Prevalence and factors associated with stunting and excess weight in children aged 0-5 years from the Brazilian semi-arid region

Trajectory Patterns of Weight and Length in Children: From Birth Until 2-Years of Age

OBJECTIVE

The aim was to identify trajectory patterns of weight and length in children from birth until two years of life and establish associations with maternal and child characteristics.

METHODS

A mixed-cohort study was conducted in public health services in Colombo-PR, Brazil, between 2018 and 2022. Pregnancy information was gathered through anthropometric data collection and questionnaires. Birth data were extracted from birth record forms, while weight and length data in the first two years of life were obtained from physical and electronic health service records. Weight and length trajectory patterns were identified using a group-based trajectory model. The definition of the number of trajectory patterns to be selected considered the model fit to the type of variable, its practical utility, as well as the probabilities of group membership.

RESULTS

Two trajectory patterns of weight and length were identified among the children. The majority exhibited a pattern of weight (67.8%, n = 382) and length (90.9%, n = 472) considered high and stable, with a tendency to decelerate from one and a half years of age. The probability of belonging to the lower weight gain group was associated with female sex (41.5%, p < 0.001), smoking during pregnancy (48.7%, p = 0.008), prematurity (65.0%, p = 0.001), cesarean delivery (36.4%, p = 0.009), small for gestational age (69.0%, p < 0.001), and twinning (69.2%, p = 0.002). Similarly, the probability of belonging to the lower length gain group was associated with female sex (11.7%, p < 0.001), smoking during pregnancy (20.6%, p = 0.003), cesarean delivery (10.1%, p = 0.048), born small for gestational age (46.4%, p < 0.001), and twinning (46.1%, p < 0.001).

CONCLUSION

Conditions during pregnancy and childbirth can impact growth patterns in the first two years of life.

Prevalence and factors associated with stunting among children aged 6-59 months in Kabale district, Uganda

BACKGROUND

Despite of the global efforts undertaken to improve nutrition, malnutrition still continues to be a serious public health concern. Malnutrition in its various forms has been closely associated to major causes of illness, disability and death. Malnutrition in the form of childhood stunting has therefore been identified as a significant hindrance to human development. The aim of this study was to assess the nutritional status of children aged 6-59 months and determine factors associated with a high prevalence of stunting (48%) among children in Kabale district.

METHODOLOGY

A cross sectional study was conducted among 640 children, aged 6-59 months selected using both simple random and systematic random sampling techniques. Interview administered questionnaires were used to collect household data whereas anthropometric data was collected using height boards, digital weighing scales and Mid Upper Arm Circumference (MUAC) Tapes. Nutrition status data was analyzed using ENA for SMART, 2011 and then exported to STATA version 12.0 for further analysis.

RESULTS

The overall prevalence of stunting among children 6-59 months was 41.1%. Factors independently associated with stunting included; age of the child (children in the age category of 36-47 months APOR = 0.38; 95% CI 0.18-0.79 and those in the age category of 24-35 months APOR = 0.42; 95% CI 0.19-0.88), major source of food for the household that is children from households in which mothers indicated market as the major source of food (APOR = 0.67; 95% CI 0.48-0.94) and disposal of child stool that is children whose stool was put/ rinsed in a latrine (APOR = 0.41; 95% CI: 0.23-0.74) as well as those that whose stool was thrown in garbage (APOR = 0.29; 95% CI: 0.12-0.72).

CONCLUSION

The prevalence of stunting among children aged 6-59 months in Kabale district was high. Practices/ factors independently associated with stunting among children aged 6-59 months included; age of the child, major source of food for the household and disposal of child stool. Addressing these factors requires a proper mix of both community and health based interventions. There is also need to strengthen on strategies for reducing stunting like; sanitation and hygiene as well as food and nutrition security within rural households.

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan

Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent's anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

Efeitos da cesárea eletiva sobre desfechos no primeiro ano de vida: estudo de coorte

Resumo Objetivo verificar o efeito da cesárea eletiva, em comparação ao parto vaginal, sobre os desfechos no primeiro ano de vida da criança. Método estudo de coorte com 499 mães e seus bebês. Foram coletados dados sociodemográficos, relativos à história gestacional, ao parto e nascimento e sobre o primeiro ano de vida do bebê, em entrevista realizada na unidade de triagem neonatal, do registro do prontuário da maternidade e em entrevistas no domicílio. Avaliaram-se as associações de interesse mediante análises de regressão de Cox, ajustadas para as covariáveis identificadas, considerando-se resultados de análises bivariadas que apresentaram significância estatística em nível de p<0,20. Nas análises ajustadas, consideraram-se as relações significativas se p<0,05, tendo como medida de efeito o risco relativo. Resultados as cesáreas eletivas não se associaram aos desfechos estudados (interrupção do aleitamento materno, infecções respiratórias, atopias e sobrepeso/obesidade). Conclusão e implicações para a prática a ausência de associação da cesárea eletiva e os desfechos do primeiro ano de vida poderão ser confirmados em investigações futuras. Pelos achados, sugere-se que a equipe de saúde apoie as mães, com o intuito de aumentar sua confiança e empenho em relação à amamentação, prática que pode repercutir positivamente nos demais desfechos estudados.

