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d'Errico A, Fontana D, Sacerdote C, Ardito C. Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children. BMC Public Health 2024; 24:272. [PMID: 38263016 PMCID: PMC10804732 DOI: 10.1186/s12889-023-17119-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.
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Affiliation(s)
- Angelo d'Errico
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Dario Fontana
- Epidemiology Unit Piedmont Region ASL TO3, Grugliasco (TO), Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, University of Turin, Turin, Italy
- Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - Chiara Ardito
- Competence Centre On Microeconomic Evaluation (CC-ME), European Commission, Joint Research Centre (JRC), Ispra, Italy.
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Cavagnari BM, Guerrero-Vaca DJ, Carpio-Arias TV, Duran-Aguero S, Vinueza-Veloz AF, Robalino-Valdivieso MP, Morejón-Terán YA, Vinueza-Veloz MF. The double burden of malnutrition and gross motor development in infants: A cross-sectional study. Clin Nutr 2023; 42:1181-1188. [PMID: 37225559 DOI: 10.1016/j.clnu.2023.05.001] [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: 04/11/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of the present work was to study the relationship between the double burden of malnutrition and gross motor development in infants. METHOD ology: Sample included 5900 infants under 24 months of age, participants of the ENSANUT-ECU study. To evaluate nutritional status, we calculated z-scores for body mass index/age (BAZ) and height/age (HAZ). Six gross motor milestones were considered: sitting without-support, crawling, standing and walking with-support, standing and walking without-support. Data was analysed using logistic regression models in R. RESULTS Independently form age, sex and other socio-economic factors, the probability of achieving three gross motor milestones was significantly lower among chronically undernourished infants compared to their peers: sitting without-support, crawling, and walking without-support. Compared to no malnourished infants the probability of sitting without-support at six months was 10% lower for chronically undernourished infants (0.70, 95%CI [0.64-0.75]; 0.60, 95%CI [0.52-0.67]; respectively). The probability of crawling at eight months and walking without-support at 12 months were also significantly lower among chronically undernourished infants (0.62, 95%CI [0.58-0.67]); 0.25, 95%CI [0.20-0.30]; respectively) in comparison to no malnourished infants (0.67, 95%CI [0.63-0.72]); 0.29, 95%CI [0.25-0.34]; respectively). Obesity/overweight was not associated with the achievement of gross motor milestones, except for sitting without-support. Chronically undernourished infants with low or high BMI/age were generally delayed in the achievement of gross motor milestones than their peers. CONCLUSIONS Chronic undernutrition is related to delayed gross motor development. Public health measures are needed to be implemented to prevent the double burden of malnutrition and its detrimental effects on infant development.
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Affiliation(s)
- Brian M Cavagnari
- School of Nutrition, Faculty of Medical Sciences, Pontificia Universidad Católica, Buenos Aires, Argentina
| | - Darío Javier Guerrero-Vaca
- School of Medicine, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Tannia Valeria Carpio-Arias
- School of Nutrition and Dietetics, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Samuel Duran-Aguero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago, Chile
| | | | | | - Yadira Alejandra Morejón-Terán
- Research Program Social Change, Asthma and Allergy in Latin America - SCAALA, Universidade Federal de Bahía, Salvador, Brazil; Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo (FCSEE). Universidad UTE, Quito, Ecuador
| | - María Fernanda Vinueza-Veloz
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Sahiledengle B, Mwanri L, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Kene C, Seyoum K, Gomora D, Woldeyohannes D, Agho KE. The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors. BMC Pediatr 2023; 23:218. [PMID: 37147654 PMCID: PMC10163774 DOI: 10.1186/s12887-023-04037-7] [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: 08/19/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia. METHODS Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO. RESULTS The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)]. CONCLUSION The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Centre for Public Health Research, Equity and Human Flourishing, Torrens University, Adelaide Campus, Adelaide, SA, 5000, Australia
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - 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
| | - Chala Kene
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Jones-Antwi RE, Cunningham SA. Weight patterns among mother-child pairs in the Middle East and North African Region. Ann Epidemiol 2023; 77:67-74. [PMID: 36519722 PMCID: PMC9807028 DOI: 10.1016/j.annepidem.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/20/2021] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
AIM We aim to evaluate weight status in mother-child household pairs and patterns specific to over-nutrition households and double burden households. METHODS We used nationally representative data from the most recent Demographic and Health Survey (2001-2014) in the Middle East & North African (MENA) Region (n = 45,104) to examine weight status of mother-child dyads. Under-nutrition households were defined as mothers with underweight and children with wasting; over-nutrition households as mothers with overweight/obesity and children with overweight; and double burden households as mothers with underweight and children with overweight or mothers with overweight/obesity mother and children with wasting. Survey-adjusted multinomial logistic regression were used to quantify predictors of weight patterns. RESULTS Across the MENA region, 8.6% of households were experiencing double burden malnutrition, 11% were experiencing over-nutrition and 0.2% were experiencing under-nutrition. Wealthier households with older mothers, higher birth-order children, more educated parents and private water access were more likely to be over-nutrition or double burden households. Compared to over-nutrition households, double burden households were poorer and more likely to have a child with low birthweight. CONCLUSIONS Over-nutrition is the most common unhealthy weight pattern, followed by double-burden; socioeconomic status and birth weight are consistent predictors of unhealthy mother-child pairs.
