Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels

Trends in the prevalence of concurrent anaemia and stunting among infants and young children in Rwanda: a cross-sectional study from 2010 to 2020

BACKGROUND

Concurrent anaemia and stunting (CAS) pose severe public health risks in low- and middle-income countries, affecting child health and development.

OBJECTIVES

To determine trends in CAS prevalence and associated factors among infants and young children aged 6-23 months in Rwanda.

METHODS

Analyses of nationally representative samples from the Rwanda Demographic and Health Surveys (RDHS) of 2010, 2014/15, and 2019/20 were conducted. Participants' characteristics, trends, and prevalence of CAS were analysed using frequencies and percentages. Multivariable binary logistic regression analyses were used to assess factors associated with CAS.

RESULTS

The prevalence of CAS among children aged 6-23 months in Rwanda declined from 21.3% in 2010 to 16.9% in 2019/20 (p = 0.005). Significant factors associated with CAS included child's age above 12 months, male sex, small/very small birth size, breastfeeding initiation 1 day post-birth, inadequate minimum acceptable diet, history of cough 2 weeks prior to the survey, multiple births, being from a mother with no or only primary education, mother aged below 20 years, mother with no iron supplementation during pregnancy, maternal anaemia, resident of an eastern province, resident of high altitude areas (>2000 m), low household wealth and unimproved toilet facilities.

CONCLUSIONS

This study reveals persistent CAS among infants and young children in Rwanda. CAS was associated with various child, maternal, and household-related factors. Despite a notable decline in CAS prevalence in Rwanda over the past decade, CAS remains a significant public health issue, requiring targeted interventions.

Determinants of Infant Growth in a Birth Cohort in the Nepal Plains

This study aimed to identify the determinants of infant growth in terms of length-for-age z-score (LAZ) in a birth cohort (n = 602) in the plains of Nepal. Children were enrolled within 72 h of birth and followed-up every 28 days until they were 2 years. We fitted mixed-effects linear regression models controlling for multiple measurements within individuals to examine the impact of household and maternal factors, feeding practices and infection on infant LAZ. We conducted separate analyses for the age periods 0-6 months (exclusive breastfeeding period) and 7-24 months (complementary feeding period) to check whether the importance of determinants differed by child age. Maternal factors related to both the environment in-utero and in postnatal life were the most important determinants of infant growth. The overall most important determinant of growth was low birthweight. At birth, babies born with low birthweight had a -1.21 (-1.38, -1.05) lower LAZ compared to normal birthweight babies. The difference in LAZ between low birthweight and normal birthweight babies attenuated with age but low birthweight remained the factor with the largest effect size. The second largest factor was maternal education. Infants of mothers with any level of education had a 0.22 (0.07, 0.38) higher LAZ in the 7-24 months age-period than those whose mothers had never been to school. Other relevant determinants were adolescent pregnancy, minimum dietary diversity, symptoms of respiratory infection, household food insecurity, season and maternal absence. The importance of maternal factors for infant growth calls for public health interventions targeting girls and young women.

Factors associated with childhood undernutrition in poor Ethiopian households: Implications for public health interventions

BACKGROUND

Childhood undernutrition is a significant public health concern linked to poverty. Despite the persistent high burden of childhood undernutrition in Ethiopia, there is a lack of robust evidence identifying factors associated with undernutrition in under-five children from poor households in the nation. This study aimed to identify the determinants of childhood undernutrition among children living in poor households in Ethiopia.

METHODS

The 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys were combined, and analysis was restricted to children aged 0-59 months from poorer and poorest households, yielding a weighted sample of 12,466 analysed. The adverse nutritional status indicators of child nutritional status: height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), and weight-for-height z-scores (WHZ) were the outcomes of interest. The child's HAZ, WHZ, and WAZ were below -2 standard deviations (SD) were categorized as binary and into stunted, wasted, and underweight, respectively. Multilevel mixed-effect logistic regression analyses were conducted to examine factors associated with childhood undernutrition in poor households.

RESULTS

The prevalence of stunting, wasting and underweight among children aged 0-59 months in poor households was 47.5% (95% CI: 46.5-48.4), 12.7% (95% CI: 12.1-13.3), and 32.8% (95% CI: 31.9-33.7), respectively. The most significant factors positively associated with stunting, wasting, and being underweight comprised of male gender, younger age, having diarrhea two week before each survey, children perceived as smaller by their mothers (stunted and wasted only), children of uneducated mothers (stunting and underweight only), maternal short stature (stunting and underweight only), and children from households having unimproved sanitation facility (stunting and underweight only). The odds of wasting were significantly higher among children who lived in urban areas, children from female-headed households and those children who had fever two weeks before each survey.

CONCLUSION

Child undernutrition in poor Ethiopian households is significantly higher than the national average, highlighting a critical public health issue. Urgent intervention focusing on the identified risk factors, such as sanitation, maternal education, and childhood diarrhea is needed, to improve child nutrition and well-being in disadvantaged households.

Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction-A Narrative Review

Stunting is a major global health concern, particularly in low- and middle-income countries, due to its persistently high prevalence. It often originates from chronic malnutrition during the critical first 1000 days of life. Maternal and child nutrition are critical determinants of a child's growth and development. This article aimed to explore the impact, causes, and evidence-based strategies to accelerate the reduction of stunting incidence worldwide. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025 using the keyword "Stunting", "Causes of stunting", "Stunting Impact", "Stunting Intervention", and "Stunting Prevention". The findings highlight the multifactorial causes of stunting, including maternal malnutrition, inadequate breastfeeding and complementary feeding, poor sanitation, and socioeconomic factors. Stunting is associated with impaired linear growth, cognitive deficits, gut dysbiosis, endocrine disruption, anemia, and increased risk of chronic diseases later in life. Addressing stunting demands multisectoral strategies focusing on maternal and child nutrition, infection prevention, improved WASH (Water, Sanitation, and Hygiene) practices, and socioeconomic support. The evidence presented may guide policy development and targeted interventions to prevent stunting and its long-term effects.

