Unveiling predictive factors for household-level stunting in India: A machine learning approach using NFHS-5 and satellite-driven data

OBJECTIVES

Childhood stunting remains a significant public health issue in India, affecting approximately 35% of children under 5. Despite extensive research, existing prediction models often fail to incorporate diverse data sources and address the complex interplay of socioeconomic, demographic, and environmental factors. This study bridges this gap by employing machine learning methods to predict stunting at the household level, using data from the National Family Health Survey combined with satellite-driven datasets.

METHODS

We used four machine learning models-random forest regression, support vector machine regression, K-nearest neighbors regression, and regularized linear regression-to examine the impact of various factors on stunting. The random forest regression model demonstrated the highest predictive accuracy and robustness.

RESULTS

The proportion of households below the poverty line and the dependency ratio consistently predicted stunting across all models, underscoring the importance of economic status and household structure. Moreover, the educational level of the household head and environmental variables such as average temperature and leaf area index were significant contributors. Spatial analysis revealed significant geographic clustering of high-stunting districts, notably in central and eastern India, further emphasizing the role of regional socioeconomic and environmental factors. Notably, environmental variables like average temperature and leaf area index emerged as strong predictors of stunting, highlighting how regional climate and vegetation conditions shape nutritional outcomes.

CONCLUSIONS

These findings underline the importance of comprehensive interventions that not only address socioeconomic inequities but also consider environmental factors, such as climate and vegetation, to effectively combat childhood stunting in India.

Bridging the gender, climate, and health gap: the road to COP29

Focusing specifically on the gender-climate-health nexus, this Personal View builds on existing feminist works and analyses to discuss why intersectional approaches to climate policy and inclusive representation in climate decision making are crucial for achieving just and equitable solutions to address the impacts of climate change on human health and societies. This Personal View highlights how women, girls, and gender-diverse people often face disproportionate climate-related health impacts, particularly those who experience compounding and overlapping vulnerabilities due to current and former systems of oppression. We summarise the insufficient meaningful inclusion of gender, health, and their intersection in international climate governance. Despite the tendency to conflate gender equality with number-based representation, climate governance under the UNFCCC (1995-2023) remains dominated by men, with several countries projected to take over a decade to achieve gender parity in their Party delegations. Advancing gender-responsiveness in climate policy and implementation and promoting equitable participation in climate governance will not only improve the inclusivity and effectiveness of national strategies, but will also build more resilient, equitable, and healthier societies.

Nature-based solutions for improving food security: A systematic global review

Nature-based solutions (NBS) have been promoted as a holistic way to solve a variety of societal issues while benefiting biodiversity at the same time. To date, applications of NBS approaches that help ensure food security have yet been systematically reviewed. In this paper, we critically review the specific NBS for food security, highlighting their limitations, to provide recommendations that promote their applications for improving global food security. We accessed and evaluated publications on four different scholastic databases, and our systematic review of relevant materials indicated that many NBS approaches can be applied to enhance food security dimensions individually or together. However, there is a strong bias towards food availability, and not enough research has been done to link NBS with improvements in food access and utilization. Over 80 % of the reviewed papers were of short-term studies or without specific timeframes, and 25 % offered no information on the economic effectiveness of NBS. Environmental benefits of NBS were explicitly described in about 60 % of these papers, and biodiversity enhancement was measured in only about 10 %. We, therefore, recommend future applications of NBS to safeguard food security be shifted to food access and utilization with careful consultation with local communities to address their specific context, using indicators that are easily measured and managed. Systematic monitoring regimes and robust and diversified financial support systems are also equally important in efforts to successfully implement NBS. Moreover, environmental and societal benefits, especially water productivity and biodiversity, must be incorporated into the planning and design of NBS.

Reimagining nutrition education for pregnant adolescents in the face of climate change: a community approach

Objectives

To explore challenges with current nutrition education for teenage pregnant women in a drought-prone community in Kenya and to elicit the communities' suggestions on how to best adapt it in the face of climate change.

