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Islam MZ, Chowdhury MRK, Kader M, Billah B, Islam MS, Rashid M. Determinants of low birth weight and its effect on childhood health and nutritional outcomes in Bangladesh. J Health Popul Nutr 2024; 43:64. [PMID: 38741173 DOI: 10.1186/s41043-024-00565-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The high incidence of low birth weight (LBW) is associated with an increased risk of infant mortality, adverse pregnancy outcomes for mothers, and a decline in overall health and well-being. The current study aimed to identify the various determinants of LBW and its effect on adverse health and nutritional outcomes of children aged 0-23 months in Bangladesh. METHODS Bangladesh Demography and Health Survey (BDHS) 2017-18 data was used. A chi-square test and multivariable logistic regression analysis were used to find out the associations between independent variables and outcomes (e.g., LBW, child illness and undernutrition). RESULTS The overall prevalence of LBW among was 16.3%. Mother with no formal education (AOR = 2.64, 95% CI = 0.55-3.30, p = 0.01), female child (AOR = 1.31, 95% CI = 1.04-1.65, p = 0.023); and poorest economic status (AOR = 1.69, 95% CI = 1.13-2.51, p = 0.010), were identified significant determinants of LBW. Of home environment and hygiene factors, unimproved toilet facilities (AOR = 1.38, 95% CI = 1.03-1.84, p = 0.030) had a significant effect on LBW. In addition, children born with LBW were more likely to suffer fever (AOR = 1.26, 95% CI = 1.05-1.60, p = 0.050), stunting (AOR = 2.42, 95% CI = 1.86-3.15, p = < 0.001), wasting (AOR = 1.47, 95% CI = 1.02-2.25 p = 0.049), and underweight (AOR = 3.19, 95% CI = 2.40-4.23, p = < 0.001). CONCLUSION One out of five children was LBW in Bangladesh. Maternal education, sex of child, wealth index, and toilet facilities had significant effects on LBW. In addition, LWB contributed to children's poor health and nutritional outcomes. Enhancing maternal pregnancy, and child health outcomes necessitates policies addressing poverty, gender inequality, and social disparities. Key strategies include promoting regular prenatal care, early medical intervention, reproductive health education, and safe hygiene practices. To combat the negative impacts of LBW, a comprehensive strategy is vital, encompassing exclusive breastfeeding, nutritional support, growth monitoring, accessible healthcare, and caregiver education.
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Affiliation(s)
- Md Zahidul Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Mohammad Rocky Khan Chowdhury
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Manzur Kader
- Department of Medical Science, School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Mamunur Rashid
- Department of Public Health and Sports Sciences, University of Gävle, Gävle, Sweden.
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Wagnew F, Alene KA, Kelly M, Gray D. Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study. J Infect 2024; 89:106175. [PMID: 38729526 DOI: 10.1016/j.jinf.2024.106175] [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: 12/06/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia. METHODS A retrospective cohort study was conducted using data from different hospitals in northwest Ethiopia, for the period from July 2017 to August 2023. A Cox proportional hazard model was performed to determine the effect of undernutrition on TB treatment outcomes, which were defined as a composite of death, treatment failure, or loss to follow-up. RESULTS A total of 602 patients with TB were included in the analysis. Of these, 367 (60.9%) were male, and 344 (57.1%) were undernourished. Upon completion of the follow-up period, 65 (10.8%) adults with TB had unsuccessful treatment outcomes. After adjusting for potential confounders, patients with undernutrition had a two times higher risk of experiencing unsuccessful treatment outcomes compared to well-nourished patients (AHR: 2.0, 95% CI: 1.2, 3.6). In addition, patients residing in rural areas (AHR: 3.1, 95% CI: 1.7, 5.4), having a history of prior TB treatment (AHR: 2.2, 95%CI: 1.1, 4.1), and the presence of diabetes comorbidity (AHR: 2.4, 95% CI: 1.1, 5.2) were at higher risk of unsuccessful treatment outcomes. CONCLUSIONS Undernutrition increases the risk of unsuccessful treatment outcomes in Ethiopia. This finding suggests that nutritional support during TB treatment can improve successful treatment outcomes in high TB burden and low-income countries such as Ethiopia.
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Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia; College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Moga Lencha F, Mekonnen Workie H, Tadesse Mequanint F, Jebero Zaza Z. Survival status and its predictors among undernourished children on antiretroviral therapy in Bahir Dar city, Northwest Ethiopia, 2010 - 2020, a multicenter retrospective cohort study. BMC Pediatr 2024; 24:290. [PMID: 38689230 PMCID: PMC11059629 DOI: 10.1186/s12887-024-04745-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In environments with limited resources, undernutrition is a serious public health risk. Its dual relationship to human immunodeficiency virus infection (HIV) leads to crises in a child's physical, emotional, social, and economic spheres of life. Nevertheless, little research has been done on the survival rate and risk factors that lead to poor survival outcomes in undernourished children receiving antiretroviral therapy. This study sought to evaluate survival status and its predictors among undernourished children on antiretroviral therapy (ART) in public health facilities, Bahir Dar city, September 1, 2010 - December 31, 2020. METHODS An institution-based retrospective cohort study design was used among 414 study participants from September 1, 2010 - December 31, 2020. A simple random sampling method was applied to select study participants. All collected data were entered into epi data version 4.6 and exported to STATA version 14.0 for analysis. Each independent predictor variable with a p-value < 0.05 in the multivariable Cox proportional hazard regression was considered statistically significant. RESULTS The overall incidence of mortality was 11.6 deaths per 1000 child year observation (95%CI: 7.7- 17.5). Baseline weight for age < -3 Z score (adjusted hazard ratio (AHR) = 4.9, 95% CI: 1.30-18.98), height for age < -3 Z score (AHR = 4.34, 95%CI 1.13-16.6), cotrimoxazole prophylaxis given (AHR = 0.27, 95%CI 0.08-0.87), hemoglobin level < 10 g/dl (AHR = 3.7, 95%CI 1.1-12.7), CD4 cells < threshold (AHR = 4.86, 95%CI 1.9-12.7), and WHO clinical disease stage III and IV (AHR = 8.1, 95%CI 1.97-33) were found independent predictors of mortality. CONCLUSION AND RECOMMENDATION The incidence of mortality was determined in the study to be 11.6 per 1000 child years. Mortality was predicted by severe stunting, severe underweight, a low hemoglobin level, a low CD4 count, and WHO clinical stages III and IV. But the risk of death is reduced by starting cotrimoxazole preventative therapy early. The risk factors that result in a low survival status should be the primary focus of all concerned bodies, and early cotrimoxazole preventive treatment initiation is strongly recommended.
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Affiliation(s)
- Fikre Moga Lencha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia.
| | | | | | - Zenebe Jebero Zaza
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia
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Bountogo M, Sié A, Zakane A, Compaoré G, Ouédraogo T, Lebas E, O'Brien KS, Lietman TM, Oldenburg CE. Neonatal anthropometric indicators of infant growth and mortality in Burkina Faso. Public Health Nutr 2024; 27:e123. [PMID: 38639113 DOI: 10.1017/s1368980024000880] [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: 04/20/2024]
Abstract
OBJECTIVE Most evidence supporting screening for undernutrition is for children aged 6-59 months. However, the highest risk of mortality and highest incidence of wasting occurs in the first 6 months of life. We evaluated relationships between neonatal anthropometric indicators, including birth weight, weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), length-for-age Z-score (LAZ) and mid-upper arm circumference (MUAC) and mortality and growth at 6 months of age among infants in Burkina Faso. DESIGN Data arose from a randomised controlled trial evaluating neonatal azithromycin administration for the prevention of child mortality. We evaluated relationships between baseline anthropometric measures and mortality, wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) at 6 months of age were estimated using logistic regression models adjusted for the child's age and sex. SETTING Five regions of Burkina Faso. PARTICIPANTS Infants aged 8-27 d followed until 6 months of age. RESULTS Of 21 832 infants enrolled in the trial, 7·9 % were low birth weight (<2500 g), 13·3 % were wasted, 7·7 % were stunted and 7·4 % were underweight at enrolment. All anthropometric deficits were associated with mortality by 6 months of age, with WAZ the strongest predictor (WAZ < -2 to ≥ -3 at enrolment v. WAZ ≥ -2: adjusted OR, 3·91, 95 % CI, 2·21, 6·56). Low WAZ was also associated with wasting, stunting, and underweight at 6 months. CONCLUSIONS Interventions for identifying infants at highest risk of mortality and growth failure should consider WAZ as part of their screening protocol.
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Affiliation(s)
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | | | - Elodie Lebas
- Francis I Proctor Foundation, San Francisco, CA, USA
| | - Kieran Sunanda O'Brien
- Francis I Proctor Foundation, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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Kassaw A, Chekole B, Agimas MC, Azmeraw M, Beletew B, Zeleke S, Asferi WN, Demis S, Hailemeskel HS, Bayih WA, Chane ES, Kefale D, Aytenew TM. Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Heliyon 2024; 10:e29308. [PMID: 38601598 PMCID: PMC11004412 DOI: 10.1016/j.heliyon.2024.e29308] [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: 01/06/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Background Undernutrition is the leading cause of mortality among children infected with HIV particularly in resource-deprived settings. Despite several studies were disclosed the effect of undernutrition on mortality of children living with HIV in Ethiopia, the findings were fragmented and inconclusive. Therefore, this review aimed to determine the pooled effects of undernutrition on mortality of children infected with HIV in Ethiopia. Methods The search were performed using international online electronic data bases (MEDLINE/though PubMed, Google scholar, Hinari, Scopus and open Google). The review included only retrospective/prospective cohort studies reporting the effects of undernutrition on mortality of children infected with HIV. Heterogeneity between included studies was assessed using Cochrane Q-test and the I2 statistics. Sub-group analysis was done by study regions, sample size and publication year. Results A total of 1345 articles were identified from databases. Among these, 14 studies met the inclusion criteria and included in the study. Meta-analysis of 4 studies revealed that stunting has a significant effect on mortality of children infected with HIV (AHR: 3.36; 95 % CI: 2.95-3.77). Of 14 included studies, 6 articles indicated that wasting has a significant effect on mortality in children infected with HIV (AHR: 3.93; 95 % CI: 2.56-5.30) as compared to their counterparts. Furthermore, the pooled effect of 8 studies showed that underweight has 3.4 times hazard of death among children who lived with HIV as compared to well-nourished children. Conclusion This review revealed that undernutrition has deleterious effect on mortality of children infected with HIV/AIDS by disease progression and prone the children to serious opportunistic infections. From the study, the authors recommended that nutritional status of children on antiretroviral therapy need to be evaluated regularly.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferi
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimeles Hailemeskel
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chane
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Hansen MC, Uhrenfeldt L, Ingstad K, Pedersen PU. Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial. Trials 2024; 25:262. [PMID: 38622729 PMCID: PMC11017647 DOI: 10.1186/s13063-024-08096-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital. METHOD This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up. DISCUSSION This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.