Undernutrition and Intestinal Infections in Children: A Narrative Review

Undernutrition affects thousands of children under five years old worldwide, and various factors are related to its onset, among which we highlight enteric infections and gastrointestinal barrier dysfunction. The cycle of intestinal infections and undernutrition has long-term consequences, such as cognitive deficits, poor growth, and metabolic diseases in adulthood. This review explores factors linked to childhood undernutrition, focusing on intestinal infections and markers of intestinal permeability that affect child development. This narrative review was conducted using Medline/PubMed, Web of Science, and Scopus, from July 2024 to March 2025. Studies involving children under five years old and addressing undernutrition, intestinal infections, or intestinal permeability markers were included. Exclusion criteria comprised studies without therapeutic focus, and books, case reports, or academic theses. No language restrictions were applied, and registration on global platforms was not required. Overall, the studies reported a close relationship between enteric pathogens, diarrheal and non-diarrheal stools, and undernutrition. Among the pathogens most frequently found in the feces of malnourished children were Shigella, enterotoxigenic Escherichia coli, enteroaggregative E. coli (EAEC), and Cryptosporidium. The studies also showed the relationship between gastrointestinal barrier function and undernutrition, with the deterioration of nutrient absorption and, consequently, repercussions on development, linear growth, and weight in children. Although the studies analyzed had different designs and heterogeneity in the age range of the studied children, it was possible to observe the relationship between the infection/undernutrition cycle. Future studies should optimize personalized nutrient-based therapies, assess long-term effects on gut health and growth, and explore the gut microbiome's role in enteric infection susceptibility and undernutrition.

Growth faltering or deceleration toward target height: Linear growth interpretation using WHO growth standard 2006 for Indonesian children

OBJECTIVE

When referred to the WHO Growth Standards 2006, children in many developing countries showed growth faltering in childhood. A previous study showed that the faltering affected the whole population, not only the disadvantaged ones. We aimed to look for an alternative explanation for this universal decline in length or height-for-age z-scores (HAZ), as lengths/ heights of Indonesian children were compared to the WHO growth standard 2006: Is it a faltering of growth or is it a deceleration toward target height.

METHODS

We used data on age, gender, height, BMI, parental height and education, household socioeconomic status, and place of residence of children <  5 years old collected by the Indonesia Family Life Survey (IFLS) in 1993, 2000, 2007, and 2014. HAZ was calculated according to the WHO 2006 growth standard. Target heights were calculated from parental heights and converted to target height z-scores (THz). Discrepancies between the two values were used to show the children's growth patterns in relation to their target heights across ages.

RESULTS

The study included 11,241 parent-child pairs from four surveys. At birth, infants were around 1.50 z-scores longer than their THz. However, at two years of age, the discrepancies were almost zero. At 2-5 years old, the discrepancies stayed at the same level. The patterns were similar regardless of the position of the target heights among the height distribution, at the upper or the lower part.

CONCLUSION

We observed a deceleration toward target height, not growth faltering, in the first two years of life of Indonesian children when the WHO Growth Standard 2006 was used as the reference.

A high prevalence of stunting was observed among under-five children: A community-based cross-sectional study

BACKGROUND

In low-income countries, stunting remains a major public health problem. It contributes to 50 % of all morbidity and mortality of under-five children and results in diminished mental and physical development.

OBJECTIVES

This study aims to determine the prevalence of stunting and identify the key socio-demographic, clinical, and environmental factors that associated with stunting among children aged 6-59 months in Pawie District, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from March 1st to April 1st, 2019 among 841 children aged 6-59 months. An anthropometric measurement was taken for all children to determine their nutritional status, but demographic, clinical, and associated factor data were obtained through face-to-face interviews with the mother of the child using a structured questionnaire. Before analysis, the data was cleaned thoroughly to check for completeness. Then, enter into Epi Info version 7 and export to SPSS v25 for analyses. Frequencies mean, SD, percentage, and cross-tabulations were used to summarize the descriptive statistics of the data. Bi-variable and multi-variable logistic regression was employed to identify the associated factors of stunting. Lastly, results were presented using tables, charts, graphs, and result statements.

RESULTS

A total of 841 respondents were included in this study, with a 99 % response rate. The prevalence of stunting among children aged 6-59 months was 37.2 % (95 % CI: 33.9-40.4). Of these, half (50.1 %) were female. Child age (AOR = 1.988 [95 % CI: 1.140, 3.465]), maternal education (AOR = 5.164 [95 % CI: 1.207, 22.099]), maternal occupation (AOR: 4.975 [95 % CI: 1.720, 14.385]), episodes of malaria (AOR = 1.900 [95 % CI: 1.262, 2.862]), colostrum feeding (AOR = 2.519 [95 % CI: 1.310, 4.846]), and meal frequency (AOR = 1.857 [95 % CI: 1.084, 3.179]) were factors significantly associated with stunting.

CONCLUSIONS

In this study, a relatively high prevalence of stunting and many factors associated with it were observed. Therefore, confirming food security at the household level and creating awareness among mothers and guardians are the best methods to reverse under-5 stunting.