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Affiliation(s)
| | - Solveig A Cunningham
- Hubert Department of Global Health, Emory University, Atlanta, GA; Department of Sociology, Emory University, Atlanta, GA
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Sarker AR, Hossain Z, Morton A. Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother-child dyads from a national household survey. Public Health Nutr 2022; 25:3158-71. [PMID: 36111605 DOI: 10.1017/S1368980022002075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh. DESIGN The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM. SETTING Nationally representative cross-sectional survey. PARTICIPANTS 8697 mothers aged 15 to 49 years with <5 children. RESULTS The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers' occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM. CONCLUSIONS Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.
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Chauhan S, Kumar S, Patel R, Simon DJ, Kumari A. Burden of communicable and non-communicable diseases-related inequalities among older adults in India: a study based on LASI survey. BMC Geriatr 2022; 22:790. [PMID: 36217103 PMCID: PMC9552506 DOI: 10.1186/s12877-022-03481-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India. Methods Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017–18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural–urban inequalities in CDs and NCDs. Results Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1–1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62–0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62–2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural–urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural–urban inequality in the prevalence of NCDs among the elderly. Conclusion The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03481-x.
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Affiliation(s)
- Shekhar Chauhan
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Shubham Kumar
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Ratna Patel
- Research Scholar, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
| | - David Jean Simon
- Research Scholar, Paris 1 Pantheon Sorbonne University, Paris, France
| | - Aradhana Kumari
- Research Scholar, Jawaharlal Nehru University, New Delhi, India
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Christian AK, Dake FA. Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors. Public Health Nutr 2022; 25:1563-76. [PMID: 33896443 DOI: 10.1017/S1368980021001750] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. SETTING The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. PARTICIPANTS The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years). DESIGN Logistic regression analyses were used to determine household correlates of household burden of malnutrition. RESULTS Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. CONCLUSIONS The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.
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Cai W, Wang Y. 2.10 Nutritional Problems in Transitional Countries. World Rev Nutr Diet 2022; 124:203-210. [PMID: 35240611 DOI: 10.1159/000516711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Wei Cai
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Institute for Pediatric Research, Shanghai, China.,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Ying Wang
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
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Uwishema O, Okereke M, Onyeaka H, Hasan MM, Donatus D, Martin Z, Oluwatomisin LA, Mhanna M, Olumide AO, Sun J, Adanur I. Threats and outbreaks of cholera in Africa amidst COVID-19 pandemic: a double burden on Africa's health systems. Trop Med Health 2021; 49:93. [PMID: 34819175 PMCID: PMC8611385 DOI: 10.1186/s41182-021-00376-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/21/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022] Open
Abstract
Every year, about 4 million cases and 143,000 deaths due to cholera are recorded globally, of which 54% were from Africa, reported in 2016. The outbreak and spread of cholera have risen exponentially particularly in Africa. Coupled with the recent emergence of the Coronavirus Pandemic (COVID-19) in Africa, the local health systems are facing a double burden of these infectious diseases due to their cumulative impact. In this paper, we evaluate the dual impact of cholera and COVID-19 in Africa and suggest plausible interventions that can be put in place to cushion its impact.
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Affiliation(s)
- Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda. .,Clinton Global Initiative University, New York, USA. .,Faculty of Medicine, Karadeniz Technical University, 61080, Trabzon, Turkey.
| | - Melody Okereke
- Faculty of Pharmaceutical Sciences, University of Ilorin, Kwara State, Nigeria
| | - Helen Onyeaka
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, 1902, Bangladesh
| | - Deocles Donatus
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,University of Dar es salaam Tanzania, Dar es Salaam, Tanzania
| | - Zebadiah Martin
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Mbeya Zonal Consultant Hospital, Mbeya, Tanzania
| | - Lawal Abdulwahab Oluwatomisin
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Department of Surgery, University of Ilorin Teaching Hospital, Kwara State, Nigeria
| | - Melissa Mhanna
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine, University of Saint Joseph Beirut, Beirut, Lebanon
| | - Adesipe Olaoluwa Olumide
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Jeffrey Sun
- Clinton Global Initiative University, New York, USA.,Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Irem Adanur
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine, Karadeniz Technical University, 61080, Trabzon, Turkey
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Aborode AT, Babatunde AO, Osayomwanbor BAS, Fajemisin EA, Inya OC, Olajiga O, Uwandu-Uzoma AC. Measles outbreak amidst COVID-19 pandemic in Africa: grappling with looming crises. Trop Med Health 2021; 49:89. [PMID: 34727984 PMCID: PMC8561678 DOI: 10.1186/s41182-021-00375-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/11/2021] [Accepted: 10/02/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) and measles are major threats to the health and wellbeing of Africans. Measles is an endemic disease in Africa with a high mortality rate especially in children despite available vaccines. This letter aims to discuss the impact of the COVID-19 pandemic on prevention and management of measles in Africa. The emergence of COVID-19 has exacerbated the morbidities of measles due to multi-factors like the disruption of mass measles routine vaccination, a monopolistic focus on COVID-19 eradication, malnutrition, and poor surveillance. Currently, the COVID-19 pandemic and looming measles epidemic pose a double burden on the African health sector. We recommend urgent interventions from government and other stakeholders including community leaders to strengthen measles research and vaccination programs in Africa amidst the pandemic.
