1
|
Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition 2024; 122:112390. [PMID: 38458063 DOI: 10.1016/j.nut.2024.112390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Concurrent wasting and stunting (WaSt) in a child is a health problem that leads to detrimental effects. However, to our knowledge, there is limited research regarding the prevalence and determinants of WaSt, including in Indonesia. The aim of this study was to analyze the prevalence and determinants of WaSt in children 6 to 23 mo of age. METHODS This cross-sectional study was conducted with data sets from the Indonesia Nutritional Status Survey (INSS). Data was collected between January and December 2021. About 15 641 children, ages 23 mo, were included. A χ2 analysis examined the association between the dependent and independent variables. A multivariate test analyzed the risk for the independent variable to the dependent, seen through the adjusted odds ratio (aOR). RESULTS The prevalence of WaSt was 2.4%. Higher odds for WaSt were seen in the following: • Boys: 2.15 times (95% confidence interval [CI], 1.72-2.68); • Children ages 12 to 23 mo 3.15 times (95% CI, 2.33-4.25); • Those with low birth weight 3.11 times (95% CI, 2.33-4.15) • Those with small birth size: 2 times (95% CI, 1.59-2.54) • Babies born from mothers >35 y of age: 1.5 times (95% CI, 1.19-1.89); • Children who experienced infection: 1.43 times (95% CI, 1.16-1.76); • Children not using the Integrated Health and Nutrition Services (Posyandu): 1.17 times (95% CI; 1.29-2.27); • Children from middle- income families:2.54 times higher odds (95% CI, 1.75-3.7); and • Children from rural areas: 1.37 times (95% CI, 1.1-1.71). CONCLUSION WaSt is associated with multiple factors in Indonesia. Hence, policymakers need to address this problem comprehensively.
Collapse
Affiliation(s)
- Lidya Alwina Jokhu
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ahmad Syauqy
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
| |
Collapse
|
2
|
Adediran OA. The effect of women's decision-making on child nutritional outcomes in South Africa. Econ Hum Biol 2024; 53:101355. [PMID: 38350224 DOI: 10.1016/j.ehb.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Women's decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women's decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15-2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women's decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child's weight-for-age and weight-for-height, the result was inconclusive on the child's height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.
Collapse
Affiliation(s)
- Olanrewaju Adewole Adediran
- Department of Sustainable Livelihoods, School of Business Leadership (SBL), University of South Africa, South Africa.
| |
Collapse
|
3
|
Kundu RN, Gautam RK, Chatterjee A, Bharati P, Liczbińska G, Malina RM. Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys. Eur J Clin Nutr 2024:10.1038/s41430-024-01427-7. [PMID: 38467858 DOI: 10.1038/s41430-024-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. METHODS Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. RESULTS Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. CONCLUSIONS The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.
Collapse
Affiliation(s)
- Ramendra Nath Kundu
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Rajesh K Gautam
- Department of Anthropology, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India
| | - Arna Chatterjee
- Department of Anthropology, West Bengal State University, Kolkata, 700126, West Bengal, India
| | - Premananda Bharati
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India
| | - Grażyna Liczbińska
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznań, Poland.
| | - Robert M Malina
- Professor Emeritus, Department of Kinesiology and Health Education, University of Texas, Austin, TX, 78705, USA
- Adjunct Professor, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| |
Collapse
|
4
|
Adamou H, Naba G, Koné H. Socioeconomic inequalities in underweight children: a cross-sectional analysis of trends in West Africa over two decades. BMJ Open 2024; 14:e074522. [PMID: 38388508 PMCID: PMC10884214 DOI: 10.1136/bmjopen-2023-074522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE To study trends in socioeconomic inequalities in underweight children in West Africa, and specifically to analyse the concentration index of underweight inequalities and measure inequalities in the risk of being malnourished by household wealth index. DESIGN Cross-sectional study. SETTING The study used 50 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys conducted between 1999 and 2020 across 14 countries by the DHS and UNICEF. PARTICIPANTS The study included 481 349 children under the age of 5 years. PRIMARY AND SECONDARY OUTCOME MEASURES The analysis used three variables: weight-for-age index, household wealth index and household residence. The inequality concentration index for underweight children and the relative risk of being underweight between 2000 and 2020 were calculated. RESULTS The prevalence of underweight in West Africa showed a downward trend from 2000 to 2020. Nonetheless, the prevalence of underweight children under 5 years of age is still very high in West Africa compared with other sub-Saharan African countries, and the sustainable development objective is yet to be achieved. There was a wide disparity among countries and significant socioeconomic inequalities in underweight children within countries. The proportions of underweight children were concentrated in poor households in all countries in West Africa and over all periods. Socioeconomic inequalities in underweight children were more significant in countries where the prevalence of underweight was low. These inequalities were more pronounced in urban areas in West Africa from 2000 to 2020. CONCLUSIONS AND RELEVANCE There is a high concentration of socioeconomic inequalities in underweight children in disadvantaged households in West Africa.
Collapse
Affiliation(s)
- Habila Adamou
- Center for Research in Regional Planning and Development (CRAD), Université Laval, Quebec, Quebec, Canada
- Evaluation Platform on Obesity Prevention, Institut Universitaire de Cardiologie et de Pneumologie de Quebec - Université Laval, Quebec, Quebec, Canada
| | - Gregoire Naba
- Bureau central du recensement, Institut national de la statistique, Niamey, Niger
| | - Hamidou Koné
- Institut de Formation et de Recherche Demographiques, Yaounde, Cameroon
| |
Collapse
|
5
|
Lin K, Zhou P, Liu M, Chen B, Zhou Z, Zhang Y, Zhou Y, Jiang Y, Bao S, Chen D, Zhu Y, Xing Y. The relationship between intimate partner violence and child malnutrition: a retrospective study in 29 sub-Saharan African countries. Front Public Health 2024; 11:1231913. [PMID: 38249369 PMCID: PMC10796995 DOI: 10.3389/fpubh.2023.1231913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction and background Intimate partner violence (IPV) and child malnutrition are global public health issues. Assessing the association between IPV and child anthropometric failures (stunting, underweight, and wasting) in 29 Sub-Saharan African (SSA) countries can provide significant global health solutions. Some studies have found an association between IPV against women and child malnutrition, but the conclusions are inconsistent. The physical and psychological conditions, living environment, and rights of the mother may be involved. Methods We collected and analyzed the Demographic and Health Surveys data (2010-2021) of 29 SSA countries. The main exposure variables were various types of IPV, classified as physical, sexual, and emotional violence. The outcome was the child's development index, which can be roughly divided into stunting, wasting, and underweight. An adjusted binary logistic regression model was used to test the relationship between IPV and children's nutritional status. Results A total of 186,138 children under 5 years of age were included in the analysis; 50,113 (27.1%) of the children were stunted, 11,329 (6.1%) were wasted, and 39,459 (21.3%) were underweight in all regions. The child's gender, age, duration of breastfeeding, complementary feeding, and vitamin A supplements intake in the past 6 months were associated with their nutritional status (p < 0.001). Sexual violence was the strongest factor associated with stunting, which remained statistically significant after controlling all variables (AOR = 1.11; 95% CI: 1.02, 1.21; p = 0.012). We also found a small negative association between wasting and IPV. For underweight, there were no associations with IPV after controlling for all variables (p > 0.05). Conclusion IPV is positively associated with child stunting in SSA countries. Sexual violence showed a strong positive correlation with stunting. Wasting was unexpectedly negatively associated with IPV. There was no clear correlation between underweight and violence.
Collapse
Affiliation(s)
- Kunhong Lin
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Mengyuan Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Botian Chen
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zibei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yijia Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Ying Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yanan Jiang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Shuyun Bao
- Peking University Health Science Center, Beijing, China
| | - Dijia Chen
- Peking University Health Science Center, Beijing, China
| | - Yu Zhu
- Peking University Health Science Center, Beijing, China
| | - Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| |
Collapse
|
6
|
Okyere J, Donkoh IE, Seidu AA, Ahinkorah BO, Aboagye RG, Yaya S. Mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. J Health Popul Nutr 2024; 43:1. [PMID: 38167549 PMCID: PMC10759505 DOI: 10.1186/s41043-023-00479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. METHODS Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother-child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child's undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). RESULTS Higher likelihood of OWOBM-SUWC was found among women aged 45-49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC. CONCLUSION Combination of child, maternal, and contextual factors could explain mother-child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition.
Collapse
Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
| |
Collapse
|
7
|
Ahmed KY, Dadi AF, Ogbo FA, Page A, Agho KE, Akalu TY, Baraki AG, Tesema GA, Teshale AB, Alamneh TS, Tessema ZT, Kabthymer RH, Tamirat KS, Ross AG. Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa. JAMA Netw Open 2023; 6:e2338321. [PMID: 37851439 PMCID: PMC10585405 DOI: 10.1001/jamanetworkopen.2023.38321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.
Collapse
Affiliation(s)
- Kedir Y. Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Abel F. Dadi
- Charles Darwin University, Menzies School of Health Research, Northern Territory, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Felix Akpojene Ogbo
- Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, South Australia Health, Government of South Australia, Berri, South Australia, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Getayeneh Antehunegn Tesema
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Achamyeleh Birhanu Teshale
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tesfa Sewunet Alamneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Zemenu Tadesse Tessema
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robel Hussen Kabthymer
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Human Nutrition, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Koku Sisay Tamirat
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rural Health, Monash University, Warragul, Victoria, Australia
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| |
Collapse
|
8
|
Addo IY, Boadu EF, Osei Bonsu E, Boadi C, Dadzie FA. Prevalence and factors associated with undernutrition among children under the age of five years in Benin. PLoS One 2023; 18:e0289933. [PMID: 37561793 PMCID: PMC10414565 DOI: 10.1371/journal.pone.0289933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Benin ranks as one of the countries in the world with an alarmingly high prevalence of stunting, wasting, and underweight in children under five years. However, limited studies have examined the factors associated with the prevalence of these undernutrition indicators among children under five years in the country. This study aimed to fill this research gap by examining the prevalence rates and factors associated with stunting, wasting, and underweight among this specific population of interest. METHODS This quantitative study utilised data from the most recent Benin Demographic and Health Survey (BDHS) conducted in 2017-18. The survey employed a nationally representative cross-sectional design and utilised a two-stage stratified cluster sampling technique to select participants. The study included a sample of 13,589 children under the age of five years. The main analytical approach employed was binary logistic regression, which was used to explore the associations between undernutrition (the combined outcome variable representing stunting, wasting, and underweight) and various socio-demographic factors. RESULTS The combined prevalence of stunting, wasting, and underweight among children under five years in Benin during the 2017-18 survey period was 14.95%. Several factors were significantly associated with these indicators of undernutrition, including female gender (AOR = 0.71, 95% CI = 0.59-0.85), birth weight of 4.1 kg and over (AOR = 0.26, 95% CI = 0.14-0.48), multiple births (AOR = 3.22, 95% CI = 2.11-4.91), and a child's experience of diarrhoea (AOR = 1.76, 95% CI = 1.40-2.20). Furthermore, the prevalence of these undernutrition indicators was higher among children whose mothers had lower levels of education (AOR = 0.82, 95% CI = 0.01-0.42) and were unmarried (AOR = 0.67, 95% CI = 0.49-0.93). CONCLUSIONS This present study confirms that undernutrition rates are elevated in Benin and are closely linked to perinatal factors such as birth weights and multiple births, postnatal health conditions including diarrheal episodes, and socio-demographic determinants such as a child's gender, maternal education level, and marital status. Therefore, there is the need to consider specific modifiable factors, such as low birth weight, episodes of child diarrhoea, and maternal education as priority targets for child nutrition interventions in Benin.
Collapse
Affiliation(s)
- Isaac Yeboah Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | | | - Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Boadi
- Department of Operations and Management Information Systems, University of Ghana, Accra, Ghana
| | - Frederick Asankom Dadzie
- Centre for Ecosystem Science, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
- Evolution and Ecology Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
| |
Collapse
|
9
|
Asmare AA, Agmas YA. Multilevel multivariate modeling on the association between undernutrition indices of under-five children in East Africa countries: evidence from recent demographic health survey (DHS) data. BMC Nutr 2023; 9:82. [PMID: 37420303 DOI: 10.1186/s40795-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Malnutrition is the main cause of illness and death in children under the age of five. It affects millions of children worldwide, putting their health and future in jeopardy. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHOD The study was carried out in 10 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Zimbabwe, Kenya, Zambia, and Malawi. A weighted total sample of 53,322 children under the age of five was included. Given the impact of other predictors such as maternal, child, and socioeconomic variables, a multilevel multivariate binary logistic regression model was employed to analyze the relationship between stunting, wasting, and underweight. RESULT The study included 53,322 children, and 34.7%, 14.8%, and 5.1% were stunted, underweight, and wasted, respectively. Almost half of the children (49.8%) were female, and 22.0% lived in urban areas. The estimated odds of children from secondary and higher education mothers being stunted and wasted were 0.987; 95% CI: 0.979 - 0.994 and 0.999; 95% CI: 0.995 - 0.999, respectively, times the estimated odds of children from no education mothers. Children from middle-class families were less likely to be underweight than children from poorer families. CONCLUSION The prevalence of stunting was higher than in the sub-Saharan Africa region, but the prevalence of wasting and underweight was lower. According to the study's findings, undernourishment among young children under the age of five continues to be a significant public health issue in the East African region. Governmental and non-governmental organizations should therefore plan public health participation focusing on paternal education and the poorest households in order to improve the undernutrition status of children under five. Additionally, improving the delivery of healthcare at health facilities, places of residence, children's health education, and drinking water sources are essential for lowering child undernutrition indicators.
