Progression of stunting and its predictors among school-aged children in western Kenya

Association between diet quality and risk of stunting among school-aged children in Schistosoma mansoni endemic area of western Kenya: a cross-sectional study

BACKGROUND

Healthy eating habits are essential for improving nutritional status and strengthening immunity against infectious diseases. This study examined the relationship between diet quality and stunting in school-aged children in an infectious disease-endemic area of western Kenya.

METHODS

This cross-sectional study included 260 school-aged children (age 9-17 years) enrolled in primary schools in Mbita Sub-county, western Kenya. The nutritional status was assessed using anthropometric measurements. Dietary intake was measured using food frequency questionnaires and evaluated using the Food Pyramid (FP) score, which indicates adherence to the Kenyan food-based dietary guideline. Information on the children's age, sex, maternal education, and household wealth index was collected using a household-based questionnaire. Infections with the predominant parasites, such as Schistosoma (S.) mansoni, were detected via microscopy. The trend associations of the FP score with food group intake were examined to characterize the dietary intake of this population. Logistic regression analysis was performed to investigate the relationship between stunting and FP score tertiles, adjusted for sociodemographic and economic indicators and parasitic infection status.

RESULTS

Among the studied schoolchildren, 15.0% exhibited stunting, while 76.2% were infected with S. mansoni. The mean FP score was 25.6 out of 50 points. A higher FP score was characterized by a high intake of roots and tubers, dairy products, pulses, and fruits and a low intake of cereals and animal-source foods. The analysis revealed a trend: a lower risk of stunting was evident in groups with elevated FP scores (p for trend = 0.065). However, these trend associations were observable among subjects with either negative or light S. mansoni infection (p for trend = 0.016).

CONCLUSIONS

A higher quality diet, as evaluated by FP scores, was associated with a low risk of stunting among school-aged children. Notably, this association seemed to weaken in the presence of a high burden of S. mansoni infection. It highlights the importance of enhancing dietary quality through the promotion of diverse nutrient-dense foods alongside effective S. mansoni infection control for improved growth. This study contributes fundamental knowledge for understanding the diet-malnutrition relationship in areas endemic for S. mansoni infection.

Engaging Mothers on the Growth of School-Age Children in a Rural South African Health and Demographic Site: A Qualitative Insight

A qualitative study was conducted to explore mothers' insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth.

Stunting as a Synonym of Social Disadvantage and Poor Parental Education

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

Do we need to reconsider the CMAM admission and discharge criteria?; an analysis of CMAM data in South Sudan

Background

Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. However, there exists disparity between the groups identified as malnourished by them. Thus, here we aim to investigate the clinical features and linkage with chronicity of the acute malnutrition cases identified by either WHZ or MUAC. Besides, there exists evidence indicating that fat restoration is disproportionately rapid compared to that of muscle gain in hospitalized malnourished children but related research at community level is lacking. In this study we suggest proxy measure to inspect body composition restoration responding to malnutrition management among the malnourished children.

Methods

The data of this study is from World Vision South Sudan’s emergency nutrition program from 2006 to 2012 (4443 children) and the nutrition survey conducted in 2014 (3367 children). The study investigated clinical presentations of each type of severe acute malnutrition (SAM) by WHZ (SAM-WHZ) or MUAC (SAM-MUAC), and analysed correlation between each malnutrition and chronic malnutrition. Furthermore, we explored the pattern of body composition restoration during the recovery phase by comparing the relative velocity of MUAC³ with that of weight gain.

Results

As acutely malnourished children identified by MUAC more often share clinical features related to chronic malnutrition and minimal overlapping with malnourished children by WHZ, Therefore, MUAC only screening in the nutrition program would result in delayed identification of the malnourished children.

Conclusions

The relative velocity of MUAC³ gain was suggested as a proxy measure for volume increase, and it was more prominent than that of weight gain among the children with SAM by WHZ and MUAC over all the restoring period. Based on this we made a conjecture about dominant fat mass gain over the period of CMAM program. Also, considering initial weight gain could be ascribed to fat mass increase, the current discharge criteria would leave the malnourished children at risk of mortality even after treatment due to limited restoration of muscle mass. Given this, further research should be followed including assessment of body composition for evidence to recapitulate and reconsider the current admission and discharge criteria for CMAM program.

Nutritional status of Ugandan school-children: The effect of age imprecision

OBJECTIVES

To analyze the nutritional status of Ugandan school-children in a cross-sectional and longitudinal perspective, considering the effect of age imprecision.