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Affiliation(s)
- Abdullahi Tunde Aborode
- Healthy Africans Platform, Research and Development, Ibadan, Nigeria.,Student Against COVID-19, Research and Education, New York, USA
| | - Abdulhammed Opeyemi Babatunde
- Healthy Africans Platform, Research and Development, Ibadan, Nigeria.,Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Oko Christian Inya
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olayinka Olajiga
- Department of Entomology, Kansas State University, Manhattan, USA
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Abstract
OBJECTIVE To examine the association of household type and household composition with concurrent stunting and overweight in young children from urban and rural Indonesia. DESIGN This study is a secondary data analysis using a nationally representative cross-sectional survey. Household structure was analysed as household type, household size, number of working adults, number of dependent adults and children, and household head's gender. We defined 'concurrent stunting and overweight' as height-for-age Z-score <-2 and weight-for-height Z-score >+2 based on WHO growth standards. Multivariable logistic regression to test the aforementioned association was performed separately for urban and rural areas. SETTING Data were from Indonesia Basic Heath Research 2013. PARTICIPANTS Children aged 2-5 years (n 45 050). RESULTS The prevalence of concurrent stunting and overweight children was 5·6 %. In rural areas, this prevalence differed significantly by household types and the highest prevalence was among children in nuclear two-parent households (6·8 %). In rural areas, children in extended households had lower odds of concurrent stunting and overweight than those from nuclear households (OR = 0·73, 95 % CI 0·59, 0·92). In urban areas, household size and number of working adults were significantly associated with the decreased odds of concurrent stunting and overweight in children. CONCLUSIONS Household structure was associated with children's concurrent stunting and overweight in urban and rural regions of Indonesia. The patterns of the association might differ between urban and rural regions, but no significant interaction term was found.
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Peng W, Mu Y, Hu Y, Li B, Raman J, Sui Z. Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis. J Epidemiol Glob Health 2021; 10:16-27. [PMID: 32175706 PMCID: PMC7310807 DOI: 10.2991/jegh.k.191117.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 05/07/2019] [Accepted: 10/27/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Double Burden of Malnutrition (DBM)—the coexistence of undernutrition along with overnutrition—is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region. Methods: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0). Results: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3–10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3–26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition. Conclusion: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.
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Affiliation(s)
- Wen Peng
- Department of Public Health, Medical School, Qinghai University, Qinghai, China
| | - Yuhan Mu
- Department of Public Health, Medical School, Qinghai University, Qinghai, China
| | - Yang Hu
- Department of Public Health, Medical School, Qinghai University, Qinghai, China
| | - Bin Li
- Department of Public Health, Medical School, Qinghai University, Qinghai, China
| | - Jayanthi Raman
- Clinical Psychology, Australian College of Applied Psychology, Sydney, NSW 2000, Australia
| | - Zhixian Sui
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia.,The BMI Clinic, Double Bay, NSW 2028, Australia
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Silva NJ, Ribeiro-Silva RC, Rasella D, Alves FJO, Campello T, Fiaccone RL, Barreto ML. Shifts towards overweight and double burden of malnutrition among socio-economically vulnerable children: a longitudinal ecological analysis of Brazilian municipalities. Public Health Nutr 2021; 24:4908-17. [PMID: 33222714 DOI: 10.1017/S1368980020004735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the shifts and factors associated with different scenarios resulting from the prevalence of child stunting and overweight in Brazilian municipalities. DESIGN This is an ecological study using municipality-level panel data of stunting and overweight prevalence and socio-economic characteristics from 2008 to 2014. The municipalities were classified according to the WHO-UNICEF prevalence thresholds for stunting and overweight and were categorised into four nutritional scenarios: no burden (prevalence of stunting < 20 % and overweight < 10 %), stunting burden (prevalence of stunting ≥ 20 % and overweight < 10 %), overweight burden (prevalence of stunting < 20 % and overweight ≥ 10 %) and double burden (prevalence of stunting ≥ 20 % and overweight ≥ 10 %). SETTING Totally, 4443 Brazilian municipalities. PARTICIPANTS Aggregated data of children under 5 years old enrolled in the Brazil's conditional cash transfer programme (Bolsa Família). RESULTS A mean reduction from 14·2 % to 12·7 % in the prevalence of stunting and an increase from 17·2 % to 18·4 % in the prevalence of overweight were observed. The predominant scenarios were overweight burden and double burden. The odds of both scenarios increased with higher gross domestic product (GDP) per capita and decreased with higher unemployment rates. Stunting and double burden decreased with higher expected years of schooling, and stunting burden increased with household crowding. CONCLUSION Our findings indicate an advanced nutrition transition stage in Brazil, associated mainly with municipal GDP per capita growth, which has contributed to increasing the burden of overweight alone or coexisting with stunting (double burden) among children in the most socio-economically vulnerable strata of the population.
