Factors associated with stunting in infants aged 5-11 months in the Dodota-Sire District, rural Ethiopia

Type 1 diabetes mellitus in the context of high levels of rural deprivation: differences in demographic and anthropometric characteristics between urban and rural cases in NW Ethiopia

Background

While there is increasing evidence for an altered clinical phenotype of Type 1 diabetes in several low-and middle-income countries, little is known about urban-rural differences and how the greater poverty of rural environments may alter the pattern of disease.

Objective

Investigation of urban-rural differences in demographic and anthropometric characteristics of type 1 diabetes in a resource-poor setting.

Research design and methods

Analysis of a unique case register, comprising all patients (rural and urban) presenting with Type 1 diabetes over a 20 yr. period in a poor, geographically defined area in northwest Ethiopia. The records included age, sex, place of residence, together with height and weight at the clinical onset.

Results

A total of 1682 new cases of Type 1 diabetes were registered with a mean age of onset of 31.2 (SD 13.4) yr. The patients were thin with 1/3 presenting with a body mass index (BMI) <17kg/m2. There was a striking male predominance of cases when clinical onset was between 20 and 35 yr., this was more marked in the very poor rural dwellers compared to the urban population. While most patients with Type 1 diabetes presented with low BMIs and reduced height, stunting preferentially affected rural men.

Conclusions

These data have led to the hypothesis that complex interactions among poor socioeconomic conditions in early life affect both pancreatic function and the development of autoimmunity and provide a possible explanation of the unusual phenotype of Type 1 diabetes in this very poor community.

Human Milk Micronutrients and Child Growth and Body Composition in the First 2 years: A Systematic Review

Human milk (HM) provides a plethora of nutritional and non-nutritional compounds that support infant development. For many compounds, concentrations vary substantially among mothers and across lactation, and their impact on infant growth is poorly understood. We systematically searched MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science to synthesize evidence published between 1980 and 2022 on HM components and anthropometry through 2 y of age among term-born infants. Outcomes included weight-for-length, length-for-age, weight-for-age, body mass index (in kg/m2)-for-age, and growth velocity. From 9992 abstracts screened, 144 articles were included and categorized based on their reporting of HM micronutrients, macronutrients, or bioactive components. Micronutrients (vitamins and minerals) are reported here, based on 28 articles involving 2526 mother-infant dyads. Studies varied markedly in their designs, sampling times, geographic and socioeconomic settings, reporting practices, and the HM analytes and infant anthropometrics measured. Meta-analysis was not possible because data were sparse for most micronutrients. The most-studied minerals were zinc (15 articles, 1423 dyads) and calcium (7 articles, 714 dyads). HM iodine, manganese, calcium, and zinc concentrations were positively associated with several outcomes (each in ≥2 studies), whereas magnesium (in a single study) was negatively associated with linear growth during early lactation. However, few studies measured HM intake, adjusted for confounders, provided adequate information about complementary and formula feeding, or adequately described HM collection protocols. Only 4 studies (17%) had high overall quality scores. The biological functions of individual HM micronutrients are likely influenced by other HM components; yet, only 1 study analyzed data from multiple micronutrients simultaneously, and few addressed other HM components. Thus, available evidence on this topic is largely inconclusive and fails to address the complex composition of HM. High-quality research employing chronobiology and systems biology approaches is required to understand how HM components work independently and together to influence infant growth and to identify new avenues for future maternal, newborn, or infant nutritional interventions.

Impact of low birth weight and breastfeeding practices on the nutritional status of children aged 2 to 5 years in the slums

Malnutrition among children in developing countries is a major public health problem, especially in India. Inappropriate feeding practices, in combination with other causes such as infection and food shortage, may be responsible for 1/3rd of malnutrition. Moreover, the risk of mortality is inversely related to children's height-for-age and weight-for-height. The aim: To assess the nutritional status of children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati and to determine the impact of low birth weight, breastfeeding practices and other related factors on the nutritional status of the above study population. Materials and methods: This is a community-based observational cross-sectional study conducted among 282 children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati. Socio-demographic data, Birth history, breastfeeding practices and anthropometric measurements were noted in the study questionnaire. Nutritional status was determined using HAZ, WHZ and WAZ scores of WHO child growth standards. Data was entered and analyzed using IBM SPSS Statistics 26 version to test for association between categorical variables, and a p-value < 0.05 was considered statistically significant. Results: A total of 282 school children with mean age of 39.9 (+10.4) months participated in the study, of which 132 (46.8 %) were boys and 150 (53.2 %) were girls. This study observed exclusive breastfeeding in 193 (68.4 %) children. Prevalence of stunting, wasting and being underweight were 22 %, 12.4 % and 23.8 %, respectively. A statistically significant association was found between stunting (p=0.006) and underweight (p=0.001) with low birth weight children. Conclusions: The present study revealed a high prevalence of malnutrition, especially stunting, a common outcome of long-term malnutrition among young children. Low birth weight and inappropriate breastfeeding practices result in long-term adverse consequences on the nutrition of preschool children, which should be prevented through appropriate strategies.

Dietary intake and stunting in children aged 6-23 months in rural Sumba, Indonesia

Background Linear growth retardation in the first two years of life leads to numerous harmful consequences. Lack of diversity in the diet and inadequate amounts of complementary food have been associated with stunted growth in children. Objective To assess the dietary intake and investigate for associations with stunting among children aged 6-23 months. Methods This case-control study compared the dietary intake of children aged 6-23 months with and without stunting in the South and West Wewewa subdistricts of Southwest Sumba, East Nusa Tenggara, Indonesia. Complementary food types, dietary diversity, and nutritional intake were assessed and compared between groups. Nutrient intake sufficiency and stunting were analyzed by logistic regression. Results A total of 200 participants were equally allocated into groups with and without stunting. Only 6% of stunted children received adequate complementary food diversity compared to 14% of non-stunted children (P=0.05). The stunted group had significantly lower consumption of flesh foods (beef, fish, poultry, organ meat, and other kinds of meat) compared to the non-stunted group (7% vs. 16% of subjects, respectively; P<0.05). The median total protein intake was also significantly lower in stunted children compared to non-stunted children [7.72 (IQR 6.46, 11.31) g vs. 10.02 (IQR 6.53, 13.95) g, respectively; P<0.05] although no association was found between protein intake sufficiency and stunting in the multivariate analysis. Only maternal unemployment was positively associated with stunting (OR 2.32; 95%CI 1.26 to 4.26). Conclusion Overall, most subjects did not receive sufficient amounts of nutrients. Although dietary diversity was not found to be significantly different between those with and without stunting, a significantly lower proportion of stunted children consumed flesh food. The stunted group also received significantly lower protein from their diet although no association was found between nutrient intake sufficiency and stunting. Further studies are needed to longitudinally assess the effects of macronutrient and micronutrient intake sufficiency on linear growth in children.

Factors Affecting the Knowledge and Motivation of Health Cadres in Stunting Prevention Among Children in Indonesia

Purpose

Stunting is a public health problem in Indonesia with a relatively high incidence, thereby making its prevention a priority for the Indonesian government. It potentially causes short and long effects on the quality of human resources as well as the productivity of stunted children when they grow up. Therefore, prevention and early detection efforts are needed by health professionals and cadres. Earlier studies have identified complexities associated with the determinant factors of stunting. This study aims to examine the association between sociodemographic factors as well as the knowledge and motivation of health cadres in stunting prevention in West Java.

