Not water, sanitation and hygiene practice, but timing of stunting is associated with recovery from stunting at 24 months: results from a multi-country birth cohort study

Influence of Enterocytozoon bieneusi Infection on Child Growth: A Secondary Analysis of the MAL-ED Birth Cohort Study

Malnutrition in the early days of life is a global public health concern that affects children's growth. It results from a variety of factors, including pathogenic infections. Enterocytozoon bieneusi is a microsporidian parasite that can cause diarrhea and malnutrition in children. The study aimed to assess the impact of E. bieneusi on child growth. The MAL-ED study, a multicountry birth cohort research project, investigated the relationship between enteric infections and malnutrition in participating children from eight countries. A customized real-time polymerase chain reaction-based TaqMan array card was used in this study to identify enteropathogens from stool samples, where E. bieneusi was one of the target pathogens. The impacts of E. bieneusi infection on growth measures were assessed. Mixed-effect linear models were used to investigate the relationship between E. bieneusi and growth outcomes, including length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z scores. At the endpoint (last month of measurement), the infected group had significantly lower scores than the noninfected group for all outcomes. The adjusted difference-in-difference (D-in-D) values were -0.53 (95% CI: -0.67 to -0.38) for LAZ, -0.38 (95% CI: -0.52 to -0.23) for WAZ, and -0.22 (95% CI: -0.38 to -0.06) for WLZ. Enterocytozoon bieneusi infection has been identified as a factor associated with reduced linear growth, weight gain, and weight gain relative to linear growth in children, underscoring the importance of treating this infection.

Identification of amendable risk factors for childhood stunting at individual, household and community levels in Northern Province, Rwanda - a cross-sectional population-based study

BACKGROUND

Childhood stunting, defined as height-for-age below - 2 standard deviations (SD), disproportionately affects the Northern Province of Rwanda. We investigated risk factors contributing to stunting in this region at individual, household, and societal/community levels to inform future interventions.

METHODS

We conducted a population-based, cross-sectional study using a quantitative questionnaire in households with children aged 1-36 months in the Northern Province. Anthropometric measurements of children and mothers were taken to estimate nutritional status. Multivariable logistic regressions were performed to identify independent risk factors of stunting, reporting odds ratios, 95% confidence intervals and p-values.

RESULTS

Overall, stunting prevalence was 27.1% in children aged 1-36 months. At the individual level, boys exhibited 82% higher risk of stunting compared to girls (aOR: 1.82, 95% CI: 1.19, 2.78). Household-level factors such as maternal height and BMI were inversely associated with the risk of childhood stunting (aOR: 0.94, 95% CI: 0.90, 0.97 and aOR: 0.92, 95% CI: 0.86, 0.99, respectively). Other risk factors included no breastfeeding at the time of interview (aOR: 2.00, 95% CI: 1.23, 3.25), presence of twins or triplets aged 1-36 months (aOR: 2.60, 95% CI: 1.21, 5.57), female-headed (single parent) households (aOR: 2.07, 95% CI: 1.00, 4.26), and absence of handwashing facilities near the toilet (aOR: 3.30, 95% CI: 1.36, 7.98). No societal/community factors were significantly associated with childhood stunting in the Northern Province.

CONCLUSION

Childhood stunting in the Northern Province of Rwanda is associated with several factors that could lend themselves to interventions, e.g., improved handwashing facilities, improved childcare practices and targeting vulnerable groups such as boys, households with twins or single parents. Additionally, a thorough exploration of identified risk factors through qualitative approaches involving all stakeholders in child and maternal nutrition is warranted.

Complementary feeding hygienic practices and its associated factors among mothers of children aged 6-23 months old in Central Ethiopia, 2023

Background

Complementary feeding is a critical period for child development and normal nutritional status, playing a vital role in the prevention of malnutrition and related health issues. However, poor hygiene practices during this phase can lead to foodborne diseases and inadequate nutrient intake.

Objective

To assess poor hygienic practice related to complementary feeding and associated factors among mothers of children aged 6-23 months in Lemo District, 2023.

Methods

A community-based cross-sectional study was conducted from September to November 2023, utilizing a systematic sampling technique. A total of 402 mother-child pairs were randomly selected for participation. Data were collected using a pretested and structured questionnaire and then entered into Epi-Data version 4.6. The data were subsequently exported to SPSS version 26 for analysis. In the multivariable binary logistic regression analysis, variables with a p-value less than 0.05 were deemed to be statistically significant.

Results

The prevalence of poor hygienic practices related to complementary feeding among mothers of children aged 6-23 months was found to be 65%. Factors significantly associated with poor hygienic practices of complementary feeding was the absence of a separate kitchen [AOR = 3.17, 95% CI: (1.32, 7.59)], lack of access to a protected source of drinking water [AOR = 8.17, 95% CI: (3.06, 18.7)], and lack of access to media [AOR = 2.12, 95% CI: (1.25, 3.6)].

Conclusion

The study revealed a significant prevalence of inadequate hygienic practices in the context of complementary feeding among mothers. Factors that were identified as significant contributors to the observed poor hygienic practices includes the absence of separate kitchen, unprotected source of drinking water, and a lack of exposure to media.