MATERIALS AND METHODS

Anthropometric measurements of 831 school-children (381 males and 450 females) were analyzed. A subsample of 246 children was measured in July 2014 and 2015. Stunting (based on height-for-age Z-scores), underweight (weight-for-age), and thinness (body mass index-for-age) prevalence were calculated. Three different ages were used: declared (from schools registers), attributed (based on multiple information sources), and bootstrap (from 10,000 replicates). Significant differences among malnutrition prevalence calculated with different ages and in different groups were assessed by means of bootstrap analysis. Longitudinal analysis was conducted using a paired t test.

RESULTS

The mean prevalence of malnutrition calculated with declared, attributed, or bootstrap ages were very similar: stunting (11.9-12.7); underweight (5.4-5.9); thinness (3.3-3.7); and obesity (0.7). Undernutrition was more prevalent among older children, while obesity was mostly associated with young age. Obesity was equally distributed among sexes, while undernutrition was more prevalent among females of up to 10 years of age and males above 10 years. The longitudinal analysis indicated a reduction in underweight and thinness, and an increase in stunting, especially among older children.

DISCUSSION

Age imprecision did not significantly affect malnutrition estimates. Despite the decline in the prevalence of thinness and underweight observed over a 1-year period, undernutrition persists, with an observed rise in stunting. On the other hand, obesity is starting to appear. Public health efforts are required to eliminate stunting and address the emerging burden of obesity.

MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007-2016)

BACKGROUND

Somalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy.

METHODS

We analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately.

RESULTS

A total 255,623 measurements of children 6-59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used.

CONCLUSIONS

The MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed.

Usual nutrient intake adequacy among young, rural Zambian children

Inadequate nutrient intakes put children at risk for impaired growth and development. We described diet, usual intakes of energy and macro- and micronutrients and prevalence of nutrient intake adequacies among 4–8-year-old Zambian children. Children not yet in school and living in Mkushi District, Central Province, Zambia were enrolled into an efficacy trial of pro-vitamin A biofortified maize. Children in the non-intervened arm were included in this analysis (n 202). Dietary intake data were collected by tablet-based 24-h recall on a monthly basis over the 6-month trial. Observed nutrient intakes were derived from reported food quantities, standard recipes and food composition tables. Usual nutrient intake distributions were modelled based on observed intakes. Prevalence of inadequacy was estimated by comparing the usual nutrient intake distribution to the nutrient requirement distribution. Frequency and quantity of consumption of commonly reported foods were described and key sources of energy and nutrients were identified. Median usual energy intake was 6422 kJ/d (1535 kcal/d). Most childrens’ macronutrient intakes fell within recommended ranges (74–98 %). Estimated prevalences of inadequate intakes of Fe, folate, vitamin B12 and Ca were 25, 57, 76 and >99 %, respectively. Estimated prevalences of inadequacy for other micronutrients were low (0·1–2·2 %). Commonly consumed foods included maize, vegetable oil, tomatoes, rape leaves and small fish (>0·6 servings/d), whereas meat, eggs or dairy were rarely eaten (<0·2 servings/d). These findings suggest that the heavily plant-based diet of rural Zambian children provides inadequate Ca, folate, vitamin B12 and Fe to meet recommended nutrient intakes.

Cross-sectional and longitudinal analysis of nutritional status of school-children from Bumbire Island (United Republic of Tanzania)

OBJECTIVE

To analyze the nutritional status of schoolchildren from Bumbire Island (Tanzania) from cross-sectional and longitudinal perspectives.

METHODS

During 2014 and 2015, we collected anthropometric measurements in a sample of 437 schoolchildren (226 males, 211 females; 5-16 years). A sub-sample of 126 children were measured in both surveys. Socio-demographic data have been taken and dietary habits investigated. The accuracy of age data was checked. Malnutrition prevalence was calculated according to the WHO references and the z-score criteria.

RESULTS

The prevalence of undernutrition was high (stunting: 30.7%; underweight: 12.9%; thinness: 4.5%), while overweight was rare (2.4%). The prevalence of stunting was higher in males and in older children. The one-year longitudinal analysis indicated that stunting prevalence increased.

CONCLUSIONS

Undernutrition is affecting Bumbire Island children, likely due to micronutrient deficiencies. The effects of linear growth deficit continue to accumulate throughout childhood and adolescent years.