Collapse
Affiliation(s)
- Abebew Aklog Asmare
- Department of Statistics, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia.
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, P.O. Box: 32, Tuluawlyia, Ethiopia
| |
Collapse
|
10
|
Amegbor PM, Sabel CE, Mortensen LH, Mehta AJ, Rosenberg MW. Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00572-8. [PMID: 37386059 DOI: 10.1038/s41370-023-00572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. OBJECTIVE Explore the effect of early-life environmental exposures on stunting among children under the age of five years. METHODS In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. RESULTS The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. IMPACT STATEMENT This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.
Collapse
Affiliation(s)
- Prince M Amegbor
- School of Gobal Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark.
| | - Clive E Sabel
- Department of Public Health, Bartholins Allé 2, 8000, Aarhus C, Denmark
- The Big Data Centre for Environment and Health (BERTHA), Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Mark W Rosenberg
- Department of Geography & Planning, Queen's University, Kingston, ON, Canada
| |
Collapse
|
11
|
Mavragani A, Hailegebreal S, Sako S, Haile F, Gilano K, Seboka BT, Kashala K. Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models. JMIR Public Health Surveill 2023; 9:e39744. [PMID: 36753309 PMCID: PMC9947770 DOI: 10.2196/39744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. OBJECTIVE This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. METHODS We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model's assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. RESULTS In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (-40.40, 95% CI -40.41 to -40.32), home delivery (-35.51, 95% CI -35.55 to -35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (-12.65, 95% CI -12.69 to -12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). CONCLUSIONS According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services.
Collapse
Affiliation(s)
| | - Samuel Hailegebreal
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Sewunet Sako
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Firehiwot Haile
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Kasarto Gilano
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Southern Nation Nationalities Peoples' Region, Ethiopia
| | - Kefita Kashala
- Department of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Nation Nationalities Peoples' Region, Ethiopia
| |
Collapse
|
12
|
Clarke K, Rivas AC, Milletich S, Sabo-Attwood T, Coker ES. Prenatal Exposure to Ambient PM 2.5 and Early Childhood Growth Impairment Risk in East Africa. Toxics 2022; 10:705. [PMID: 36422914 PMCID: PMC9699051 DOI: 10.3390/toxics10110705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Height for age is an important and widely used population-level indicator of children's health. Morbidity trends show that stunting in young children is a significant public health concern. Recent studies point to environmental factors as an understudied area of child growth failure in Africa. Data on child measurements of height-for-age and confounders were obtained from fifteen waves of the Demographic and Health Surveys (DHS) for six countries in East Africa. Monthly ambient PM2.5 concentration data was retrieved from the Atmospheric Composition Analysis Group (ACAG) global surface PM2.5 estimates and spatially integrated with DHS data. Generalized additive models with linear and logistic regression were used to estimate the exposure-response relationship between prenatal PM2.5 and height-for-age and stunting among children under five in East Africa (EA). Fully adjusted models showed that for each 10 µg/m3 increase in PM2.5 concentration there is a 0.069 (CI: 0.097, 0.041) standard deviation decrease in height-for-age and 9% higher odds of being stunted. Our study identified ambient PM2.5 as an environmental risk factor for lower height-for-age among young children in EA. This underscores the need to address emissions of harmful air pollutants in EA as adverse health effects are attributable to ambient PM2.5 air pollution.
Collapse
|
13
|
Hoffman DJ, Posluszny HR. Navigating Linear and Ponderal Growth in Undernourished Children. J Nutr 2022; 152:1810-1811. [PMID: 35849077 PMCID: PMC9466570 DOI: 10.1093/jn/nxac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Hannah R Posluszny
- Department of International Health, Program in Human Nutrition, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|