Methods

A correlational study with a cross-sectional approach was conducted on health cadres samples from 8 districts/cities in West Java Province namely Karawang, Tasikmalaya, Garut, Bandung, Subang, Sukabumi, Cianjur, and West Bandung. A total of 363 health cadres participated and the sampling technique used is the stratified method. The data were collected using a questionnaire developed specifically for this study and were analyzed using a correlation with chi-square test and presented in the form of a frequency distribution.

Results

The results showed the majority of health cadres namely 81.27% had good knowledge, which was significantly influenced by education level and marital status with a P-value <0.05. Meanwhile, approximately half of the respondents had moderate motivation with 47.66%, while one-third or 39.12% had high motivation. This motivation was significantly influenced by education level, marital status, and age with p <0.05.

Conclusion

Based on the results, it was concluded that the roles and functions of health cadres need to be improved in the prevention and early detection of stunting in West Java by providing continuous guidance, stunting prevention training, and award presentations.

Synergy from Village, Integrated Healthcare Center, and Early Childhood Education in Stunting Prevention (Case Study)

BACKGROUND: Stunting is a growth faltering condition due to the accumulation of insufficient nutrition that lasts a long time, especially in the first 1000 days of life Basic health research (Riskedas) in 2013 stated that in Indonesia, there has been an increase in the prevalence of stunting in children from 36.8% in 2010 to 37.2% in 2013. Although the stunting rate based on Riskesdas 2018 fell to 30.8%, the challenge of accelerating stunting reduction still quite big. One of the causes is the problem of multisector convergence of planning, budgeting, actuation-implementation, monitoring, and control of programs that have not synergized with each other. AIM: This research is intended to see the picture of the synergy between village, Integrated Health Center (IHC), and early childhood education (PAUD) in preventing stunting. METHODS: This research is a case study took place s in Klaten and Boyolali areas. Research respondents are the officers of village, IHC, and PAUD. The research instrument used was questionnaire aimed at assessing the synergy between stunting prevention activities that had been carried out. This synergy includes knowledge, planning, budgeting, mobilization-implementation, monitoring, and evaluation carried out by the village, IHC and PAUD officials. Data were analyzed using one-way analysis of variance and Duncan test for further analysis (post hoc). The test was carried out with a significance level of 5%. RESULTS: Analysis of stunting prevention activities which include knowledge, planning, budgeting, actuation-implementation, monitoring, and evaluation has a relatively low average score in general. These results indicate that the synergy between village, IHC, and PAUD officials in preventing stunting is still not optimal. The achievement of the best efforts and synergies in the two areas can be seen in the implementation aspect. On the other hand, the less visible aspect is the funding aspect. The knowledge score of IHC officers is known to be lower than that of village officials and PAUD officers. Therefore, this multisector convergence problem requires a solution that is appropriate to the geographical conditions and local context. CONCLUSION: Based on the results of research conducted in the two areas that were used as research locations, the synergy between the village apparatus, IHC, and PAUD in stunting prevention activities still needs to be optimized, especially in terms of the role of each agency and the coordination of the three.

Concordance of Mother-Child (6-23 Months) Dietary Diversity and Its Associated Factors in Kucha District, Gamo Zone, Southern Ethiopia: A Community-Based Cross-Sectional Study

Meeting minimum standards of dietary quality in mothers and children is a challenge in many developing countries including Ethiopia. Emerging evidence suggests that maternal and child dietary diversity is associated, but little is known about the associated factors of concordance of mother-child dietary diversity in Ethiopia and none is documented in the study area. This study examines the concordance between mother-child (6-23 months) dyads dietary diversity and the associated factors in Kucha District, Gamo Zone, Southern Ethiopia. A community-based cross-sectional study was conducted among 791 mother-child (6-23 months) pairs from 11 selected kebeles on March 6 to April 13, 2017. Multistage cluster sampling technique was used to select the study subjects. The sampling frame was obtained from the family folder of health posts in each kebele. The mother-child pairs were selected by the simple random sampling method. The 7 food groups of the World Health Organization (WHO) for children and the 10 food groups of FANTA/FAO 2016 for mothers were used to analyze the dietary diversity. Cohen's kappa statistics was calculated to see the strength of concordance. The multivariable logistic regression model was fitted to determine factors affecting mother-child dietary diversity concordance. A good concordance was noted between mother-child dietary diversity scores (Kappa = 0.43). Only 56 (7.1%) mothers were negative deviants, and 133 (16.8%) mothers were positive deviants in dietary diversity consumption. Rural residence (AOR = 3.49; 95% CI: 1.90-6.41), having no formal education (AOR = 1.8; 95% CI: 1.08-3.05), not owning milking cow (AOR = 1.7; 95% CI: 1.10-2.56), children with low dietary diversity (AOR = 8.23; 95% CI: 5.17-13.08), and mothers with low dietary diversity (AOR = 0.46; 95% CI: 0.29-0.74) were found to be factors associated with mother-child dietary diversity concordance. An increase in the percentage of children reaching the minimum dietary diversity was greater with a successive increase in maternal dietary diversity. Despite interesting similarities between mothers and children dietary consumption, more than three-quarters of concordants did not achieve the recommended dietary diversity score (were low concordants). Interventions targeting on rural women's access to high school education, home-based milking cow rearing, and promoting nutrition-sensitive agriculture to meet the dietary requirements of mothers and children in a sustainable manner and public health efforts to improve child nutrition may be strengthened by promoting maternal dietary diversity due to its potential effect on the entire family.

Machine learning algorithms for predicting undernutrition among under-five children in Ethiopia

OBJECTIVE

Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms.

DESIGN

This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia.

SETTING

Households in Ethiopia.

PARTICIPANTS

A total of 9471 children below 5 years of age participated in this study.

RESULTS

The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others.

CONCLUSIONS

The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia.

Spatial Variation of Child Stunting and Maternal Malnutrition after Controlling for Known Risk Factors in a Drought-Prone Rural Community in Southern Ethiopia

Background

Globally, understanding spatial analysis of malnutrition is increasingly recognized. However, our knowledge on spatial clustering of malnutrition after controlling for known risk factors of malnutrition such as wealth status, food insecurity, altitude and maternal characteristics is limited from Ethiopia. Previous studies from southern Ethiopia have shown seasonal patterns of malnutrition, yet they did not evaluate spatial clustering of malnutrition.

Objective

The aim of this study was to assess whether child stunting and maternal malnutrition were spatially clustered in drought-prone areas after controlling for previously known risk factors of malnutrition.

Methods

We used a community-based cohort study design for a one-year study period. We used SaTScan software to identify high rates of child stunting and maternal malnutrition clustering. The outcome based was the presence or absence of stunting and maternal malnutrition ([BMI] <18.5 kg/m2). We controlled for previously known predictors of child stunting and maternal malnutrition to evaluate the presence of clustering. We did a logistic regression model with declaring data to be time-series using Stata version 15 for further evaluation of the predictors of spatial clustering.

Results

The crude analysis of SaTScan showed that there were areas (clusters) with a higher risk of stunting and maternal malnutrition than in the underlying at risk populations. Stunted children within an identified spatial cluster were more likely to be from poor households, had younger and illiterate mothers, and often the mothers were farmers and housewives. Children identified within the most likely clusters were 1.6 times more at risk of stunting in the unadjusted analysis. Similarly, mothers within the clusters were 2.4 times more at risk of malnutrition in the unadjusted analysis. However, after adjusting for known risk factors such as wealth status, household food insecurity, altitude, maternal age, maternal education, and maternal occupation with SaTScan analysis, we show that child stunting and maternal malnutrition were not spatially clustered.