Mitigating the Impact of Intergenerational Risk Factors on Stunting: Insights From Seven of the Most Food Insecure Districts in South Africa

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

Childhood Anemia in Mozambique: A Multilevel Mixed-Effects Analysis of 2011-2022/23 Population-Based Surveys

Background/Objectives: Anemia adversely affects children's cognitive and motor development and remains a global public health problem. This study aimed to identify the individual, feeding, household, and community determinants of anemia among children in Mozambique. Methods: We used pooled datasets of two Mozambique representative population-based surveys: the 2011 and 2022-2023 Demographic and Health Surveys. A total sample of 8143 children aged 6-59 months with available hemoglobin testing was included. Multilevel mixed-effects analysis was performed using STATA (18.0). Results: Over a decade, the prevalence of anemia in children aged 6-59 months remained high, increasing slightly from 69.1% in 2011 to 72.9% in 2022. Children aged 6-11 months were less likely to have anemia than children from other age groups (aOR = 0.77, 95% CI = 0.62-0.96). Children who suffered from illnesses (aOR = 1.44, 95% CI = 1.18-1.75), received vitamin A supplements (aOR = 0.76, 95% CI = 0.63-0.93), lived in female-headed households (aOR = 1.16, 95% CI = 1.01-1.32), and who lived in households with unimproved drinking water sources (aOR = 1.40, 95% CI = 1.19-1.65) were more likely to have anemia than their peers. Overall, 16% of the variability in anemia prevalence was attributed to differences between clusters (ICC = 0.16). Conclusions: Childhood anemia remains a critical public health challenge in Mozambique, with prevalence rates exceeding the average for sub-Saharan Africa. Multisectoral approaches to enhance essential supplies' provision and the primary healthcare monitoring of children at risk favored more investments in rural development and sustainable agriculture, water sanitation, and social care and gender-sensitive work policies that can help tackle childhood anemia.

Drivers of stunting and wasting across serial cross-sectional household surveys of children under 2 years of age in Pakistan: potential contribution of ecological factors

BACKGROUND

The impact of direct and indirect drivers on linear growth and wasting in young children is of public health interest. Although the contributions of poverty, maternal education, empowerment, and birth weight to early childhood growth are well recognized, the contribution of environmental factors like heat, precipitation, agriculture outputs, and food security in comparable datasets is less well established.

OBJECTIVES

This study aims to investigate the association of length-for-age z-score (LAZ) and weight-for-length z-score (WLZ) with various indicators among children aged under 2 y in Pakistan using representative household-level nutrition surveys and ecological datasets.

METHODS

Using geo-tagged metadata from Pakistan's 2011 and 2018 National Nutrition Surveys, anthropometric data from 29,887 children (9231 from 2011 and 20,656 from 2018) were analyzed. Dietary intake and food security data for 140 districts were linked to gridded data on temperature, precipitation and soil moisture, and district measures of agriculture production of edible crops. Multiple linear regressions assessed factors associated with LAZ and WLZ in index children.

RESULTS

LAZ was positively associated with improved socioeconomic conditions (β = 0.06), food security (β = 0.10), birth size (β = 0.26), maternal age (β = 0.02), body mass index (β = 0.02), height (β = 0.02), and dietary score (β = 0.03). Negative associations with LAZ were found for increased temperature, precipitation, diarrhea, household crowding, and parity. Similar patterns were observed with WLZ for higher surface temperatures and precipitation was associated with declines in linear growth, alongside increased diarrhea prevalence and higher maternal parity.

CONCLUSIONS

Apart from recognized multifactorial drivers of stunting and wasting among children such as poverty, food insecurity, and maternal undernutrition, our analysis suggests the potential independent association with climatic factors such as heat and excess precipitation over time. These findings underscore the need for further research and the potential integration of climatic mitigation and adaptation with nutrition response strategies.

Prevalence and associated factors of psychological distress among caregivers of children with malnutrition: a cross‑sectional study

BACKGROUND

Malnutrition is a major child health problem in developing countries, contributing to 53% of child deaths annually. Psychological distress is an emotional and behavioral condition that causes significant suffering and interferes with a person's daily life. Caregivers' psychological distress can negatively impact a child's development. Studies have shown that psychological distress has an impact on infant growth and nutritional status. However, evidence regarding the relationship between psychological distress and child malnutrition is scarce.

OBJECTIVES

The aim of this study was to determine the prevalence of psychological distress among caregivers of malnourished children and to identify factors associated with this.

METHODS

This was a cross-sectional study was conducted and 409 caregivers participated. Outcome variable was assessed using Kessler Psychological Distress Scale (K-10).The collected data were analyzed using SPSS version 25. Bivariable and multivariable logistic analysis was conducted to identify factors associated with Psychological distress and Variables with P-value < 0.05 were considered to have significant association with 95% confidence interval.

RESULTS

The prevalence Psychological distress among caregivers of malnourished children was 42.5%. Unemployment (AOR = 3.39, 95% CI: 2.14-9.11), poor socioeconomic status (AOR = 3.91, 95% CI: 1.46-9.34), low child feeding practices (AOR = 2.18, 95% CI: 1.12-4.21), poor social support (AOR = 4.44, 95% CI: 1.75-11.29), physical and emotional abuse (AOR = 3.37, 95% CI: 1.36-8.35), and child underweight (AOR = 4.36, 95% CI: 3.94-8.36) were factors statically significant associated with psychological distress.

CONCLUSION

Caregivers of malnourished children experienced high psychological distress linked to unemployment, poverty, poor feeding practices, poor social support, both physical and emotional abuse and child underweight. Therefore, strategies should focus on improving employment, strengthening social support, promoting proper child feeding, raising economic status, preventing abuse, and combating underweight to reduce caregiver psychological distress.

Children's Characteristics as the Predictors of Stunting among Children Under 2 Years in East Nusa Tenggara in Indonesia

Background

East Nusa Tenggara is a province in the east of Indonesia with a relatively high stunting proportion than other provinces. This situation is exacerbated by the poverty that characterizes the people of this region. The study analyzes children's characteristics related to stunting among children under 2 years in East Nusa Tenggara, Indonesia.