Birth weight and prepubertal body size predict menarcheal age in India, Peru, and Vietnam

Evidence on the associations of birth weight and prepubertal nutritional status with menarcheal age for low- and middle-income countries is limited. We investigated these relationships using the Young Lives younger cohort for 2001 Indian, Peruvian, and Vietnamese girls born in 2001-2002. Girls were followed at approximately ages 1, 5, 8, and 12 years. Weibull survival models estimated hazards of earlier menarche on the basis of birth weight Z-scores (BWZ), and age-8 BMI-for-age Z-scores (BMIZ) and height-for-age Z-scores (HAZ). Estimates controlled for potential individual-, mother-, and household-level confounders and for changes in anthropometry between 1 and 8 years. In adjusted models, BWZ predicted later age at menarche (hazard ratio (HR) = 0.90, 95% CI: 0.83-0.97). Conversely, HAZ (HR = 1.66, 95% CI 1.5-1.83) and BMIZ at 8 years (HR = 1.28, 95% CI: 1.18-1.38) predicted earlier menarche. Changes in HAZ and BMIZ between 1 and 8 years were not associated with earlier menarche. Associations were consistent across countries, though with variation in estimated magnitudes. Maternal height and age were associated with later menarche. This evidence points to consistently robust and opposite associations of birth weight versus prepubertal attained height and body mass index with menarcheal age in three diverse settings with regard to nutrition, ethnicity, and socioeconomic status.

Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau

BACKGROUND

The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world.

OBJECTIVE

Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau.

METHODS

A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data.

RESULTS

Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition.

CONCLUSION

There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.

Anaemia and nutritional status of adolescent girls in Babile District, Eastern Ethiopia

INTRODUCTION

Nutritional status during adolescence plays an important role in the human lifecycle that influences growth and development and during this period nutrient needs are the greatest. The objective of this study is to assess anaemia and nutritional status of adolescent girls in the Babile district, Eastern Ethiopia.

METHODS

Data were collected from 547 adolescent aged 10-19 years by cross sectional study design. WHO Anthro-plus software was used to analyse Nutritional statuses of adolescents and magnitudes were determined using WHO 2007 references point. Haemoglobin was measured on site by hem cue machine. Descriptive and inferential statistical analysis was carried out depending on the nature of variables.

RESULTS

The result of the study show that 21.6% thin, 4.8% were over weighted and 1.1% was obese, 32% were anaemic and 15% of adolescents were stunted/ short stature than normal. Nutritional status of adolescent were low both in urban and rural adolescents, but severe thinness were higher among of rural (39.3%) compared to urban (37.5%) adolescents. Factors independently associated with stunting were place of residence, father occupation source of drinking water and age of the adolescents.

CONCLUSION

Nutritional status of adolescent girls contributes to the nutritional status of the community. There is a need to initiate intervention measures to improve the nutritional status of adolescent girls who are the future 'mothers-to-be'. Hence, there is a need to create awareness among adolescents and their family about nutrition and health.

Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference: contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh

BACKGROUND

The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC125) or a Weight-for-Height Z-score<-2 (WHZ-2), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy.

METHODS

Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ-2 or MUAC125 as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ<-2) but no linear growth retardation (HAZ≥-2), was modified by the contributors.

RESULTS

Overall 23.1% of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5% of those (949/3,328) were identified by both indicators. Being stunted (+17.8%; 95 % CI: 14.8%; 22.8%), being a female (+16.5%; 95 % CI: 13.5%; 19.5%) and being younger than 24 months (+33.6%; 95 % CI: 30.4%; 36.7%) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2%; 95 % CI: 0.7%; 7.6%). The sensitivity to detect slim children by MUAC125 was 31.0% (95 % CI: 26.8%; 35.2%) whereas it was 70.6% (95 % CI: 65.4%; 75.9%) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4% vs. 18.1% in children aged < 24 months vs. ≥ 24 months). Specificity was high for both indicators.

CONCLUSIONS

MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ-2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition.