Conclusion

The observed spatial clustering of child stunting and maternal malnutrition before controlling for known risk factors for child stunting and maternal malnutrition could be due to non-random distribution of risk factors such as poverty and maternal characteristics. Moreover, our results indicated the need for geographically targeted nutritional interventions in a drought-prone area.

Complementary Foods and Milk-Based Formulas Provide Excess Protein but Suboptimal Key Micronutrients and Essential Fatty Acids in the Intakes of Infants and Toddlers from Urban Settings in Malaysia

This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6-23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.

The association between household socio-economic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-Saharan Africa: a systematic review

Adverse birth outcomes and infant undernutrition remain the leading causes of morbidity and mortality in sub-Saharan Africa (SSA). Impaired infant growth and development, which often begins during foetal development, may persist during the first 2 years of life and has been associated with higher risks of cardiometabolic diseases. This systematic review assessed the associations between maternal demographic characteristics and household socio-economic status (SES), and preterm birth (PTB), small for gestational age, low birth weight (LBW), stunting, wasting and underweight in children under 2 years of age in SSA countries. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched for publications in three electronic databases (PubMed, Scopus and ScienceDirect). Eleven studies on children under 2 years of age, in four SSA regions, published in English between 1990 and 2018, were included. All the studies were observational in design (cross-sectional or cohort studies). Maternal education was the most commonly explored exposure. Most studies (63.3%) focused on undernutrition during the first 2 years of life: LBW, PTB and stunting. Lower maternal education, maternal unemployment and lower household wealth index were the SES factors most commonly associated with adverse birth outcomes and infant undernutrition. Maternal marital status was not associated with any infant outcomes. The definitions of the SES varied, which may explain discrepancies between studies. Nutrition intervention programs in SSA need to promote education and poverty alleviation in women at reproductive age, starting from pre-pregnancy, to optimise infant growth and development and prevent the increase in the prevalence of cardiometabolic diseases.

Pesticide Exposure and Stunting among Children in Agricultural Areas

Background:

The prevalence of growth disorders among school-aged children in Indonesia is high (30.7%). Pesticides have been massively used in Indonesian agricultural areas.

Objective:

Objective: To determine if exposure to pesticides is associated with stunting among children in agricultural areas.

Methods:

This case-control study included 160 children (48 cases and 112 controls) aged 8–12 years. Exposure to pesticides was measured based on the history of the exposure since perinatal period, infancy, and childhood of the participants. Stunting was determined as a height for age z-score (HAZ) < -2 SD. Other variables measured were levels of thyroid stimulating hormone (TSH), insulin-like growth factor-1 (IGF-1), hemoglobin, zinc, albumin, nutrient adequacy level (energy and protein), and history of infection, low-birth weight (LBW), and mother's height.

Results:

There were no significant difference between the cases and controls in terms of in the baseline characteristics, except for the median IGF-1 level; it was significantly (p<0.001) lower in the cases (66.73 ng/mL) than the controls (112.57 ng/mL). High level of pesticide exposure (p=0.029) and low IGF-1 levels (p<0.001) were significantly associated with stunting. After adjusting for confounding variables, these variables were found to be independent risk factors for stunting in children (aOR 3.90, 95% CI 1.15 to 13.26; and aOR 8.35, 95% CI 3.65 to 19.14, respectively).

Conclusion:

Pesticide exposure could be a risk factor for the occurrence of growth disorders in children living in agricultural areas. Necessary actions should be taken to protect children living in agricultural areas from exposure to pesticides.

Stunting, food security, markets and food policy in Rwanda

BACKGROUND

Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern.

METHODS

Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household.

RESULTS

Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production.

CONCLUSIONS

Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.

Development and validation of a tool to assess appetite of children in low income settings

Reliable and validated tools for measuring appetite of children in South Asia are not available. This study aimed to develop and validate a tool for assessing appetite level of under-five children. Based on literature review and findings from focus group discussions (FGDs), an initial 27-item interview-based tool, the "Early Childhood Appetite and Satiety Tool (ECAST)" was developed in Bangladesh. Fourteen FGDs were carried out in rural and urban settings and constructs for inclusion were derived from the themes and coding of FGDs and appetite assessment tools used in Western contexts. For structural validation, the ECAST-27-was administered on 150 mothers/primary caregivers of children aged 6-59 months, living in urban and rural areas. To validate the association with other variables, the ECAST was administered on mothers of children aged 12-24 months in the community (N = 50), and two groups of wasted, hospitalized children (Weight-for-length, Z score <-2SD) [group1: twenty acutely ill children aged 6-59 months; group 2: twenty children in nutritional rehabilitation aged 18-24 months]. Reliability of ECAST was estimated using Cronbach's alpha and Pearson's correlation coefficient. Kaiser-Meyer-Olkin = 0.73 and the Bartlett's test of sphericity, χ²(253) = 755.791, p < 0.001 indicated that the raw data were suitable. Given the convergence of the Scree plot, Kaiser's criterion and dropping of cross loading items, a 16-item ECAST was produced with three sub scales: Appetite cue; Food responsiveness and Emotion and preference, which were internally valid and had good test-retest reliability (Cronbach's alpha 0.6 and test-retest reliability 0.797). Total ECAST scores of wasted children with good appetite were significantly higher from those with poor appetite (p = 0.004 and 0.001 for two wasted groups respectively). Results suggest that ECAST may provide a useful measure to assess the appetite level of under-five children.

Dietary zinc intake and its determinants among Ethiopian children 6-35 months of age

Background

Adequate zinc intake is essential for the growth and neurobehavioral development of young children. Zinc deficiency in children is recognized as risk factor for stunting. In Ethiopia, 38% of children under five years of age are stunted. This analysis was conducted to measure dietary zinc intake and to identify its determinants among children 6–35 months of age to design appropriate intervention.

Methods

Nationally and regionally representative data available from 6752 children 6–35 months of age from the Ethiopian national food consumption survey were analyzed. A multivariate model was used to identify determinants of dietary zinc intake.

Results

We found low dietary zinc intake among children 6–35 month age. National average dietary zinc intake was 1.74 mg/day. Socio-economic status, maternal education, and maternal age were positively associated with dietary zinc intake, while the number of children under 5 years-of-age in a household was negatively associated with dietary zinc intake (p < 0.0001). Children reportedly sick in the previous 2 weeks were most likely to have low dietary zinc intake (p < 0.0001).

Conclusion

The observed low dietary zinc intake in Ethiopian children has a significant association with health status of children, providing evidence for nutrition and health planners to emphasize on promoting consumption of zinc rich foods and preventing morbidity from common infections.

Type 1 Diabetes in a Resource-Poor Setting: Malnutrition Related, Malnutrition Modified, or Just Diabetes?

PURPOSE OF REVIEW

Very little is known about the occurrence of type 1 diabetes (T1DM) in resource-poor countries and particularly in their rural hinterlands.