Maternal Feeding Practices of Children One to Three Years in Collins Chabane Municipality of South Africa

The aim was to assess maternal feeding practices of children one to three years. A descriptive observational design was employed. The sample consisted of mothers-child dyads. A validated structured questionnaire was used. Data was analyzed using SPSS version 26.0. The nutrition status of the children at birth indicated 11.6% underweight as compared to the time of the study (7.2%), 7.9% were stunted increased to 38.0%, while wasting decreased from 11.4%-2.4%. Early cessation of breastfeeding and inappropriate complementary feeding practices were the factors influencing growth. The prevalence of underweight and wasting were low while stunting and overweight were high.

Hygienic practice during complementary food preparation and associated factors among mothers of children aged 6-24 months in Debark town, northwest Ethiopia, 2021: An overlooked opportunity in the nutrition and health sectors

BACKGROUND

Hygienic practices during complementary food preparation are suboptimal in developing countries, in Ethiopia in particular. Hygienic complementary food preparation is crucial to prevent childhood communicable diseases like diarrhea and associated malnutrition among children aged 6-24 months. However, in Ethiopia, there is a paucity of evidence on the practice of hygiene during complementary food preparation. Thus, this study is aimed to assess the hygienic practice of complementary food preparation and associated factors among women having children aged 6-24 months in Debark town, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 423 mothers with 6-24 months of age children from December 1 to January 30, 2021. A simple random sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. Epi-data version 4.6 and SPSS version 23 software were used for data entry and analysis, respectively. Binary logistic regressions (Bivariable and multivariable) were performed to identify statistically significant variables. Adjusted odds ratio with 95% CI was used to declare statistically significant variables on the basis of p-value < 0.05 in the multivariable logistic regression model.

RESULTS

The study revealed that 44.9% (95% CI (40.2, 49.4%)) of the mothers having children aged 6-24 months had good practice of complementary food preparation. Maternal age of 25-29 years[AOR:3.23, 95% CI: (1.555-9.031)], husband's attained secondary school and above (AOR:2.65, 95% CI (1.211-5.783)], using modern stove for cooking [AOR:3.33,95% CI (1.404-7.874)], having a separate kitchen[AOR: 8.59, 95%Cl: (2.084-35.376], and having a three bowl dishwashing system(AOR: 8.45, 95% CL: (4.444-16.053)) were significantly associated with good hygiene practice of complementary food preparation.

CONCLUSIONS

The findings have indicated that the majority of the mothers had poor hygienic practices of complementary food preparation. Mother's age, husband's educational status, type of stove used for cooking, having a separate kitchen, having a three bowl dishwashing system were factors that significantly influenced the hygiene practice of mothers during complementary food preparation. Therefore, training and counseling mothers and caregivers on complementary food processing and preparation is important and such endeavors which inform the development and implementation of complementary food hygiene interventions in urban communities are recommended.

High prevalence of small intestine bacteria overgrowth and asymptomatic carriage of enteric pathogens in stunted children in Antananarivo, Madagascar

Environmental Enteric Dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the small intestine. It is widespread among children and adults in low- and middle-income countries and is also associated with poor sanitation and certain gut infections possibly resulting in an abnormal gut microbiota, small intestinal bacterial overgrowth (SIBO) and stunting.

We investigated bacterial pathogen exposure in stunted and non-stunted children in Antananarivo, Madagascar by collecting fecal samples from 464 children (96 severely stunted, 104 moderately stunted and 264 non-stunted) and the prevalence of SIBO in 109 duodenal aspirates from stunted children (61 from severely stunted and 48 from moderately stunted children). SIBO assessed by both aerobic and anaerobic plating techniques was very high: 85.3% when selecting a threshold of ≥10⁵ CFU/ml of bacteria in the upper intestinal aspirates. Moreover, 58.7% of the children showed more than 10⁶ bacteria/ml in these aspirates. The most prevalent cultivated genera recovered were Streptococcus, Neisseria, Staphylococcus, Rothia, Haemophilus, Pantoea and Branhamella. Feces screening by qPCR showed a high prevalence of bacterial enteropathogens, especially those categorized as being enteroinvasive or causing mucosal disruption, such as Shigella spp., enterotoxigenic Escherichia coli, enteropathogenic E. coli and enteroaggregative E. coli. These pathogens were detected at a similar rate in stunted children and controls, all showing no sign of severe diarrhea the day of inclusion but both living in a highly contaminated environment (slum-dwelling). Interestingly Shigella spp. was the most prevalent enteropathogen found in this study (83.3%) without overrepresentation in stunted children.

About 2 million children under the age of 5 suffer from stunted growth in Madagascar. Although deficient diet is the major cause of undernutrition, impaired absorption or assimilation caused by Environmental Enteric dysfunction (EED) has been proposed to play an important role in stunting. EED is widespread among children and adults in low- and middle-income countries (LMIC) and is also associated with undernutrition, poor sanitation, certain gut infections resulting in an abnormal gut microbiota and small intestinal bacterial overgrowth (SIBO) although the role of SIBO in EED remains unclear. The current study highlights the presence at high concentrations of bacterial taxa usually found in the oro-pharyngeal sphere in a high number of duodenal fluids of stunted children. This uncommon presence suggests a decompartmentalization of the gastrointestinal tract and a possible pro-inflammatory effect due to the ectopic presence of some of these bacteria in the duodenum.

The study also points to a high prevalence of enteropathogens (especially Shigella spp.) in the feces of both stunted and control children, hence preventing from proposing a direct association with stunting. This suggests that, beside combatting poverty and improving diet, environmental sanitation, quality of water sources, hygiene promotion and health education are key points to mitigate stunting and restore nutritional benefits.