Malnutrition in India: status and government initiatives

Prevalence of nutritional risk and malnutrition in hospitalized patients: a retrospective, cross-sectional study of single-day screening

Hospital malnutrition remains a significant public health issue, particularly in developing countries. The Global Leadership Initiative on Malnutrition (GLIM) proposed homogenizing criteria to standardize malnutrition diagnosis. This study aimed to retrospectively determine the prevalence of nutritional risk and malnutrition diagnoses among hospitalized patients using the Nutritional Risk Screening (NRS)-2002 screening instrument and the GLIM criteria, respectively. We conducted a retrospective, cross-sectional study from nutritional records of patients hospitalized in a single centre 2021. Nutrition data from records included medical diagnosis, gender, length of stay, age, weight, height, body mass index, weight loss, calf circumference, and middle upper arm circumference. Nutritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. The study included 616 records of patients; 52.3% (n = 322) of the population were male. The prevalence of nutritional risk, according to NRS-2002, was 69.5% (n = 428). Nutritional risk as well as malnutrition diagnosis according to GLIM criteria was observed in 87.8% (n = 374) of patienttritional risk and malnutrition were evaluated using NRS-2002 and GLIM criteria. Its concordance was further evaluated by using a Kappa test. Ws. Tools showed a strong concordance (κ= 0.732). All anthropometric data, except for height, were found to be significantly different between patients with moderate and severe malnutrition (p < 0.05). Our findings highlight a high prevalence of malnutrition in this group of hospitalized patients in Mexico. NRS-2002 demonstrated good agreement with the diagnosis of malnutrition according to GLIM criteria and could be considered part of the straightforward two-step approach for malnutrition; however, further studies are needed.

Indicators of Malnutrition Among School-Going Children in an Eastern State (West Bengal) of India

This study identified determinants of malnutrition among school children in West Bengal, India. A total of 896 children aged between 4 and 13 years in eight districts were evaluated. BMI, weight, and height-for-age z-scores were used to categorize the stages of malnutrition. The study results revealed that the average height of the boys and girls was as per the standards set by the National Council of Health Sciences. Body mass index of the children ranged between 14.4 and 21.42 kg/m2, and stunting was 56.77%. Age and stunting were positively correlated in 5- to 10-year-old children. The most common deficiency was of fluoride.

Global Burden of Tuberculosis in Adolescents and Young Adults: 1990-2019

OBJECTIVE

Tuberculosis (TB) is a major health threat in adolescents and young adults. However, its burden in this population remains unclear. This study aimed to assess TB burden and changing trends in individuals aged 10 to 24 years from 1990 to 2019.

METHODS

All data were obtained from the Global Burden of Disease Study 2019. We calculated the percentage of relative changes in incident cases, deaths, and disability-adjusted life years (DALYs). The temporal trends of the incidence, mortality, and DALYs were assessed using estimated annual percentage changes (EAPCs).

RESULTS

At global level, TB incidence (per 100 000 population) decreased from 144.12 in 1990 to 97.56 in 2019, with average 1.28% (95% confidence interval [CI]: 1.36%-1.19%) of decline per year. Similar decreasing trends occurred across sex, age, sociodemographic index regions, and in most Global Burden of Disease study regions and countries. TB incidence in female adolescents decreased faster than that in male. However, there was an increasing trend in the incidence of extensively drug-resistant TB (EAPC = 11.23, 95% CI: 8.22-14.33) and multidrug-resistant TB without extensive drug resistance (EAPC = 3.28, 95% CI: 1.73-4.86). South Africa had the highest increase in TB incidence (EAPC = 3.51, 95% CI: 3.11-3.92).

CONCLUSIONS

Global TB incidence, mortality, and DALYs in adolescents and young adults decreased from 1990 to 2019. However, the incidence of drug-resistant TB increased. TB remains a threat in adolescents and young adults worldwide, especially in low- and middle-income countries.