Methods

The cross-sectional study examined 3,134 children under 2 years. Besides nutritional status (stature), the study analyzed five children's characteristics as exposure variables (birth weight, birth length, early initiation of breastfeeding, gender, and age) and six control variables (residence, maternal age, marital, maternal education, employment, wealth). We employed a binary logistic regression test in the last step.

Results

Low-birth-weight children are 1.970 times more likely than normal children to experience stunting [95% confidence interval (CI) 1.905-2.037]. Children with short birth lengths are 1.373 times more likely than those with standard measurements to be stunted (95% CI 1.331-1.417). On the other hand, children without early initiation of breastfeeding are 1.034 times more likely than those with early initiation of breastfeeding (95% CI 1.013-1.057). Meanwhile, a boy is 1.426 times more likely to be stunted than a girl to experience stunting (95% CI 1.397-1.456). Moreover, based on children's age, 12-23 are 3.435 times more likely than those ≤12 to be stunted (95% CI 3.360-2.513).

Conclusion

The study concluded that five children's characteristics were related to the stunting incidence in East Nusa Tenggara, Indonesia: birth weight, birth length, early breastfeeding initiation, gender, and age.

Associations of body size and morphology with cardiometabolic health in children: the contribution of genetic factors

OBJECTIVE

We analyzed how anthropometric measures predict cardiometabolic health and how genetic and environmental factors contribute to these associations.

METHODS

Data on 8 indicators of cardiometabolic health, 21 anthropometric measures, and 11 anthropometric indices were available for 216 twin pairs of individuals age 3 to 18 years living in the Autonomous Region of Madeira, Portugal (51% girls). Genetic twin modeling was used to estimate genetic and environmental correlations between the cardiometabolic and anthropometric indicators.

RESULTS

Anthropometric indicators were positively associated with blood pressure and triglycerides and inversely associated with high-density lipoprotein cholesterol. The associations with glucose, low-density lipoprotein cholesterol, total cholesterol, and heart rate were close to zero. BMI and waist circumference showed similar or slightly higher absolute correlations with cardiometabolic health indicators compared with other anthropometric indices. Additive genetic and unique environmental correlations were at the same level as trait correlations.

CONCLUSIONS

BMI and waist circumference provide information on cardiometabolic health that is not less accurate than that provided by more comprehensive anthropometric indices. These associations reflect causal associations between obesity and cardiometabolic disorders rather than only shared genetic associations. Measuring obesity is important for monitoring cardiometabolic risks and can be accomplished using simple indicators at the population level.

Stature and Its Association With Physiological Stress Exposure in a Pediatric Autopsy Sample

INTRODUCTION AND BACKGROUND

Experiencing illnesses or other stressors may disrupt processes of growth and development throughout the different stages of prepubertal development. Stunted stature for age is one potential outcome from such disruption, with both the nature and timing of stressors playing a role in the development of stunting. This study explores whether stress events in utero or during birth, and prepubertal development have an impact on stature, by examining associations between experience of prenatal or birth issues, postnatal stressor exposure by severity, and stature at time-of-death, with the impact of different stress experiences compared.

METHODS

A coronial pediatric dataset of individuals aged 0-20.9 years (280 male, 195 female) who died in the state of New Mexico from years 2011 to 2019 was assessed for presence/absence of stunting associated with physiological stress exposure type whilst controlling for low socioeconomic status (as inferred by housing type) and sex using two multiple logistic regression models for ages < 12, and for ages 12+. Broad postnatal condition categories were then investigated, again controlling for socioeconomic status and sex for these two cohorts. A linear regression model was also used to assess relationships between stunting, physiological stress, low socioeconomic status housing, and age-at-death.

RESULTS AND DISCUSSION

For both groups aged < 12 and 12+, experiencing moderate to severe illness prior to 12 years of age increased the odds of being stunted at death. Only experience of prenatal or birth issues was associated with younger age-at-death, but stunting itself was not, potentially reflecting the prolonged exposure to severe stressors necessary for stunted growth.

Small Intestinal Bacterial Overgrowth and Childhood Malnutrition: A Comprehensive Review of Available Evidence

The gut microbiome is essential for children's normal growth and development, with its formation aligning closely with key stages of growth. Factors like birth method, feeding practices, and antibiotic exposure significantly shape the composition and functionality of the infant gut microbiome. Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase in bacteria within the small intestine. This overgrowth can interfere with digestion, impair nutrient absorption, and lead to both local and systemic inflammation, potentially contributing to malnutrition. In this review, we provide a comprehensive overview of the current understanding of the relationship between SIBO and malnutrition, with a particular focus on the pediatric population. SIBO seems to play an important role in nutrient malabsorption through the gut microbiome imbalance, local inflammation, and disruption of the mucosal intestinal barrier. Additionally, SIBO is more prevalent in digestive disorders linked to malabsorption and malnutrition. Different therapeutic strategies for addressing malnutrition-related SIBO have been proposed. While antibiotics are the primary treatment for SIBO, their effectiveness in promoting weight gain among malnourished children remains uncertain. Hence, future research directed at the impact of microbiome imbalance on nutrient intake and absorption could bring to light new strategies for the effective prevention and treatment of malnutrition.

Predictive modelling of linear growth faltering among pediatric patients with Diarrhea in Rural Western Kenya: an explainable machine learning approach

INTRODUCTION

Stunting affects one-fifth of children globally with diarrhea accounting for an estimated 13.5% of stunting. Identifying risk factors for its precursor, linear growth faltering (LGF), is critical to designing interventions. Moreover, developing new predictive models for LGF using more recent data offers opportunity to enhance model accuracy, interpretability and capture new insights. We employed machine learning (ML) to derive and validate a predictive model for LGF among children enrolled with diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) study and the Enterics for Global Heath (EFGH) - Shigella study in rural western Kenya.