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Affiliation(s)
| | - Lisbeth Uhrenfeldt
- Institute for Regional Health Research, Southern Danish University, Ortopedic dep., Lillebaelt University Hospital, Odense, Denmark
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Preben U Pedersen
- Department of Clinical Medicine, Centre of Clinical Guidelines, Aalborg University, Aalborg, Denmark
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Ayenew B, Belay DM, Gashaw Y, Gimja W, Gardie Y. WHO's end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022. BMC Public Health 2024; 24:961. [PMID: 38575958 PMCID: PMC10996214 DOI: 10.1186/s12889-024-18400-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health challenge, despite the World Health Organization (WHO) actively working towards its eradication through various initiatives and programs. Undernutrition, forced displacement, and homelessness worsen TB's burden and challenge control efforts; however, there is still no adequate research that shows the trend of these underlying factors to attain the WHO's ambitious TB targets. So, this study aims to analyze the trend analysis of these underlying factors worldwide from 2015 to 2022 and their impact on the feasibility and implications of reaching the End TB targets by 2035. We utilized international databases, including UNHCR, FAO, and WHO reports, as secondary data sources. Data were extracted chronologically from 2015 to 2022 to illustrate trends in undernutrition, forced displacement, and homelessness on a global level.This trend analysis reveals that undernutrition, forced displacement, and homelessness have worsened over time. Undernutrition rose from 8.4 to 9.8% globally between 2015 and 2021, affecting 22.7 million additional individuals each year. In 2022, undernutrition affected 735 million people globally. Africa (21.9%) and Asia (10.6%) had the highest rates, while Western Europe and North America had lower rates than the global average: 3.4% and 2.5%, respectively.Similarly, the global rate of forced displacement increased from 65.1 million people in 2015 to 108.4 million in 2022, a 21% increase from 2021. This means that an extra 19 million people were displaced in 2021. Globally, homelessness, affecting 1.6 billion people, has worsened over time. Despite being a highly vulnerable group to TB, homeless individuals are often neglected in TB control efforts. Our findings underscore the critical importance of addressing undernutrition, forced displacement, and homelessness in achieving the World Health Organization's ambitious End TB targets by 2035, as highlighted through trend analysis from 2015 to 2022. Implementing policies focusing on nutrition, stable housing, and the challenges faced by displaced populations is imperative for progress toward a TB-free world.
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Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Dawit Misganaw Belay
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Wondimu Gimja
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Yimenu Gardie
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
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Mondon C, Tan PY, Chan CL, Tran TN, Gong YY. Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review. BMC Public Health 2024; 24:960. [PMID: 38575928 PMCID: PMC10996139 DOI: 10.1186/s12889-024-18419-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Childhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0-18 years old. METHODS Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist. RESULTS Seventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0-11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children's growth and eating behaviours, but there is a lack of data on childhood obesity. CONCLUSION This finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.
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Affiliation(s)
- Charlotte Mondon
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Pui Yee Tan
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK.
| | - Chong Ling Chan
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Thuy Nga Tran
- Department of Micronutrient, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Yun Yun Gong
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK.
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Van der Spek L, Sonneveld BGJS. Analyzing the impact of an MDG-Fund program on childhood malnutrition in Timor-Leste. J Health Popul Nutr 2024; 43:46. [PMID: 38576057 PMCID: PMC10993443 DOI: 10.1186/s41043-024-00539-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Timor-Leste's food insecurity, propelled by political conflicts, a fragile economy and biophysical limitations that characterize mountainous Small Island Developing States (SIDS), is expressed in a high incidence (50%) of stunted children. Hence, the Millennium Development Goals Achievement Fund's Joint Program's (MDG-F JP) in 2009 was a timely intervention to reduce prevalence of underweight among under-fives. Since the impact of the program remains largely unclear, the current study investigates the contributions of the MDG-F JP on improving children's nutritional status in Timor-Leste, in order to inform policymakers on how to make future programs more effective. METHODS Using bivariate analyses and multiple linear regression models we analyzed Demographic and Health Survey (DHS) data from under-fives in 2009-2010 and 2016, combined with spatially explicit data from geographic information systems (GIS). The analyses generated trends and factors associated with undernutrition, which were used in a quasi-experimental setting to compare districts that received the MDG-F JP with similar districts that did not receive MDG-F JP interventions. RESULTS A comprehensive set of factors dependent on seasons, locations, and individuals determine undernutrition in Timor-Leste. A positive impact of the MDG-F JP was found for the average severity of wasting, but not for stunting and underweight. CONCLUSIONS The findings reinforce the pressing need for integrated and cross-sectoral programs, aimed especially at agricultural workers, mothers, and children. The agricultural challenge is to sustainably select, produce and conserve higher-yield and nutrient-rich crops, and educational enhancement should be aligned with local practices and research.
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Affiliation(s)
- L Van der Spek
- Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - B G J S Sonneveld
- Amsterdam Centre for World Food Studies, Athena Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Malta DC, Gomes CS, Felisbino-Mendes MS, Veloso GA, Machado IE, Cardoso LDO, Azeredo RT, Jaime PC, Vasconcelos LLCD, Naghavi M, Ribeiro ALP. Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019. Public Health 2024; 229:176-184. [PMID: 38452562 DOI: 10.1016/j.puhe.2023.12.037] [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: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. STUDY DESIGN This is an epidemiological time-series study. METHODS This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. RESULTS A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. CONCLUSION Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - C S Gomes
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M S Felisbino-Mendes
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - G A Veloso
- Universidade Federal Fluminense, Instituto de Matemática e Estatística, Departamento de Estatística, Brazil.
| | - I E Machado
- Programa de Pós-graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.
| | - L de O Cardoso
- Secretaria de vigilância em saúde e ambiente, Ministério da Saúde, Brasilia/DF, Brazil.
| | - R T Azeredo
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Jaime
- Departamento de Nutrição, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | - M Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, United States
| | - A L P Ribeiro
- Departamento de Clinica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Joh HK, Kwon H, Son KY, Yun JM, Cho SH, Han K, Park JH, Cho B. Trends in underweight and severe underweight disparities in Korean adults and older adults: a nationwide, repeated cross-sectional study. J Nutr Health Aging 2024; 28:100185. [PMID: 38341966 DOI: 10.1016/j.jnha.2024.100185] [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: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Little is known about the disparities in underweight prevalence among the general population in high-income countries. We investigated the trends in underweight prevalence and disparities across sociodemographic groups among Korean adults and older adults. SETTING AND PARTICIPANTS A series of cross-sectional data on Korean national health checkups for adults aged ≥20 years were analyzed from 2005 to 2016. MEASUREMENTS Based on body mass index (kg/m2), underweight was graded as mild (17.0-18.49), moderate (16.0-16.9), and severe (<16.0). Underweight prevalence was compared across sociodemographic subgroups in 2015-2016. Trends in underweight disparities were examined from 2005-2006 to 2015-2016. Multivariable-adjusted odds ratios (ORs; 95% confidence intervals, CIs) were calculated using logistic regression. RESULTS Approximately 11-22 million adults were included in each wave. In 2015-2016, the overall prevalence of underweight was 3.6% (men 2.0%, women 5.2%); severe underweight was 0.2% (men 0.1%, women 0.3%). The prevalence of underweight varied by sex and age groups. In men, those aged ≥80 years had the highest prevalence (overall 7.33%, severe underweight 0.84%). In women, those aged 20-29 years had the highest prevalence of overall underweight (14.57%), whereas those aged ≥80 years had the highest prevalence of severe underweight (1.38%). Compared with individuals in the lowest income quartile, men in the highest income had lower ORs of overall (0.59, 95% CI 0.59-0.60) and severe underweight (0.46, 95% CI 0.44-0.48); women in the highest income quartile had a higher OR of overall (1.12, 95% CI 1.12-1.13) but a lower OR of severe underweight (0.89, 95% CI 0.86-0.92). From 2005-2006 to 2015-2016, severe underweight consistently declined in older men but remained constant in women aged ≥80 years, widening sex disparities among older adults. Severe underweight decreased or leveled off in the highest income quartile but steadily increased in the lowest quartile, worsening income disparities. CONCLUSION In this nationwide study, underweight was more prevalent among women, older adults aged ≥80 years, and low-income individuals. Disparities in severe underweight widened across sociodemographic subgroups over time.
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Affiliation(s)
- Hee-Kyung Joh
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; Department of Family Medicine, Seoul National University Health Service Center, Seoul 08826, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ki Young Son
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Su Hwan Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; Institute on Aging, Seoul National University College of Medicine, 71 Ihwajang-Gil, Jongno-gu, Seoul 03087, Republic of Korea.
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Nalwanga D, Bakker C, Kiggwe A, Negash AA, Ocan M, Briend A, Maitland K, Musiiime V, Karamagi C. Mortality among non-severely under nourished children with pneumonia globally: protocol for a systematic review and meta-analysis. Wellcome Open Res 2024; 8:551. [PMID: 38404639 PMCID: PMC10891427 DOI: 10.12688/wellcomeopenres.20200.1] [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] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 02/27/2024] Open
Abstract
Background Pneumonia remains the commonest cause of ill health and mortality among children worldwide. Severe undernutrition increases the mortality risk among children with pneumonia. While children with pneumonia are at increased risk of developing malnutrition, the impact of pneumonia on mortality and nutritional status of non-severely undernourished children is not well described. The impact of nutritional supplementation on mortality and nutritional status in this population is not well understood. This review will collate available evidence on the all-cause mortality and anthropometric indices outcomes following pneumonia, as well as the impact of nutritional supplementation on mortality and anthropometry among non-severely malnourished children with pneumonia. Methods The review will be done using a priori criteria developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data will be obtained from data bases, grey literature, and bibliographies. An experienced librarian will conduct article search in PUBMED, MEDLINE, EMBASE, Web of Science, Google scholar, and Scopus. Retrieved articles will be entered in Endnote ver 9.0, duplicates removed, and transferred to Epi-reviewer for screening and data abstraction. Risk of bias in the included articles will be assessed using standard criteria. Heterogeneity will be assessed using I 2-statistic and sub-group analysis will be done. Data will be analysed using both narrative and quantitative synthesis. Quantitative synthesis will be done using DeSimonian and Laird Random-effects model in STATA ver 15.0. Conclusions The results will provide baseline information about the mortality and anthropometric outcomes of pneumonia among non-severely malnourished children as well as the potential effect of nutritional supplementation on these outcomes. This will provide a basis to explore the potential for nutritional supplementation improving clinical outcomes like mortality and occurrence of severe acute malnutrition among children with severe pneumonia worldwide. Registration The review has been registered in PROSPERO (CRD42021257272; 15 July 2021).