Prevalence and Assessment of Factors Associated With Malnutrition in Children Residing in Slums of Mumbai: A Cross-Sectional Study

Background Malnutrition in children continues to be a serious public health problem in India. Therefore, this study aims to evaluate the prevalence of malnutrition and assess factors contributing to it in children of the marginalized slum population of India, masked in the metropolitan cities.  Methods A retrospective data analysis with a cross-sectional model was conducted by medical volunteers affiliated with the Rotaract Club of Medicrew who had organized a free pediatric health check-up camp in the Dharavi village of Mumbai, India for children under five. Children under five years of age group of either sex residing in the slums of Dharavi and whose parents consented are included in the study. Neonates, children older than five years of age, and children whose parents did not consent for them to be included in the study were excluded. A pretested, pre-validated questionnaire was administered, and statistical analysis was done with p-values <0.05 considered to be statistically significant. Results  A total of 126 children were included. Out of these children, 109 of them (86.50%) had a mid-arm circumference of more than 12.5 cm (normal), 11 (8.73%) were between 11.5 cm and 12.5 cm (moderate acute malnutrition), and five (4.77%) were less than 11.5 cm (severe acute malnutrition). Among the 126 kids, 86 kids were above the age of two and their BMI was assessed, 36 (44.19%) were found to be underweight (<5th percentile) while 14 (16.3%) were obese (>95th percentile), and four (4.65%) were overweight (85th-95th percentile). For 106 (84.13%) of these children, the caregivers were mothers while others were fathers (n=4; 3.18%), grandmothers (n=5; 3.97%), sisters (n=5; 3.97%), and aunts (n=6; 4.76%). Out of those who had commenced receiving formal education, only 39 (55.71%) were in an appropriate grade for their age. The mean expenditure on food as a proportion of the total household income was 36.40% (standard deviation (SD) 15.0%). On the single-item sleep quality scale, the sleep of only 36 kids (28.58%) was reported by their caregivers as excellent. A high proportion of other medical problems were reported in the children. Conclusion Our study reports a substantial burden of malnutrition among children residing in the slums of Dharavi. Rigorous strengthening and conceptualization of on-ground nutritional programs targeted toward slum children should be done by Indian healthcare policymakers.

Uncovering the genomic regions underlying grain iron and zinc content using genome-wide association mapping in finger millet

Finger millet, being rich source of essential minerals like iron and zinc, is an ideal model to identify candidate genes contributing to high grain iron content (GIC) and zinc content (GZC) in plants. Hence, finger millet diversity panel comprised of 202 genotypes was evaluated in two geographical locations and found to have a wide variation for GIC and GZC. A genome-wide association study using 2977 single nucleotide polymorphism (SNP) markers identified reliable marker-trait associations (MTAs). The use of general linear model (GLM) and mixed linear model (MLM) approaches revealed 5 and 8 common MTAs linked to GIC and GZC, respectively, for both Almora and Pantnagar locations, with a high level of significance (P < 0.01). However, 12 significant MTAs were found to be linked with GIC for Pantnagar location alone. The MTAs were associated with specific genes that produce ferritin (Fer1), iron-regulated transporter-like protein (IRT2), and yellow stripe-like 2 proteins (YSL2). These genes are likely linked to GIC variation in finger millet. Additionally, the variation in GZC in finger millet was connected to genes that encode zinc transporters, namely ZIP1 protein (ZIP1) and ZTP29-like protein (ZTP29). Compared to low GIC and GZC genotypes, high GIC and GZC genotypes exhibited greater relative expression of these genes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03889-1.

India's biogeochemical capacity to attain food security and remediate climate

In order to supply wholesome food and slow down climate change, this paper covers India's agrogeological resources. The soils are the result of the weathering of rocks with ages ranging from more than a billion years to the most recent Holocene. Because they are severely deficient in vital minerals, many soils have low agricultural production. In addition to helping to fertilise soils, reduce atmospheric carbon dioxide levels, and stop the acidification of the Indian Ocean, rock powder weathering and biochar have significant positive effects on the productivity of Indian soils. The nutrient density of food is also increased which improves health and lowers the demand for and cost of medical treatment. Remineralization may help to solve Indian soil issues including soil infertility and texture. To improve soil and plant nutrition, dusts of carbonate, basic, and ultrabasic rocks are readily available at mining sites in India combined with biochar. Adding different grain sizes to the soil helps improve the texture of the soil. Silicate and carbonate rock powders enhance soil structure by promoting the creation of soil organic matter and fostering the growth of advantageous microbial communities. These processes offer a low-cost method of remineralizing soils with important macro- and micronutrients. For each significant soil/crop/climate system, an optimised application of India's rock powder resources must be determined through a national research and development programme. India's capacity to adapt to the mounting challenges of population expansion and climate change would be significantly improved by the findings of this study programme.