A multilevel analysis of individual, household and community level factors on stunting among children aged 6-59 months in Eswatini: A secondary analysis of the Eswatini 2010 and 2014 Multiple Indicator Cluster Surveys

Introduction

Child stunting is a significant public health problem in Eswatini. It is associated with a range of child health outcomes, including morbidity, physical and cognitive growth.

Objective

To determine the individual, household, and community-level factors associated with child stunting in Eswatini in 2010 and 2014.

Methods

Using the Eswatini Multiple Indicator Cluster Surveys conducted in 2010 and 2014, a secondary analysis was done of the children surveyed, aged 6–59 months. A total of 1,891 were surveyed in 2010, and 1,963 children in 2014. Univariate, bivariable analysis and multivariable multilevel logistic regression were used to establish the factors associated with stunting.

Results

The study found that stunting decreased significantly between 2010 and 2014, from 31.4% to 25.5% (p<0.001). In both 2010 and 2014, lower odds of stunting were observed among female children, in children born to women with tertiary education compared to those born to women with no formal education. Lower odds of stunting were observed among children from rich households compared to poorest households. In both 2010 and 2014, increased odds of stunting were observed among children aged 12–23, 24–35 and 36–47 months compared to children aged 6–11 months. At the household level, higher odds of stunting were observed among children from households with two and more children under five years of age compared to those with only one child and in 2010, among children from households with a pit latrine and no toilet facility compared to households with a flush toilet. At the community level, in 2010, higher odds of stunting were observed among children from the Shiselweni compared to those from the Lubombo region.

Conclusion

The findings highlight the individual, household, and community-level factors significantly associated with stunting and the changes between the two surveys.

Chronic malnutrition and oral health status in children aged 1 to 5 years: An observational study

To evaluate the effect of chronic malnutrition on the oral health of children aged 1 to 5 years.An observational, analytical, cross-sectional study was conducted and involved 82 children (12-71 months of age). Nutritional status was evaluated using anthropometric indicators and oral health status/caries prevalence was measured. Non-stimulated saliva was collected and flow rate and buffering capacity was measured.The mean dmft index was 1.38 for the adequately nourished children, 3.04 for those with mild malnutrition, 2.5 for those with moderate malnutrition and 2.4 for those with severe malnutrition. 69 of the 82 children had low to very low buffering capacity. No significant differences among the groups were found between malnutrition and age, buffering capacity or the dmft index (P > .05). However, significant differences in salivary flow were found among the different malnutrition categories (P < .05). Spearman correlation coefficient revealed a weak negative correlation between nutrition and salivary flow (r = -0.267).Malnutrition exerts a negative impact on the oral cavity of children and a reduction in salivary flow rate was observed with the increase in malnutrition. Diagnosing the effects of malnutrition in oral environment of children is important because it could improve the quality of life and give them an adequate treatment.

[Excess weight in Xukuru indigenous children in Ororubá, Pernambuco State, Brazil: magnitude and associated factors]

The few studies on health and nutrition in indigenous peoples in Northeast Brazil point to some differences with indigenous peoples in the North and Central of the country. This study estimated the prevalence rates and risk of overweight and excess weight in Xukuru children in the village of Ororubá, Pernambuco State, and assessed the socioeconomic and demographic factors potentially associated with these conditions. This cross-sectional study analyzed the associations between adequate weight, excess weight (overweight and obesity), and risk of overweight according to the indices and cutoff points of the World Health Organization for children and the explanatory variables, using multinomial logistic regression. Prevalence of excess weight was 7.7% and risk of overweight was 24.2%. The odds of risk of overweight and excess weight were higher in children < 2 years. Children of obese mothers showed higher odds of excess weight. Prevalence of risk of overweight was 97% higher when compared to households with fixed income. The findings suggest that the Xukuru are experiencing an accelerated nutritional transition, with a paradoxical situation to which other indigenous peoples in Brazil are also exposed.

Relationship between stunting in children 6 to 36 months of age and maternal employment status in Peru: A sub-analysis of the Peruvian Demographic and Health Survey

Objectives

This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru.

Methods

A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers.

Results

The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers.

Conclusion

No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children.