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Lokossou YUA, Azandjèmè C, Ayuk BT, Mbhenyane X. The presence of the double burden of malnutrition in children and their mothers in Grand-Popo, Benin. Nutr Health 2020; 27:89-96. [PMID: 33045915 DOI: 10.1177/0260106020962787] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Malnutrition is a public health problem, with 45% of child deaths attributed to undernutrition. AIM The aim of this study was to investigate the presence of the double burden of malnutrition in children-mother pairs in Benin. METHODS An analytical cross-sectional approach was used to collect data from 408 randomly selected children aged 0-59 months and their mothers. A pretested questionnaire was used to collect information on demographic and socioeconomic status, and anthropometric measurements were used to estimate the nutritional status of children and body mass indexes of the mothers. The World Health Organization Anthro software was used to estimate Z-scores whereas SPSS version 25 was used for statistical analysis. Descriptive and regression analysis were carried out on the data. RESULTS The mean age of children was 24.45 ± 14.9 months and 53.2% were girls. The mean age of mothers was 27.99 ± 6.99, 93.1% were married and approximately 91.7% of households had a monthly income of US$60. Prevalence of wasting in children was 9.8% and stunting was 29.7%. The mean waist circumference of mothers was 79.95 ± 10.35 cm and 19.3% were classified as high metabolic risk. Body mass index measurements showed that 16.9% of mothers were overweight and 7.4% obese. CONCLUSIONS Stunting and wasting were highly prevalent. There is a coexistence of underweight and overweight in Grand-Popo, Benin. The results drew attention to the need for coordination of preventive interventions to focus on the household food distribution.
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Affiliation(s)
| | - Colette Azandjèmè
- Institut Régional de Santé Publique, 107790Université d'Abomey-Calavi, Benin
| | - Betrand Tambe Ayuk
- Division Human Nutrition, 121470Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Xikombiso Mbhenyane
- Division Human Nutrition, 121470Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Wang Q, Ma A, Schouten EG, Kok FJ. A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency. Clin Nutr 2020; 40:350-357. [PMID: 32948348 DOI: 10.1016/j.clnu.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/05/2019] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 01/19/2023]
Abstract
Tuberculosis remains a major global health challenge, particularly in low-to-middle income countries such as China. At the same time, the country is facing a rapidly increasing diabetes incidence over the last 10 years. Diabetes aggravates the tuberculosis epidemic which poses a serious challenge in public health. In recent years, the high prevalence of vitamin D deficiency represents a global health problem, which is also associated with the risk of diabetes, and tuberculosis. Therefore, this review aims to provide an overall and updated understanding of the epidemiology of co-occurrence of tuberculosis and diabetes in China, and to elucidate the possible role of vitamin D deficiency. In conclusion, significant aggravation of the tuberculosis epidemic due to diabetes may exist in China for a relatively long period of time to come. Further, the double burden and its implications to public health in this country may be significantly influenced by the high prevalence of vitamin D deficiency. Bidirectional screening for tuberculosis and diabetes is recommended, and extra vitamin D may benefit especially in a situation of a heavy tuberculosis burden combined with prevalent vitamin D deficiency. Longitudinal studies to verify the role of vitamin D deficiency in the double burden, and trials on the effect of vitamin D supplementation are needed in the future.
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Affiliation(s)
- Qiuzhen Wang
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China.
| | - Aiguo Ma
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Evert G Schouten
- Division of Nutrition and Health, Wageningen University&Research, Wageningen, the Netherlands
| | - Frans J Kok
- Division of Nutrition and Health, Wageningen University&Research, Wageningen, the Netherlands
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Abstract
OBJECTIVE In low- and middle-income countries, undernutrition remains a major risk factor for child growth retardation. In addition, the emergence of obesity in recent years is adding another public health concern in that both stunting and obesity are associated with serious adverse health consequences. This review was designed to evaluate the prevalence of stunting and obesity in Ecuador. DESIGN Electronic databases were searched for articles published through February 2018 reporting the prevalence of stunting and/or obesity. Selected data were subjected to meta-analysis and pooled prevalence and their 95 percentiles (95 % CI) were calculated. SETTING Studies were identified in Medline, Web of Science, CINAHL, Cochrane Database and Ibero-America databases. PARTICIPANTS Population of Ecuador. RESULTS Twenty-three articles were selected according to the inclusion/exclusion criteria of the study. The estimate of pooled prevalence of stunting was 23·2 % (95 % CI 23·3, 23·5) in preschoolers (age < 5 years), but was markedly higher in indigenous and rural communities. Pooled prevalence of obesity was 8·1 % (95 % CI 6·9, 9·3), 10·7 % (95 % CI 9·6, 11·7) and 10·5 % (95 % CI 9·2, 11·8) in preschoolers, school-age children (age: 5-11 years) and adolescent (age: 12-18 years), respectively. In adults (age ≥ 19 years), the rate of obesity was remarkably high as indicated by an overall estimate equal to 44·2 % (95 % CI 43·1, 45·4). CONCLUSIONS This study underlines high levels of stunting among children and obesity among adults in Ecuador, both of which are not equally distributed among the population. The magnitude of this double burden emphasises the need for sustained and targeted interventions.