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Affiliation(s)
- Damalie Nalwanga
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Caitlin Bakker
- University Libraries, University of Minnesota, Minneapolis, Minneapolis, USA
| | - Andrew Kiggwe
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Abel Abera Negash
- Armauer Hansen Research Institute, Addis Ababa, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Andre Briend
- School Of Medicine, University of Tampere, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
| | - Kathryn Maitland
- Clinical, KERMI Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
| | - Victor Musiiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
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Saito A, Kondo M. Continuum of care for maternal and child health and child undernutrition in Angola. BMC Public Health 2024; 24:680. [PMID: 38439029 PMCID: PMC10910721 DOI: 10.1186/s12889-024-18144-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status. METHODS We used nationally representative data from the Angola 2015-2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels. RESULTS The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight. CONCLUSIONS The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
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Affiliation(s)
- Akiko Saito
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan
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Talukdar R, Ravel V, Barman D, Kumar V, Dutta S, Kanungo S. Prevalence of undernutrition among migrant, refugee, internally displaced children and children of migrated parents in lower-middle-income countries: A meta-analysis of published studies from last twelve years. Diabetes Metab Syndr 2024; 18:102976. [PMID: 38508036 DOI: 10.1016/j.dsx.2024.102976] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIMS This review aims to estimate the prevalence of undernutrition among migrants, refugees, internally displaced children, and children of migrated parents living in lower-middle-income countries. METHODS PubMed, Scopus, Science-Direct, CINAHL-Plus, & Google Scholar were searched for peer-reviewed evidence published between January 2010 to March 2023. Two researchers independently examined the studies and retrieved the data. The internal and external validity of the studies was assessed using the NIH quality assessment tool, and a checklist adapted from Downs & Black, Bracht & Glass, and Del Siegle's guidelines. A random effect model was chosen to pool the estimates. Subgroup analysis, Meta-regression, and sensitivity analysis were done to explore the source of heterogeneity and the robustness of estimates. RESULTS Among the 1978 records initially searched, 21 studies were selected for analysis. The pooled prevalence estimates for stunting, wasting, and underweight were estimated to be 29.39% (Confidence Interval [CI] 21.69-37.73; I2 99%; p < 0.01), 12.76% (CI 7.84-18.68; I2 99%; P < 0.01), and 24.05% (CI 16.17-32.94; I2 100%; p < 0.001) respectively. Among different WHO regions, all three undernutrition estimates were higher in LMICs belonging to the Southeast Asian region (Stunting 37.62%; wasting 14.28% and underweight 31.24%). Undernutrition among migrant Indian children was 43.55%, 18.71%, and 37.45% respectively. High heterogeneity was noted across all estimates with I2-value >90%. Sensitivity analysis across indicators showed the stability of our estimates. CONCLUSIONS The extent of undernutrition, particularly wasting was high among migrant/refugee children living in lower-middle-income countries. Measures should be taken to strengthen the government-subsidized public food distribution system, increase healthcare outreach, and ensure public health insurance coverage among the migrant population.
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Affiliation(s)
- Rounik Talukdar
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vanessa Ravel
- ICMR - National Institute of Epidemiology, Chennai, Tamil Nadu, India.
| | - Diplina Barman
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Vivek Kumar
- Deepak Foundation, Katni, Madhya Pradesh, India.
| | - Shanta Dutta
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
| | - Suman Kanungo
- ICMR - National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.
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Nigatu A, Abdureshid N, Abate S, Dagne I, Oumer A. Undernutrition and determinants among adolescent street children in DireDawa City, eastern Ethiopia: Vulnerability assessment. Nutrition 2024; 119:112307. [PMID: 38218049 DOI: 10.1016/j.nut.2023.112307] [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: 09/08/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Adolescents go through rapid development and increased nutritional requirements that can put them at higher risk of undernutrition--a problem that can be highest among orphaned or street children. Evidence on nutritional risk and its contributing factors among this segment is lacking in the city of Dire Dawa, where many children are on the streets with limited access to proper care. The aim of this study was to identify determinants of undernutrition among street adolescents in Ethiopia. METHODS A community-based cross-sectional study was conducted with 358 street adolescents 12 to 19 y of age in Dire Dawa from January to February 2022. After conducting a preliminary survey and registering all available street children, a complete enumeration was made. For data collection, an interviewer-administered questionnaire was used along with anthropometric measurements using standard procedures. Height-for-age (HAZ) and body mass index (BMI) for age z scores were computed using World Health Organization (WHO) Anthroplus and statistical analysis was done using SPSS software version 26. Independent variables with P < 0.25 in bivariable analysis were included in multivariable logistic regression, and variables with P < 0.05 were considered statistically significant. A crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. RESULTS Among 358 street adolescents, 44% (38.9-49.5) and 56% (50.8-61.4) were thin and stunted, respectively. Thinness among street children could be associated with a longer stay on the street (AOR, 1.65; 95% CI, 1.40-1.90), infrequent meal frequency (AOR, 1.32; 95% CI, 1.19-1.45), unprotected drinking water sources (AOR, 1.55; 95% CI, 1.40-1.71), alcohol drinking (AOR, 2.92; 95% CI, 1.51-4.32), inadequately diversified diet (AOR, 1.21; 95% CI, 1.06-1.36), and illness history (AOR, 1.34; 95% CI, 1.21-1.47). Moreover, odds of stunting were significantly associated with staying on the street (AOR, 1.32; 1.10-1.54), unsafe drinking water (AOR, 1.63; 95% CI, 1.13-2.66), smoking cigarettes (AOR, 1.54; 95% CI, 1.21-2.52), dietary diversity (AOR, 2.34; 95% CI, 1.43-3.82), and acute illness (AOR, 2.12; 95% CI, 1.31-5.23). CONCLUSION Thinness and stunting were prevalent among street children and are associated with infrequent meals, poor dietary diversity, substance abuse, unsafe water sources, and illness histories that could be targeted for multisectoral interventions.
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Affiliation(s)
- Abel Nigatu
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Neil Abdureshid
- Department of Midwifery, College of Medicine and Health Sciences, Dire-Dawa University, Dire-Dawa, Ethiopia
| | - Shambel Abate
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Imam Dagne
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
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Noritake K, Fujii K, Kubo Y, Yorozuya K, Hayashi T, Goto F, Watanabe H, Yoshida A, Tsubouchi Y, Nakashima D. Appetite and family and friends network among community-dwelling older adults: A cross-sectional study. Nutrition 2024; 119:112321. [PMID: 38199033 DOI: 10.1016/j.nut.2023.112321] [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: 08/21/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the stronger correlate of appetite-family or friend networks-in community-dwelling older adults, given that undernutrition can impair physical function, increase mortality, and be influenced by social networks. METHODS A cross-sectional study was conducted in Kasugai City, Aichi Prefecture, and Nara City, Nara Prefecture, Japan, between August 2019 and March 2023. The analysis included 119 participants (women: 79%, mean age: 76.5 ± 5.6 y). A multiple regression analysis was performed, using the scores from the Japanese version of the Simplified Nutritional Appetite Questionnaire (SNAQ-J) as the dependent variable and family network and friend network as the independent variables. The analysis included social participation, living alone status, sex, age, body mass index, skeletal muscle mass index, grip strength, walking speed, and the Japanese version of the 15 Geriatric Depression Scale score as covariates to examine their relationship with appetite. RESULTS The mean value of the SNAQ-J score of the participants was 15.4 ± 1.2. Seven participants (6%) had a loss of appetite. Family network was significantly associated with appetite (B = 0.121, β = 0.266, P <0.05; 95% condidence interval [CI], 0.030-0.212). In the single regression analysis, the friend network was significantly associated with the total score of the SNAQ-J (B = 0.115, P <0.001; 95% CI, 0.052-0.177); however, this association was not observed in the multiple regression analysis (B = 0.002, β = 0.006, P = 0.954; 95% CI, -0.074-0.078). CONCLUSION Appetite was associated with family networks. Among social networks, focusing on family networks may help prevent the loss of appetite in older adults in Japan.
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Affiliation(s)
- Kento Noritake
- Faculty of Health Sciences, Nihon Fukushi University, Handa, Japan
| | - Keisuke Fujii
- Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Yuta Kubo
- Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Kyosuke Yorozuya
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Takahiro Hayashi
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Fumihiko Goto
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | - Hidehiro Watanabe
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | - Akihiro Yoshida
- Department of Rehabilitation, Tokai Memorial Hospital, Kasugai, Japan
| | | | - Daiki Nakashima
- Faculty of Health Science, Naragakuen University, Nara, Japan
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Bridge R, Lin TK. Evidence on the impact of community health workers in the prevention, identification, and management of undernutrition amongst children under the age of five in conflict-affected or fragile settings: a systematic literature review. Confl Health 2024; 18:16. [PMID: 38413996 PMCID: PMC10900658 DOI: 10.1186/s13031-024-00575-8] [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: 08/18/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Malnutrition, specifically undernutrition, is a significant global challenge that contributes to nearly half of deaths in children under the age of five. The burden of undernutrition is disproportionately borne by conflict-affected, fragile settings (CAFS); children living in a conflict zone being more than twice as likely to suffer from malnourishment. Community health worker (CHW) models have been employed in CAFS to improve healthcare coverage and identify and treat illnesses. However, there lacks systematic evidence on the impact of CHW models in preventing, identifying, and managing child undernutrition in CAFS. We conducted this review to systematically evaluate evidence of CHW models in preventing, identifying, and managing undernutrition in children under the age of five in CAFS. METHODOLOGY This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. The search strategy was developed using the Population-Intervention-Comparisons-Outcomes-Setting framework as a guide. Searches were performed using Ovid online database search platform, searching the databases of Ovid MEDLINE(R), COCHRANE, Embase Classic, Embase, Econlit, Global Health, SCOPUS, and Social Policy and Practice. Peer-reviewed publications were eligible for inclusion if they evaluated an intervention using a CHW model that aims to prevent, identify, or manage some form of undernutrition in children under five in a CAFS. RESULTS We identified 25 studies-spanning 10 countries-that were included in the systematic review. CHW models were implemented alongside a variety of interventions, including behaviour change communication, supplementary foods, nutrition counselling, and integrated community health programmes. Key barriers in implementing successful CHW models include disruption of programmes due to active conflict, states of emergency, militancy, or political unrest; weak links between the community-based interventions and public health system; weak health system capacity that impeded referral and follow-ups; and cost of care and care-seeking. Key facilitators include CHWs' connection to the community, close proximity of programmes to the community, supervision, and investment in high quality training and tools. CONCLUSIONS The findings suggest that CHW models may be effective, cost-effective, acceptable, feasible, and scalable in the prevention, identification, and management child undernutrition in CAFS. The study findings also confirmed a need for greater evidence in the field. These findings may inform policymaking, programme implementation, and design to strengthen best practices for CHW models addressing child undernutrition in CAFS.
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Affiliation(s)
| | - Tracy Kuo Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, 490 Illinois St, 123K, San Francisco, CA, 94158, USA.
- Middle East Centre, London School of Economics and Political Science, London, UK.
