Wasting
- sd, Standard Deviation
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Affiliation(s)
- Bezawit Ketema
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Tafese Bosha
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fentaw Wassie Feleke
- College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
- College of Health Science, Woldia University, P.O. Box 400, Woldia, Ethiopia
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