RECENT FINDINGS

Studies of the epidemiology of T1DM in Ethiopia and similar countries in sub-Saharan Africa show that the pattern of presenting disease differs substantially from that in the West. Typically, the peak age of onset of the disease is more than a decade later with a male excess and a low prevalence of indicators of islet-cell autoimmunity. It is also associated with markers of undernutrition. These findings raise the question as to whether the principal form of T1DM seen in these resource-poor communities has a different pathogenesis. Whether the disease is a direct result of malnutrition or whether malnutrition may modify the expression of islet-cell autoimmunity is unclear. However, the poor prognosis in these settings underlines the urgent need for detailed clinical and epidemiological studies.

Determinants of child anthropometric indicators in Ethiopia

Background

Malnutrition is one of the major contributors to child mortality in Ethiopia. Currently established, child nutrition status is assessed by four anthropometric indicators. However, there are other factors affecting children’s anthropometric statuses. Thus, the main objective of this paper is to explore some of the determinants of child anthropometric indicators in Ethiopia.

Methods

Data from GROW (the Growing Nutrition for Mothers and Children), a survey including 1261 mothers and 1261 children was carried out in Ethiopia in 2016. Based on the data gathered, the goal of GROW is to improve the nutritional status of women of reproductive age (15–49), as well as boys and girls under 5 years of age in Ethiopia. In order to investigate the association between different factors and child anthropometric indicators, this study employs various statistical methods, such as ANOVA, T-test, and linear regressions.

Results

Child’s sex (confidence intervals for (wasting = − 0.782, − 0.151; stunting = − 0.936,-0.243) (underweight = − 0.530, − 0.008), child’s age (confidence intervals for (wasting = − 0.020, 0.007; stunting = − 0.042,-0.011) (underweight = − 0.025, − 0.002), maternal MUAC (confidence intervals for (wasting = 0.189, 0.985; BMI-for-age = 0.077, 0.895), maternal education (stunting = 0.095, 0.897; underweight = 0.120, 0.729), and open defecation (stunting = 0.055, 0.332; underweight = 0.042, 0.257) were found to be significantly associated with anthropometric indicators. Contrary to some findings, maternal dietary diversity does not present significance in aforementioned child anthropometric indicators.

Conclusion

Depending on the choice of children anthropometric indicator, different conclusions were drawn demonstrating the association between each factor to child nutritional status. Results showed child’s sex, age, region, open defecation, and maternal MUAC significantly increases the risk of child anthropometric indicators. Highlighting the factors influencing child undernutrition will help inform future policies and programs designed to approach this major problem in Ethiopia.

Nutritional Status of Under Five Children in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Undernutrition is the outcome of insufficient food intake and recurrent infectious diseases. The baseline levels of undernutrition remain so high that Ethiopia still needs to continue substantial investment in nutrition.Therefore, the aim of this study was to obtain estimates of over-time trends in the prevalence of undernutrition in Ethiopia and to determine risk factors for undernutrition among children of under five years of age.

METHODS

Cross-sectional studies published in English from 1997 to 2015 focusing the prevalence of stunting, wasting and underweight in children aged 0-5 years (n = 39,585) in Ethiopia were included in this systematic review and meta-analysis. We searched in PubMed and Scopus databases and other articles manually. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias in the included studies. The protocol number of the study is PROSPERO 2015: CRD42015027940.

RESULTS

Eighteen studies were included and the overall pooled prevalence estimate of stunting, underweight and wasting was 42.0% (95% CI: 37.0, 46.0), 33.0 % (95% CI: 27.0, 39.0) and 15.0% (95% CI: 12.0, 19.0), respectively. The sensitivity analyses resulted in the prevalence of stunting, 40% (95% CI: 32.0, 48.0; I2=99.19%), prevalence of underweight, 33%(95% CI: 24.0, 42.0; I²=99.34%) and wasting rate equal to 19%(95% CI: 14.0, 24.0; I2=99.19%). Cumulative analysis revealed a stabilization trend of stunting and underweight (1996-2010) followed by an upward trend (2010-2014). Child age, child sex, complementary food, poor dietary diversity, diarrheal diseases, maternal education, maternal height, residential area and socio- economic status were significant risk factors for undernutrition.

CONCLUSION

The result of the meta-analysis of thes observational studies revealed that the trend of undernutrition in Ethiopia indicates that there is an increment of chronic malnutrition cases in recent years, and the prevalence of undernutrition remains extremely high. Thus, the implementation of policies to reverse child undernutrition should get maximum emphasis.

Associations of childhood, maternal and household dietary patterns with childhood stunting in Ethiopia: proposing an alternative and plausible dietary analysis method to dietary diversity scores

BACKGROUND

Identifying dietary patterns that consider the overall eating habits, rather than focusing on individual foods or simple counts of consumed foods, better helps to understand the combined effects of dietary components. Therefore, this study aimed to use dietary patterns, as an alternative method to dietary diversity scores (DDSs), and investigate their associations with childhood stunting in Ethiopia.

METHODS

Mothers and their children aged under 5 years (n = 3788) were recruited using a two-stage random cluster sampling technique in two regions of Ethiopia. Socio-demographic, dietary and anthropometric data were collected. Dietary intake was assessed using standardized dietary diversity tools. Household, maternal and child DDSs were calculated and dietary patterns were identified by tetrachoric (factor) analysis. Multilevel linear and Poisson regression analyses were applied to assess the association of DDSs and dietary patterns with height-for-age z score (HAZ) and stunting, respectively.

RESULTS

The overall prevalence of stunting among children under-five was 38.5% (n = 1459). We identified three dietary patterns each, for households ("fish, meat and miscellaneous", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"), mothers ("plant-based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit" and children ("grain based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"). Children in the third tertile of the household "dairy, vegetable and fruit" pattern had a 0.16 (β = 0.16; 95% CI: 0.02, 0.30) increase in HAZ compared to those in the first tertile. A 0.22 (β = 0.22; 95% CI: 0.06, 0.39) and 0.19 (β = 0.19; 0.04, 0.33) increase in HAZ was found for those in the third tertiles of "dairy, vegetable and fruit" patterns of children 24-59 months and 6-59 months, respectively. Those children in the second (β = -0.17; 95% CI: -0.31, -0.04) and third (β = -0.16; 95% CI: -0.30, -0.02) tertiles of maternal "egg, meat, poultry and legume" pattern had a significantly lower HAZ compared to those in the first tertile. No significant associations between the household and child "egg, meat, poultry and legume" dietary patterns with HAZ and stunting were found. Statistically non-significant associations were found between household, maternal and child DDSs, and HAZ and stunting.

CONCLUSION

A higher adherence to a "dairy, vegetable and fruit" dietary pattern is associated with increased HAZ and reduced risk of stunting. Dietary pattern analysis methods, using routinely collected dietary data, can be an alternative approach to DDSs in low resource settings, to measure dietary quality and in determining associations of overall dietary intake with stunting.

Spatial heterogeneity and risk factors for stunting among children under age five in Ethiopia: A Bayesian geo-statistical model

Background

Understanding the spatial distribution of stunting and underlying factors operating at meso-scale is of paramount importance for intervention designing and implementations. Yet, little is known about the spatial distribution of stunting and some discrepancies are documented on the relative importance of reported risk factors. Therefore, the present study aims at exploring the spatial distribution of stunting at meso- (district) scale, and evaluates the effect of spatial dependency on the identification of risk factors and their relative contribution to the occurrence of stunting and severe stunting in a rural area of Ethiopia.