Using a Responsive Feedback Approach to Develop and Pilot a Counseling Chatbot to Strengthen Child Nutrition in Rural India

INTRODUCTION

Nearly half of all deaths in children in India aged younger than 5 years are attributable to undernutrition. Reinforcing the caregiver's positive behaviors through multiple channels can lead to improved child nutrition outcomes. We describe the development and piloting of a chatbot to improve nutrition outcomes for children aged 0-12 months.

POSHAN DIDI CHATBOT DEVELOPMENT PROCESS

We engaged key stakeholders to understand existing interventions to improve nutrition outcomes and developed a theory of change that included an intervention that provides nutrition-related information directly to beneficiaries. A chatbot, Poshan Didi, was developed to provide individual counseling to mothers with children aged 0-12 months on age-appropriate, nutrition-related topics. The chatbot was piloted in Katni district from February 2019 to October 2019 in 2 phases to investigate the acceptability and feasibility of the chatbot (Phase 1, n=10 mothers) and to assess whether users would continue to be engaged and would engage with both the automated content as well as through free form questions (Phase 2, n=100 mothers). Quantitative and qualitative data were collected in focus group discussions with health care workers and mothers (n=4) and interviews with mothers (n=26).

RESULTS

Mothers viewed the chatbot as being a private channel to discuss topics and referred to Poshan Didi's persona as being knowledgeable. Eighty percent of users replied at least once to a chatbot-generated message. Sixty-four percent engaged beyond the standard chatbot content by discussing at least 1 issue with a nurse who responded to escalated messages.

CONCLUSION

This work demonstrates how chatbots could create multiple interaction touchpoints between caregivers and health care workers to increase caregivers' access to age-appropriate nutrition counseling and information. The study shows the value of using the responsive feedback approach in the chatbot design and implementation to improve the efficacy of the digital tool.

Soil micronutrients linked to human health in India

Trace soil minerals are a critical determinant of both crop productivity and the mineral concentration of crops, therefore potentially impacting the nutritional status of human populations relying on those crops. We link health data from nearly 0.3 million children and one million adult women across India with over 27 million soil tests drawn from a nationwide soil health program. We find that soil zinc availability is positively associated with children's linear height growth, and soil iron availability is positively associated with hemoglobin levels. The link between soil zinc and childhood stunting is particularly robust-a one standard deviation increase in satisfactory soil zinc tests is associated with approximately 11 fewer children stunted per 1000. We also find that this zinc-stunting relationship is strongest in wealthier households. Our results suggest that soil mineral availability impacts human nutritional status and health in at least some areas of India, and that agronomic fortification may be a beneficial intervention.

Evaluating Social Protection Policies With an Implementation Science Framework: India's Direct Benefit Transfer for Tuberculosis Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India"

Addressing the social and structural determinants of tuberculosis (TB) through social protection programs is a central feature of global public health policy and disease elimination strategies. However, how best to implement such programs remains unknown. India's direct benefit transfer (DBT) program is the largest cash transfer program in the world dedicated to supporting individuals affected by TB. Despite several studies aimed at evaluating the impact of DBT, many questions remain about its implementation, mechanisms of action, and effectiveness. Dave and Rupani's mixed-methods evaluation of this program previously published in this journal offers valuable insights into the strengths and limitations of the DBT program in improving TB treatment outcomes. Their results also provide an opportunity for demonstrating how systematically collected data may be further analyzed and presented using implementation science, a field of study using methods to promote the systematic uptake of evidence-based interventions to support sustainable program scale-up.

Reflections on Digital Maternal and Child Health Support for Mothers and Community Health Workers in Rural Areas of Limpopo Province, South Africa

INTRODUCTION

Digital health support using mobile and digital technologies, such as MomConnect and WhatsApp, is providing opportunities to improve maternal and child healthcare in low- and middle-income countries. Yet, the perspective of health service providers, pregnant women, and mothers as recipients of digital health support is under-researched in rural areas.

MATERIAL AND METHODS

An exploratory-descriptive qualitative research approach was adopted to reflect on the experiences of mothers, community leaders, and community health workers on mobile health opportunities in the context of maternal and child health in rural areas. Purposive sampling was used to select 18 participants who participated in the two focus groups and individual semi-structured interviews for data collection about digital maternal and child health support. The thematic open coding method of data analysis assisted authors in making sense of the given reflections of mothers, community leaders, and healthcare workers about digital health support.

RESULTS

Participants commented on different existing digital support apps and their importance for maternal and child health. For example, MoMConnect, Pregnancy+, WhatsApp, and non-digital resources were perceived as useful ways of communication that assist in improving maternal and child health. However, participants reported several challenges related to the use of digital platforms, which affect following the health instructions given to pregnant women and mothers.