Design

Nine serial focus group discussions (four with adolescents, two with their parents, two with community health volunteers and one with healthcare workers) were conducted on a purposively selected study population in Kaloleni, Kilifi County, Kenya. Data collection took place between March and November 2022, with a total of 73 participants. An inductive approach was used, and interpretive thematic coding was done as the primary analytic strategy to allow themes derived from participants' reflections.

Results

First, participants reported that unpredictable rainfall patterns had affected nutrition intake and variety due to reduced yield from farmland, diseases in livestock and insufficient income. Second, participants reported barriers to accessing nutrition education, as it was mainly given in clinics and not targeted at adolescents or men. Third, they experienced challenges in applying nutrition education in daily life due to a mismatch between available foods and cultural practices. Recommendations for the future encompassed equipping individuals with practical cooking skills tailored to available nutrients, initiatives aimed at water conservation and addressing animal health concerns, enhancing accessibility through community-based training programmes and fostering collaborative efforts to ensure the provision of essential nutrients.

Conclusion

Food choices in Kilifi County are getting more limited due to unpredicted rainfall patterns. Therefore, a reorientation of nutrition education is needed in order to build resilience in the community. Strengthening community action, including developing skills to increase long-term local support, would be needed to ensure the adequate nutrition status of vulnerable groups like pregnant adolescent women.

Does food biodiversity protect against malnutrition and favour the resilience to climate change-related events in Amazon Indigenous communities? A protocol for a mixed methods study

Background : Undernutrition is projected to be a major consequence of climate change. Biodiversity could enhance climate change resilience by improving nutritional outcomes and providing healthy food resources during and/or after climate-related events. For Indigenous populations who currently base their diet on local biodiversity, rapid climate changes may affect their ability to produce, access or gather food and consequently impact their nutritional status. There is a knowledge gap regarding whether nutritional status among Indigenous populations is better among those who consume a diet with greater biodiversity than those who have a diet with low biodiversity. Objective : This study aims to investigate the role of food biodiversity (FBD) in nutritional resilience to extreme flooding events of Shawi Amazon Indigenous adults living in Peruvian communities that have experienced extreme floods in the past five years. Methods : This study will use a mixed-method sequential explanatory design. The quantitative component includes a cross-sectional survey to assess the association between food biodiversity (FBD) and the prevalence of anaemia in adults aged 15 to 60 years old (n=365). Anaemia will be evaluated using blood hemoglobin and serum ferritin. FBD will be measured with a food frequency questionnaire and a 24-hour dietary recall. Soil-transmitted helminth infections, malaria, and inflammatory biomarkers will also be evaluated. The qualitative component will include a community-based participatory approach to investigate the role of FBD in the responses to extreme floods. Male (n=14) and female (n=14) participants, previously identified in the quantitative phase with high and low levels of FBD, will be invited to participate in a Photovoice activity and semi-structured interviews. A analytical framework for climate change resilience will be used to integrate the data. Discussion : Findings will be integrated to identify nutritional resilience indicators that can inform adaptative interventions to changing climatic conditions in the Amazon and that respect Indigenous worldviews.

Foundational Nutrition: Implications for Human Health

Human nutrition, and what can be considered "ideal" nutrition, is a complex, multi-faceted topic which many researchers and practitioners deliberate. While some attest that basic human nutrition is relatively understood, it is undeniable that a global nutritional problem persists. Many countries struggle with malnutrition or caloric deficits, while others encounter difficulties with caloric overconsumption and micronutrient deficiencies. A multitude of factors contribute to this global problem. Limitations to the current scope of the recommended daily allowances (RDAs) and dietary reference intakes (DRIs), changes in soil quality, and reductions in nutrient density are just a few of these factors. In this article, we propose a new, working approach towards human nutrition designated "Foundational Nutrition". This nutritional lens combines a whole food approach in conjunction with micronutrients and other nutrients critical for optimal human health with special consideration given to the human gut microbiome and overall gut health. Together, this a synergistic approach which addresses vital components in nutrition that enhances the bioavailability of nutrients and to potentiate a bioactive effect.

