Determinants of maternal low mid-upper arm circumference and its association with child nutritional status among poor and very poor households in rural Bangladesh

Determinants of school-going adolescent girls' health and nutritional status in district Malir, Karachi: a baseline cross-sectional study

Introduction

Adolescence is a phase of life marked by rapid growth. Adequate nutrition is essential during this developmental stage, leading to significant physical performance, improved cognitive ability, and productivity. Improving adolescent girls' nutrition is crucial for breaking the intergenerational cycle of malnutrition, but research in Pakistan has largely focused on children under five and pregnant women, often neglecting this vulnerable group.

Objective

This study aimed to determine the contextual and sociodemographic factors contributing toward undernutrition to improve the health and nutritional status of adolescent girls.

Methods

A school based cross sectional study was conducted as the baseline survey for a mixed methods study leading to a pilot cluster randomized controlled trial. n = 84 girls (10-14 years) from two public schools were selected by simple random sampling. Data were collected through a structured questionnaire including socio demographic profile, anthropometric measurements, dietary patterns, preferences, safe water and hygiene practices, access to health care facilities, and understanding of malnutrition-related symptoms. The data collected were analyzed through SPSS version 27.0. The chi-square test was used to determine the association between the two BMI categories; underweight and normal weight, and various socio-demographic variables.

Results

Among the total of 84 adolescent girls, overall mean height was 143.9 ± 8.1 cm and mean weight was 34.4 ± 6.9 kg, while mean BMI was 16.4 ± 2.2 kg/m2. 86.9% of girls were underweight, whereas 13.1% had a normal BMI. The z-scores for both height-for-age and BMI-for-age were in negative values, i.e., -1.62 ± 0.89 and -1.18 ± 1.05, respectively.

Conclusion

Findings of this study demonstrated that the high burden of underweight among school-going adolescent girls needs targeted approaches like nutrition education interventions to enhance awareness about healthy dietary behaviors, food preferences, and ensuring access to safe, sufficient, and healthy diet.

Recommendation

A multipronged approach is required to improve health and nutritional status of adolescent girls by involving individuals, families, education sector, health and other relevant sectors. Larger scale studies are still required for better understanding of the issue and to guide in designing targeted programs to address specific needs of this particular age group.

Risk or associated factors of wasting among under-five children in Bangladesh: A systematic review

BACKGROUND AND OBJECTIVES

Wasting among under-five years old (U-5) children is a significant global public-health-nutrition burden. To effectively address this problem in Bangladesh, knowing its prevalence, caus-es and associated-factors are essential. This review aimed to identify evidences available in the existing-accessible literature/documents that describe the individual, socioeconomic, demographic, and contextual risk-factors associated with wasting among U-5 children in Bangladesh.

METHODS AND STUDY DESIGN

Electronic-databases included were MEDLINE, EMBASE, CINAHL, WoS, and Cochrane-Library written in English and published until 29 February 2024.

RESULTS

The search from the five databases yielded 167 publications. Of these, 50 papers/articles were duplicates and 108 were irrelevant, and nine have met the inclusion criteria. Additionally, 22 articles/documents were identified from other sources. Finally, a total of 31 articles/documents have been included in this review. The odds of childhood wasting observed were high for smaller birth-size, higher birth-order, male child, 12-24 months age-group, improper breastfeeding- and complementary-feeding practices, not-receiving DPT1 and/or measles vaccine, ≥1 sibling(s), maternal-undernutrition, less food-consumption during pregnancy, lack of maternal-education, lack of hand-washing practices by the mother/caregiver, paternal tobacco use, lower socioeconomic-status, food-insecurity, lack of access to hygienic-latrine and/or improved-water, Monsoon season (May-August), flood exposure, living es-pecially in Barishal, Rajshahi Chittagong and Rangpur-division and/or Eastern part of Bangladesh, and urban-slum.

CONCLUSIONS

The risk/associated factors of wasting among U-5 children in Bangladesh were found at various multilevel. Rarely caused by any one factor alone, wasting in U-5 children results from an interplay between pregnant-mother's health and nutrition, child-caring practices, diets, poverty, and disease, which vary by context.

Predictors of stunting among children aged 6-59 months in Kitui County, Kenya

Background

Stunting in children below the age of five is a significant public health problem in Kenya. Stunting has transitory and lifelong effects on people and communities, including high risk of morbidity and death, lowered mental and physical growth, and decreased productivity.

Objective

To investigate the predictors of stunting in children aged 6 to 59 months in Kitui County, Kenya.

Methods

This was a cross-sectional analytical survey that used multistage cluster sampling. Data were gathered through questionnaires, interviews with key informants and discussions with focus groups. Anthropometric measurements were taken to assess the rate of stunting.

Results

The stunting rate was 26.6%. The independent predictors of stunting included birth weight < 2500 grams (AOR = 2.302; 95% CI: 1.027-6.150; p: 0.043), having secondary education (AOR = 5.404; 95% CI: 1.607-18.173; p: 0.006), mother's MUAC < 23 cm (AOR = 2.845; 95% CI: 1.125-7.192; p:0.012), and having no access to a latrine/toilet (AOR = 0.008; 95% CI: 0.009-0.561; p: 0.013).

Conclusions

Stunting was high and was influenced by sociodemographic factors, and the household environment.

Intimate partner violence and malnutrition among women of reproductive age in Western Africa: A geostatistical analysis

Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women's health, wellbeing, and nutritional status. We examined the association between women's lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d'Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women's vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women's risk of experiencing IPV.