Methods

A community based cross sectional study was conducted to measure the occurrence of stunting and severe stunting among children aged 0–59 months. Additionally, we collected relevant information on anthropometric measures, dietary habits, parent and child-related demographic and socio-economic status. Latitude and longitude of surveyed households were also recorded. Local Anselin Moran's I was calculated to investigate the spatial variation of stunting prevalence and identify potential local pockets (hotspots) of high prevalence. Finally, we employed a Bayesian geo-statistical model, which accounted for spatial dependency structure in the data, to identify potential risk factors for stunting in the study area.

Results

Overall, the prevalence of stunting and severe stunting in the district was 43.7% [95%CI: 40.9, 46.4] and 21.3% [95%CI: 19.5, 23.3] respectively. We identified statistically significant clusters of high prevalence of stunting (hotspots) in the eastern part of the district and clusters of low prevalence (cold spots) in the western. We found out that the inclusion of spatial structure of the data into the Bayesian model has shown to improve the fit for stunting model. The Bayesian geo-statistical model indicated that the risk of stunting increased as the child’s age increased (OR 4.74; 95% Bayesian credible interval [BCI]:3.35–6.58) and among boys (OR 1.28; 95%BCI; 1.12–1.45). However, maternal education and household food security were found to be protective against stunting and severe stunting.

Conclusion

Stunting prevalence may vary across space at different scale. For this, it's important that nutrition studies and, more importantly, control interventions take into account this spatial heterogeneity in the distribution of nutritional deficits and their underlying associated factors. The findings of this study also indicated that interventions integrating household food insecurity in nutrition programs in the district might help to avert the burden of stunting.

The Effect of Low Dose Iron and Zinc Intake on Child Micronutrient Status and Development during the First 1000 Days of Life: A Systematic Review and Meta-Analysis

Adequate supply of micronutrients during the first 1000 days is essential for normal development and healthy life. We aimed to investigate if interventions administering dietary doses up to the recommended nutrient intake (RNI) of iron and zinc within the window from conception to age 2 years have the potential to influence nutritional status and development of children. To address this objective, a systematic review and meta-analysis of randomized and quasi-randomized fortification, biofortification, and supplementation trials in women (pregnant and lactating) and children (6–23 months) delivering iron or zinc in doses up to the recommended nutrient intake (RNI) levels was conducted. Supplying iron or zinc during pregnancy had no effects on birth outcomes. There were limited or no data on the effects of iron/zinc during pregnancy and lactation on child iron/zinc status, growth, morbidity, and psychomotor and mental development. Delivering up to 15 mg iron/day during infancy increased mean hemoglobin by 4 g/L (p < 0.001) and mean serum ferritin concentration by 17.6 µg/L (p < 0.001) and reduced the risk for anemia by 41% (p < 0.001), iron deficiency by 78% (ID; p < 0.001) and iron deficiency anemia by 80% (IDA; p < 0.001), but had no effect on growth or psychomotor development. Providing up to 10 mg of additional zinc during infancy increased plasma zinc concentration by 2.03 µmol/L (p < 0.001) and reduced the risk of zinc deficiency by 47% (p < 0.001). Further, we observed positive effects on child weight for age z-score (WAZ) (p < 0.05), weight for height z-score (WHZ) (p < 0.05), but not on height for age z-score (HAZ) or the risk for stunting, wasting, and underweight. There are no studies covering the full 1000 days window and the effects of iron and zinc delivered during pregnancy and lactation on child outcomes are ambiguous, but low dose daily iron and zinc use during 6–23 months of age has a positive effect on child iron and zinc status.

Assessment of the WHO Stunting Framework using Ethiopia as a case study

Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the 'WHO framework') that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country-level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhoea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts. © 2016 John Wiley & Sons Ltd.

How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural Northern Ghana?

Background

Though the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators.

Methods

A community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure.

Results

Of the 1984 children aged 6–23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (≥4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively.

Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR = 0.75, CI = 0.50 - 0.95, P = 0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index.

After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (β = 0.10, p = 0.005) but was not associated with mean LAZ.

Conclusions

The WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2494-7) contains supplementary material, which is available to authorized users.

Nutrition education and introduction of broad bean-based complementary food improves knowledge and dietary practices of caregivers and nutritional status of their young children in Hula, Ethiopia

BACKGROUND

Nutritious complementary foods are needed in countries where undernutrition and stunting are major problems, but mothers may be reluctant to change from traditional gruels.

OBJECTIVE

To test whether a recipe-based complementary feeding education intervention would improve knowledge and practice of mothers with young children in Hula, Ethiopia.

METHODS

A baseline survey of 200 eligible, randomly selected mother-child pairs gathered data on sociodemographic characteristics, food security status, knowledge and practices concerning complementary feeding, food group intakes of children aged 6 to 23 months by 24-hour recalls, and children's anthropometric measurements. Twice a month for 6 months, women in the intervention group received an education session consisting of eight specific messages using Alive and Thrive posters and a demonstration and tasting of a local barley and maize porridge recipe containing 30% broad beans. The control group lived in a different area and had no intervention.

RESULTS

At 6 months, knowledge and practice scores regarding complementary feeding were significantly improved (p < .001) in the intervention group but not in the control group. The intervention resulted in improvement of children's dietary diversity, as well as mean intake of energy and selected nutrients, compared with children in the control group. Changes in height and weight did not differ between the two groups.

CONCLUSIONS

Community-based nutrition education over 6 months that included demonstration of a local porridge recipe with broad beans added improved the complementary feeding practices of caregivers and the nutritional status of their young children.

High frequency of symptomatic zinc deficiency in infants in northern ethiopia

Background. Zinc deficiency occurs in infants when its demand exceeds its supply. It presents with cutaneous signs which, in severe cases, are associated with diarrhea, alopecia, and irritability. Genetic and acquired forms of zinc deficiency have been reported and often overlap clinical features. Malnutrition, prematurity, malabsorption syndromes, and burns may cause an increased demand for zinc. Methods. Cases of acquired transient infantile zinc deficiency (TIZD) observed during a period of 3 years at Ayder Referral Hospital of Mekelle, Northern Ethiopia, are reported here. Since no sophisticated tests were available at our center, the diagnosis was based on the clinical signs and prompt response to oral zinc supplementation. Results. We observed 18 cases of TIZD at our center. All patients were full-term and breastfeeding infants with no relevant associated diseases. Conclusions. In this region, a high incidence of this condition is observed. We could not rule out whether heterozygosity for the genetic mutation was present or that the disease was caused by a nutritional deficiency in the mothers or more probably because both the factors coexisted together. However, further studies are necessary to better understand the causes of the increased incidence of this disease in Northern Ethiopia.

Magnitude and Determinants of Stunting Among Children in Africa: A Systematic Review

Globally it is estimated that 162 million under-five year old children are stunted. Africa is known with one of the highest prevalence of stunting in the world. Even though studies suggested various determinants for stunting in Africa; there is lack of agreement about the relative importance of factors affecting the nutritional status of children. We reviewed all literatures, including: observational studies, and prospective randomized controlled trials (RCTs) evaluating the prevalence and determinants of stunting in children under the age of five years in Africa to identify systematically, appraise and synthesize the best available evidence on the magnitude and epidemiological factors for stunting among children under the age of five years in Africa by conducting electronic search of Medline, Pub Med, Health Inter-network access to Research Initiative (HINARI), and Google Scholar databases. After exclusion of irrelevant ones, 21 out of 55 articles were considered for the final analysis. On the basis of this review, majority of the articles reported highest prevalence of stunting in Africa and its progress is found unsatisfactory. Inappropriate complementary feeding practice, maternal under nutrition, household food insecurity, economic growth and maternal education, are identified as the principal determinants of stunting. Some studies confer the determinants of stunting is multidimensional and intertwined. The remaining articles reviewed, noted the synergistic interaction between inadequate dietary intake and disease as the main determinant of stunting. The magnitude of stunting in Africa is found as one of the highest in the world and the trend shows stagnating rather than progress. It is confirmed that the determinants of stunting in the continent are varied and intertwined; showing variations from region to region. It is recommended that; African countries should give more emphasis to fight stunting; further research on target implementation sites is needed before creating health policies. They should also consider the cultural beliefs and socio cultural realities of their population. We therefore encourage policy makers to use facts from this review on creating policies to reverse the situation.