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Hailesellasie G, Oumer A, Asfaw A. Determinants of undernutrition among khat chewing and non-khat chewing male adults in Addis Ababa, Ethiopia: a comparative cross-sectional study. Sci Rep 2024; 14:4679. [PMID: 38409396 PMCID: PMC10897126 DOI: 10.1038/s41598-024-54471-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
Khat chewing is a deep-rooted socio-cultural tradition that affects appetite, gastric emptying, and food intake, ultimately influencing nutritional status. Moreover, there is significant variation in lifestyles and ways of living among khat chewing and non-chewing people. However, there is limited evidence on the disaggregated determinants of undernutrition among khat chewers and non-chewers in Ethiopia. A community-based comparative cross-sectional study was conducted with 253 Khat-chewing and 249 non-chewing male adults in Addis Ababa, Ethiopia. Weight and height were measured under standard procedure and used to calculate the body mass index (BMI < 18.5 kg/m2 indicates undernutrition). Variables with p-values below 0.25 in the bi-variable analysis were entered into a multivariable logistic regression model to identify factors associated with undernutrition and to control confounding respectively. An adjusted odds ratio with 95% confidence interval was used to declare the presence and the strength of association between the independent and outcome variable. Statistical significance was declared at a p value of 0.05. In this study, a total of 138 (27.5%: 23.6-31.6%) adult males were undernourished; among them, 78 (32.0%) were khat chewers and 60 (23.9%) were non chewers. Christian religion (AOR = 1.49; 1.02-2.30), vegetable consumption (AOR = 1.69; 95% CI 1.12-2.55) and khat chewing (AOR = 1.60; 1.04-2.45) were independent risk factors for undernutrition. However, none of the above factors showed a statistically significant association among non-khat chewer male adults. In conclusion, undernutrition was a public health concern in male adults in the study area. Frequent consumption of fruits, vegetables and family size of the households were the independent predictors of undernutrition. The practical implication of identifying risk factors of undernutrition among chewers and non-chewers could be helpful in depicting the relevant risk factors by exposure category and helping to further refine intervention packages. In addition, focusing on interventions which can increase the availability and accessibility of fruits and vegetables are important to improve the nutritional status of adult male populations.
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Affiliation(s)
- Genene Hailesellasie
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, P.O. Box: 07, Gubre, Ethiopia
| | - Abdu Oumer
- School of Public Health, College of Medicine and Health Science, Haramaya University, Harar, Ethiopia
| | - Agize Asfaw
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, P.O. Box: 07, Gubre, Ethiopia.
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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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Franke MA, Emmrich JV, Ranjaharinony F, Ravololohanitra OG, Andriamasy HE, Knauss S, Muller N. A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation. Infect Dis Poverty 2024; 13:13. [PMID: 38303047 PMCID: PMC10835822 DOI: 10.1186/s40249-024-01182-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There is a strong, bi-directional link between tuberculosis (TB) and undernutrition: TB often causes undernutrition, and undernourished people are more likely to contract TB and experience worse outcomes. Globally, several TB nutritional support programmes exist; however, evidence on their effectiveness is limited and contested. This study evaluates the effect of a nutritional support programme implemented for people with TB in the Atsimo-Andrefana region, Madagascar in 2022. Within this programme, undernourished people with TB [with a body mass index (BMI) of < 18.5 kg/m2] receive 0.6 L of vegetable oil and 6.0 kg of a soy-wheat blend per month throughout their TB treatment. METHODS We analysed secondary non-governmental organisation data collected between January and November 2022 in the Atsimo-Andrefana region, Southern Madagascar, including information on an individual's medical conditions (e.g., type of TB, treatment outcomes) and nutritional status measured prior to, during, and after completion of treatment (e.g., height, weight, mid-upper arm circumference). We conducted descriptive analyses of patient baseline characteristics and outcomes to assess the impact of the provided nutritional support on the BMI of people with TB. RESULTS A total of 1310 people with TB were included in the study [9.9% (130) children under the age of 5, 32.1% (420) children between 5 and 18 years, 58.0% (760) adults]. 55.4% of children under 5, 28.1% of children between ages 5 and 18, and 81.3% of adults were undernourished at treatment initiation. 42.3% (55/130) of children under 5 experienced severe acute malnutrition at treatment uptake. While the average BMI of adults with TB receiving food support increased over time, from 17.1 kg/m2 (interquartile range: 15.8-18.3, range: 10.3-22.5) to 17.9 kg/m2 (interquartile range: 16.6-19.1, range: 11.9-24.1), most adults remained undernourished even after completing TB treatment. CONCLUSIONS The current TB nutritional support programme falls short of sufficiently increasing the BMI of people with TB to overcome malnutrition. There is an urgent need to revise the nutritional support available for people with TB, particularly for children under 5.
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Affiliation(s)
- Mara Anna Franke
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- London School of Hygiene and Tropical Medicine, London, UK.
- Ärzte Für Madagaskar E.V., Leipzig, Germany.
| | - Julius Valentin Emmrich
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Harizaka Emmanuel Andriamasy
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Doctors for Madagascar, Antananarivo, Madagascar
| | - Samuel Knauss
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Muller
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Couvert A, Lacaze L, Touboulic S, Gautier S, Guérin S, Randuineau G, Romé V, Malbert CH, Val-Laillet D, Derbré F, Thibault R. The Yucatan minipig model: A new preclinical model of malnutrition in obese patients with acute or chronic diseases. Clin Nutr 2024; 43:357-365. [PMID: 38142480 DOI: 10.1016/j.clnu.2023.12.003] [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: 09/15/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS Malnutrition can develop in patients with obesity suffering from acute or chronic illness or after obesity surgery, promoting sarcopenic obesity. A better understanding of this pathophysiology and the development of new therapeutics for chronic diseases, that are often complicated with malnutrition and obesity, justify the development of new animal experimental models close to the human physiology. This study aims to characterize the effects of obesity and underfeeding on Yucatan obese minipigs, assessing its validity as a preclinical model for obesity-related malnutrition. METHODS Sixteen 30-month-old Yucatan minipigs were divided into two groups for 8 weeks: a standard diet group (ST, n = 5) and an obesogenic diet group (OB, n = 11). After 8 weeks, the OB group was further divided into two sub-groups: a standard diet group (OB-ST, n = 5) and a low-calorie/low-protein diet group (OB-LC/LP, n = 6) for 8 weeks. Body composition by CT-Scan and blood parameters were monitored, and trapezius muscle biopsies were collected to analyse signaling pathways involved in protein turnover and energy metabolism. RESULTS At W8, OB-ST animals exhibited significantly higher body weight (+37.7%, p = 0.03), muscle mass (+24.9%, p = 0.02), and visceral fat (+192.0%, p = 0.03) compared to ST. Trapezius cross sectional area (CSA) normalized to body weight was lower in OB-ST animals (-15.02%, p = 0.017). At W16, no significant changes were observed in protein turnover markers, although REDD1 increased in OB-ST (96.4%, p = 0.02). After 8 weeks of low-caloric/low protein diet, OB-LC/LP showed decreased body weight (-9.8%, p = 0.03), muscle mass (-6.5%, p = 0.03), and visceral fat (-41.5%, p = 0.03) compared to OB-ST animals. Trapezius fiber CSA significantly decreased in OB-LC/LP (-36.1%, p < 0.0001) and normalized to body weight (-25.4%, p < 0.0001), combined to higher ubiquitinated protein content (+38.3%, p = 0.02). CONCLUSION Our data support that the Yucatan minipig model mimics nutritional and skeletal muscle phenotypes observed in obese patients, with or without protein-energy malnutrition. It also reproduces muscle atrophy observed in chronic diseases or post-obesity surgery, making it a promising preclinical model for obesity-related malnutrition.
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Affiliation(s)
- Annaëlle Couvert
- Laboratory "Movement Sport and Health Sciences" EA 7470, University of Rennes, ENS Rennes, 35170 Bruz, France; Service Endocrinologie-Diabétologie-Nutrition, Centre labellisé de nutrition parentérale au domicile, CHU Rennes, Rennes, France
| | - Laurence Lacaze
- Service Endocrinologie-Diabétologie-Nutrition, Centre labellisé de nutrition parentérale au domicile, CHU Rennes, Rennes, France; INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Steve Touboulic
- INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Sandrine Gautier
- Laboratory "Movement Sport and Health Sciences" EA 7470, University of Rennes, ENS Rennes, 35170 Bruz, France
| | - Sylvie Guérin
- INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Gwénaëlle Randuineau
- INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Véronique Romé
- INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | | | - David Val-Laillet
- INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France
| | - Frédéric Derbré
- Laboratory "Movement Sport and Health Sciences" EA 7470, University of Rennes, ENS Rennes, 35170 Bruz, France.
| | - Ronan Thibault
- Service Endocrinologie-Diabétologie-Nutrition, Centre labellisé de nutrition parentérale au domicile, CHU Rennes, Rennes, France; INRAE, INSERM, Univ Rennes, NuMeCan, Nutrition Metabolisms Cancer, Rennes, France.
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Visser M, Sealy MJ, Leistra E, Naumann E, De van der Schueren MAE, Jager-Wittenaar H. The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties. Clin Nutr 2024; 43:446-452. [PMID: 38181522 DOI: 10.1016/j.clnu.2023.12.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND & AIMS Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. METHODS The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. RESULTS The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. CONCLUSION The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.
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Affiliation(s)
- M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - M J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands.
| | - E Leistra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - E Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Dutch Malnutrition Center of Expertise, The Netherlands.
| | - M A E De van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Department of Gastroenterology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
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Ndagijimana A, Nduwayezu G, Kagoyire C, Elfving K, Umubyeyi A, Mansourian A, Lind T. Childhood stunting is highly clustered in Northern Province of Rwanda: A spatial analysis of a population-based study. Heliyon 2024; 10:e24922. [PMID: 38312557 PMCID: PMC10835355 DOI: 10.1016/j.heliyon.2024.e24922] [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: 06/22/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
Background In Northern Province, Rwanda, stunting is common among children aged under 5 years. However, previous studies on spatial analysis of childhood stunting in Rwanda did not assess its randomness and clustering, and none were conducted in Northern Province. We conducted a spatial-pattern analysis of childhood undernutrition to identify stunting clusters and hotspots for targeted interventions in Northern Province. Methods Using a household population-based questionnaire survey of the characteristics and causes of undernutrition in households with biological mothers of children aged 1-36 months, we collected anthropometric measurements of the children and their mothers and captured the coordinates of the households. Descriptive statistics were computed for the sociodemographic characteristics and anthropometric measurements. Spatial patterns of childhood stunting were determined using global and local Moran's I and Getis-Ord Gi* statistics, and the corresponding maps were produced. Results The z-scores of the three anthropometric measurements were normally distributed, but the z-scores of height-for-age were generally lower than those of weight-for-age and weight-for-height, prompting us to focus on height-for-age for the spatial analysis. The estimated incidence of stunting among 601 children aged 1-36 months was 27.1 %. The sample points were interpolated to the administrative level of the sector. The global Moran's I was positive and significant (Moran's I = 0.403, p < 0.001, z-score = 7.813), indicating clustering of childhood stunting across different sectors of Northern Province. The local Moran's I and hotspot analysis based on the Getis-Ord Gi* statistic showed statistically significant hotspots, which were strongest within Musanze district, followed by Gakenke and Gicumbi districts. Conclusion Childhood stunting in Northern Province showed statistically significant hotspots in Musanze, Gakenke, and Gicumbi districts. Factors associated with such clusters and hotspots should be assessed to identify possible geographically targeted interventions.