METHODS

We used 7 diverse ML algorithms to retrospectively build prognostic models for the prediction of LGF (≥ 0.5 decrease in height/length for age z-score [HAZ]) among children 6-35 months. We used de-identified data from the VIDA study (n = 1,106) combined with synthetic data (n = 8,894) in model development, which entailed split-sampling and K-fold cross-validation with over-sampling technique, and data from EFGH-Shigella study (n = 655) for temporal validation. Potential predictors (n = 65) included demographic, household-level characteristics, illness history, anthropometric and clinical data were identified using boruta feature selection with an explanatory model analysis used to enhance interpretability.

RESULTS

The prevalence of LGF in the development and temporal validation cohorts was 187 (16.9%) and 147 (22.4%), respectively. Feature selection identified the following 6 variables used in model development, ranked by importance: age (16.6%), temperature (6.0%), respiratory rate (4.1%), SAM (3.4%), rotavirus vaccination (3.3%), and skin turgor (2.1%). While all models showed good prediction capability, the gradient boosting model achieved the best performance (area under the curve % [95% Confidence Interval]: 83.5 [81.6-85.4] and 65.6 [60.8-70.4]) on the development and temporal validation datasets, respectively.

CONCLUSION

Our findings accentuate the enduring relevance of established predictors of LGF whilst demonstrating the practical utility of ML algorithms for rapid identification of at-risk children.

A systematic review of parenting and feeding practices, children's feeding behavior and growth stunting in Asian countries

This systematic review evaluates studies focusing on parenting and feeding practices, children's feeding behavior, and growth stunting in Asian countries. Eight electronic databases were searched to screen studies published between Jan 2015 and May 2021. There were contradictory findings related to gender differences in growth stunting and factors that reinforce/facilitate or inhibit acquisition of optimum growth in children. Theme of parenting practices showed that time spent on childcare, traditional beliefs about child-care feeding and responsive feeding were also contributing factors. Amidst economic improvement, political, social changes, and worldwide execution of various nutritional programs, stunting continues to be relentlessly persistent and widespread in Asia. Undernutrition disturbs areas of the mind involved in reasoning, reminiscence, locomotor skills and also an adverse influence on the physical and psychological growth of children and ensuing learning capabilities. Stunted children have more anxiety and depression and lower self-esteem than non-stunted children. A public health strategy is required to: (i) properly examine stunting with time through collaborated efforts of community members and various sectors, (ii) tackle malnutrition with steps to enhance maternal nutrition during pregnancy, infant feeding practices and (iii) involvement of effective multi-sectoral partnership programs for management of stunting.

A formative study of the sociocultural influences on dietary behaviours during pregnancy in rural Bangladesh

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers-in-law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal-source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers-in-law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial 'add-on' to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women.

Effect of maternal postnatal balanced energy protein supplementation and infant azithromycin on infant growth outcomes: an open-label randomized controlled trial

BACKGROUND

Maternal undernutrition is a direct risk factor for infant growth faltering.

OBJECTIVES

We evaluated the effect of postnatal balanced energy protein (BEP) supplementation in lactating women and azithromycin (AZ) in infants on infant growth outcomes.

METHODS

A randomized controlled superiority trial of lactating mother-newborn dyads was conducted in Karachi, Pakistan. Mothers intending to breastfeed their newborns with mid-upper arm circumference of <23 cm and live infants between 0 and 6 d of life were randomly assigned to 1 of 3 arms in a 1:1:1 ratio. Lactating mothers in the control arm received standard-of-care counseling on exclusive breastfeeding, nutrition, infant immunization, and health promotion plus iron-folate supplementation until the infant was 6 mo old. In intervention arm 1, mothers additionally received two 75-g sachets of BEP per day. In intervention arm 2, along with the standard-of-care and BEP to the mother, the infant also received 1 dose of azithromycin (20 mg/kg) at the age of 42 d . The primary outcome was infant length velocity at 6 mo. The total sample size was 957 (319 in each arm).

RESULTS

From 1 August, 2018 to 19 May, 2020, 319 lactating mother-newborn dyads were randomly assigned in each arm, and the last follow-up was completed on 20 November, 2020. The mean difference in length velocity (cm/mo) between BEP alone and control was 0.01 (95% confidence interval [CI]: -0.03, 0.06), BEP plus AZ and control was 0.08 (95% CI: 0.03, 0.13), and between BEP + AZ and BEP alone was 0.06 (95% CI: 0.01, 0.11). There were 1.46% (14/957) infant deaths in the trial, and 17.9% (171/957) nonfatal events (injectable treatment and/or hospitalizations) were recorded.

CONCLUSIONS

Postnatal maternal BEP supplementation and infant AZ administration could modestly improve infant growth outcomes at 6 mo, suggesting potential benefits in simultaneously addressing maternal and infant undernutrition. This trial was registered at clinicaltrials.gov as NCT03564652.

Maternal knowledge on nutritional-focused nurturing care and associated factors among women with stunted children aged 6-23 months in Yogyakarta, Indonesia: A cross-sectional study

Background

Childhood stunting poses serious long-term risks to cognitive development, education, and adult productivity. While research has explored stunting's causes and effects, there is a lack of focus on maternal knowledge of nutrition-focused nurturing care for stunted children. This gap limits the ability to design effective interventions that target improved caregiving practices.

Objective

This study aimed to assess maternal knowledge of nutrition-focused nurturing care and explore associated factors, including child gender, maternal age, education, income, and prior exposure to nurturing care information, among mothers of stunted children aged 6-23 months in Indonesia.