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Lerm BR, Crochemore-Silva I, Costa JC, Victora CG. The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries. Public Health Nutr 2021; 24:2944-51. [PMID: 32633230 DOI: 10.1017/S1368980020001226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 12/04/2022]
Abstract
Objective To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. Design We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. Setting Nationally representative surveys from ninety-three LMIC. Participants A total of 825 633 children were studied. Results DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. Conclusions The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Thow AM, Waqa G, Browne J, Phillips T, McMichael C, Ravuvu A, Tutuo J, Gleeson D. The political economy of restricting marketing to address the double burden of malnutrition: two case studies from Fiji. Public Health Nutr 2021; 24:354-63. [PMID: 32552919 DOI: 10.1017/S1368980020000440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To draw lessons from Fiji regarding the challenges and opportunities for policy initiatives to restrict (i) food marketing to children and (ii) marketing of breast milk substitutes, to inform policy for the double burden of malnutrition. DESIGN Qualitative political economy analysis of two policy case studies. SETTING Fiji. PARTICIPANTS Eleven key informants from relevant sectors, representing public health, economic and consumer interests. RESULTS This study used two policy initiatives as case studies to examine factors influencing decision-making: Marketing Controls (Foods for Infants and Young Children) Regulations 2010, amended in 2016 to remove guidelines and restrictions on marketing in the form of labelling, and the draft Advertising and Promotion of Unhealthy Foods and Non-Alcoholic Beverages to Children Regulation developed in 2014 but awaiting review by the Solicitor General's Office. Factors identified included: a policy paradigm in which regulation of business activity contradicts economic policy goals; limited perception by key policy actors of links between nutrition and marketing of breast milk substitutes, foods and beverages; and a power imbalance between industry and public health stakeholders in policymaking. Regulation of marketing for health purposes sits within the health sector's interest but not its legislative remit, while within the economic sector's remit but not interest. Opportunities to strengthen restrictions on marketing to improve nutrition and health include reframing the policy issue, strategic advocacy and community engagement. CONCLUSIONS Restricting marketing should be recognised by public health actors as a public health and an industry policy issue, to support strategic engagement with economic policy actors.
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Little M, Humphries S, Dodd W, Patel K, Dewey C. Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study. BMC Public Health 2020; 20:675. [PMID: 32404080 PMCID: PMC7218837 DOI: 10.1186/s12889-020-08679-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India. METHODS We undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes. RESULTS Prevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70). CONCLUSION This study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.
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Affiliation(s)
- Matthew Little
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada.
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
| | - Sally Humphries
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Warren Dodd
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kirit Patel
- Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB, Canada
| | - Cate Dewey
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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Sunuwar DR, Singh DR, Pradhan PMS. Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey. BMC Public Health 2020; 20:405. [PMID: 32223749 PMCID: PMC7104542 DOI: 10.1186/s12889-020-8356-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 08/16/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household. METHODS A total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM). RESULTS Prevalence of DBM and TBM was 6.60% (95% CI: 5.13-8.84) and 7.00% (95% CI: 5.42-8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04-8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17-5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20-7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45-10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28-5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26-9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM. CONCLUSIONS Overall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal APF Hospital, Kathmandu, Nepal.
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
- Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Masibo PK, Humwa F, Macharia TN. The double burden of overnutrition and undernutrition in mother-child dyads in Kenya: demographic and health survey data, 2014. J Nutr Sci 2020; 9:e5. [PMID: 32042413 PMCID: PMC6984123 DOI: 10.1017/jns.2019.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/10/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/03/2023] Open
Abstract
The double burden of overnutrition and undernutrition is rapidly becoming a public health concern in low- and middle-income countries. We explored the occurrence of mother-child pairs of over- and undernutrition and the contributing factors using the 2014 Kenya Demographic and Health Survey data. A weighted sample of 7830 mother-child pairs was analysed. The children's nutritional status was determined using the WHO 2006 reference standards while maternal nutritional status was determined with BMI. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. The proportion of overweight and obese mothers was 26 % (18·8 % overweight and 7·2 % obese). The prevalence of child stunting, underweight and wasting was 26·3, 12·8 and 5·1 %, respectively. Out of the overweight/obese mothers (weighted n 2034), 20 % had stunted children, 5·4 % underweight children and 3·1 % wasted children. Overweight/obese mother-stunted child pairs and overweight/obese mother-underweight child pairs were less likely to occur in the rural areas (adjusted OR (aOR) = 0·43; P < 0·01) in comparison with those residing in the urban areas (aOR = 0·54; P = 0·01). Children aged more than 6 months were more likely to be in the double burden dyads compared with children below 6 months of age (P < 0·01). The double burden mother-child dyads were more likely to be observed in wealthier households. Mother-child double burden is a notable public health problem in Kenya. Household wealth and urban residence are determinants of the double burden. There is need for target-specific interventions to simultaneously address child undernutrition and maternal overweight/obesity.