The pervasive impact of global climate change on plant-nematode interaction continuum

Pest profiles in today's global food production system are continually affected by climate change and extreme weather. Under varying climatic conditions, plant-parasitic nematodes (PPNs) cause substantial economic damage to a wide variety of agricultural and horticultural commodities. In parallel, their herbivory also accredit to diverse ecosystem services such as nutrient cycling, allocation and turnover of plant biomass, shaping of vegetation community, and alteration of rhizospheric microorganism consortium by modifying the root exudation pattern. Thus PPNs, together with the vast majority of free-living nematodes, act as ecological drivers. Because of direct exposure to the open environment, PPN biology and physiology are largely governed by environmental factors including temperature, precipitation, humidity, atmospheric and soil carbon dioxide level, and weather extremes. The negative effects of climate change such as global warming, elevated CO2, altered precipitation and the weather extremes including heat waves, droughts, floods, wildfires and storms greatly influence the biogeographic range, distribution, abundance, survival, fitness, reproduction, and parasitic potential of the PPNs. Changes in these biological and ecological parameters associated to the PPNs exert huge impact on agriculture. Yet, depending on how adaptable the species are according to their geo-spatial distribution, the consequences of climate change include both positive and negative effects on the PPN communities. While assorting the effects of climate change as a whole, it can be estimated that the changing environmental factors, on one hand, will aggravate the PPN damage by aiding to abundance, distribution, reproduction, generation, plant growth and reduced plant defense, but the phenomena like sex reversal, entering cryptobiosis, and reduced survival should act in counter direction. This seemingly creates a contraposition effect, where assessing any confluent trend is difficult. However, as the climate change effects will differ according to space and time it is apprehensible that the PPNs will react and adapt according to their location and species specificity. Nevertheless, the bio-ecological shifts in the PPNs will necessitate tweaking their management practices from the agri-horticultural perspective. In this regard, we must aim for a 'climate-smart' package that will take care of the food production, pest prevention and environment protection. Integrated nematode management involving precise monitoring and modeling-based studies of population dynamics in relation to climatic fluctuations with escalated reliance on biocontrol, host resistance, and other safer approaches like crop rotation, crop scheduling, cover cropping, biofumigation, use of farmyard manure (FYM) would surely prove to be viable options. Although the novel nematicidal molecules are target-specific and relatively less harmful to the environment, their application should not be promoted following the global aim to reduce pesticide usage in future agriculture. Thus, having a reliable risk assessment with scenario planning, the adaptive management strategies must be designed to cope with the impending situation and satisfy the farmers' need.

The relationship between climate change induced natural disasters and selected nutrition outcomes: a case of cyclone Idai, Zimbabwe

BACKGROUND

The increased frequency of climate induced natural disasters has exacerbated the risks of malnutrition in the already vulnerable regions. This study was aimed at exploring the effects of Cyclone Idai on nutrition outcomes of women of child-bearing age and children under 5 years.

METHOD

The household-based cross-sectional study was conducted in Eastern Zimbabwe. Data were collected through face-to-face interviews to determine food consumption score (FCS) and household dietary diversity (HDDS), minimum dietary diversity for women (MDD-W) and minimum dietary diversity for children (MDD-C). Severity of Cyclone Idai was grouped into five categories based on the extent of damage to infrastructure and loss of human lives. Association between continuous and categorical variables was tested using Pearson correlation test and Chi square test, respectively. Linear and binary logistic regression was performed to investigate determinants of food security.

RESULTS

A total of 535 households were interviewed. There was a significant correlation between severity of Cyclone Idai and MDD-W (p = 0.011), HDDS (p = 0.018) and FCS (p = 0.001). However, severity of Cyclone Idai was not a determinant of any nutrition outcome, but gender of household head was a negative predictor of HDDS (β = - 0.734, p = 0.040), and marital status of household head was a positive predictor (β = 0.093, p = 0.016) of FCS.