Methods

A cross-sectional study was conducted with 73 mothers in Kulon Progo, Yogyakarta. Data were collected from February to March 2024 using a validated self-assessment questionnaire covering four domains: responsive caregiving, early learning opportunities, safety and security, and supportive caregiver well-being. Statistical analyses, including t-tests and one-way ANOVA, were performed.

Results

Overall maternal knowledge of nurturing care was high, with a mean score of 25.15 (SD = 4.72). Factors significantly associated with higher knowledge included having male children (p = 0.017), being aged 30-34 years (p = 0.035), possessing higher education levels (p = 0.002), and prior exposure to nurturing care information (p <0.001). Family income significantly influenced knowledge in the domain of early learning opportunities (p = 0.006), though not in other areas.

Conclusion

Maternal knowledge of nutrition-focused nurturing care was influenced by child gender, maternal age, education, income, and prior exposure to nurturing care information. These findings emphasize the importance of focused educational interventions in nursing practice to enhance maternal knowledge. Addressing these factors can help align nursing strategies better to support the healthy growth and development of children.

Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0-5 months. In children aged 6-59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting.

Assessment of Childhood Stunting Prevalence over Time and Risk Factors of Stunting in the Healthy Village Programme Areas in Bangladesh

Childhood stunting is a significant public health concern in Bangladesh. This study analysed the data from the Healthy Village programme, which aims to address childhood stunting in southern coastal Bangladesh. The aim was to assess childhood stunting prevalence over time and explore the risk factors in the programme areas. A cross-sectional, secondary data analysis was conducted for point-prevalence estimates of stunting from 2018 to 2021, including 132,038 anthropometric measurements of under-five children. Multivariate logistic regression analyses were conducted for risk factor analysis (n = 20,174). Stunting prevalence decreased from 51% in 2018 to 25% in 2021. The risk of stunting increased in hardcore poor (aOR: 1.46, 95% CI: 1.27, 1.68) and poor (aOR: 1.50, 95% CI: 1.33, 1.70) versus rich households, children with mothers who were illiterate (aOR: 1.25, 95% CI: 1.09, 1.44) and could read and write (aOR: 1.35, 95% CI: 1.16, 1.56) versus mothers with higher education, and children aged 1-2 years compared with children under one year (aOR: 1.32, 95% CI: 1.20, 1.45). The stunting rate was halved over three years in programme areas, which is faster than the national trend. We recommend addressing socioeconomic inequalities when tackling stunting and providing targeted interventions to mothers during the early weaning period.

Systematic review of associations between gut microbiome composition and stunting in under-five children

Childhood stunting is associated with impaired cognitive development and increased risk of infections, morbidity, and mortality. The composition of the enteric microbiota may contribute to the pathogenesis of stunting. We systematically reviewed and synthesized data from studies using high-throughput genomic sequencing methods to characterize the gut microbiome in stunted versus non-stunted children under 5 years in LMICs. We included 14 studies from Asia, Africa, and South America. Most studies did not report any significant differences in the alpha diversity, while a significantly higher beta diversity was observed in stunted children in four out of seven studies that reported beta diversity. At the phylum level, inconsistent associations with stunting were observed for Bacillota, Pseudomonadota, and Bacteroidota phyla. No single genus was associated with stunted children across all 14 studies, and some associations were incongruent by specific genera. Nonetheless, stunting was associated with an abundance of pathobionts that could drive inflammation, such as Escherichia/Shigella and Campylobacter, and a reduction of butyrate producers, including Faecalibacterium, Megasphera, Blautia, and increased Ruminoccoccus. An abundance of taxa thought to originate in the oropharynx was also reported in duodenal and fecal samples of stunted children, while metabolic pathways, including purine and pyrimidine biosynthesis, vitamin B biosynthesis, and carbohydrate and amino acid degradation pathways, predicted linear growth. Current studies show that stunted children can have distinct microbial patterns compared to non-stunted children, which could contribute to the pathogenesis of stunting.

Undernutrition and associated factors among pregnant women in Ethiopia. A systematic review and meta-analysis

Background

Maternal undernutrition is a major public health concern due to its association with mortality and overall disease burden for mothers and their children. Maternal nutrition determines pregnancy outcomes since reduced intake of nutrients influences gestational age length, placental function, and fetal growth during pregnancy. The complexity of the intergenerational aspects of maternal nutrition may also confound the design of interventions. Therefore, this research aimed to assess the prevalence of undernutrition and associated factors among pregnant women in Ethiopia.

Methods

We identified the literature from PubMed, EMBASE, Scopus, and CINAHL databases. Data were entered into Microsoft Excel and then exported to Stata version 17 statistical software for analysis. The I2 and Q-statistic values detect the level of heterogeneity, and meta regression was performed to investigate between-study heterogeneity using more than one moderator. JBI quality assessment tools were used to include relevant articles. Evidence of publication bias was indicated using the funnel plot and Egger's linear regression test. The effect size was expressed in the form of point estimates and an odds ratio of 95% CI in the fixed-effect model.

Result

In total, 19 studies fulfill the inclusion criteria. The pooled prevalence of undernutrition among pregnant women was 32% (95% CI 31.3-33.2 I2 = 97.5%, P < 0.0). Illiteracy (AOR = 3.6 95% CI; 2.3-5.6), rural residence (AOR = 2.6 95% CI; 1.2-3.5), a lack of prenatal dietary advice (AOR = 2.6 95% CI; 1.8-3.7), household food insecurity (AOR = 2.5 95% CI; 1.9-3.2), and low dietary diversity score (AOR = 3.7 95% CI; 2.2-5.9) appear to be significantly associated with undernutrition among pregnant women.