CONCLUSIONS

Participants expressed the significant role of digital support apps in maternal and child health, which is impacted by various challenges. Addressing the lack of digital resources could improve access to health instructions for pregnant women and mothers.

Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015-2016

Anthropometric markers are the most important aspect of a child's health assessment. Using large-scale nationally representative data from the National Family Health Survey (NFHS-4), 2015-2016, this study aimed to investigate the relationship between children born to women with high-risk fertility behaviours and children's health outcomes. The sample consisted of 2,55,726 children of currently married women aged 15-49 years in India. The key explanatory variable, high-risk fertility behaviour was defined by women's age at birth (below 18 or above 34 years), birth interval (less than 24 months), and higher birth orders (four and above). The key outcome variables for assessing child health outcomes were stunting, wasting, and underweight in children aged 0-59 months. We used descriptive statistics, Pearson's chi-square test and logistic regression models to analyse the objectives. Approximately 33% of children were born with any single high-risk condition in the last 5 years in India. The bivariate analysis showed that all three components of child health, stunting, wasting, and underweight, were higher among children born to women with high-risk fertility behaviour. The findings from the multivariable analysis suggest that children born with a high risk fertility behaviour were suffering from stunting (AOR = 1.30; 95% CI 1.27-1.33) and underweight (AOR = 1.23; 95% CI 1.20-1.27). In addition, children born to women of multiple high-risk categories had higher odds of stunting (AOR = 1.53; 95% CI 1.46-1.59) and underweight (AOR = 1.38; 95% CI 1.32-1.44) as compared to children born to women with no risk. Our findings highlight an urgent need for effective legislation to prevent child marriage that would be helpful in increasing the maternal age at birth. The government should also focus on the interventions in health education and improvement of reproductive healthcare to promote optimal birth spacing.

India consists of multiple food systems with scoioeconomic and environmental variations

Agriculture in India accounts for 18% of greenhouse gas (GHG) emissions and uses significant land and water. Various socioeconomic factors and food subsidies influence diets in India. Indian food systems face the challenge of sustainably nourishing the 1.3 billion population. However, existing studies focus on a few food system components, and holistic analysis is still missing. We identify Indian food systems covering six food system components: food consumption, production, processing, policy, environmental footprints, and socioeconomic factors from the latest Indian household consumer expenditure survey. We identify 10 Indian food systems using k-means cluster analysis on 15 food system indicators belonging to the six components. Based on the major source of calorie intake, we classify the ten food systems into production-based (3), subsidy-based (3), and market-based (4) food systems. Home-produced and subsidized food contribute up to 2000 kcal/consumer unit (CU)/day and 1651 kcal/CU/day, respectively, in these food systems. The calorie intake of 2158 to 3530 kcal/CU/day in the food systems reveals issues of malnutrition in India. Environmental footprints are commensurate with calorie intake in the food systems. Embodied GHG, land footprint, and water footprint estimates range from 1.30 to 2.19 kg CO2eq/CU/day, 3.89 to 6.04 m2/CU/day, and 2.02 to 3.16 m3/CU/day, respectively. Our study provides a holistic understanding of Indian food systems for targeted nutritional interventions on household malnutrition in India while also protecting planetary health.

What matters most for early childhood development? Evidence from Malda district, India

Background

The early period of a child’s life is considered to be the most important developmental stage throughout the lifespan. Around 250 million children of age below five years in low-and middle- income countries (LMICs) are at risk of not attaining their developmental potential. A cross-sectional case study was conducted to assess the early childhood developmental (ECD) status and to investigate the factors influencing the same in Malda, India.

Methods

Information on 731 pre-school children aged 36 to 59 months was collected in 2018 using a structured questionnaire following a multi-stage, stratified simple random sampling procedure. ECD was measured following the UNICEF’s Multiple Indicator Cluster Survey, which monitors early child development in LMICs. A path analysis using structural equation modelling was carried out to examine the relationship between possible associated factors and ECD status.

Results

It has been found that only about 25% of children are developmentally on track of literacy-numeracy domain of ECD. Although, in the other domains, the situation is better. Results of the path analysis revealed that there are certain proximal factors, i.e., home environment, mother’s time for care, having home tuition and attending private pre-school, which are influenced by certain distal factors and subsequently affecting ECD. The total effects revealed that place of residence (urban or rural) affects ECD mostly (Coef. -0.87, p = <0.001) directly or via mothers’ time for stimulating activities, home environment and having home tuition for children. Further, it revealed that private pre-schools (Coef. 0.76, p = <0.001) and home tuition (Coef. 0.43, p = <0.001) also play a significant role in ECD.