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Affiliation(s)
- Albert Ndagijimana
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Gilbert Nduwayezu
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
- University of Rwanda, College of Sciences and Technology, Centre for Geographic Information Sciences, Kigali, Rwanda
| | - Clarisse Kagoyire
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
- University of Rwanda, College of Sciences and Technology, Centre for Geographic Information Sciences, Kigali, Rwanda
| | - Kristina Elfving
- School of Public Health and Community Medicine, Gothenburg University and the Queen Silvia's Children Hospital, Gothenburg, Sweden
| | - Aline Umubyeyi
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Ali Mansourian
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Jeyashree K, Shanmugasundaram P, Shanmugasundaram D, Priya G SL, Thangaraj JWV, Ts S, Pandey S, Ramasamy S, Sharma R, Arunachalam S, Shah V, Janagaraj V, Sundari S S, Chadwick J, Shewade HD, Chowdhury A, Iyer S, Rao R, Mattoo SK, Murhekar MV. Direct benefit transfer for nutritional support of patients with TB in India-analysis of national TB program data of 3.7 million patients, 2018-2022. BMC Public Health 2024; 24:299. [PMID: 38273246 PMCID: PMC10811802 DOI: 10.1186/s12889-024-17777-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Patients with TB have additional nutritional requirements and thus additional costs to the household. Ni-kshay Poshan Yojana(NPY) is a Direct Benefit Transfer (DBT) scheme under the National Tuberculosis Elimination Programme(NTEP) in India which offers INR 500 monthly to all notified patients with TB for nutritional support during the period of anti-TB treatment. Five years after its implementation, we conducted the first nationwide evaluation of NPY. METHODS In our retrospective cohort study using programmatic data of patients notified with TB in nine randomly selected Indian states between 2018 and 2022, we estimated the proportion of patients who received at least one NPY instalment and the median time to receive the first instalment. We determined the factors associated (i) with non-receipt of NPY using a generalised linear model with Poisson family and log link and (ii) with time taken to receive first NPY benefit in 2022 using quantile regression at 50th percentile. RESULTS Overall, 3,712,551 patients were notified between 2018 and 2022. During this period, the proportion who received at least one NPY instalment had increased from 56.9% to 76.1%. Non-receipt was significantly higher among patients notified by private sector (aRR 2.10;2.08,2.12), reactive for HIV (aRR 1.69;1.64,1.74) and with missing/undetermined diabetic status (aRR 2.02;1.98,2.05). The median(IQR) time to receive the first instalment had reduced from 200(109,331) days in 2018 to 91(51,149) days in 2022. Patients from private sector(106.9;106.3,107.4days), those with HIV-reactive (103.7;101.8,105.7days), DRTB(104.6;102.6,106.7days) and missing/undetermined diabetic status (115.3;114,116.6days) experienced longer delays. CONCLUSIONS The coverage of NPY among patients with TB had increased and the time to receipt of benefit had halved in the past five years. Three-fourths of the patients received at least one NPY instalment, more than half of whom had waited over three months to receive the first instalment. NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure.
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Affiliation(s)
- Kathiresan Jeyashree
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India.
| | - Prema Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Devika Shanmugasundaram
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sri Lakshmi Priya G
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Jeromie W V Thangaraj
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumitha Ts
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sumit Pandey
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Sabarinathan Ramasamy
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Rahul Sharma
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Vaibhav Shah
- TB support network, WHO Country Office for India, New Delhi, India
| | | | - Sivakami Sundari S
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Joshua Chadwick
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Hemant Deepak Shewade
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
| | - Aniket Chowdhury
- TB support network, WHO Country Office for India, New Delhi, India
| | - Swati Iyer
- TB support network, WHO Country Office for India, New Delhi, India
| | | | | | - Manoj V Murhekar
- ICMR-National Institute of Epidemiology, R-127, TNHB, Ayapakkam, Chennai, Tamil Nadu, 600077, India
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Bozkurt ME, Erdogan T, Catikkas NM, Ozkok S, Kilic C, Bahat G, Karan MA. Undernutrition in obese older adults by fat percentage. Aging Clin Exp Res 2024; 36:3. [PMID: 38261071 PMCID: PMC10805819 DOI: 10.1007/s40520-023-02650-1] [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: 08/19/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The prevalence of obesity by fat percentage has seen a steady increase in older adults in recent years, secondary to increases in fat mass in body composition, even in healthy aging. Malnutrition is a common geriatric syndrome with serious clinical outcomes. Increases in fat mass and waist circumference with healthy aging should not prevent the risk of malnutrition from being masked. Malnutrition is often ignored in obese older people due to low BMI cut-off values in many screening tests. The present study seeks to raise awareness of the need to assess the frequency of undernutrition and related factors in obese older adults. METHODS The data of 2013 community-dwelling patients aged ≥ 60 years who applied to a university geriatrics outpatient clinic between April 2012 and November 2022 were analyzed retrospectively, of which 296 were found to be obese based on fat percentage and were included in the study. Demographic data and the presence of any geriatric syndromes were obtained retrospectively from the patient files, functional status was assessed using the KATZ Activities of Daily Living (ADL) Scale and the LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL); frailty was screened using FRAIL-scale; and the sample was assessed for malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF), with undernutrition defined as an MNA-SF score of [Formula: see text] The patients' fat percentage and weight were measured using a bioimpedance analyzer. Fatty obesity was defined using the Zoico methodology (fat percentage [Formula: see text] 27.3% for males, [Formula: see text] 40.7% for females)[Formula: see text] handgrip strength (HGS) was measured using a hand dynamometer, and probable sarcopenia was defined as low HGS based on regional cut-off values (35 kg for males, 20 kg for females). RESULTS The mean age of the 296 fatty obese older adults (102 males/194 females) was 74.4 + 6.5 years, and the median fat was 42.2% (27.4-59.5). Undernutrition was detected in 19.6% of the patients based on MNA-SF screening. A univariate analysis revealed age, sex, educational status, daily physical activity status, depression, difficulty in swallowing, chewing difficulty, probable sarcopenia, number of chronic diseases, and IADL to be associated with undernutrition, while a multivariate logistic regression analysis revealed depression [OR = 3.662, 95% CI (1.448-9.013), p = 0.005] and daily physical activity status [OR:0.601, 95% CI (0.417-0.867), p = 0.006] to be independently associated with malnutrition in obese older adults based on fat percentage. CONCLUSION The present study clarifies the significance of undernutrition in obese older adults also in our country, and recommends undernutrition screening to be carried out, by fat percentage, on obese older adults, especially with depression and low daily physical activity.
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Affiliation(s)
- Meris Esra Bozkurt
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey.
| | - Tugba Erdogan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey
| | | | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey
| | - Cihan Kilic
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, 34390, Istanbul, Turkey
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Robyn S, Veronica N, Stephen B, Joanne P. Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment. BMC Pediatr 2024; 24:73. [PMID: 38262979 PMCID: PMC10804775 DOI: 10.1186/s12887-023-04508-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Malnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery. METHODS Children 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively. RESULTS Forty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score - 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score - 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable. CONCLUSION Malnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.
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Affiliation(s)
- Smith Robyn
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Ntsiea Veronica
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brown Stephen
- Department of Pediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | - Potterton Joanne
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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He J, Zhang J, Liao X, Xiao Y, Li J, Zheng Z, Chen D, Chen J. Upregulation of PD-1/PD-L1 and downregulation of immune signaling pathways lead to more severe visceral leishmaniasis in undernutrition mice. Parasit Vectors 2024; 17:8. [PMID: 38185681 PMCID: PMC10773036 DOI: 10.1186/s13071-023-06018-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/16/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Leishmaniasis is mainly prevalent in tropical and subtropical developing countries, where chronic undernutrition often co-exists. Undernutrition is reported to promote the progression of leishmaniasis, but its immune mechanisms have not been fully elucidated. METHODS To simulate chronic undernutrition of patients in epidemic areas and explore the immune mechanism of undernutrition promoting leishmaniasis, BALB/c mouse models with different nutritional imbalances were established, including undernutrition 75%, undernutrition 65% and obesity mouse models. After infection with Leishmania donovani in these model mice, we focused on evaluating the progress of leishmaniasis in the spleen and liver, the expression of important immunosuppressive and immunoactivation molecules, and changes of spleen transcriptome. The immune signaling pathways enriched by differentially expressed genes and hub genes were analyzed. RESULTS The results showed that among the mouse infection models, undernutrition 75% + infection group had the highest parasite load in the spleen and liver at the 8th week post-infection, possibly due to the continuous increase of PD-1, PD-L1 and TCR. Spleen RNA-seq results suggested that some immune signaling pathways were downregulated in undernutrition 75% + infection group, including neutrophil extracellular trap formation, IL-17 signaling pathway, natural killer cell-mediated cytotoxicity, etc. Among them, neutrophil extracellular trap formation pathway had the largest number of downregulated genes. This also explained why undernutrition 75% + infection group had the highest parasite load. Through PPI network analysis, hub genes such as Lcn2, Ltf, Mpo, Dnaja1, Hspa1a, Hspa1b and Hsph1 were screened out and might play important roles in the process of undernutrition promoting leishmaniasis. CONCLUSIONS Undernutrition upregulated PD-1 and PD-L1 expression and downregulated immune signaling pathways in mice with visceral leishmaniasis. The signaling pathways and hub genes may serve as drug targets or intervention targets for the treatment of leishmaniasis patients with undernutrition.
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Affiliation(s)
- Jinlei He
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jianhui Zhang
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Xuechun Liao
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yuying Xiao
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Jiao Li
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Zhiwan Zheng
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Dali Chen
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China.
| | - Jianping Chen
- Department of Pathogenic Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China.
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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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Headey DD, Alderman H, Hoddinott J, Narayanan S. The glass of milk half-empty? Dairy development and nutrition in low and middle income countries. Food Policy 2024; 122:102585. [PMID: 38314439 PMCID: PMC10831119 DOI: 10.1016/j.foodpol.2023.102585] [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: 11/03/2023] [Revised: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 02/06/2024]
Abstract
Dairy products have an exceptionally rich nutrient profile and have long been promoted in high income countries to redress child malnutrition. But given all this potential, and the high burden of undernutrition in low- and middle-income countries (LMICs), why isn't dairy consumption more actively promoted in the developing world? In this review we focus on a broadly defined concept of "dairy development" to include production, trade, marketing, regulation, and demand stimulation. We address three key questions. First, how strong is the evidence on the importance of dairy production and consumption for improving nutrition among young children in LMICs? Second, which regions have the lowest consumption of dairy products? Third, what are the supply- and demand-side challenges that prevent LMICs from expanding dairy consumption? We argue that although more nutrition- and consumer-oriented dairy development interventions have tremendous potential to redress undernutrition in LMICs, the pathways for achieving this development are highly context-specific: LMICs with significant agroecological potential for dairy production primarily require institutional solutions for the complex marketing challenges in perishable milk value chains; lower potential LMICs require consumer-oriented trade and industrial approaches to the sector's development. And all dairy strategies require a stronger focus on cross-cutting issues of nutrition education and demand creation, food safety and quality, gender and inclusiveness, and environmental sustainability and resilience. We conclude our review by emphasizing important areas for research and policy expansion.
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Affiliation(s)
- Derek D. Headey
- The International Food Policy Research Institute (IFPRI), United States
| | - Harold Alderman
- The International Food Policy Research Institute (IFPRI), United States
| | - John Hoddinott
- H.E. Babcock Professor of Food & Nutrition Economics and Policy Division of Nutritional Sciences, Applied Economics and Management, United States
| | - Sudha Narayanan
- The International Food Policy Research Institute (IFPRI), United States
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Faraji Gavgani L, Alipour S, Khabiri R, Laghousi D, Sarbakhsh P, Farajiazad H, Abbasalizad Farhangi M, Jahangiry L. Association between nutritional risk status and health related quality of life: An investigation on the aging patients with cardiovascular disease. J Cardiovasc Thorac Res 2023; 15:231-237. [PMID: 38357565 PMCID: PMC10862038 DOI: 10.34172/jcvtr.2023.32903] [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: 12/10/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran. Methods This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL. Results Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status. Conclusion The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD.