Conclusion

The review showed that the prevalence of undernutrition is still high among pregnant women. Illiteracy, rural residence, a lack of prenatal dietary advice, household food insecurity, and low dietary diversity score were significantly associated with undernutrition during pregnancy. Interventions should focus on educating the public and helping families access food or supplements they need through local markets, health systems, and community-based support, as undernutrition is caused by numerous interconnected causes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42023417028.

Stunting and its associated factors among children living with HIV/AIDS: a cross-sectional study

Background

Growth failure is a common feature of children living with HIV/AIDS. This study was intended to assess the level of stunting and its associated factors among children living with HIV/AIDS.

Methods

An institution-based cross-sectional study was conducted among 218 children living with HIV/AIDS. An interviewer-administered data collection tools and anthropometric measurements were used to collect data. Bivariable and multivariable logistic regression analyses were used to identify independent variables. Adjusted odds ratio with a 95% CI at a P value of 0.05, which was considered to declare statistical significance.

Result

The level of stunting among children infected with HIV/AIDS in selected northwest comprehensive specialized hospitals in western Amhara was 56.9%. Poor anti-retroviral therapy (ART) adherence [adjusted odds ratio (AOR)=6.15, 95% CI, (3.88-9.69)], lack of co-trimoxazole prophylaxis [AOR=2.0, 95% CI, (1.88-2.98)], opportunistic infection [AOR=4.66, 95% CI, (3.24-6.11), and feeding twice [AOR=3.88, 95% CI, (1.94-5.14)] and feeding three times [AOR=1.52, 95% CI, (1.23-3.89)] were significantly associated with stunting.

Conclusion

Stunting among HIV/AIDS-infected children was very high. Poor ART adherence, lack of co-trimoxazole prophylaxis, opportunistic infection, and low feeding frequency were significantly associated to stunting among HIV/AIDS-infected children. Strategies need to be devised to address factors amenable to modification to improve the growth of children living with HIV/AIDS.

Understanding stunting risk factors in Kampar Regency: Insights from mothers with stunted children (qualitative study)

Objective

To assess the perceptions of mothers with stunted children regarding the factors contributing to stunting in Kampar Regency, Riau Province, Indonesia.

Introduction

Stunting is intricately linked to underlying risk factors, and understanding these factors is crucial for preventing its recurrence, particularly for mothers who play a central role in caring for stunted children.

Methods

The research sample consisted of mothers referred by the Perhentian Raja Community Health Center with stunted children. Purposive sampling was employed to select informants and thematic analysis was used for data analysis.

Results

A total of 15 informants were interviewed, leading to the identification of five themes related to stunting risks: (1) before pregnancy, (2) during pregnancy, (3) postnatal, (4) infectious disease factors, and (5) socio-demographic factors.

Conclusion

The study indicates that mothers hold diverse opinions about factors contributing to stunting, with their views being shaped by health programs and personal experiences, specifically focusing on aspects like breastfeeding and weaning foods. Additionally, it underscores that education and economic challenges introduce complexity to understanding how mothers perceive the risk factors associated with stunting.

Etiology of diarrheal hospitalizations following rotavirus vaccine implementation and association of enteric pathogens with malnutrition among under-five children in India

Malnourished children are at higher risk of mortality and morbidity following diarrheal illness and certain enteropathogens have been associated with malnutrition in children. Very few studies have comprehensively looked at the etiology of diarrhea in malnourished children and most have used conventional diagnostic methods with suboptimal sensitivity. We used a highly sensitive molecular approach against a broad range of pathogens causing diarrhea and examined their association with malnutrition. In addition, we looked at the pathogen diversity of pediatric diarrhea, three years after the nationwide rotavirus vaccine introduction to understand the evolving landscape of pathogens, which is crucial for planning strategies to further reduce the diarrhea burden. Clinical details and diarrheal stool samples were collected from hospitalized children aged < 5 years from three sentinel sites in India for a period of one year. The samples were tested by qPCR for 16 established causes of diarrhea using TaqMan Array Cards. A total of 772 children were enrolled, from whom 482 (62.4%) stool specimens were tested. No specific pathogen was associated with diarrhea among children with acute or chronic malnutrition compared to those with better nutritional status. Overall, adenovirus was the leading pathogen (attributable fraction (AF) 16.9%; 95% CI 14.1 to 19.2) followed by rotavirus (AF 12.6%; 95% CI 11.8 to 13.1) and Shigella (AF 10.9%; 95% CI 8.4 to 16.4). The majority of diarrhea requiring hospitalization in children aged < 2 years could be attributed to viruses, while Shigella was the most common pathogen among children aged > 2 years. These data on the prevalence and epidemiology of enteropathogens identified potential pathogens for public health interventions.

Concurrence of anemia and stunting and associated factors among children aged 6 to 59 months in Peru

Anemia and stunting are two health problems in the child population; therefore, their concurrence needs to be quantified. We estimated the prevalence of concurrent anemia and stunting (CAS) in children aged 6-59 months and identified the factors associated with this condition. The data came from the Demographic and Health Survey of Peru (DHS), 2022. The study design was cross-sectional and included 19,191 children. Height and hemoglobin measurement followed the specifications of National Health Institute of Peru. To reduce error in measures, the anthropometry personnel was training, the quality of measuring equipment was ensuring, and protocolized techniques and procedures was applying. Hemoglobin concentration was measured in capillary blood using the Hemocue model Hb 201+. Stunting was defined as a height-for-age Z-score less than minus two standard deviations (SD) from the median, following the 2006 WHO child growth standard. Anemia was classified into mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), severe (< 7.0 g/dL), and no anemia (11.0 to 14.0 g/dL). We performed a bivariate analysis to evaluate factors associated with CAS. To include variables in the multivariate analysis, we applied a statistical criterion (p < 0.10 in the crude analysis) and an epidemiological criterion. We used a binary logistic hierarchical regression model. The prevalence of CAS was 5.6% (95%CI: 5.2 to 5.9). The modifiable factors associated with higher odds of CAS were: "poorest" (aOR: 3.87, 95%CI: 1.99 to 7.5) and "poorer" (aOR: 2.07, 95%CI: 1.08 to 3.98) wealth quintiles, mother with no formal education or primary (aOR: 2.03, 95%CI: 1.46 to 2. 81), father with no formal education or primary (aOR: 1.55, 95%CI: 1.16 to 2.07), no improved water source (aOR: 1.36, 95%CI: 1.10 to 1.68), no roof with improved material (aOR: 1.49, 95%CI: 1.12 to 1.98) and low birth weight (aOR: 7.31, 95%CI: 4.26 to 12.54). In Peru, five out of every 100 children suffer from anemia and stunting simultaneously; there are modifiable factors that, if addressed, could reduce their prevalence.