CONCLUSION

The findings provide a good baseline to inform future programming of food aid activities during disasters. More so, our findings call for evidence-based policies regarding composition of a food aid basket and targeting of beneficiaries. The main strength of this study is that it is the first to investigate the effects of cyclones on food and nutrition security indicators and is based on a large sample size thus making our results generalisable.

An overview of the interactions between food production and climate change

This paper provides an overview of how food production influences climate change and also illustrates the impact of climate change on food production. To perform such an overview, the (inter)link between different parts of the food supply chain continuum (agriculture production, livestock farming, food processing, food transport and storing, retail food, and disposal of food waste) and climate change has been investigated through a bibliometric analysis. Besides UN Sustainable Development Goal (SDG) 13, associated with climate change, other SDGs that are associated with this overview are goals #1, #2, #3, #6, #7, #12, and #15. Based on the evidence gathered, the paper provides some recommendations that may assist in efforts to reduce the climate-related impacts of food production.

Community-level environmental characteristics predictive of childhood stunting in Bangladesh - a study based on the repeated cross-sectional surveys

Coastal morphology makes Bangladesh vulnerable to environmental hazards and climate change. Therefore, environmental characteristics may shape population health, including child health. The prevalence of stunting among under-five aged (U5) children is high in Bangladesh. However, there is a lack of research on environmental predictors of stunting. This study aimed to assess the association between community-level environmental characteristics and stunting using pooled data from the three latest Bangladesh demographic and health surveys (BDHS). According to the multilevel model, rainfall, distance to protected areas, and vegetation index showed a nonlinear association with stunting. The temperature was inversely, and distance to water bodies was positively related to stunting. Overall, results evidence the environmental characteristics are predictive of stunting, and these characteristics should be taken into account during intervention design to minimise the negative effects of environmental change on child health. Further research is also necessary to comprehend the causal pathways between environmental characteristics and stunting in Bangladesh.

Linking Climate Change Adaptation Strategies and Nutrition Outcomes: A Conceptual Framework

BACKGROUND

The relationship between climate adaptation strategies and nutrition security is poorly understood and often unclear. Although several adaptation strategies have been implemented to mitigate the impact of climate change, there is still a lack of conclusive evidence or studies on the interrelationships between adopted climate change adaptation strategies and nutrition outcomes.

OBJECTIVE

This study aimed at developing a conceptual framework that links climate change, adaptation strategies and nutrition and show the indicators that can be used to assess the impact of climate adaptation strategies on nutrition.

METHODOLOGY

The proposed conceptual framework was developed through a literature review.

RESULTS

A generic conceptual framework that could be used to assess the impact of adopted climate change adaptation strategies on nutrition outcomes was developed. The framework consists of 5 key elements: Agro-food system, context characteristics, adaptation strategies, climatic shocks and stress, and system output. The principles used in designing the conceptual framework include systems approach, contingency theory, and system output.

CONCLUSION

The developed framework offers a channel to evaluate adopted climate change adaptation strategies and their impact on nutrition outcomes. Such a conceptual framework can also be used in selecting and identifying more suitable climate adaptation strategies given specific contextual environments.

Enhancing climate resilience of irrigated agriculture: A review

Emerging evidence showing trends in climate change with a strong likelihood those changes will continue elevates the importance of finding affordable adaptations by irrigated agriculture. Successful climate adaptation measures are needed to affordably sustain irrigated agriculture in the face of elevated carbon emissions affecting the reliability of water supplies. Numerous potential adaptation options are available for adjusting irrigated agricultural systems to implement climate risk adaptation. This work focuses on addressing the gap in the literature defined by a scarcity of reviews on measures to elevate the capacity of irrigated agriculture to enhance its climate change resilience. Accordingly, the original contribution of this work is to review the literature describing measures for enhancing climate resilience by irrigated agriculture. In addition, it describes the role of economic analysis to discover affordable measures to enhance resilience by irrigated agriculture. It achieves those aims by posing the question "What principles, practices, and recent developments are available to guide discovery of measures to improve resilience by irrigated agriculture to adapt to ongoing evidence of climate change?" It addresses that question by reviewing several risk reduction measures to control the economic cost of losses to irrigators in the face of growing water supply unreliability. Following this review, a role for optimizing a portfolio of climate adaptation measures is described, followed by a discussion of potential contributions that can be made by the use of hydroeconomic analysis. Results provide a framework for economic analysis to discover economically attractive methods to elevate resilience of irrigated agriculture.