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Affiliation(s)
- Peninah Kinya Masibo
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Nutrition, Moi University, School of Public Health, Nairobi, Kenya
| | - Felix Humwa
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Teresia Njoki Macharia
- Global Programs for Research & Training, Kenya, Affiliate of the University of California San Francisco (UCSF), San Francisco, CA, USA
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Yarparvar A, Jewell JM, Al-Jawaldeh A. Regional Overview on Maternal and Child Nutrition and Examples of Nutrition Governance and Policy Responses: Europe, Central Asia and Eastern Mediterranean Regions. Ann Nutr Metab 2019; 75:135-138. [PMID: 31743908 DOI: 10.1159/000503673] [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] [Received: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
The Eastern Mediterranean Regions and Europe and Central Asia Regions are facing an epidemiological and nutrition transition, especially among vulnerable groups including mothers, children and adolescents. This has led to a double burden of malnutrition (DBM). Poor infant and young child feeding (IYCF), poor dietary diversity, excessive consumption of energy dense unhealthy foods, a growing obesogenic environment for children, including aggressive marketing of unhealthy foods for children, and reduced physical activity are among the main causes. In addition, several countries in the region lack the nutrition governance capacity to respond effectively to the DBM. This article reviews the context and provides a set of conclusions in which countries are called to reduce the marketing of unhealthy foods for children, enforce the fortification of staple foods with micronutrients to reduce micronutrient deficiencies and improve IYCF, including breastfeeding in the region. Also, the call is strong for cross-border multi-sectoral efforts to address the DBM in these regions.
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Affiliation(s)
- Amirhossein Yarparvar
- Health and Nutrition Unit, UNICEF Regional Office for Europe and Central Asia, Almaty, Kazakhstan,
| | - Jo Martin Jewell
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ayoub Al-Jawaldeh
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Hoffman D. The Double Burden of Malnutrition: Research Agenda for Reversing Global Trends. Ann Nutr Metab 2019; 75:149-152. [PMID: 31743922 DOI: 10.1159/000503676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
The double burden of malnutrition (DBM) is becoming more prevalent throughout the world, but most alarming is the fact that it is also prevalent in lower-income countries, those with limited research and policy funding. To that end, a number of research gaps have been identified related to the biology, research methodologies/data systems, and programs and policies that could be improved to best address the DBM across the globe, especially in diverse settings with limited resources. Clearly, understanding the biology of the DBM is fundamental to developing policies, but research needs to become more interdisciplinary and communicate better with policymakers. At the same time, research methods need to become more innovative, and data systems must advance to accommodate new research methods and approaches. Filling these gaps will allow for broad and effective policies to be implemented through both public and private groups, an area that could be leveraged through transparent public-private engagement and programs. Without novel and integrated approaches to research, efforts to reverse the DBM will be limited. Therefore, the time has come for truly cooperative and collaborative efforts on all fronts to work together and promote the health of future generations across the globe.
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Affiliation(s)
- Daniel Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA,
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Hoffman D, Arts M, Bégin F. The "First 1,000 Days+" as Key Contributor to the Double Burden of Malnutrition. Ann Nutr Metab 2019; 75:99-102. [PMID: 31743897 DOI: 10.1159/000503665] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
Growth from conception through age 2 years, the "First 1,000 days," is important for long-term health of the growing fetus and child and is influenced by several factors including breastfeeding and complementary feeding. Low- and middle-income countries face a complicated array of factors that influence healthy growth, ranging from high food insecurity, poor sanitation, limited prenatal or neonatal care, and high levels of poverty that exacerbate the "vicious cycle" associated with intergenerational promotion of growth retardation. It is now well recognized that the period prior to conception, both maternal and paternal health and diet, play an important role in fetal development, giving rise to the concept of the "First 1,000 Days+". Breastfeeding and complementary feeding practices can be improved through a combination of interventions such as baby-friendly hospitals, regulations for marketing of foods and beverages to children, adequate counseling and support, and sound social and behavior change communication, but continued research is warranted to make such programs more universal and fully effective. Thus, improving the overall understanding of factors that influence growth, such as improved breastfeeding and age-appropriate and adequate complementary feeding, is critical to reducing the global prevalence of the double burden of malnutrition.
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Affiliation(s)
- Daniel Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA,
| | - Maaike Arts
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
| | - France Bégin
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
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Grajeda R, Hassell T, Ashby-Mitchell K, Uauy R, Nilson E. Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses: Latin America and the Caribbean. Ann Nutr Metab 2019; 75:139-143. [PMID: 31743911 DOI: 10.1159/000503674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hunger, food insecurity, stunting, anemia, overweight, and noncommunicable diseases (NCDs) may coexist in the same person, household, and community in Latin America and the Caribbean (LAC). The double burden of malnutrition (DBM) is an important cause of disability and premature death, which could be addressed with comprehensive policies such as the Plan of Action for the Prevention of Obesity in Children and Adolescents. This paper summarizes the main policies and actions aimed to prevent undernutrition and obesity. SUMMARY Several countries are implementing the Plan of Action, Caribbean Public Health Agency is actively supporting Ministries of Health, Education, and Sport to develop school nutrition policies and strategies to create health-promoting environments at school and in their surrounding communities. Chile is implementing the comprehensive child protection system "Chile Crece Contigo" that integrates health, social development, and educational activities to optimize growth and childhood cognitive-motor development. Brazil is implementing policies and plans to commit to international targets regarding food and nutrition security, NCDs and their risk factors. Key Messages: The DBM exists in the Americas and contributes to disability and premature death. The Region is making progress implementing policies and actions addressing the DBM. However, stronger political will and leadership are needed to enact legislation and policies that create and support enabling -environments.