Influence of the Suchana intervention on exclusive breastfeeding and stunting among children aged under 6 months in the Sylhet region of Bangladesh

Exclusive breastfeeding (EBF) provides significant health benefits to children. However, mothers may find it difficult to continue EBF for 6 months. The present analysis aimed to examine the influence of the Suchana intervention-a large-scale programme implemented with the aim of improving the health and nutritional status of mothers and children from poor households in the Sylhet region of Bangladesh-on EBF and stunting among children under 6 months. Baseline and endline data were obtained from the Suchana evaluation. EBF was defined as an infant (<6 months) only receiving breast milk in the previous 24 h. Childhood stunting was defined as a length-for-age z-score of less than -2 among children of the same age. Multiple logistic regression analysis was used to assess the associations of the Suchana intervention with EBF and stunting. EBF prevalence improved from 64% at baseline to 85% at the endline in the intervention area, with the intervention group having 2.25 times higher odds of EBF compared to the control group. Stunting prevalence reduced from 28% at baseline to 24% at the endline in the intervention group, but after controlling for covariates, the association between stunting and the intervention was not significant. However, the interaction analysis showed significantly lower stunting prevalence among EBF children in both intervention and control areas. The Suchana intervention had a positive impact on the EBF practice of rural children in a vulnerable region of Bangladesh, and EBF was identified as a significant factor associated with stunting. The findings suggest that the continuation of the EBF intervention has the potential to have an impact on reducing stunting in the region, highlighting the importance of promoting EBF to improve child health and development.

Drivers and distribution of the household-level double burden of malnutrition in Bangladesh: analysis of mother-child dyads from a national household survey

OBJECTIVE

The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh.

DESIGN

The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM.

SETTING

Nationally representative cross-sectional survey.

PARTICIPANTS

8697 mothers aged 15 to 49 years with <5 children.

RESULTS

The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers' occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM.

CONCLUSIONS

Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.

Does a child's mid-upper arm circumference-for-age z-score represent another nutritional indicator of childhood malnutrition status?

Child wasting is defined as a weight-for-height/length z-score (WLZ/WHZ) < -2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child's nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid-upper arm circumference-for-age z-score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut-off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut-off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ -2), a positive outcome, the optimal cut-off point for the MUACZ was -1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child's MUACZ was correlated with WLZ, and a MUACZ below -1.27 appeared to accurately identify wasting among children aged 3-23 months. MUACZ < -1.27 might be another useful indicator of childhood wasting than a WLZ < -2.

Energy Intake and Food Restriction as Determinant Factors of Chronic Energy Deficiency among Pregnant Women in Rural Area of Sungai Sembilan, Riau, Indonesia

BACKGROUND OF THE STUDY: Maternal malnutrition is a major public health problem in Indonesia which is shown by high prevalence of chronic energy deficiency (CED) among pregnant women. CED was expressed by the measurement of Mid Upper Arm Circumference (MUAC) showing value less than 23.5 cm. AIM OF THE STUDY: This study aimed to identify the factors associated with chronic energy deficiency among pregnant women in rural area, Riau Province. METHODOLOGY: A community- based cross sectional study was conducted among 130 samples of pregnant women in Sungai Sembilan Community Health Center in June 2020. Data was collected using structured and field-study questionnaires. Mid Upper Arm Circumference (MUAC) was measured by MUAC tape. Energy and protein intake were assessed using 24-hour food recall. Multiple logistic regression was employed to analyse factors associated with CED by using SPSS version 20. RESULTS: The prevalence of CED among pregnant women was 64.9%. Age of mothers, food restriction, infection disease status, protein and energy intake were associated significantly with CED. Furthermore, energy intake and food restriction in pregnancy were risk factors of CED (AOR = 3.04, 95% CI: 1.1 – 8.3 and AOR = 6.73, 95% CI: 1.33 – 33.9, respectively). We found that proportion of energy intake below 80% RDA and mothers with food restriction were higher among CED group. CONCLUSION: High prevalence of chronic energy deficiency (CED) was found among pregnant women. Hence, innovative intervention was required to overcome this problem.

The impact of climate change on children's nutritional status in coastal Bangladesh

This paper studies the impact of climate change on the nutritional status of very young children between the ages of 0-3 years by using weather data from the last half century merged with rich information on child, mother, and household characteristics in rural coastal Bangladesh. We evaluate the health consequences of rising temperature and relative humidity and varying rainfall jointly employing alternate functional forms. Leveraging models that control for annual trends and location-specific seasonality, and that allow the impacts of temperature to vary non-parametrically while rainfall and humidity have flexible non-linear forms, we find that temperatures that exceed 25 °C (the "comfortable" benchmark) in the month of birth exert negative effects on children's nutritional status as measured by mid upper arm circumference. Humidity has a positive impact which persists when child, mother and household controls are included. We find that exposure to changing climate in utero also matters. Explanations for these results include consequences of weather fluctuations on the extent of pasture, cropland, and rainfed lands planted with rice and other crops, and on mother's age at first marriage. Our results underline that climate change has real consequences for the health of very young populations in vulnerable areas.

The large-scale community-based programme 'Suchana' improved maternal healthcare practices in north-eastern Bangladesh: Findings from a cluster randomized pre-post study

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large-scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron-folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron-folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger-scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh.