Prevalence and determinants of malnutrition among primary school going children in the haor areas of Kishoreganj district of Bangladesh

Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review

Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity.

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial

Background

Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education.

Methods and Materials

A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline.

Results

Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001).

Conclusion

The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Nutritional status and prevalence of helminthic infection among primary school children in Bangladesh: A cross-sectional study

AIM

Malnutrition and infectious diseases, such as helminthic infections, are widespread among primary school children, especially in low- and middle-income countries. However, there are limited studies on school health in Bangladesh, particularly in rural settings. This study aimed to explore the nutritional status and prevalence of helminthic infections in relation to associated health behavior, awareness, and knowledge regarding malnutrition and helminthic infections which were evaluated by school nurses among primary school children in Bangladesh.

METHODS

This was a descriptive, cross-sectional survey study with a total duration of 1 month, from September to October, 2021. This study formed part of a school nurse project as a cluster non-randomized clinical trial in Bangladesh. Selected variables from that clinical trial were analyzed and reported in the results section. The study participants were primary school children from four schools in rural Bangladesh.

RESULTS

In total, 604 children participated in the baseline survey and health checkups. Among them, 163 (27.0%) children were classified as malnourished according to the World Health Organization growth reference standard 2007. The prevalence of helminthic infections was 53 (8.8%). Approximately >50% of the children responded that they never/rarely practiced hygiene-related behaviors and had no awareness and knowledge regarding malnutrition and helminthic infections. However, differences between the variables were not statistically significant.

CONCLUSION

Children's nutritional status and prevalence of helminthic infections with related deprived health behaviors, and minimal awareness and knowledge, reinforce the importance of implementing educational interventions in the future.

A systematic analysis and future projections of the nutritional status and interpretation of its drivers among school-aged children in South-East Asian countries

Background

Nutrition inadequacy during childhood and adolescence can cause suboptimal growth, intergenerational effects on offspring and an increased risk of chronic diseases in adulthood. There is little information on the prevalence and drivers of malnutrition in children aged 5-19 years, in the South-East Asian setting, since most existing interventions have to date targeted undernutrition. We assessed the national prevalence of nutritional indicators, their trends, and associated risk factors among children aged 5-19 years from 11 countries of WHO South-East Asia Region (SEA Region) in order to provide evidence to guide future policy direction.

Methods

We included 5,210,646 children for analysis from 345 studies and 25 survey datasets. A Newcastle-Ottawa Scale was used to assess the quality of the study. Bayesian regression models were used to estimate the prevalence of malnutrition between 2000 and 2030, and a series of subgroup analyses were performed to assess variation in pooled estimates by different socio-demographic and lifestyle factors. The protocol was registered with PROSPERO database (CRD42023400104).

Findings

Overall, pooled analysis demonstrated that indicators of undernutrition in SEA is predicted to decrease between 2000 and 2030 including stunting (36.6%-27.2%), thinness (29.5%-6.2%), and underweight (29.2%-15.9%). However, a substantial increase in prevalence of overweight (6.0% in 2000-16.9% in 2030), and obesity (2.6%-9.5%) are predicted. The prevalence of micronutrient deficiencies between 2000 and 2030 is predicted to decrease-vitamin A by 84% and vitamin D by 53%. Parents' education levels and household wealth were inversely associated with malnutrition. Children's health-related behaviours, such as unhealthy dietary habits and spending more time watching TV, playing games, or using the computer, were associated with increased chance of overweight and obesity. There were no clear signs of publication bias in our study.

Interpretation

Our analysis highlights the pattern of a double burden of malnutrition, with clear differences between different socio-demographic groups. Despite a substantial reduction in the prevalence of stunting, underweight, and anaemia since 2000, an emerging increase in overweight/obesity and micronutrient deficiencies warrants urgent attention.

Funding

World Health Organization Regional Office for South-East Asia New Delhi, India.

Prevalence and Determinant Factors of Intestinal Parasitic Infections and Undernutrition among Primary School Children in North-Central Ethiopia: A School-Based Cross-Sectional Study

Background. Intestinal parasitic infections (IPIs) are a major public health problem with high morbidity and mortality in developing countries. Undernutrition is a major health problem among school children and affects their cognitive development, psychological development, motor skills, and academic achievements. Therefore, this study aimed to assess the prevalence and determinant factors of IPIs and undernutrition among primary school children. Method. Cross-sectional study was conducted among 450 children from February to March 2021 at selected primary schools in Dessie town, North-central Ethiopia. Participants were selected using a stratified sampling technique. Pretested questionnaires were used to collect sociodemographic and nutrition-related data. Stool samples were used to diagnose IPIs. Participants’ height and weight were measured and body mass index (BMI) was calculated. Nutritional assessment was done using WHO AnthroPlus software. Data were analyzed using SPSS version 26 software. $P$ -values <0.05 were considered statistically significant. Result. The overall prevalence of intestinal parasites was 28.9%. The prevalence of intestinal protozoa and helminths were 19.1% and 9.8%, respectively. Entamoeba histolytica/dispar was the most prevalent parasite (9.3%) followed by Giardia intestinalis (7.6%), Enterobius vermicularis (2.9%), and Ascaris lumbricoides (2.7%). The prevalence of intestinal parasites was higher in male (16.5%) than in female (12.4%) participants. Children whose mother’s level of education is illiterate, 6–11 years old, have a habit of eating raw/undercooked fruits and vegetables, untrimmed and dirty fingernails, and sickness in the past week were significantly associated with IPIs. The prevalence of underweight, stunting, and wasting were 22.4%, 26.2%, and 20.7%, respectively. Multivariable logistic regression showed gender, family size, meal frequency, and breakfast were significantly associated with undernutrition. IPIs had a statistically significant association with underweight, stunting, and wasting. Conclusion. The study showed that IPIs and undernutrition are still major health problems among children in North-central Ethiopia. Periodic deworming, community health, and school health education will be valuable to improve the health, growth, and educational outcome of children.