Perfil nutricional de crianças no estado do Maranhão

RESUMO: Introdução: O combate à má nutrição está entre os maiores desafios de saúde e precisa ser norteado conforme a realidade de cada região. Estudos que avaliem o estado nutricional são imprescindíveis para embasar intervenções, principalmente em crianças. Objetivo: Analisar o perfil epidemiológico nutricional de crianças menores de cinco anos atendidas pela Estratégia Saúde da Família (ESF) no Maranhão. Método: Estudo transversal com crianças de 6 a 59 meses, de uma amostra do tipo probabilística e estratificada, representativa para o estado. Foram coletadas, por entrevistas, as variáveis “idade da criança”, “sexo”, “situação do domicílio” e “classificação de Insegurança Alimentar” (Escala Brasileira de Insegurança Alimentar). Foi realizado o cálculo dos valores de escore z (Z) de estatura para a idade, peso para a estatura e índice de massa corpórea (IMC) para a idade. Oestado nutricional foi classificado segundo as normas do Ministério da Saúde. Para a análise dos dados foram utilizados métodos estatísticos de correlação. Resultados: Das 956 crianças, 9,6% apresentaram estatura baixa ou muito baixa. Segundo o Z de IMC, o excesso de peso foi observado em 23,2% das crianças. As crianças da zona rural têm média Z de estatura e de IMC menor. No total, 70,4% das crianças apresentaram situação de insegurança alimentar, com correlação inversa com a estatura (r: -0,15; p < 0,0001) e sem correlação com o Z de IMC (r: -0,05; p = 0,09). Conclusão: A desnutrição crônica ainda pode ser considerada um problema de saúde pública no Maranhão, a despeito da transição nutricional que já ocorre nessas famílias.

Nutritional status of children under 5 years of age in Brazil: evidence of nutritional epidemiological polarisation

The objective of this study was to evaluate the nutritional status of children under 5 years of age in Brazil in 2009 and its association with social and demographic factors. Data from the Household Budget Survey (Pesquisa de Orçamento Familiar - POF 2008-2009) were used, in which the nutritional profile was evaluated according to the weight-for-age (W/A), height-for-age (H/A) and weight-for-height (W/H) indices (n = 14,569). The association was estimated by applying the Pearson association test, a logistic regression and a correspondence analysis. The correspondence analysis showed a higher association of thinness with children in the North and Northeast regions, in families with lower levels of income and in those of black colour/race. Overweight and obesity had a stronger relationship with children living in the South, Southeast and Central-West, in males, in those from urban areas, in those of Caucasian colour/race, in those aged 3 years and in those from families with intermediate income ranges. Overweight and obesity showed a heterogeneous spatial distribution amongst Brazilian states. A nutritional epidemiological polarisation that presents a major challenge for public health is indicated: we must reduce nutritional deficiencies and promote healthy eating habits from childhood to improve the nutritional and epidemiological profiles and mortality of the population.

DIFICULDADES ALIMENTARES EM PRÉ-ESCOLARES, PRÁTICAS ALIMENTARES PREGRESSAS E ESTADO NUTRICIONAL

Objective:

To identify the prevalence of feeding difficulties in preschoolers, its association with epidemiological factors and previous eating habits, and repercussion on nutritional status.

Methods:

Cross-sectional study with a questionnaire given to the mothers of 301 children aged 2-6 years enrolled in public and private kindergartens in Natal, Northeast Brazil, conducted in 2014-2015. Feeding difficulty was assessed according to Kerzner’s criteria, resulting in the profiles “highly selective intake”, “active child with small appetite”, “fear of feeding”, and “child with psychological disorder or neglected”. Association with the following independent variables was analyzed by logistic regression: breastfeeding time, age of cows’ milk and complementary feeding introduction, age range, family income, type of school, mothers’ profile (responsive or nonresponsive), and body mass index (BMI).

Results:

Feeding difficulty was found in 37.2% of cases, with predominance of “highly selective intake” (25.4%). It was not associated with infancy feeding practices, family income or type of school. There were no differences between the BMI Z score means for the groups with and without feeding difficulty (1.0±1.5 SD and 1.1±1.4 SD, respectively). The five-to-six age range had more occurrences (OR 1.8; 95%CI 1.1-2.9). Children of responsive mothers were less likely to have feeding difficulties (OR 0.4; 95%CI 0.2-0.8).

Conclusions:

Feeding difficulties were very frequent. Nutritional status was not impacted by it, and infancy eating habits were not associated with it. Responsive mothers’ profile is a protective factor against eating difficulties and reinforces the importance of behavioral factors and mother-child interaction.

Growth status of small for gestational age Indian children from two socioeconomic strata

AIMS

To assess growth and factors associated with growth in children born small for gestational age (SGA) from two socioeconomic strata in comparison to age- and sex-matched healthy controls.