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Affiliation(s)
- Leili Faraji Gavgani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Alipour
- Health Education and Health Promotion Department, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghayeh Khabiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Delara Laghousi
- Social Determinants of Health Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haniyeh Farajiazad
- Madani Heart Center, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leila Jahangiry
- Health Education and Health Promotion Department, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [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: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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Muro BB, Carnevale RF, Leal DF, Almond GW, Monteiro MS, Poor AP, Schinckel AP, Garbossa CA. The importance of optimal body condition to maximise reproductive health and perinatal outcomes in pigs. Nutr Res Rev 2023; 36:351-371. [PMID: 35748154 DOI: 10.1017/s0954422422000129] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Overnutrition or undernutrition during all or part of the reproductive cycle predisposes sows to metabolic consequences and poor reproductive health which contributes to a decrease in sow longevity and an increase in perinatal mortality. This represents not only an economic problem for the pig industry but also results in poor animal welfare. To maximise profitability and increase sustainability in pig production, it is pivotal to provide researchers and practitioners with synthesised information about the repercussions of maternal obesity or malnutrition on reproductive health and perinatal outcomes, and to pinpoint currently available nutritional managements to keep sows' body condition in an optimal range. Thus, the present review summarises recent work on the consequences of maternal malnutrition and highlights new findings.
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Affiliation(s)
- Bruno Bd Muro
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus Pirassununga, SP, Brazil
| | - Rafaella F Carnevale
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus Pirassununga, SP, Brazil
| | - Diego F Leal
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus Pirassununga, Pirassununga, SP, Brazil
| | - Glen W Almond
- Department of Population Health & Pathobiology, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, North Carolina, USA
| | - Matheus S Monteiro
- Department of Preventive Veterinary Medicine and Animal Health, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus São Paulo, São Paulo, SP, Brazil
| | - André P Poor
- Department of Preventive Veterinary Medicine and Animal Health, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus São Paulo, São Paulo, SP, Brazil
| | - Allan P Schinckel
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Cesar Ap Garbossa
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), Campus Pirassununga, SP, Brazil
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Batool M, Saleem J, Zakar R, Butt MS, Iqbal S, Haider S, Fischer F. Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan. BMC Public Health 2023; 23:2153. [PMID: 37924076 PMCID: PMC10625272 DOI: 10.1186/s12889-023-17135-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: 12/28/2022] [Accepted: 11/02/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Reasons for undernutrition are food insufficiency, impaired child care, limited access to healthcare, and maternal lack of health literacy. In addition, there are several environmental factors, such as drinking water quality, poor sanitation, and hygienic practices that can lead to poor nutritional status in children. The present study aimed to compare household-associated risk factors, including water, sanitation, and hygiene (WASH) practices of mothers, with children's stunting under the age of five. METHODS A face-to-face cross-sectional survey was conducted with mothers of children under the age of five in the Dera Ghazi Khan district in southern Punjab, Pakistan. World Health Organization criteria for stunting were used to identify the participants. A sociodemographic questionnaire was used to collect information from consented parents/guardians on children's age, feeding, and WASH practices. Pearson's chi-square, simple regression, and hierarchical regression models were applied for data analysis. RESULTS A total of 204 mothers of children of both genders participated in this study. The children's mean (SD) age was 15.67 (± 10.2) months, their weight was 5.44 (± 1.45) kg, their height was 67.69 (± 10.05), and their mid-upper arm circumference was 9.75 (± 1.30) cm. Children's stunting was mild (z-score > -2) at 17.6%, moderate (z-score - 2 to -3) at 16.7%, and severe (z-score < -3) at 65.7% of participants. A simple regression model showed a strong association, r2 = 0.062, p = 0.013, with age as the most significant sociodemographic factor. The hierarchical regression model showed a combined value of r2 = 0.0128, p = 0.027, with hand pump and tank water as the significant source of drinking water that was related to stunting among children. CONCLUSION Stunting can be associated with several risk factors, including WASH parameters. This study concluded that children aged under five years are susceptible to stunting in southern Punjab, Pakistan. The contamination of hand pumps and tank water resources was found to be the major contributing factor to stunting.
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Affiliation(s)
- Munazza Batool
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore, Pakistan
| | | | - Sanaullah Iqbal
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shahroz Haider
- Bakhtawar Amin Medical and Dental College Multan, Multan, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Roy A, Rahaman M. Prevalence of Undernutrition and Change Detection among under five years Children of Empowered Action Group States in India: Scrutinizing from National Family Health Survey, 2016-2021. Ecol Food Nutr 2023; 62:223-242. [PMID: 37614031 DOI: 10.1080/03670244.2023.2247333] [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: 08/25/2023]
Abstract
Change detection and prevalence of child undernutrition among the Empowered Action Group (EAG) states of India were studied using National Family Health Survey-4 and 5 data. The results identified that the prevalence of undernutrition in most of the EAG states is still more than 30%. Although stunting and underweight have decreased in all EAG states, this pattern is higher than that of the national level but the prevalence of wasting has only increased in Bihar. Strengthening public health initiatives and collaborative endeavor between organizations, enhancing mother's education, increasing awareness, and raising the economic as well as sociopolitical empowerment of mothers are essential for addressing the undernutrition issue.
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Affiliation(s)
- Arabinda Roy
- Department of Geography, Dr. Meghnad Saha College (affiliated to University of Gour Banga), Itahar, Uttar Dinajpur, India
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Moreno JM, Chapman AJ, Ebido CC, Sougou NM, Diallo AH, Tening RN, Dial FB, Massonnié J, Firoozmand M, Niang CEHA, Heffernan C, Harder MK. Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal. Public Health Nutr 2023; 26:2418-2432. [PMID: 37288526 PMCID: PMC10641654 DOI: 10.1017/s1368980023001088] [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: 09/12/2022] [Revised: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This work aims to demonstrate an original approach to identify links between locally situated shared values and contextual factors of stunting. Stunting results from multi-factorial and multi-sectoral determinants, but interventions typically neglect locally situated lived experiences, which contributes to problematic designs that are not meaningful for those concerned and/or relatively ineffective. DESIGN This case study investigates relevant contextual factors in two steps: by first facilitating local stakeholder groups (n 11) to crystallise their shared-values-in-action using a specialised method from sustainability studies (WeValue_InSitu (WVIS)). Secondly, participants (n 44) have focus group discussions (FGD) about everyday practices around child feeding/food systems, education and/or family life. Because the first step strongly grounds participants in local shared values, the FGD can reveal deep links between contextual factors and potential influences on stunting. SETTING Kaffrine, Senegal, an 'Action Against Stunting Hub' site. December 2020. PARTICIPANTS Eleven stakeholder groups of mothers, fathers, grandmothers, pre-school teachers, community health workers, farmers, market traders and public administrators. RESULTS Local contextual factors of stunting were identified, including traditional beliefs concerning eating and growing practices; fathers as decision-makers; health worker trust; financial non-autonomy for women; insufficient water for preferred crops; merchants' non-access to quality produce; religious teachings and social structures affecting children's food environment. CONCLUSIONS Local contextual factors were identified. Pre-knowledge of these could significantly improve effectiveness of intervention designs locally, with possible applicability at other sites. The WVIS approach proved efficient and useful for making tangible contextual factors and their potential links to stunting, via a lens of local shared values, showing general promise for intervention research.
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Affiliation(s)
- Juan Manuel Moreno
- Values and Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, BrightonBN2 4GJ, UK
| | - Annabel J Chapman
- Values and Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, BrightonBN2 4GJ, UK
| | - Chike C Ebido
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People’s Republic of China
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Ndèye Marième Sougou
- Preventive Medicine and Public Health, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Amadou H Diallo
- International Research Laboratory (IRL 3189), Environnement santé et sociétés/CNRS /UCAD, Dakar, Senegal
| | - Rahel Neh Tening
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People’s Republic of China
| | - Fatou Binetou Dial
- Laboratory of Cultural Anthropology, IFAN, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Jessica Massonnié
- Department of Psychology and Human Development, University College London, Institute of Education, London, UK
- Faculty of Humanities and Social Sciences, School of Education, Languages and Linguistics, University of Portsmouth, Portsmouth, UK
| | - Mahsa Firoozmand
- Values and Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, BrightonBN2 4GJ, UK
| | | | | | - Marie K Harder
- Values and Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, BrightonBN2 4GJ, UK
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People’s Republic of China
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Nadhiroh SR, Micheala F, Tung SEH, Kustiawan TC. Association between maternal anemia and stunting in infants and children aged 0-60 months: A systematic literature review. Nutrition 2023; 115:112094. [PMID: 37572547 DOI: 10.1016/j.nut.2023.112094] [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: 02/25/2023] [Revised: 05/05/2023] [Accepted: 05/22/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Maternal anemia is a worldwide health issue and a common pregnancy complication. It leads to consequences including infant mortality, low birth weight, preterm birth, unrecoverable or partially reversible neurobehavioral and cognitive deficits, and short birth length. However, the relationship between maternal anemia and stunting in children is not well defined. This systematic literature review sought to determine whether maternal anemia was associated with height or length and stunting conditions in infants and children ages 0-60 mo in cohort, case-control, and cross-sectional studies carried out in several countries. METHODS A systematic review was performed on articles published from 2014-2021 related to maternal anemia and stunting. The electronic databases used were ScienceDirect, PubMed, Scopus, ProQuest, Google Search, and AJOG (American Journal of Obstetrics and Gynecology). The literature search was performed up to December 7, 2021. RESULTS Twelve studies were included. Nine studies examined the correlation between maternal anemia and length or weight in children. Seven of the nine studies showed an association between maternal anemia and stunting in children; the others showed an association between maternal anemia and birth length. Three studies found no association between maternal anemia and stunting in children under age 5 y. CONCLUSIONS The current review emphasizes that stunting in children may be associated with maternal anemia, specifically in developing countries. This implies that it is crucial to prevent anemia in adolescent girls and women before and during pregnancy as a part of programs to eliminate stunting in children.
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Affiliation(s)
- Siti Rahayu Nadhiroh
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
| | - Fedora Micheala
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Serene En Hui Tung
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
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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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Banerjee S, P S. Exploring the paradox of Muslim advantage in undernutrition among under-5 children in India: a decomposition analysis. BMC Pediatr 2023; 23:515. [PMID: 37845616 PMCID: PMC10578034 DOI: 10.1186/s12887-023-04345-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND While there is a substantial body of research on inequalities in child nutrition along the axes of gender and socioeconomic gradient, the socio-religious differences in health and nutrition outcomes remain grossly understudied. The handful of studies on the socio-religious differential in child health outcomes has found a Muslim advantage in chances of survival and nutritional status over Hindus despite their comparatively lower socioeconomic status, which undeniably warrants investigating the pathways through which this paradoxical Muslim advantage manifests. METHODS Using data from the National Family Health Survey, 2015-16, we quantify the inter-group differentials in child undernutrition (stunting, wasting, and underweight) between Muslims and caste-disaggregated Hindus. We further decompose the gap to delineate its major contributory factors by employing Fairlie's decomposition method. RESULTS The analysis revealed that, compared to the Hindus as an aggregated group, Muslims have a higher rate of stunting and lower rates of wasting and being underweight. However, the differences get altered when we disaggregate the Hindus into high and low castes. Muslims have a lower prevalence of all three measures of undernutrition than the low-caste Hindus and a higher prevalence of stunting and underweight than the high-caste Hindus, consistent with their levels of socioeconomic status. However, the prevalence of wasting among Muslim children is lower than among high-caste Hindus. This nutritional advantage is paradoxical because Muslims' relatively poorer socioeconomic status compared to high-caste Hindus should have disadvantaged them. In the decomposition analysis, the Muslim advantage over the low-caste Hindus could only be partially attributed to the former's better economic status and access to sanitation. Moreover, the poor performance of Muslim children compared to the high-caste Hindus in stunting and underweight could mainly be explained by the religious differentials in birth order, mother's education, and wealth index. However, Muslim children's comparatively better performance in wasting than the high-caste Hindus remained a puzzle. CONCLUSION The Muslim advantage over high-caste Hindus in wasting and low-caste Hindus in all the indicators of undernutrition may have been rendered by certain 'unobserved' behavioural and cultural differences. However, further exploration is needed to make a definitive claim in this respect.
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Affiliation(s)
- Shreya Banerjee
- Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, 110067, India.
| | - Shirisha P
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, 600036, Tamil Nadu, India
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Tafasa SM, Darega J, Dida N, Gemechu FD. Dietary diversity, undernutrition and associated factors among pregnant women in Gindeberet district, Oromia, Ethiopia: a cross-sectional study. BMC Nutr 2023; 9:115. [PMID: 37833770 PMCID: PMC10576272 DOI: 10.1186/s40795-023-00773-2] [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: 09/17/2022] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Appropriate levels of dietary diversity are essential for proper physiology of human being and it is crucial to consume healthy foods at every phase of life, especially during pregnancy. Inadequate dietary diversity and malnutrition are risk factors for low birth weight, intrauterine growth reduction and small for gestational age. This study was aimed to assess dietary diversity, undernutrition and associated factors among pregnant women in Gindeberet district, Oromia, Ethiopia, 2020. METHOD A community based cross-sectional study was conducted among 627 pregnant women in Gindeberet district selected by systematic random sampling from October 10/2020- November 10/2020. Data were collected through interviewer administered questionnaires. The collected data were coded and entered to Epi-info version 7.2.2.6 and analyzed by SPSS version 23. Logistic regression analysis was carried out to identify factor associated with undernutrition and dietary diversity. Level of statistical significance was declared at p-value < 0.05. RESULTS overall prevalence of inadequate dietary diversity and undernutrition were 276 (44.4%) and 110 (17.7%) respectively. Pregnant women who did not receive antenatal care (AOR = 2.32, [95% CI: 1.38, 3.90]), family size ≥ 5 (AOR: 2.93; [95%CI: 1.10, 7.79]), unprotected sources of water (AOR: 4.14; [95% CI: 1.63, 10.52]) were significantly associated with undernutrition. Rural residence (AOR = 2.59, [95% CI: 1.66-4.04]), pregnant women who did not received ANC (AOR = 2.52, [95% CI: 1.58-4.03]) and nutrition information (AOR = 1.43; [95% CI: 1.10, 2.10]) were significantly associated with dietary diversity among pregnant women. CONCLUSION undernutrition and inadequate dietary diversity among pregnant women were high in study area. Source of drinking water, ANC visit and family size were significantly associated with pregnant women undernutrition. Place of residence, ANC visit and nutrition information were significantly associated with inadequate dietary diversity. Therefore, pregnant women, government, non-governmental organization and stakeholders should focus on importance of ANC visit, clean source of drinking water and adequate dietary diversity to improve nutritional status of pregnant women.
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Affiliation(s)
- Segni Mulugeta Tafasa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia.
| | - Jiregna Darega
- Department of Public Health, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
| | - Nagasa Dida
- Department of Public Health, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
| | - Feyisa Dudema Gemechu
- Department of Public Health, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
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Kolberg M, Paur I, Sun YQ, Gjøra L, Skjellegrind HK, Thingstad P, Strand BH, Selbæk G, Fagerhaug TN, Thoresen L. Prevalence of malnutrition among older adults in a population-based study - the HUNT Study. Clin Nutr ESPEN 2023; 57:711-717. [PMID: 37739727 DOI: 10.1016/j.clnesp.2023.08.016] [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: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Malnutrition is common in older adults and is associated with increased morbidity and mortality rates. AIM The aim of the study is to describe the prevalence of malnutrition based on low BMI, involuntary weight loss, and reduced food intake, in a Norwegian population of community-dwelling older adults and older adults living in nursing homes. METHODS This population-based study is part of the fourth wave of the Trøndelag Health Study (HUNT4) and includes participants ≥70 years from the HUNT4 70+ cohort. The HUNT4 70+ cohort consist of 9930 (response rate 51.2%) participants. In the current study 8127 older people had complete dataset for inclusion in the analyses. Participants completed a self-report questionnaire and standardised interviews and clinical assessments at field stations, in participants' homes or at nursing homes. Malnutrition was defined using the following criteria: low BMI, involuntary weight loss and severely reduced food intake. The standardised prevalence of malnutrition was estimated using inverse probability weighting (IPW) with weights for sex, age and education of the total population in the catchment area of HUNT. RESULTS Of the 8127 included participants, 7671 (94.4%) met at field stations, 356 (4.4%) were examined in their home, and 100 (1.2%) in nursing homes. In total, 14.3% of the population were malnourished based on either low BMI, weight loss, or reduced food intake, of which low BMI was the most frequently fulfilled criterion. The prevalence of malnutrition was less common among men than among women (10.1 vs 18.0%, p < 0.001), also after adjustment for age (OR 0.53, 95% confidence interval (CI) 0.46-0.61). The prevalence increased gradually with increasing age and the regression analysis adjusted for sex showed that for each year increase in age the prevalence of malnutrition increased with 4.0% (OR 1.04, 95% CI 1.03-1.05). The prevalence was higher both among older adults examined in their homes (26.4%) and residents in nursing home (23.6%), as compared to community-dwelling older adults who met at field stations (13.5%). CONCLUSION The prevalence of malnutrition is high in the older population. Special attention on prevention and treatment of malnutrition should be given to older women, the oldest age groups, and care-dependent community-dwelling older adults and nursing home residents.
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Affiliation(s)
- Marit Kolberg
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway.
| | - Ingvild Paur
- Norwegian Advisory Unit on Disease-related Undernutrition, Oslo, Norway; Section for Clinical Nutrition, Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Norway; Department of Clinical Medicine, Clinical Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Yi-Qian Sun
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Natland Fagerhaug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lene Thoresen
- Oncology Clinic, Trondheim University Hospital, Trondheim, Norway
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Treuil M, Mahmutovic M, Di Patrizio P, Nguyen-Thi PL, Quilliot D. Assessment of dynapenia and undernutrition in primary care, a systematic screening study in community medicine. Clin Nutr ESPEN 2023; 57:561-568. [PMID: 37739706 DOI: 10.1016/j.clnesp.2023.08.003] [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: 02/27/2023] [Revised: 07/07/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023]
Abstract
Screening for sarcopenia is a growing public health issue since associated with functional alterations and an increase in morbidity and mortality. OBJECTIVE To analyze the prevalence of decreased muscle strength (dynapenia) in patients aged 18 to 74 in community medicine, as measured in the general practitioner's office, and to assess the prevalence of undernutrition in this population. METHOD Muscle strength was measured with a Hand Grip (HG) dynamometer according to European recommended thresholds and French guidelines. Malnutrition was defined according to the GLIM criteria. RESULTS Of 341 patients, 303 were evaluated (89%): mean age was 47.8 ± 17.4 years, including 51.2% women, 103 with an acute disease (AD) and 200 with a chronic disease (CD). 23.5% were below the 10th percentile threshold in the CD group and 19.4% in the AD group. For these patients, muscle age, evaluated on the median values for age, was higher by 39.3 ± 15.2 years for men and by 41.5 ± 13.6 years for women. Maximum HG values were significantly correlated with changes in International Physical Activity Questionnaire (IPAQ) score (F = 10.22; p = 0.0017) and weight changes (%) (F = 5.30; p = 0.0227) in women only, regardless of age, BMI, disease, professional status or type of work (manual or not); 19.1% suffered from malnutrition (10.9% Stage 1 and 8.3% Stage 2), with 20.0% in the CD group and 17.4% in the AD group. CONCLUSION This study highlights the feasibility of screening for sarcopenia in primary care community medicine. The prevalence of dynapenia in the studied population (nearly one in 5 patients) and the observed higher-than-expected undernutrition (17.5%) justify their screening for appropriate management care. CLINICAL TRIAL REGISTRATION NCT04451694; referred to as "observational research", "non-interventional", or « non-RIPH ».
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Affiliation(s)
- Marie Treuil
- Departement de Médecine Générale, Nancy UFR Médecine, Université de Lorraine, France
| | - Meliha Mahmutovic
- Unité Transversale de Nutrition, Hopital de Brabois, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-Lès-Nancy, Université de Lorraine, France
| | - Paolo Di Patrizio
- Departement de Médecine Générale, Nancy UFR Médecine, Université de Lorraine, France; Departement Grand Est de Recherche en Soins Primaires, Nancy UFR Médicine, Université de Lorraine, France
| | - Phi-Linh Nguyen-Thi
- Unité d'Evaluation Médicale, Service d'Evaluation et Information Médicale, CHRU Nancy, France
| | - Didier Quilliot
- Unité Transversale de Nutrition, Hopital de Brabois, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-Lès-Nancy, Université de Lorraine, France.
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Anuradha K, Ketan G, Vaman K, Veena E. Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys. Indian J Pediatr 2023; 90:982-987. [PMID: 35713770 DOI: 10.1007/s12098-022-04143-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4). METHODS National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ. RESULTS A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 ± 1.8 to -1.5 ± 1.7) but relatively less improved weight for age (-1.8 ± 1.4 to -1.5 ± 1.2), the change in wasting status was either nil or meagre (-0.8 ± 1.4 to -0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05). CONCLUSION Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.