Factors associated with stunting among children of age 24 to 59 months in Meskan district, Gurage Zone, South Ethiopia: a case-control study

Background

Stunting is one of the major causes of morbidity among under-five children Knowledge about risk factors of stunting is an important precondition for developing and strengthening nutritional intervention strategies. The purpose of this study was to assess factors associated with stunting among children of age 24 to 59 months in Meskan District of Gurage Zone, South Ethiopia.

Methods

Community based case-control study was conducted among children of age 24 to 59 months. A multistage sampling technique was used to select the study participants. Cases were stunted children while controls were not stunted children. A total of 121 cases and 121 controls were studied.. Data were analyzed using SPSS 16.0 statistical software.

Results

Children living in households with eight to ten [Adjusted Odds Ratio (AOR) = 4.44, 95% CI: 1.65, 11.95] and five to seven [AOR = 2.97, 95% CI: 1.41, 6.29] family members were more likely to be stunted than those living in households with two to four family members. Similarly, children living in households with three under-five children [AOR = 3.77, 95% CI: 1.33, 10.74] were more likely to develop stunting than those living in households with one under-five child. Children whose mothers worked as merchants [AOR = 4.03, 95% CI: 1.60, 10.17] were more likely to be stunted than children whose mothers worked as house wives. Children who breast fed for <2 years [AOR = 5.61, 95% CI: 1.49, 11.08] were more likely to be stunted than those who breast fed ≥2 years. Children who were exclusively breast fed for <6 months [AOR = 3.27, 95% CI: 1.21, 8.82]were more likely to develop stunting than children who were exclusively breast fed for the first 6 months. Children who bottle fed [AOR =3.30, 95% CI: 1.33, 8.17)] were more likely to be stunted than children who fed their complementary food using spoon/cup.

Conclusions

Family size, number of under-five children in the household, maternal occupation, duration of exclusive breastfeeding, duration breast feeding, and method of feeding complementary food were independently associated with stunting. Thus, public health intervention working on improving child nutrition should consider these determinants.

Consumption of vitamin A rich foods and dark adaptation threshold of pregnant women at Damot Sore District, Wolayita, Southern Ethiopia

BACKGROUND

More than 7.2 million pregnant women in developing countries suffer from vitamin A deficiency. The objective of this study was to assess dark adaptation threshold of pregnant women and related socio-demographic factors in Damot Sore District, Wolayita Zone, Southern Ethiopia.

METHODS

A cross-sectional study design was employed to collect data from 104 pregnant women selected by a two stage cluster sampling. A Dietary Diversity Score was calculated by counting the number of food groups consumed by the women in 24 hour period prior to the study. Scotopic Sensitivity Tester-1 was used to test participant's pupillary response to graded amounts of light in a dark tent.

RESULTS

Half of the pregnant women in this study had dietary diversity score less than three. The majority of participants (87.5%) had consumed either animal or plant source vitamin A rich foods less than three times a week. For a unit increase in individual dietary diversity score, there was a decrease in dark adaptation measurement by 0.29 log cd/m(2) (p=0.001). For a unit increase in gestational week of pregnancy, there was an increase in dark adaptation measurement by 0.19 log cd/m(2) (P=0.027).

CONCLUSIONS

Results from this study indicated that the pregnant women had low consumption of vitamin A rich foods, and their dark adaptation threshold increases with gestational age indicating that their vitamin A status is getting worse. There is a need to design appropriate intervention and target this group of population.

Contextualising complementary feeding in a broader framework for stunting prevention

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short- and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia

Introduction

The period from birth to two years of age is a “critical window” of opportunity for the promotion of optimal growth, health and behavioral development of children. Poor child feeding patterns combined with household food insecurity can lead to malnutrition which is a major public health problem in developing countries like Ethiopia.

Methods

A community based cross-sectional study that involved 575 participants from rural Sidama was conducted from February to March 2011. A two-stage stratified sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics.

Results

Only 14.4% of mothers fed their children optimally. Prevalence of stunting was higher for infants aged 6 to 8 months (43%) than for those in 0-5 months (26.6%) or 9-23 months (39%) category. Women who did not receive antenatal care(ANC) during pregnancy were 1.5 times more likely to practice pre-lacteal feeding and 2.8 and 1.9 times more likely to feed their children below minimum dietary diversity and minimum meal frequency, respectively (P=0.01). Mothers older than 18 years during the birth of index child were 86% less likely to feed their child below minimum meal frequency than their younger counterparts (P=0.01). Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01).

Conclusion

The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ANC attendance should be strengthened through extensive use of the Health Extension Workers to reduce the level of child stunting in the study area.

Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings

BACKGROUND

Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested.

OBJECTIVE

The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal.

DESIGN

This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion.

RESULTS

A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ) <-2.0] rates increased from ~33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P < 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group.

CONCLUSION

The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods.

Application of in vitro bioaccessibility and bioavailability methods for calcium, carotenoids, folate, iron, magnesium, polyphenols, zinc, and vitamins B(6), B(12), D, and E

A review of in vitro bioaccessibility and bioavailability methods for polyphenols and selected nutrients is presented. The review focuses on in vitro solubility, dialyzability, the dynamic gastrointestinal model (TIM)™, and Caco-2 cell models, the latter primarily for uptake and transport, and a discussion of how these methods have been applied to generate data for a range of nutrients, carotenoids, and polyphenols. Recommendations are given regarding which methods are most justified for answering bioaccessibility or bioavailability related questions for specific nutrients. The need for more validation studies in which in vivo results are compared to in vitro results is also discussed.

Meat consumption is associated with less stunting among toddlers in four diverse low-income settings

BACKGROUND

Early growth faltering is common but is difficult to reverse after the first 2 years of life.

OBJECTIVE

To describe feeding practices and growth in infants and young children in diverse low-income settings prior to undertaking a complementary feeding trial.

METHODS

This cross-sectional study was conducted through the Global Network for Women's and Children's Health Research in Guatemala, Democratic Republic of Congo, Zambia, and Pakistan. Feeding questionnaires were administered to convenience samples of mothers of 5- to 9-month old infants and 12- to 24-month-old toddlers. After standardized training, anthropometric measurements were obtained from the toddlers. Following the 2006 World Health Organization Growth Standards, stunting was defined as length-for-age < -2SD, and wasting as weight-for-length < -2SD. Logistic regression was applied to evaluate relationships between stunting and wasting and consumption of meat (including chicken and liver and not including fish).