Wasting and Stunting—Similarities and Differences: Policy and Programmatic Implications

Wasting and stunting are often presented as two separate forms of malnutrition requiring different interventions for prevention and/or treatment. These two forms of malnutrition, however, are closely related and often occur together in the same populations and often in the same children. Wasting and stunting are both associated with increased mortality, especially when both are present in the same child. A better understanding of the pathophysiology of these two different forms of malnutrition is needed to design efficient programs. A greatly reduced muscle mass is characteristic of severe wasting, but there is indirect evidence that it also occurs in stunting. A reduced muscle mass increases the risk of death during infections and also in many other different pathological situations. Reduced muscle mass may represent a common mechanism linking wasting and stunting with increased mortality. This suggests that to decrease malnutrition-related mortality, interventions should aim at preventing both wasting and stunting, which often share common causes. Also, this suggests that treatment interventions should focus on children who are both wasted and stunted and therefore have the greatest deficits in muscle mass, instead of focusing on one or the other form of malnutrition. Interventions should also focus on young infants and children, who have a low muscle mass in relation to body weight to start with. Using mid-upper-arm circumference (MUAC) to select children in need of treatment may represent a simple way to target young wasted and stunted children efficiently in situations where these two conditions are present. Wasting is also associated with decreased fat mass. A decreased fat mass is frequent but inconsistent in stunting.

Fat secretes multiple hormones, including leptin, which may have a stimulating effect on the immune system. Depressed immunity resulting from low fat stores may also contribute to the increased mortality observed in wasting. This may represent another common mechanism linking wasting and stunting with increased mortality in situations where stunting is associated with reduced fat mass. Leptin may also have an effect on bone growth. This may explain why wasted children with low fat stores have reduced linear growth when their weight-for-height remains low. It may also explain the frequent association of stunting with previous episodes of wasting. Stunting, however, can occur in the absence of wasting and even in overweight children. Thus, food supplementation should be used with caution in populations where stunting is not associated with wasting and low fat stores.

Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review

BACKGROUND

Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.

OBJECTIVE

This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.

METHODS

Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.

RESULTS

A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.

CONCLUSIONS

This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.

PROSPERO REGISTRATION NUMBER

CRD42013004399.

Stunting and soil-transmitted-helminth infections among school-age pupils in rural areas of southern China

BACKGROUND

Stunting and soil-transmitted helminth (STH) infections including ascariasis, trichuriasis and hookworm remain major public health problems in school-age pupils in developing countries. The objectives of this study were to determine the prevalence of stunting for children and its association with three major soil-transmitted helminths (STH) in rural areas of southern China. The study also aims to determine risk factors for stunting and to provide guidance on the prevention and control of stunting and STH infections for future studies in this field.

RESULTS

A cross-sectional survey was carried out in the poor rural areas in Guangxi Autonomous Regional and Hainan Province where STH prevalence was higher between September and November 2009. Pupils were from 15 primary schools. All the school-age pupils aged between 9 and 12 years old (mean age 11.2 ± 3.2 years), from grades three to six took part in this study. Study contents include questionnaire surveys, physical examination and laboratory methods (stool checking for eggs of three major STH infections and haemoglobin determination was performed for the anaemia test). Finally 1031 school-age pupils took part in survey. The results showed that the overall prevalence of stunting (HAZ < 2SD) was 25.6%, based on the WHO Child Growth Standards (2007). Risk factors for stunting based on logistic regression analyses were: (1) STH moderate-to-heavy intensity infections (OR = 1.93;95%CI:1.19,3.11); (2) anaemia (OR = 3.26;95%CI: 2.02,5.27); (3) education level of mother (OR = 2.13; 95%CI: 1.39,3.25). The overall prevalence of major STH infections was 36.7%, STH moderate-to-heavy intensity infections was 16.7%. The overall prevalence of ascariasis, trichuriasis, hookworm and co-infection were 18.5%, 11.2%, 14.7% and 9.1% respectively. The prevalence of anaemic children (HB < 12 g/dl) was 13.1%.

CONCLUSION

The present study showed that stunting was highly prevalent among the study population and STH infection is one of the important risk factors for stunting, with moderate-to-heavy intensity infections being the main predictor of stunting. Hence, additional interventions measures such as to promote de-worming treatment, to enhance health education and to improve hygiene and sanitation in order to reduce stunting in this population, are needed throughout the primary school age group.

Stunting, adiposity, and low-grade inflammation in African adolescents from a township high school

OBJECTIVE

The objective of this study was to compare the inflammatory status of children with differences in nutritional status.

METHODS

This was a cross-sectional study of 184 African children aged 13-18 y from a low socioeconomic background that compared stunted with non-stunted and lean with over-fat (percentage of body fat above normal cutoff points) children. Fasting serum tumor necrosis factor-alpha, interleukin-6, C-reactive protein, and insulin were measured using high-sensitivity methods. Body composition was assessed using anthropometry and air-displacement plethysmography. T tests for parametric data and the Mann-Whitney test for non-parametric data were used to compare groups. Regression analyses and principal components analyses were done to assess relations between body composition and biochemical variables.