Conclusion

Urgent attention from policymakers or other stakeholders is needed to promote ECD for the betterment of children and society of Malda district. In addition to that, special attention needs to be given to the children who belong to Muslim families, socially deprived communities and living in rural areas.

Traditional Dietary Knowledge of a Marginal Hill Community in the Central Himalaya: Implications for Food, Nutrition, and Medicinal Security

Himalayan communities illustrate a rich agriculture–medicine use system that not only provides adequate dietary diversity and nutrition but also delivers therapeutic security. This study explores the food–medicine interface as observed by the marginal hill communities in the central Himalaya with an aim to assess traditional agriculture and food plants with relation to dietary diversity and nutritional and medicinal values based on comprehensive research. A total of 445 respondents were interviewed to obtain data on food intakes using dietary recall methods and dietary diversity indices (DDIs). The ethnomedical use of plant species was gathered from respondents as well as from various published studies for respective species. Nutritional parameters were collected from the Indian Food Composition Table developed by the ICMR, India to analyze the average nutritional intake. The traditional food system achieves the dietary and nutritional needs of the community within the standard norms. The average household dietary diversity of 7.45, 7.34, and 8.39 in summer, monsoon, and winter seasons, respectively, sustain 79, 74, and 93% of energy requirements in respective, seasons. The average food consumption score (FCS) was 73.46, and all the food exhibited rich phytochemicals, such as amino acids, alkaloids, carotenoids, flavonoids, glycosides, and phenolic acids. These plants also provided effective treatments against several ailments and illnesses, such as cardiovascular diseases, diabetics, gastrointestinal issues, and inflammation The indigenous cuisines also have significant food and medicinal values. Considering that the community had significant knowledge of food systems with their nutritional and therapeutic utility, there is a need to protect and document this indigenous knowledge. Also, most of the crops are still under cultivation, so there is a need to create more awareness about the nutritional and therapeutic value of the system so that it could be retained intact and continued. The implications of this research are of both academic importance and practical significance to ensure food–medicine security and avoid malnutrition among rural communities. It is expected that the study would lead to renewed thinking and policy attention on traditional agriculture for its role in food and nutritional security that may lead to a sustainable food supply system.

Association of Grain Iron and Zinc Content With Other Nutrients in Pearl Millet Germplasm, Breeding Lines, and Hybrids

Micronutrient deficiency is most prevalent in developing regions of the world, including Africa and Southeast Asia where pearl millet (Pennisetum glaucum L.) is a major crop. Increasing essential minerals in pearl millet through biofortification could reduce malnutrition caused by deficiency. This study evaluated the extent of variability of micronutrients (Fe, Zn, Mn, and Na) and macronutrients (P, K, Ca, and Mg) and their relationship with Fe and Zn content in 14 trials involving pearl millet hybrids, inbreds, and germplasm. Significant genetic variability of macronutrients and micronutrients was found within and across the trials (Ca: 4.2–40.0 mg 100 g⁻¹, Fe: 24–145 mg kg⁻¹, Zn: 22–96 mg kg⁻¹, and Na: 3.0–63 mg kg⁻¹). Parental lines showed significantly larger variation for nutrients than hybrids, indicating their potential for use in hybrid parent improvement through recurrent selection. Fe and Zn contents were positively correlated and highly significant (r = 0.58–0.81; p < 0.01). Fe and Zn were positively and significantly correlated with Ca (r = 0.26–0.61; p < 0.05) and Mn (r = 0.24–0.50; p < 0.05). The findings indicate that joint selection for Fe, Zn, and Ca will be effective. Substantial genetic variation and high heritability (>0.60) for multiple grain minerals provide good selection accuracy prospects for genetic enhancement. A highly positive significant correlation between Fe and Zn and the nonsignificant correlation of grain macronutrients and micronutrients with Fe and Zn suggest that there is scope to achieve higher levels of Fe/Zn simultaneously in current pearl millet biofortification efforts without affecting other grain nutrients. Results suggest major prospects for improving multiple nutrients in pearl millet.