RESULTS

Data were obtained from 1,500 infants with a mean (+/- SD) age of 6.9 +/- 1.4 months and 1,658 toddlers with a mean age of 17.2 +/- 3.5 months. The majority of the subjects in both age groups were breastfed. Less than 25% of the infants received meat regularly, whereas 62% of toddlers consumed these foods regularly, although the rates varied widely among sites. Stunting rate ranged from 44% to 66% among sites; wasting prevalence was less than 10% at all sites. After controlling for covariates, consumption of meat was associated with a reduced likelihood of stunting (OR = 0.64; 95% CI, 0.46 to 0.90).

CONCLUSIONS

The strikingly high stunting rates in these toddlers and the protective effect of meat consumption against stunting emphasize the need for interventions to improve complementary feeding practices, beginning in infancy.

Iron and zinc content of selected foods in the diet of schoolchildren in Kumi district, east of Uganda: a cross-sectional study

BACKGROUND

Iron and zinc are essential micronutrients for humans and deficiency of the two elements is widespread in the world with the highest prevalence in less developed countries. There are few data on dietary intake of iron and zinc in Uganda, and no food composition table is available. There is hardly any widely published literature that clearly documents the quality of Ugandan children's diet. Thus information of both food intake and the concentration of these trace elements in local food ingredients are needed in order to assess daily intake.

METHODS

The present study focused on the iron and zinc content in selected foods and intake of the micronutrients iron and zinc among schoolchildren in Kumi District, Uganda. Over a period of 4 weeks single 24-hour dietary recall interviews were carried out on a convenience sample of 178 schoolchildren (9-15 years old). Data from the dietary recalls was used when selecting foods for chemical analysis.

RESULTS

Results from this study showed that the iron concentrations varied, and were high in some cereals and vegetables. The zinc concentrations in foods generally corresponded with results from other African countries (Mali and Kenya). Data from the 24-hour dietary recall showed that the daily Recommended Nutrient Intake (RNI) was met for iron but not for zinc.

CONCLUSIONS

The schoolchildren of Kumi district had a predominantly vegetable based diet. Foods of animal origin were consumed occasionally. The iron content in the selected foods was high and variable, and higher than in similar ingredients from Kenya and Mali, while the zinc concentrations were generally in accordance with reported values. The total daily zinc (mg) intake does not meet the daily RNI. The iron intake is adequate according to RNI, but due to iron contamination and reduced bioavailability, RNI may not be met in a vegetable based diet. More studies are needed to investigate possible sources of contamination.

The impact of prenatal vitamin A and zinc supplementation on growth of children up to 2 years of age in rural Java, Indonesia

OBJECTIVE

To determine whether prenatal vitamin A and/or Zn supplementation affects postnatal growth.

DESIGN

Follow-up of a randomized controlled trial monitoring growth in children from birth up to 24 months of age.

SETTING

Central Java, Indonesia.

SUBJECTS

Children (n 343) of mothers participating in a double-blinded, randomized controlled study of vitamin A and/or Zn supplementation during pregnancy. We report the effects of prenatal supplementation on infant growth, measured as weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and weight-for-height Z-scores (WHZ ), from 0 to 24 months, as well as differences in growth faltering among the supplementation groups.

RESULTS

For HAZ, the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0·34 SD and 0·37 SD, respectively, and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0·31 SD. Compared with placebo, none of the supplements affected growth. Defining growth faltering as a downward crossing of two or more major percentile lines, 50-75% of the children were found to be growth faltering within 9 months of age, whereas 17% and 8% scored <-2 SD for WAZ and HAZ, respectively. Prenatal supplementation did not reduce the prevalence of growth faltering.

CONCLUSIONS

Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of children's length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone, but not compared with placebo. It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering. Future studies should duplicate these findings before recommendations can be made.

Essential role of vitamin C and zinc in child immunity and health

With the progressive elimination of dietary protein-energy deficits, deficiencies of micronutrients are emerging as the limiting factors in ensuring children's optimal health. Data from several countries in Asia and Latin America indicate that deficiencies of vitamin C and zinc continue to be at alarming levels. This article reviews the roles of vitamin C and zinc in supporting children's growth and development, with a particular focus on the complementary roles they play in supporting immune functions and combating infections. The contemporary relevance of vitamin C and zinc deficiency in the Asian and Latin American regions, both undergoing a rapid nutritional transition, are also discussed. Overall, there is increasing evidence that deficiency of vitamin C and zinc adversely affects the physical and mental growth of children and can impair their immune defences. Nutrition should be the main vehicle for providing these essential nutrients; however, supplementation can represent a valid support method, especially in developing regions.

Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: the P-MaMiE Birth Cohort

Background

Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts.

Methods

A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age <-2), underweight (weight-for-age <-2) and wasting (weight-for-length <-2).

Results

The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life.

Conclusion

There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.

A cross-sectional study of the growth characteristics of Nigerian infants from birth to 2 years of age

Malnutrition compromises the growth of children in sub-Saharan Africa. In Nigeria, the prevalence of childhood malnutrition approaches 40%. There are few reports relating the growth characteristics of breast-fed Nigerian infants to the anthropometric properties of their mothers. A total of 100 urban and rural mother/baby pairs were recruited. The mean BMI values of the urban and rural mothers were 24.2 and 21.3 kg m(-2), respectively. The mean length, weight and head circumference of the rural infants were significantly lower than those of the urban infants. Z-scores based on World Health Organization standards showed: (i) length-for-age z-score <-2 in urban (27%) and rural (33%) children; (ii) a higher incidence of underweight and small HC in rural (33%; and 13%) versus urban children (12% and 0%); and (iii) positive correlations between all three z-scores and maternal BMI. Negative correlations were observed between infant age and z-scores for length-for-age, weight-for-age and HC-for-age.

Dietary intervention strategies to enhance zinc nutrition: promotion and support of breastfeeding for infants and young children

Breastmilk is the only dietary source of zinc for exclusively breastfed young infants, and it remains a potentially important source of zinc for older infants and young children who continue breastfeeding beyond early infancy. Therefore, we examined available information on breastmilk zinc concentration and total milk consumption to develop estimates of the amount of zinc transferred in breastmilk to children of different ages. Breastmilk zinc concentration declines rapidly during the first few months postpartum and more slowly thereafter. Breastmilk supplies all of the theoretical zinc needs for at least the first several months of life, although the period during which breastmilk alone remains sufficient is uncertain. Breastmilk continues to provide more than half of children's estimated zinc requirements after the introduction of complementary foods, even into the second year of life. Public health programs to promote and support breastfeeding should be included among the strategies to ensure adequate zinc status of young children.

Inadequate feeding practices and impaired growth among children from subsistence farming households in Sidama, Southern Ethiopia

Whether current child feeding practices and behaviours among rural households in Sidama, Southern Ethiopia conform to the World Health Organization (WHO) guiding principles for complementary feeding is uncertain. We assessed socio-demographic status, anthropometry, breastfeeding, complementary feeding practices and behaviours, and motor development milestones in a convenience sample of 97 breastfed children aged 6-23 months from three rural Sidama communities. Energy and nutrient intakes from complementary foods were also calculated from 1-day in-home weighed records. Prevalence of stunting ranged from 25% for infants aged 6-8 months to 52% for children aged 12-23 months, whereas for wasting, the corresponding prevalence was 10% and 14%, respectively. Very few children were exclusively breastfed up to 6 months of age (n = 2), or received solids/semi-solids for the recommended minimum number of times containing the recommended number of food groups. Responsive feeding was not practised and no cellular animal products were consumed. Median intakes of energy, and intakes and densities of micronutrients from complementary foods (but not protein) were below WHO recommendations, assuming average breast milk intakes; greatest shortfalls were for retinol, vitamin C and calcium densities. Mothers of stunted children were shorter and lighter, and from households of lower socio-economic status than non-stunted children (P < 0.05). Acquisition of some motor development milestones was delayed in stunted infants compared with their non-stunted counter-parts. In conclusion, interventions that address the WHO guiding principles for complementary feeding practices and behaviours, as well as prenatal influences on growth, are urgently required in this setting.