RESULTS

Of all participants 18% were stunted. Serum tumor necrosis factor-alpha of stunted girls was higher than in non-stunted girls. More of the stunted boys were over-fat compared with their non-stunted counterparts. Regression analyses showed that insulin resistance, diastolic blood pressure, and C-reactive protein contributed significantly to interleukin-6 in boys. Serum C-reactive protein, waist circumference, and body mass index clustered together in factor analysis in boys. Serum interleukin-6, waist-hip ratio, and tumor necrosis factor-alpha clustered together in factor analysis in girls.

CONCLUSION

An association between adiposity and stunting and between adiposity low-grade inflammation was found in this study. Interventions for stunted children focus mainly on correction of undernutrition by providing feeding schemes. Attention should, however, also be paid to changes in body composition over time to prevent excessive abdominal fat accumulation and risk for cardiovascular diseases later in life.

Habitual physical activity and body composition of black township adolescents residing in the North West Province, South Africa

Objective

It is known that stunting and obesity affect a large proportion of children in the world, and these can be affected by the physical activity levels of the children. In the present study, we evaluated the association between physical activity, physical development and body composition in black adolescent children.

Design

Cross-sectional study.

Setting

Black township schools in the North West Province, South Africa.

Methods

Three-hundred and thirteen grade 8 children were included in the Physical Activity in Youth study. Anthropometric measurements, body composition measures and maturity level as assessed by Tanner stages were determined in these children. In addition, Previous Day Physical Activity Recall questionnaires were administered on the children to record the various activities they undertake daily.

Results

The demographic characteristics of the children showed a high level of homogeneity. A high prevalence of stunting (16.3%) was observed in the children, which was higher in boys than in girls (21.6 vs. 12.3%). Also prevalent was overweight/obesity (8.6%), but this was higher in girls than in boys (13.4 vs. 1.6%). The children also showed a reduction in levels of physical activity with advancement in maturity; furthermore, boys showed a more central form of fat deposition whilst girls showed more gynoid deposition.

Conclusions

The study revealed that physical activity plays a role in determining body composition, and further indicated that physical activity is associated with favourable body composition measures. Children who were more active were likely to have less fat deposits.

Nutritional solutions to major health problems of preschool children: how to optimise growth and development

Despite major economic development in the last few decades, childhood nutrition remains a great challenge for the human species. A combination of undernutrition, overnutrition, and poor dietary quality affect to a variable extent all of the world's populations, and are often combined in the same areas and even in the same families. Malnutrition is part of the life of many individuals since conception and is transmitted by 1 generation to the next. Countries with lower income per capita and poor socioeconomic strata are mainly affected and, in turn, malnutrition hampers their development. The eradication of child malnutrition is crucial in the fight against poverty. This article examines whether this goal will be achieved within the time frame the United Nations has set.

Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru

Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.

Nutritional status improves after treatment of schistosoma japonicum-infected children and adolescents

Studies addressing the relation between chronic schistosomiasis japonica and nutritional status are limited. We conducted a longitudinal treatment-reinfection study in Leyte, the Philippines, among 477 Schistosoma japonicum-infected subjects aged 7-20 y, to evaluate changes in nutritional status after treatment with praziquantel. Stool, Tanner stage, anthropometric indices, and hemoglobin (Hb) were evaluated at baseline, 4 wk post-treatment, and every 3 mo for 18 mo. Height-for-age Z-score (HAZ) and BMI Z-score (BMIZ) were calculated. Change scores relative to baseline were created for all outcome measures. Multilevel repeated-measures analyses were used to adjust for socioeconomic status, sex, either pubertal status or age, and household-level clustering. Z-scores improved modestly but significantly over time. BMIZ in children wasted at baseline improved the most [0.41 (0.26-0.56) Z-score unit] and HAZ improved only in children stunted at baseline [0.17 (0.l2-0.21) Z-score unit]. Hb improvement peaked at 15 mo and occurred only in subjects that were anemic at baseline [peak improvement: 8.3 (6.0-10.6) g/L] and in males [peak improvement 4.7 (2.9-6.6) g/L]. Reinfection, evaluated as egg count over time and egg count 3 mo earlier to assess a delay in effect, was inversely associated with improvement in Hb (P = 0.06 and 0.004, respectively). High-intensity reinfection at 18 mo was associated with significantly less absolute growth from baseline compared with lower-intensity and no reinfection. Based on the peak Hb improvement at 15 mo post-treatment, annual treatment intervals are recommended to reduce schistosomiasis-associated nutritional morbidity.