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Affiliation(s)
- Ruben Grajeda
- Risk Factors and Nutrition Unit, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA,
| | | | | | - Ricardo Uauy
- Institute of Nutrition INTA, University of Chile, Santiago, Chile, Santiago, Chile
| | - Eduardo Nilson
- Coordination of Food and Nutrition, Ministry of Health, Brasilia, Brazil
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Ramírez-Luzuriaga MJ, Belmont P, Waters WF, Freire WB. Malnutrition inequalities in Ecuador: differences by wealth, education level and ethnicity. Public Health Nutr 2020; 23:s59-67. [PMID: 31559941 DOI: 10.1017/S1368980019002751] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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 To describe and quantify the magnitude and distribution of stunting, wasting, anaemia, overweight and obesity by wealth, level of education and ethnicity in Ecuador. DESIGN We used nationally representative data from the 2012 Ecuadorian National Health and Nutrition Survey. We used the Multidimensional Poverty Index (MPI) as a proxy of wealth. The MPI identifies deprivations across three dimensions (health, education and standard of living). We defined education by years of schooling and ethnicity as a social construct, based on shared social, cultural and historical experiences, using Ecuadorian census categories. SETTING Urban and rural Ecuador, including the Amazon rainforest and the Galapagos Islands. PARTICIPANTS Children aged <5 years (n 8580), adolescent women aged 11-19 years (n 4043) and adult women aged 20-49 years (n 15 203). RESULTS Among children <5 years, stunting and anaemia disproportionately affected low-wealth, low-education and indigenous groups. Among adolescent and adult women, higher rates of stunting, overweight and obesity were observed in the low-education and low-wealth groups. Stunting and short stature rates were higher in indigenous women, whereas overweight and obesity rates were higher in Afro-Ecuadorian women. CONCLUSIONS Malnutrition differs significantly across sociodemographic groups, disproportionately affecting those in the low wealth tertile and ethnic minorities. Rates of stunting remain high compared with other countries in the region with similar economic development. The effective implementation of double-duty actions with the potential to impact both sides of the double burden is urgently required.
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Abstract
Undernutrition in both its acute and chronic forms (wasting and stunting) is strongly inversely correlated with the wealth of nations. Consequently, as many low- and middle-income countries (LMICs) achieve economic advancement and pass through the so-called "nutrition transition," their rates of undernutrition decline. Many countries successfully achieved the Millennium Development Goal of halving undernutrition and whole continents have been transformed in recent decades. The exception is Africa where the slower rates of decline in the prevalence of undernutrition has been overtaken by population growth so that the absolute number of stunted children is rising. In many regions, economic transition is causing a rapid increase in the number of overweight and obese people. The rapidity of this rise is such that many nations bear the simultaneous burdens of under- and overnutrition; termed the "double burden" of malnutrition. This double burden, accompanied as it is by the unfinished agenda of high levels of infectious diseases, is crippling the health systems of many LMICs and thus requires urgent attention. Although the prognosis looks threatening for many poor countries, they have the advantage of being able to learn from the mistakes made by other nations that have passed through the transition before them. Concerted action across many arms of government would achieve huge future dividends in health and wealth for any nations that can grasp the challenge.
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Affiliation(s)
- Andrew M Prentice
- MRC Unit The Gambia at LSHTM, Banjul, Gambia.,London School of Hygiene & Tropical Medicine, London, United Kingdom
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Min J, Zhao Y, Slivka L, Wang Y. Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev 2018; 19:49-61. [PMID: 28940822 PMCID: PMC5962023 DOI: 10.1111/obr.12605] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 05/24/2017] [Revised: 07/13/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This systematic examination and meta-analysis examined the scope and variation of the worldwide double burden of diseases and identified related socio-demographic factors. DESIGN We searched PubMed for studies published in English from January 1, 2000, through September 28, 2016, that reported on double disease burden. Twenty-nine studies from 18 high-income, middle-income and low-income countries met inclusion criteria and provided 71 obesity-undernutrition ratios, which were included in meta-regression analysis. RESULTS All high-income countries had a much higher prevalence of obesity than undernutrition (i.e. all the obesity/undernutrition ratios >1); 55% of the ratios in lower middle-income and low-income countries were <1, but only 28% in upper middle-income countries. Meta-analysis showed a pooled obesity-undernutrition ratio of 4.3 (95% CI = 3.1-5.5), which varied by country income level, subjects' age and over time. The average ratio was higher in high-income rather than that in lower middle-income and low-income countries (β [SE] = 10.8 [2.6]), in adults versus children (7.1 [2.2]) and in data collected since 2000 versus before 2000 (5.2 [1.5]; all P values < 0.05). CONCLUSIONS There are considerable differences in the obesity versus undernutrition ratios and in their prevalence by country income level, age groups and over time, which may be a consequence of the cumulative exposure to an obesogenic environment.