Superfood: Value and Need

Abstract:

Superfood is the name coined by the marketing industries to segregate the food which is claimed to have an edge over the common food, having increased nutritional efficiency, and possessing more amounts of antioxidants which lead to the prevention of many coronary heart diseases. The history and introduction of the superfood have been discussed through brief instances, and nutritional analysis of some of the most popularly available superfoods like quinoa, goji berry, acai berry, etc. has been done. Some of the indigenous superfood nutritional benefits have also been stated. The need and value with respect to the therapeutic and economic aspects of the superfood are reported in the present review in accordance with the current and relevant data.

Effect of a maternal counselling intervention delivered by community health workers on child nutrition: secondary analysis of a cluster randomised controlled trial in India

Background

India suffers from a double burden of malnutrition and anaemia. The Karnataka anaemia project indicated that a counselling intervention delivered by community health workers improved anaemia cure rates.

Objective

To evaluate the effect of maternal counselling on nutritional aspects of anaemia prevention.

Methods

Secondary analysis of a cluster randomised controlled trial (55 simultaneously randomised villages using random number generator in Chamrajnagar district, Northern India). In the intervention group mothers of anaemic children received five monthly counselling sessions plus usual care (iron and folic acid supplements), while mothers of anaemic children in the control group received usual care alone. Daily intake of nutrients related to anaemia prevention, i.e. iron (mg) and vitamin C (mg), was estimated using the 24-h dietary recall method at baseline and 6 months follow-up. Linear and logistic mixed regression models were used to assess between-groups difference in changes in nutrients intake from baseline to end of follow-up. Data collectors and analysts were blinded to the group assignment.

Results

Participants were 534 (intervention n = 303; usual treatment n = 231) anaemic children, aged 1 to 5 years and their caregivers, of whom 521(intervention n = 299 from 28 villages; usual treatment n = 222 from 27 villages) were retained at 6 months follow-up and included in the analysis. This study provides inconclusive evidence of improvement in the intake of nutrients that prevent anaemia from baseline to follow-up among the intervention compared to the control group; increase in iron intake was 0.24 mg/day (95% CI -0.67; 1.15) and increase in vitamin C intake was 4.61 mg/day (95% CI -0.69, 9.91). Although encouraging, it is notable that the overall intake of nutrients that prevent anaemia remained well below the national recommended daily allowance.

Conclusion

This study provides inconclusive evidence of the effect of parental counselling on nutritional aspects of anaemia prevention. The results highlight the need to devise multi-component anaemia-prevention interventions that include facilitators of the availability of nutritious food and should be evaluated in studies that are adequately powered to detect nutritional changes.

Trial registration

International Standard Randomized Controlled Trial Number ISRCTN68413407, prospectively registered on 17/12/2013.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11998-w.

Tuberculosis-Learning the Impact of Nutrition (TB LION): protocol for an interventional study to decrease TB risk in household contacts

BACKGROUND

Comorbidities such as undernutrition and parasitic infections are widespread in India and other tuberculosis (TB)-endemic countries. This study examines how these conditions as well as food supplementation and parasite treatment might alter immune responses to Mycobacterium tuberculosis (Mtb) infection and risk of progression to TB disease.

METHODS

This is a 5-year prospective clinical trial at Jawaharlal Institute of Post Graduate Medical Education and Research in Puducherry, Tamil Nadu, India. We aim to enroll 760 household contacts (HHC) of adults with active TB in order to identify 120 who are followed prospectively for 2 years: Thirty QuantiFERON-TB Gold Plus (QFT-Plus) positive HHCs ≥ 18 years of age in four proposed groups: (1) undernourished (body mass index [BMI] < 18.5 kg/m2); (2) participants with a BMI ≥ 18.5 kg/m2 who have a parasitic infection (3) undernourished participants with a parasitic infection and (4) controls-participants with BMI ≥ 18.5 kg/m2 and without parasitic infection. We assess immune response at baseline and after food supplementation (for participants with BMI < 18.5 kg/m2) and parasite treatment (for participants with parasites). Detailed nutritional assessments, anthropometry, and parasite testing through polymerase chain reaction (PCR) and microscopy are performed. In addition, at serial time points, these samples will be further analyzed using flow cytometry and whole blood transcriptomics to elucidate the immune mechanisms involved in disease progression.

CONCLUSIONS

This study will help determine whether undernutrition and parasite infection are associated with gene signatures that predict risk of TB and whether providing nutritional supplementation and/or treating parasitic infections improves immune response towards this infection. This study transcends individual level care and presents the opportunity to benefit the population at large by analyzing factors that affect disease progression potentially reducing the overall burden of people who progress to TB disease. Trial registration ClinicalTrials.gov; NCT03598842; Registered on July 26, 2018; https://clinicaltrials.gov/ct2/show/NCT03598842.