A scoping review on climate change and tuberculosis

Climate change is a global public health challenge. The changes in climatic factors affect the pattern and burden of tuberculosis, which is a worldwide public health problem affecting low and middle-income countries. However, the evidence related to the impact of climate change on tuberculosis is few and far between. This study is a scoping review following a five-stage version of Arksey and O'Malley's method. We searched the literature using the keywords and their combination in Google scholar, and PubMed. Climate change affects tuberculosis through diverse pathways: changes in climatic factors like temperature, humidity, and precipitation influence host response through alterations in vitamin D distribution, ultraviolet radiation, malnutrition, and other risk factors. The rise in extreme climatic events induces population displacement resulting in a greater number of vulnerable and risk populations of tuberculosis. It creates a conducive environment of tuberculosis transmission and development of active tuberculosis and disrupts tuberculosis diagnosis and treatment services. Therefore, it stands to reasons that climate change affects tuberculosis, particularly in highly vulnerable countries and areas. However, further studies and novel methodologies are required to address such a complex relationship and better understand the occurrence of tuberculosis attributable to climate change.

Climate Change and Women's Health: A Scoping Review

Climate change is a significant global health threat that is, underpinned by the existing issue of gender inequality. A scoping review was conducted to better understand the relationship between climate change and women's health. We found a notably higher proportion of existing studies focused on low- and middle-income countries (LMICs). Most of the studies included were published after 2010, with predominantly qualitative study designs. Four key themes were identified, including women's exposure to climate change risks, the impacts on women's health, factors contributing to the vulnerability, and responding strategies in addressing climate change. The scoping review indicates that women's health is at higher risks due to the vulnerability to climate change, especially in LMICs. Meanwhile, it is beneficial to have insights from women in terms of adaptation and mitigation strategies to build stronger resilience. Mixed methods are strongly recommended to support evidence-based policy making in responding to climate change.

COVID-19 pandemic: the possible influence of the long-term ignorance about climate change

In addressing the current COVID-19 pandemic and evaluating the measures taken by global leaders so far, it is crucial to trace back the circumstances influencing the emergence of the crisis that the world is presently facing. Could it be that the failure to act in a timely manner dates way back to when first concerns about climate change and its inevitable threat to human health came up? Multiple lines of evidence suggest that the large-scale and rapid environmental changes in the last few decades may be implicated in the emergence of COVID-19 pandemic by increasing the potential risk of the occurrence and the spread of zoonotic diseases, worsening food security, and weakening the human immune system. As we are facing progressive climatic change, a failure to act accordingly could inevitably lead to further, more frequent confrontations with newly emerging diseases.

Nitrogen Losses and Potential Mitigation Strategies for a Sustainable Agroecosystem

Nitrogen (N) in the agricultural production system influences many aspects of agroecosystems and several critical ecosystem services widely depend on the N availability in the soil. Cumulative changes in regional ecosystem services may lead to global environmental changes. Thus, the soil N status in agriculture is of critical importance to strategize its most efficient use. Nitrogen is also one of the most susceptible macronutrients to environmental loss, such as ammonia volatilization (NH3), nitrous oxide (N2O) emissions, nitrate leaching (NO3), etc. Any form of N losses from agricultural systems can be major limitations for crop production, soil sustainability, and environmental safeguard. There is a need to focus on mitigation strategies to minimize global N pollution and implement agricultural management practices that encourage regenerative and sustainable agriculture. In this review, we identified the avenues of N loss into the environment caused by current agronomic practices and discussed the potential practices that can be adapted to prevent this N loss in production agriculture. This review also explored the N status in agriculture during the COVID-19 pandemic and the existing knowledge gaps and questions that need to be addressed.