Outcome of severely malnourished children treated according to UNICEF 2004 guidelines: a one-year experience in a zone hospital in rural Ethiopia

Malnutrition still has a dramatic impact on childhood mortality in sub-Saharan African countries. Very few studies have tried to evaluate the outcome of severely malnourished children treated according to the UNICEF 2004 guidelines and reported fatality rates are still very high. During 2006, 1635 children were admitted to the paediatric ward of St. Luke Catholic Hospital in Wolisso, South West Shewa, Ethiopia. Four hundred and ninety-three (30.15%) were severely malnourished and were enrolled in the study. We reviewed the registration books and inpatient charts to analyze their outcome. A mortality rate of 7.1% was found, which is significantly lower than reported in the literature. 28.6% of deaths occurred within 48 h of admission; the recovery rate was 88.4%; the drop-out rate was 4.5%. Early deaths were due to the poor condition of the children on admission, leading to failure of treatment. Late mortality was considered to be related to electrolyte imbalances, which we were unable to measure. The clinical skills of nursing and medical staff were considered an important factor in improving the outcome of malnourished patients. We found that proper implementation of WHO guidelines for the hospital treatment of severely malnourished children can lead to a relatively low mortality rate, especially when good clinical monitoring is assured.

Nutritional status of low-birthweight ethnic minority infants in Backan province, Vietnam

BACKGROUND

Birthweight and length have been reported to be important determinants of infant growth and future nutritional status. The study aims to describe the weight and length growth patterns during the first year of life of low-birthweight (LBW) ethnic minority infants in the mountainous province Backan, Vietnam.

METHODS

A total of 64 LBW and normal birthweight infants of ethnic minority mothers were recruited from 2001 to 2002 into a prospective cohort study. The weight and length of infants were measured monthly for 1 year. Data on nutritional status and feeding practices of the infants were collected from monthly health records and face-to-face interviews with mothers while their infants were 6 and 12 months of age.

RESULTS

Most of the increase in weight, length and catch-up to the 10th percentile for LBW infants occurred during the first 3 and 6 months for boys and for girls, respectively. After these ages, the mean weight and length diverged from National Center for Health Statistics (NCHS) reference curves to below the 10th percentile. LBW infants' weight-for-age z-scores was below the NCHS standard at birth (-2.16 SD), caught up after birth, became sustainable by 4 months, fell rapidly from the sixth month, then decreased to -2 SD at 12 months of age. LBW infants' length-for-age z-scores increased in the first month after birth, decreased in the second month and sharply increased again until 5 months of age before decreasing.

CONCLUSIONS

For LBW infants, it is difficult to achieve the same weight or length curves at 12 months of age as the NCHS standard.

Complementary feeding: clinically relevant factors affecting timing and composition

Exclusive breastfeeding for the first 6 mo of life followed by optimal complementary feeding are critical public health measures for reducing and preventing morbidity and mortality in young children. Clinical factors, such as birth weight, prematurity, and illness, that affect the iron and zinc requirements of younger infants are discussed. Maternal diet and nutritional status do not have a strong effect on the mineral content of human milk, but physiologic changes in milk and the infants' status determine the dependence of the infant on complementary foods in addition to human milk to meet iron and zinc requirements after 6 mo. The nature of zinc absorption, which is suitably characterized by saturation response modeling, dictates that plant-based diets, which are low in zinc, are associated with low absolute daily absorbed zinc, which is inadequate to meet requirements. Foods with a higher zinc content, such as meats, are much more likely to be sufficient to meet dietary requirements. Current plant-based complementary feeding patterns for older fully breastfed infants in both developed and developing countries pose a risk of zinc deficiency. The strong rationale for the potential benefits of providing meat as an early complementary food, and the examples of successful intervention programs, provide potent incentives to pursue broader implementation programs, with concurrent rigorous evaluation of both efficacy and effectiveness.

Diabetes, metallothionein, and zinc interactions: a review

Epidemiological evidence, associating diabetes with zinc (Zn) deficiencies, has resulted in numerous research studies describing the effects of Zn and associated metallothionein (MT), on reducing diabetic complications associated with oxidative stress. MT has been found to have a profound effect on the reduction of oxidative stress induced by the diabetic condition. Over expression of MT in various metabolic organs has also been shown to reduce hyperglycaemia-induced oxidative stress, organ specific diabetic complications, and DNA damage in diabetic experimental animals, which have been further substantiated by the results from MT-knockout mice. Additionally, supplementation with Zn has been shown to induce in vivo MT synthesis in experimental animals and to reduce diabetes related complications in both humans and animal models. Although the results are promising, some caution regarding this topic is however necessary, due to the fact that the majority of the studies done have been animal based. Hence more human intervention trials are needed regarding the positive effects of MT and Zn before firm conclusions can be made regarding their use in the treatment of diabetes.

Benefits and risks of breastfeeding

In the absence of significant, unpreventable risks, breastfeeding should be the norm for the nourishment of human infants and should, therefore, be encouraged for populations in all countries. Continued efforts of international and national agencies and healthcare professionals to aid and abet breastfeeding, reduce the risks that occur in some women during breastfeeding, provide the safest substitutes for human milk when that is necessary, and encourage further research into the posed questions should considerably improve the health of many children.

A regional model (Northeastern Brazil) of induced mal-nutrition delays ontogeny of reflexes and locomotor activity in rats

The aim of this study was to investigate the effects of malnutrition, induced by a regional basic diet (RBD), on motor development. RBD is a 7.87%-protein diet based on aliments typical of Northeastern Brazil, elaborated after nutritional investigation by Teodosio et al. (1979). Female rats were treated with RBD during lactation. The reflex ontogenesis and the development of locomotor activity in their offspring were assessed. Malnourished (MN) rats showed a delay in reflex maturation and in locomotor activity evolution. The decreased locomotor activity may be related to the reduced movement experiences induced by the delay in the reflex maturation. Occurring during the critical period of brain development, this fact could jeopardize all the steps in future locomotion evolution. The present results confirm deleterious effects of RDB-induced malnutrition on the somatic development and maturation of the nervous system (NS).

What caused the epidemic of Pneumocystis pneumonia in European premature infants in the mid-20th century?

An epidemic of interstitial pneumonia principally involving premature infants occurred in Germany and nearby European countries between the 1920s and 1960s. Fatalities were due to Pneumocystis. Because the principal defenses against Pneumocystis are T cells, an acquired T-cell deficiency was postulated. A number of potential causes including malnutrition were considered. All were implausible except for a retrovirus that was benign in adults but virulent in premature infants. Furthermore, we suspect that the virus was imported into Germany from former German African colonies. Premature infants were vulnerable because of the developmental status of their T cells. Given the practices in that part of Europe at that time, the virus was most likely transmitted by contaminated blood transfusions and subsequent contamination of reusable needles and syringes used in injections. Although the epidemic ended 4 decades ago, a search for the postulated retrovirus can be conducted if tissues from affected infants are available.