Poverty and childhood malnutrition: Evidence-based on a nationally representative survey of Bangladesh

BACKGROUND

Malnutrition contributes to children's morbidity and mortality, and the situation undermines the economic growth and development of Bangladesh. Malnutrition is associated with lower levels of education that decrease economic productivity and leads to poverty. The global burden of malnutrition continues to be unacceptably high amid social and economic growth, including in Bangladesh. Therefore, identifying the factors associated with childhood malnutrition and poverty is necessary to stop the vicious cycle of malnutrition leaded poverty.

METHODS

The study utilized the 2017-18 Bangladesh Demographic and Health Survey (BDHS), accumulating 7,738 mother-child pairs. Associations between potential risk factors and nutritional status were determined using chi-square tests, and multivariate logistic regression models were utilized on significant risk factors to measure their odds ratio (OR) with their 95% confidence intervals (CI).

RESULTS

The prevalence of moderate and severe wasting was 7.0% and 1.8%, respectively, whereas the prevalence of moderate and severe stunting was 19.2% and 8.0%, while 16.4% and 3.6% of children were moderately and severely underweight. Children from the poorest and poor households were suffering from at least one form of malnutrition. Adjusted ORs were estimated by controlling socio-economic and demographic risk factors, such as poor maternal body mass index, parents' lower education level, use of unhygienic toilet, child age in months, and recent experience of diarrhea and fever. The pattern was almost similar for each malnutrition status (i.e., stunting, underweight, and wasting) in the poorest and poor households.

CONCLUSION

Bangladesh achieved the Millennium Development Goals, focusing primarily on health-related indicators and working to achieve the Sustainable Development Goals. Even considering this success, the prevalence of malnutrition and poverty in same household remains relatively high compared to other developing countries. Therefore, the study recommends the implementation of nationwide systematic measures to prevent poverty and malnutrition.

Precision mapping child undernutrition for nearly 600,000 inhabited census villages in India

There are emerging opportunities to assess health indicators at truly small areas with increasing availability of data geocoded to micro geographic units and advanced modeling techniques. The utility of such fine-grained data can be fully leveraged if linked to local governance units that are accountable for implementation of programs and interventions. We used data from the 2011 Indian Census for village-level demographic and amenities features and the 2016 Indian Demographic and Health Survey in a bias-corrected semisupervised regression framework to predict child anthropometric failures for all villages in India. Of the total geographic variation in predicted child anthropometric failure estimates, 54.2 to 72.3% were attributed to the village level followed by 20.6 to 39.5% to the state level. The mean predicted stunting was 37.9% (SD: 10.1%; IQR: 31.2 to 44.7%), and substantial variation was found across villages ranging from less than 5% for 691 villages to over 70% in 453 villages. Estimates at the village level can potentially shift the paradigm of policy discussion in India by enabling more informed prioritization and precise targeting. The proposed methodology can be adapted and applied to diverse population health indicators, and in other contexts, to reveal spatial heterogeneity at a finer geographic scale and identify local areas with the greatest needs and with direct implications for actions to take place.

Food Insecurity and Dietary Intake among Rural Indian Women: An Exploratory Study

Food insecurity is an important contributor to health and a factor in both underweight and malnutrition, and overweight and obesity. Countries where both undernutrition and overweight and obesity coexist are said to be experiencing a double burden of malnutrition. India is one example of a country experiencing this double burden. Women have been found to experience the negative impacts of food insecurity and obesity, however, the reasons that women experience the impact of malnutrition more so than men are complex and are under-researched. This current research employed a mixed methods approach to begin to fill this gap by exploring the dietary intake, anthropometric characteristics, and food security status of rural Indian women. In total, 78 household were surveyed. The average waist measurement, waist to hip ratio, and BMI were all above WHO recommendations, with two thirds of participants categorized as obese. Contributing to these findings was a very limited diet, high in energy, and low in protein and iron. The findings of this research suggest that the rural Indian women in this study have a lack of diet diversity and may be at risk of a range of non-communicable diseases.

Underweight and Associated Factors Among Teenage Adolescent Girls in Resource-poor Settings: A Cross-sectional Study

Background and Purpose

Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.

Materials and Methods

In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.