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Affiliation(s)
- Khadilkar Anuradha
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Gondhalekar Ketan
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Khadilkar Vaman
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ekbote Veena
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
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Ghosh P. Undernutrition Among the Children from Different Social Groups in India: Prevalence, Determinants, and Transition Over Time (2005-2006 to 2019-2021). J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01796-y. [PMID: 37775680 DOI: 10.1007/s40615-023-01796-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
Combating undernutrition among children under 5 years is presently an enormous challenge for India. The study aims to determine the prevalence of undernutrition by the Composite Index of Anthropometric Failure (CIAF) and the time-dependent significant determinants of undernutrition among children under 5 years from four recognized social groups, i.e., Scheduled Tribe (ST), Scheduled Caste (SC), Other Backward Class (OBC), and Others, or General group, between 2005-2006 and 2019-2021 in India. It also explains the transition in the probability of CIAF among ST, SC, OBC, and General children belonging to different socio-demographic, economic backgrounds, and geographic regions from 2005-2006 to 2015-2016, 2015-2016 to 2019-2021, and 2005-2006 to 2019-2021 in India. Time-dependent and time-independent logistic regression models are employed to identify the major determinants and predicted probabilities of CIAF, respectively, among four social groups. The predicted probabilities of CIAF among ST, SC, OBC, and General children belonging to various socio-demographic, economic backgrounds, and geographic regions are extracted from logistic regression models and represented graphically. The study outlines a higher prevalence of CIAF among ST children, followed by SC, OBC, and General children throughout the last 15 years. Since 2005-2006, the magnitude of CIAF risk elimination has been comparatively higher among socially marginalized children (ST, SC, OBC) than in General. The investigation also outlines a significant (p < 0.001), and consistent effect of child age, maternal nutritional level, education status, household economic status, and geographic regions on the prevalence of undernutrition among all four social groups in India from 2005-2006 to 2019-2021. The policymakers must focus much on the ST, SC, and OBC sections for eliminating childhood undernutrition. Specifically, more attention is needed for the ST, SC, and OBC children living with non- or less-educated mothers, belonging to poor families, living in central, western, and eastern Indian states for eliminating the childhood CIAF. This might contribute to lowering intergroup inequality (SDG 10.2) in India in terms of the incidence of hunger (SDG 2.2), undernutrition, and child mortality (SDG 3.2).
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Affiliation(s)
- Pritam Ghosh
- Department of Geography, Ramsaday College, Amta, Howrah, West Bengal, 711401, India.
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45
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Wali N, Agho KE, Renzaho AMN. Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets. Arch Public Health 2023; 81:171. [PMID: 37726846 PMCID: PMC10507966 DOI: 10.1186/s13690-023-01186-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND South Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country's progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries. METHODS A systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings. RESULTS All eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans. CONCLUSION There is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition.
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Affiliation(s)
- Nidhi Wali
- School of Social Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Andre M N Renzaho
- School of Medicine, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
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Bhandari P, Prusty RK, Begum S. Association between intimate partner violence and nutritional status among Indian women: a latent class analysis approach. Arch Public Health 2023; 81:162. [PMID: 37644503 PMCID: PMC10463353 DOI: 10.1186/s13690-023-01152-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: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is an unabating public health issue that has numerous negative repercussions for women's health. Its detrimental impact on women's nutritional outcomes has been documented in a few studies from low- and middle-income countries; however, there is a lack of granular understanding in terms of the typology of IPV experiences and their association with nutritional outcomes. This study explores the distinct classes of IPV experience among women in India and examines how these classes are associated with their nutritional outcomes. METHODS Using data of 60,622 ever-married women aged 15-49 years from the 2019-21 National Family Health Survey (NFHS-5), latent class analysis (LCA) was performed to identify distinct groups of women based on their IPV experiences. BMI was used to assess women's nutritional status, and it was classified as: <18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal) and ≥ 25.0 kg/m2 (overweight). Further, multinomial logistic regression analyses were used to estimate the odds of being underweight or overweight by latent classes of IPV experiences. RESULTS LCA model identified four distinct IPV experience groups of women: Low Physical and Low Sexual IPV (LPLS-IPV) class (72%); High Physical and Low Sexual IPV (HPLS-IPV) (12.5%); High Sexual and Low Physical IPV (HSLP-IPV) (12%); and High Physical and High Sexual (HPHS-IPV) class (3.5%). The likelihood of being underweight was higher among women in the HPHS-IPV class (aOR: 1.24, 95% CI: 1.08-1.44), followed by those in the HPLS-IPV class (aOR: 1.11, 95% CI: 1.04-1.20). CONCLUSION The latent class groups found that high physical IPV experiences were associated with women's nutritional outcomes. The experiences of women having both high physical and sexual violence affect women's nutritional outcomes to a greater extent and they are more likely to be undernourished.
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Affiliation(s)
- Pravat Bhandari
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Ranjan Kumar Prusty
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India.
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Shawel S, Baraki N, Alemeshet Y, Abebe DS, Egata G. Undernutrition and associated factors among adults with mental and neurological disorders in public health hospitals, Eastern Ethiopia, 2019: a cross-sectional study. BMC Psychiatry 2023; 23:617. [PMID: 37612618 PMCID: PMC10463296 DOI: 10.1186/s12888-023-05117-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Poor nutritional status can be consequence of impaired mental health that may lead to involuntary weight gain, weight loss, or deficiency of essential nutrients. However, little has been documented about the nutritional status of adults with mental disorders and the contributing factors in low-income countries like Ethiopia. The aim of this study was to assess the magnitude of undernutrition and associated factors among adults with mental disorders in public hospitals of Eastern Ethiopia. METHODS Institution-based, cross-sectional study was conducted among 507 adults with mental disorders from March 1, 2019 to April 1, 2019. Interviewer administered pretested structured questionnaire was used to collect data. Anthropometric data were collected using calibrated weighing scale and height measuring board. Descriptive statistics was computed to describe the data. Bivariable and multivariable logistic regression analyses were applied to identify factors associated with the undernutrition. Odds ratio alongside 95% confidence interval (CI) were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05. RESULTS Undernutrition affected 62.7%; 95% CI: (58.3%, 67.7%) of the patients. Undernutrition was associated with meal frequency < 3 per day (adjusted odds ratio [(AOR = 2.07, 95% CI: (1.18, 3.63)], use of multiple medication (adjusted odds ratio [(AOR = 3.02, 95% CI: (1.88, 4.84)], being non-smoker [(AOR = 0.50, 95%CI: (0.25, 0.91)], and use of prescribed diet [(AOR = 0.45, 95%CI: (0.26, 0.78)]. CONCLUSIONS The magnitude of undernutrition was high among the study participants. Multiple medication, cigarette smoking, frequency of meal and taking prescribed diet were significantly associated with undernutrition. Nutrition education for patients with mental disorders and their caregivers about the impact of taking multiple medication and substance use needs to be emphasized alongside nutritional screening and support to improve their nutritional status.
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Affiliation(s)
- Samrawit Shawel
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar city, Ethiopia
| | - Negga Baraki
- Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar city, Ethiopia
| | - Yohanis Alemeshet
- Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar city, Ethiopia
| | - Dawit Shawel Abebe
- Dawit Shawel Abebe, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
| | - Gudina Egata
- School of Public Health, College of Health Sciences, Department of Nutrition and Dietetics, Addis Ababa University, P.O.Box: 18087, Addis Ababa city, Ethiopia
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Hojati A, Alesaeidi S, Izadi S, Nikniaz A, Farhangi MA. MyKid'sNutrition mobile application trial: a randomized controlled trial to promote mothers' nutritional knowledge and nutritional status of preschool children with undernutrition-a study protocol. Trials 2023; 24:544. [PMID: 37596662 PMCID: PMC10439575 DOI: 10.1186/s13063-023-07503-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Childhood malnutrition is a crucial public health issue in developing countries. Mothers' nutritional knowledge significantly affects children's nutritional status. It also appears that mothers with low health literacy are unable to adequately meet their children's nutritional needs because they do not clearly understand their children's nutrition and malnutrition status. METHODS This randomized controlled trial aims to describe the development and study protocol of the MyKid'sNutrition application, a smartphone-based intervention for mothers of preschool (2-6 years old) children. The application contains several contents on children's healthy eating, childhood underweight, children's loss of appetite, and child growth assessment. As part of the MyKid'sNutrition trial, a total of 116 participants will be randomized 1:1 either to (a) treatment as usual and MyKid'sNutrition or (b) treatment as usual alone. The results of this trial will be based on changes in growth indicators and mothers' nutritional knowledge, attitude, and practice within the groups and the differences between them. DISCUSSION Due to their widespread availability throughout society, smartphones can be used to deliver educational content on a large scale at a low cost. In addition, they can provide novel ways for patients to receive support. Hence, it is essential to conduct research studies on these types of interventions. MyKid'sNutrition application offers dietary solutions for such nutritional problems as underweight, loss of appetite, and malnutrition in children. Meanwhile, it provides detailed instructions on how to interact with the child. TRIAL REGISTRATION IRCT.ir IRCT20140907019082N11. Registered on February 19, 2022.
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Affiliation(s)
- Ali Hojati
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sogol Alesaeidi
- Department of Pediatric Medicine, Imam Hossein Hospital, Resident of Pediatric Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Izadi
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nikniaz
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Zapata RC, Nasamran CA, Chilin-Fuentes DR, Dulawa SC, Osborn O. Identification of adipose tissue transcriptomic memory of anorexia nervosa. Mol Med 2023; 29:109. [PMID: 37582711 PMCID: PMC10428576 DOI: 10.1186/s10020-023-00705-7] [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: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a complex debilitating disease characterized by intense fear of weight gain and excessive exercise. It is the deadliest of any psychiatric disorder with a high rate of recidivism, yet its pathophysiology is unclear. The Activity-Based Anorexia (ABA) paradigm is a widely accepted mouse model of AN that recapitulates hypophagia and hyperactivity despite reduced body weight, however, not the chronicity. METHODS Here, we modified the prototypical ABA paradigm to increase the time to lose 25% of baseline body weight from less than 7 days to more than 2 weeks. We used this paradigm to identify persistently altered genes after weight restoration that represent a transcriptomic memory of under-nutrition and may contribute to AN relapse using RNA sequencing. We focused on adipose tissue as it was identified as a major location of transcriptomic memory of over-nutririon. RESULTS We identified 300 dysregulated genes that were refractory to weight restroration after ABA, including Calm2 and Vps13d, which could be potential global regulators of transcriptomic memory in both chronic over- and under-nutrition. CONCLUSION We demonstrated the presence of peristent changes in the adipose tissue transcriptome in the ABA mice after weight restoration. Despite being on the opposite spectrum of weight perturbations, majority of the transcriptomic memory genes of under- and over-nutrition did not overlap, suggestive of the different mechanisms involved in these extreme nutritional statuses.
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Affiliation(s)
- Rizaldy C Zapata
- Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, San Diego, USA.
| | - Chanond A Nasamran
- Center for Computational Biology & Bioinformatics, School of Medicine, University of California San Diego, San Diego, USA
| | - Daisy R Chilin-Fuentes
- Center for Computational Biology & Bioinformatics, School of Medicine, University of California San Diego, San Diego, USA
| | - Stephanie C Dulawa
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, 92093, San Diego, CA, USA
| | - Olivia Osborn
- Division of Endocrinology and Metabolism, School of Medicine, University of California San Diego, San Diego, USA
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Jana A, Singh A, Adar SD, D'Souza J, Chattopadhyay A. In-utero exposure to multiple air pollutants and childhood undernutrition in India. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00591-5. [PMID: 37563211 DOI: 10.1038/s41370-023-00591-5] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5. OBJECTIVE This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition. METHODS This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels. RESULTS Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished. IMPACT STATEMENT Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.
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Affiliation(s)
- Arup Jana
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Akancha Singh
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Jennifer D'Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Aparajita Chattopadhyay
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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