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Affiliation(s)
- Jungwon Min
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA
| | - Yaling Zhao
- Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Lauren Slivka
- School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Youfa Wang
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.,Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
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Abstract
Recently, increasing attention has been paid to the emergence of the double burden of malnutrition within households. We provide an overview of the literature regarding this phenomenon by reviewing previous studies of the prevalence of double-burden households and associated factors together with the research methods used. Studies were identified from the electronic databases PubMed and Web of Science, using the same search terms for both. A total of thirty-five articles met the eligibility criteria, and 367 sets of prevalence data were extracted. In all, thirty-four articles were published in 2000 or later; twenty-four used secondary data and twenty-five focused on mother-child pairs. The ages of children varied from 0 to 19 years. All the studies used BMI as a nutritional indicator for adults. For children, height-for-age was most frequently used, whereas weight-for-age, weight-for-height and BMI-for-age were also used in multiple studies. The reported national prevalence of double-burden households varied from 0·0 to 26·8 % by country and year; however, few studies were directly comparable, because of differences in the combinations of undernourished and overweight persons, age ranges, nutritional indicators and cut-off points. Whereas many focused on African countries, a few involved Asian countries. Although urban residence, income and education were frequently assessed, the role of intermediate factors in nutritional status, such as diet and physical activity, remains unclear. It is recommended that future studies use comparable indicators and cut-off points, involve Asian countries, and investigate individual diet and physical activity.
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Rachmi CN, Agho KE, Li M, Baur LA. Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence? Int J Public Health 2016; 62:153-162. [PMID: 27704160 DOI: 10.1007/s00038-016-0905-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: 04/21/2016] [Revised: 09/20/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence. METHODS A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9 years. Stunting (HAZ < -2), thinness (BMIZ < -2), and overweight/obesity (BMIZ > +1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents. RESULTS 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P < 0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure. CONCLUSIONS We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.
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Affiliation(s)
- Cut Novianti Rachmi
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead (University of Sydney Clinical School), Sydney, Australia.
| | | | - Mu Li
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Louise Alison Baur
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead (University of Sydney Clinical School), Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Rachmi CN, Agho KE, Li M, Baur LA. Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys. Public Health Nutr 2016; 19:2698-707. [PMID: 27120968 DOI: 10.1017/S1368980016000926] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Indexed: 11/16/2022]
Abstract
Objective The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height. Design A secondary data analysis of children aged 2·0–4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children’s height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined ‘concurrent stunting and overweight’ as height-for-age Z-score <−2 and BMI Z-score >+1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors. Setting Thirteen out of twenty-seven provinces in Indonesia. Subjects Children (n 4101) from four waves of the Indonesian Family Life Survey (1993–2007). Results There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0–2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34–2·01). Conclusions Concurrent stunting and overweight occurs in Indonesian children aged 2·0–4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.
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Abstract
Many developing countries have achieved a remarkable improvement in nutrition status in the past decades. However, the prevalence of undernutrition remains a serious problem. At the same time, the prevalence of obesity is increasing substantially, and in some countries, it has approached that of developed countries. This article provides an update on this double burden of malnutrition (DBMN) in developing nations. One hundred countries (lower, middle-lower, and upper-middle income countries) were selected and analysed, and to support the analysis, a systematic review of current published studies was performed. The results show that DBMN already exists in almost all developing countries and that the DBMN ratio (i.e., overweight/underweight) has increased as income per capita has increased. DBMN may manifest within the community, household, or individual. In addition to common factors, poor nutrition in early childhood is suggested as another important driving factor behind the rising obesity rate in most developing countries. A life-course approach has been proposed to prevent undernutrition and overnutrition and should be integrated into the development of health systems to control double burden in developing countries.
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Affiliation(s)
- Asnawi Abdullah
- Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Jln. Leung Bata, Batoh, Banda Aceh, Indonesia, 23245.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern East, Australia.
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Haddad L, Cameron L, Barnett I. The double burden of malnutrition in SE Asia and the Pacific: priorities, policies and politics. Health Policy Plan 2014; 30:1193-206. [PMID: 25324529 DOI: 10.1093/heapol/czu110] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 12/30/2022] Open
Abstract
The double burden of malnutrition is defined by the co-existence of serious levels of under- and overnutrition.(1) Nowhere have overweight rates risen as fast as in the regions of South East Asia and the Pacific. The regions are also burdened with high and often stagnant levels of undernutrition. For countries for which data are available, the regions contain nearly half of the individuals, world wide, suffering from a double burden of malnutrition. This article reviews the trends and their consequences and for nine countries in these two regions it reviews the drivers of the problem and attempts to manage it. The article concludes with an analysis of the political challenges and opportunities presented by the double burden and some suggestions for a leadership agenda within the region to address it.
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Affiliation(s)
- Lawrence Haddad
- International Food Policy Research Institute, 2033 K Street, N.W. Washington, DC 20006-1002, USA,
| | | | - Inka Barnett
- Institute of Development studies, Brighton BN19RE, UK
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