Results

Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00–4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12–3.11), and number of people in the family >4 (AOR=2.18, 95%CI: 1.18–4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25–3.92), and <3 meals per day (AOR=2.36, 95%CI: 1.40–3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01–5.51) were more likely to be underweight than those from food-secure households.

Conclusion

The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.

Culinary and herbal resources as nutritional supplements against malnutrition-associated immunity deficiency: the vegetarian review

Background

Malnutrition may be due to undernutrition and/or overnutrition and is responsible for morbidity and mortality. Fulfilling nutrition requirements of all human age groups is necessary for maintenance of health and quality of life. Nutritional supplements, or daily diet, must include a sufficient amount of macronutrient (carbohydrate, protein, and fat), micronutrients (vitamins and minerals), and nonessential dietary components such as fiber.

Main body

There is a bidirectional relationship that exists between nutrition, infection, and immunity; children are dying due to malnutrition that weakens their immunity and makes them more susceptible to pathogen attack. Culinary and herbal resources containing macro- and micronutrients are required to achieve nutritional deficiencies.

Conclusion

In this review, we have documented different culinary herbs that have been used as prime herbal nutritional source and these herbs might be helpful in malnutrition and boosting immunity. The review contains the description of nutritional levels and their distribution to different age group people. This review gives insight to herbal products that boost immunity to fight against infections by restoring micronutrients.

Malnutrition and poverty in India: does the use of public distribution system matter?

Background

Large scale public investment in Public Distribution System (PDS) have aimed to reduce poverty and malnutrition in India. The PDS is the largest ever welfare programme which provides subsidised food grain to the poor households. This study attempt to examine the extent of stunting and underweight among the children from poor and non-poor households by use of public distribution system (PDS) in India.

Methods

Data from the National Family and Health Survey-4 (NFHS-4), was used for the analysis. A composite variable based on asset deprivation and possession of welfare card provided under PDS (BPL card), was computed for all households and categorised into four mutually exclusive groups, namely real poor, excluded poor, privileged non-poor and non-poor. Real poor are those economically poor and have a welfare card, excluded poor are those economically poor and do not have welfare card, privileged poor are those economically non-poor but have welfare card, and non-poor are those who are not economically poor and do not have welfare card. Estimates of stunting and underweight were provided by these four categories. Descriptive statistics and logistic regression were used for the analysis.

Results

About half of the children from each real poor and excluded poor, two-fifths among privileged non-poor and less than one-third among non-poor households were stunted in India. Controlling for socio-economic and demographic covariates, the adjusted odds ratio of being stunted among real poor was 1.42 [95% CI: 1.38, 1.46], 1.43 [95% CI: 1.39, 1.47], among excluded poor and 1.15 [95% CI: 1.12, 1.18], among privileged non-poor. The pattern was similar for underweight and held true in most of the states of India.

Conclusions

Undernutrition among children from poor households those excluded from PDS is highest, and it warrants inclusion in PDS. Improving the quality of food grains and widening food basket in PDS is recommended for reduction in level of malnutrition in India.

Under-Five Child Growth and Nutrition Status: Spatial Clustering of Indian Districts

Variation in human growth and the genetic and environmental factors that are influencing it have been described worldwide. The objective of this study is to assess the geographical variance of under-five nutritional status and its related covariates across Indian districts. We use the most recent fourth round of the Indian National Family Health Survey conducted in 2015–2016, which for the first time offers district level information. We employ principal component analysis (PCA) on the demographic and socio-economic determinants of childhood morbidity and conduct hierarchical clustering analysis to identify geographical patterns in nutritional status at the district level. Our results reveal strong geographical clustering among the districts of India, often crossing state borders. Throughout most of Southern India, children are provided with relatively better conditions for growth and improved nutritional status, as compared to districts in the central, particularly rural parts of India along the so called “tribal belt”. Here is also where girls are on average measured to have less weight and height compared to boys. Looking at average weight, as well as the proportion of children that suffer from underweight and wasting, north-eastern Indian districts offer living conditions more conducive to healthy child development. The geographical clustering of malnutrition, as well as below-average child height and weight coincides with high poverty, low female education, lower BMI among mothers, higher prevalence of both parity 4 + and teenage pregnancies. The present study highlights the importance of combining PCA and cluster analysis in studying variation in under-five child growth and of conducting this analysis at the district level. We identify the geographical areas, where children are under severe risk of undernutrition, stunting and wasting and contribute to formulating policies to improve child nutrition in India.