Climate-Driven Adaptation, Household Capital, and Nutritional Outcomes among Farmers in Eswatini

Globally, communities are increasingly impacted by the stressors of climate change. In response, people may adapt to maintain their livelihoods and overall health and nutrition. However, the relationship between climate adaptation and human nutrition is poorly understood and results of adaptation are often unclear. We investigated the relationship between adaptation and child nutrition, in Eswatini (formerly Swaziland) during an extreme drought. Households varied in both adaptation behavior and household resources and we found that, overall, households that adapted had better child nutrition than those that didn't adapt. When controlling for the influence of household capital, we found that more vulnerable households, those with greater dependence on natural resources and lower income, had a stronger positive relationship between adaptation and nutrition than less vulnerable households. We also found that some adaptations had stronger positive relationships with nutrition than others. In our system, the adaptation that most strongly correlated with improved nutrition, selling chickens, most likely benefits from local social networksand consistent demand, and performed better than other adaptations. Our results emphasize the need to measure adaptation outcomes and identify and support the types of adaptations are most likely to improve nutrition in the future.

Climate Change Adaptation through the Water-Energy-Food Nexus in Southern Africa

Climate change is a complex and cross-cutting problem that needs an integrated and transformative systems approach to respond to the challenge. Current sectoral approaches to climate change adaptation initiatives often create imbalances and retard sustainable development. Regional and international literature on climate change adaptation opportunities and challenges applicable to southern Africa from a water-energy-food (WEF) nexus perspective was reviewed. Specifically, this review highlights climate change impacts on water, energy, and food resources in southern Africa, while exploring mitigation and adaptation opportunities. The review further recommends strategies to develop cross-sectoral sustainable measures aimed at building resilient communities. Regional WEF nexus related institutions and legal frameworks were also reviewed to relate the WEF nexus to policy. Southern Africa is witnessing an increased frequency and intensity in climate change-associated extreme weather events, causing water, food, and energy insecurity. A projected reduction of 20% in annual rainfall by 2080 in southern Africa will only increase the regional socio-economic challenges. This is exacerbating regional resource scarcities and vulnerabilities. It will also have direct and indirect impacts on nutrition, human well-being, and health. Reduced agricultural production, lack of access to clean water, sanitation, and clean, sustainable energy are the major areas of concern. The region is already experiencing an upsurge of vector borne diseases (malaria and dengue fever), and water and food-borne diseases (cholera and diarrhoea). What is clear is that climate change impacts are cross-sectoral and multidimensional, and therefore require cross-sectoral mitigation and adaptation approaches. In this regard, a well-coordinated and integrated WEF nexus approach offers opportunities to build resilient systems, harmonise interventions, and mitigate trade-offs and hence improve sustainability. This would be achieved through greater resource mobilisation and coordination, policy convergence across sectors, and targeting nexus points in the landscape. The WEF nexus approach has potential to increase the resilience of marginalised communities in southern Africa by contributing towards attaining the Sustainable Development Goals (SDGs 1, 2, 3, 6, 7, and 13).

Synergy between the small intrinsically disordered protein Hsp12 and trehalose sustain viability after severe desiccation

Anhydrobiotes are rare microbes, plants and animals that tolerate severe water loss. Understanding the molecular basis for their desiccation tolerance may provide novel insights into stress biology and critical tools for engineering drought-tolerant crops. Using the anhydrobiote, budding yeast, we show that trehalose and Hsp12, a small intrinsically disordered protein (sIDP) of the hydrophilin family, synergize to mitigate completely the inviability caused by the lethal stresses of desiccation. We show that these two molecules help to stabilize the activity and prevent aggregation of model proteins both in vivo and in vitro. We also identify a novel in vitro role for Hsp12 as a membrane remodeler, a protective feature not shared by another yeast hydrophilin, suggesting that sIDPs have distinct biological functions.