METHODS

Retrospective study conducted at two hospitals in Pune, 0.5-5 years, 618 children: 189-SGA from upper socioeconomic strata (USS), 217-SGA from lower socioeconomic strata (LSS), and 212 appropriate for gestational age healthy controls were randomly selected. Birth and maternal history, socioeconomic status, length/height, and weight of children were recorded. Anthropometric data were converted to Z scores (height for age Z-score [HAZ], weight for age Z-score [WAZ]) using WHO AnthroPlus software.

RESULTS

The HAZ and WAZ of the SGA group were significantly lower as compared to the controls and that of the LSS SGAs were lower than USS SGAs (P < 0.05). Thirty two percent children were stunted (HAZ <-2.0) in USS and 49% in LSS (P < 0.05). Twenty nine percent children in the USS SGA group were stunted at 2 years and 17% at 5 years. In the LSS SGA group, 54% children were stunted at 2 years and 46% at 5 years. Generalized linear model revealed normal vaginal delivery (β = 0.625) and mother's age (β =0.072) were positively associated and high SES (β = -0.830), absence of major illness (β = -1.01), higher birth weight (β = -1.34) were negatively associated for risk of stunting (P < 0.05).

CONCLUSION

Children born SGA showed poor growth as compared to controls. Special attention to growth is necessary in children from LSS, very low birth weight babies, and those with major illnesses during early years of life.

Growth and development and their environmental and biological determinants

OBJECTIVE

To investigate child growth, cognitive/language development, and their environmental and biological determinants.

METHODS

This was a cross-sectional, predictive correlation study with all 92 children aged 24-36 months who attended the municipal early childhood education network in a town in the Vale do Jequitinhonha region, in 2011. The socioeconomic profile was determined using the questionnaire of the Associação Brasileira de Empresas de Pesquisa. The socio-demographicand maternal and child health profiles were created through a self-prepared questionnaire. The height-for-age indicator was selected to represent growth. Cognitive/language development was assessed through the Bayley Scale of Infant and Toddler Development. The quality of educational environments was assessed by Infant/Toddler Environment Scale; the home environment was assessed by the Home Observation for Measurement of the Environment. The neighborhood quality was determined by a self-prepared questionnaire. A multivariate linear regression analysis was performed.

RESULTS

Families were predominantly from socioeconomic class D, with low parental education. The prevalence of stunted growth was 14.1%; cognitive and language development were below average at 28.6% and 28.3%, respectively. Educational institutions were classified as inadequate, and 69.6% of homes were classified as presenting a risk for development. Factors such as access to parks and pharmacies and perceived security received the worst score regarding neighborhood environment. Biological variables showed a greater association with growth and environmental variables with development.

CONCLUSION

The results showed a high prevalence of stunting and below-average results for cognitive/language development among the participating children. Both environmental and biological factors were related to growth and development. However, biological variables showed a greater association with growth, whereas environmental variables were associated with development.

[Practice of physical activity among youths in a city in the semiarid region of Brazil]

The scope of this study was to establish the prevalence of physical activity among young people and to analyze its association with demographic, socioeconomic and behavioral factors. All youths aged 13 to 19 years of age living in the city of Caracol, Piauí, Brazil, were studied, comprising a total of 1,112 individuals. Data collection was conducted by means of household interviews using a standardized questionnaire. The dependent variable was the practice of physical activity in a typical week. Youths who performed moderate-to-vigorous-physical activity of at least one hour every day of the week were considered physically active. The prevalence of physically active youths was 12.6% (95% CI 10.6 to 14.5), being higher in males (20.3%; 95% CI 16.8 to 23.7) and those in the upper third of the asset indicator variable (16.5; 95% CI 12.7 to 20.3), and inversely related to age. Among males, afro-descendants were more active (32.3%; 95% CI 14.9 to 49.7), whereas the Arian females were more active (12.7%; 95% CI 5.2 to 20.2). The prevalence of physical activity was low in this population, particularly among females (5.9%; 95% CI 4.0 to 7.8), older youths and youth from the less privileged socioeconomic brackets.

Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990-2012

OBJECTIVE

To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC).

DESIGN

Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years.

SETTING

Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012.

SUBJECTS

Children <5 years.

RESULTS

Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3-10·9 % of children <5 years were stunted and overweight, and 0·6-37·8 % of stunted children <5 years were overweight.

CONCLUSIONS

The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic.

Validation of a subjective global assessment questionnaire

OBJECTIVE

To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents.

METHODS

A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient.

RESULTS

According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p<0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p<0.05). The interobserver reliability showed good agreement among examiners (Kappa=0.74).

CONCLUSION

This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.