Adequação normativa dos planos estaduais de segurança alimentar e nutricional no Brasil

Resumo: Com o intuito de analisar a adequação dos Planos Estaduais de Segurança Alimentar e Nutricional (PlanSAN) às normas estabelecidas pela Política Nacional de Segurança Alimentar e Nutricional (PNSAN), foi realizada pesquisa descritiva e documental, com coleta de dados entre agosto a outubro de 2016. O acesso aos planos foi realizado na página de Internet da Câmara Interministerial de Segurança Alimentar e Nutricional (CAISAN) ou dos governos estaduais, com coleta de informações complementares no âmbito dos estados. Todos os estados brasileiros aderiram ao Sistema de Segurança Alimentar e Nutricional (SISAN), entretanto menos da metade (13 estados, 48%) elaborou seus planos, destacando-se alguns aspectos: 5 (38%) dos PlanSAN tinham vigência correspondente ao plano plurianual do estado; 5 (38%) dos PlanSAN descreviam os requisitos orçamentários para execução das metas propostas; e 7 (54%) descreviam mecanismos de monitoramento do plano e apenas 2 (15%) definiam metodologia para monitoramento de segurança alimentar e nutricional. O menor tempo de existência da CAISAN e de adesão parecem estar relacionados com a inexistência de PlanSAN. Ainda que a maioria dos estados com planos atendam algumas normativas estabelecidas pela PNSAN, esses instrumentos tornam-se frágeis e pouco exequíveis quando não possuem vinculação orçamentária para suas metas. Pelo fato de a PNSAN ser estruturalmente intersetorial, a construção dos planos depende de um trabalho coletivo das diversas secretarias de governo. Reforça-se que os itens analisados foram todos normativos, o que implica necessidade do estabelecimento de mecanismos que garantam a sua adequada execução.

Individual and community level factors with a significant role in determining child height-for-age Z score in East Gojjam Zone, Amhara Regional State, Ethiopia: a multilevel analysis

Background

In Ethiopia, child undernutrition remains to be a major public health challenge and a contributing factor for child mortality and morbidity. To reduce the problem, it is apparent to identify determinants of child undernutrition in specific contexts to deliver appropriately, targeted, effective and sustainable interventions.

Methods

An agroecosystem linked cross-sectional survey was conducted in 3108 children aged 6–59 months. Multistage cluster sampling technique was used to select study participants. Data were collected on socio-demographic characteristics, child anthropometry and on potential immediate, underlying and basic individual and community level determinants of child undernutrition using the UNICEF conceptual framework. Analysis was done using STATA 13 after checking for basic assumptions of linear regression. Important variables were selected and individual and community level determinants of child height-for-age Z score were identified. P values less than 0.05 were considered the statistical level of significance.

Results

In the intercept only model and full models, 3.8% (p < 0.001) and 1.4% (p < 0.001) of the variability were due to cluster level variability. From individual level factors, child age in months, child sex, number of under five children, immunization status, breast feeding initiation time, mother nutritional status, diarrheal morbidity, household level water treatment and household dietary diversity were significant determinants of child height for age Z score. Also from community level determinants, agroecosystem type, liquid waste disposal practice and latrine utilization were significantly associated with child height-for-age Z score.

Conclusion

In this study, a statistical significant heterogeneity of child height-for-age Z score was observed among clusters even after controlling for potential confounders. Both individual and community level factors, including the agroecosystem characteristics had a significant role in determining child height-for-age Z score in the study area. In addition to the existing efforts at the individual levels to improve child nutritional status, agroecosystem and community WASH related interventions should get more attention to improve child nutritional status in the study area.

A human rights approach to the health implications of food and nutrition insecurity

Food and nutrition insecurity continues to pose a serious global challenge, reflecting government shortcomings in meeting international obligations to ensure the availability, accessibility, and quality of food and to ensure the highest attainable standard of health of their peoples. With global drivers like climate change, urbanization, greater armed conflict, and the globalization of unhealthy diet, particularly in under-resourced countries, food insecurity is rapidly becoming an even greater challenge for those living in poverty. International human rights law can serve a critical role in guiding governments that are struggling to protect the health of their populations, particularly among the most susceptible groups, in responding to food and nutrition insecurity. This article explores and advocates for a human rights approach to food and nutrition security, specifically identifying legal mechanisms to "domesticate" relevant international human rights standards through national policy. Recognizing nutrition security as a determinant of public health, this article recognizes the important links between the four main elements of food security (i.e., availability, stability, utilization, and access) and the normative attributes of the right to health and the right to food (i.e., availability, accessibility, affordability, and quality). In drawing from the evolution of international human rights instruments, official documents issued by international human rights treaty bodies, as well as past scholarship at the intersection of the right to health and right to food, this article interprets and articulates the intersectional rights-based obligations of national governments in the face of food and nutrition insecurity.

Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action

BACKGROUND

What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within 'practice silos', and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos.

METHODS

We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings.

RESULTS

The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1).

CONCLUSIONS

Our model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.

Understanding Perceptions of Climate Change, Priorities, and Decision-Making among Municipalities in Lima, Peru to Better Inform Adaptation and Mitigation Planning

Climate change poses multiple risks to the population of Lima, the largest city and capital of Peru, located on the Pacific coast in a desert ecosystem. These risks include increased water scarcity, increased heat, and the introduction and emergence of vector-borne and other climate sensitive diseases. To respond to these threats, it is necessary for the government, at every level, to adopt more mitigation and adaptation strategies. Here, focus groups were conducted with representatives from five Lima municipalities to determine priorities, perception of climate change, and decision-making processes for implementing projects within each municipality. These factors can affect the ability and desire of a community to implement climate change adaptation and mitigation strategies. The results show that climate change and other environmental factors are of relatively low priority, whereas public safety and water and sanitation services are of highest concern. Perhaps most importantly, climate change is not well understood among the municipalities. Participants had trouble distinguishing climate change from other environmental issues and did not fully understand its causes and effects. Greater understanding of what climate change is and why it is important is necessary for it to become a priority for the municipalities. Different aspects of increased climate change awareness seem to be connected to having experienced extreme weather events, whether related or not to climate change, and to higher socioeconomic status.

Extreme Weather-driven Disasters and Children’s Health

Extreme weather events such as heat waves, extreme precipitation, and storm surges are likely to become more frequent and intense with climate change. Extreme weather-driven disasters (EWDDs) cause a substantial burden of childhood mortality and morbidity worldwide. We reviewed the published literature on EWDDs and their health impacts on children, and developed a conceptual model based on complex systems thinking to identify the health risks, vulnerabilities, and capacities of children in the context of EWDDs as a means of informing areas for adaptive intervention. We found that direct and indirect physical and mental impacts of EWDDs on child health are abundant and interrelate in complex ways. The literature review and modeling demonstrated the centrality of resilience at the level of the child and his or her direct environment, suggesting that mental health status may play a key role in a child’s experience of numerous other health outcomes of EWDDs. EWDDs interact with environmental and social systems and with individual children and their contexts in complex ways, the impacts of which are nonlinear and difficult to predict. Traditional perspectives on climate change-driven health impacts often overlook complex bio-psychosocial interactions, suggesting a need to work on preventive strategies to reduce vulnerability and build individual child resilience.

Challenges and Opportunities in Scaling-Up Nutrition in Healthcare

Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity, type 2 diabetes mellitus and hypertension. An increase in ageing populations also has meant increased interest in nutrition-related chronic diseases. In many middle-income countries, there has been an increase in the double burden of malnutrition with undernourished children and overweight/obese parents and adolescents. In low-income countries, an increased evidence base has allowed scaling-up of interventions to address under-nutrition, both nutrition-specific and nutrition-sensitive interventions. Immediate barriers (institutional, structural and biological) and longer-term barriers (staffing shortages where most needed and environmental impacts on health) are discussed. Significant barriers remain for the near universal access to healthcare, especially for those who are socio-economically disadvantaged, geographically isolated, living in war zones or where environmental damage has taken place. However, these barriers are increasingly being recognized, and efforts are being made to address them. The paper aims to take a broad view that identifies and then comments on the many social, political and scientific factors affecting the achievement of improved nutrition through healthcare.