Statistical modelling of determinants of child stunting using secondary data and Bayesian networks: a UKRI Global Challenges Research Fund (GCRF) Action Against Stunting Hub protocol paper

INTRODUCTION

Several factors have been implicated in child stunting, but the precise determinants, mechanisms of action and causal pathways remain poorly understood. The objective of this study is to explore causal relationships between the various determinants of child stunting.

METHODS AND ANALYSIS

The study will use data compiled from national health surveys in India, Indonesia and Senegal, and reviews of published evidence on determinants of child stunting. The data will be analysed using a causal Bayesian network (BN)-an approach suitable for modelling interdependent networks of causal relationships. The model's structure will be defined in a directed acyclic graph and illustrate causal relationship between the variables (determinants) and outcome (child stunting). Conditional probability distributions will be generated to show the strength of direct causality between variables and outcome. BN will provide evidence of the causal role of the various determinants of child stunning, identify evidence gaps and support in-depth interrogation of the evidence base. Furthermore, the method will support integration of expert opinion/assumptions, allowing for inclusion of the many factors implicated in child stunting. The development of the BN model and its outputs will represent an ideal opportunity for transdisciplinary research on the determinants of stunting.

ETHICS AND DISSEMINATION

Not applicable/no human participants included.

Economic risks hidden in local water pollution and global markets: A retrospective analysis (1995-2010) and future perspectives on sustainable development goal 6

Pollution from untreated wastewater discharges depletes clean water supply for humans and the environment. It poses adverse economic impacts by determining agricultural yields, manufacturing productivity, and ecosystem functionality. Current studies mainly focus on quantity-related water scarcity assessment. It is unknown how low water quality amplifies local water stress and induces cascading economic risks globally. In this study, we estimated both quality and quantity-related water scarcity index (WSI), local economic water scarcity risk (WSR), and cascading virtual WSR evident in global trade markets across 40 major economies from 1995 to 2010. We find developing countries, e.g., India and China, witnessed fast growth in both quantity and quality-related WSI. Major developed economies, e.g., the US and Germany, experienced a modest increase in water stress but alleviated quality-related risks. Local economic risk (WSR) grew from $116B to $380B, with quality-related risks rising from 20 % to 30 %. Virtual economic WSR in global supply chains increased from $39B to $160B, with quality-related risks increasing from 19 % to 27 %. China became the top exporter of economic WSR, ranked above the US, France, and Japan, and the second-largest position as an importer, trailing only the US. We finally conducted scenario modeling by 2030, assuming different progresses on SDG 6 targets. The findings suggest that only the most ambitious progress in both water quality enhancement and efficiency improvement helps to alleviate ∼20 % economic WSR globally. Our findings underscore the necessity for strategies that integrate management of untreated wastewater flows, improved water use efficiency, and diversification of supply chain networks to enhance global economic resilience to water challenges in the future.

Prevalence and Correlates of Stunting among a High-Risk Population of Kenyan Children Recently Hospitalized for Acute Illnesses

Stunting (length/height-for-age z-score < -2) is associated with significant morbidity and mortality among children under 5 years of age in sub-Saharan Africa. Children who are stunted and recently hospitalized for acute illness may be at particularly elevated risk for post-discharge mortality. In this cross-sectional analysis, we measured the prevalence of stunting at hospital discharge and identified host, caregiver, and environmental correlates of stunting among children aged 1-59 months in Western Kenya enrolled in the Toto Bora Trial. Child age- and site-adjusted prevalence ratios were estimated using Poisson regression. Of the 1,394 children included in this analysis, 23% were stunted at hospital discharge. Older children (12-23 months and 24-59 months versus 0-5 months) had a higher prevalence of stunting (adjusted prevalence ratio [aPR]: 1.58; 95% CI: 1.04-2.36 and aPR: 1.59; 95% CI: 1.08-2.34, respectively). HIV-exposed, uninfected children (aPR: 1.94; 95% CI: 1.39-2.70), children with HIV infection (aPR: 2.73; 95% CI: 1.45-5.15), and those who were never exclusively breastfed in early life (aPR 2.51; 95% CI: 1.35-4.67) were more likely to be stunted. Caregiver education (primary school or less) and unimproved sanitation (pit latrine without slab floor or open defecation) were associated with increased risk of stunting (aPR: 1.94; 95% CI: 1.54-2.44; aPR: 1.99; 95% CI: 1.20-3.31; aPR: 3.57; 95% CI: 1.77-7.21, respectively). Hospital discharge represents an important opportunity for both identifying and delivering targeted interventions for nutrition-associated poor outcomes among a high-risk population of children.

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018

OBJECTIVE

The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali.

DESIGN

Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018.

SETTING

Urban and rural areas of Mali.

PARTICIPANTS

A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months).

RESULTS

In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group.

CONCLUSIONS

This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.

Childhood stunting is highly clustered in Northern Province of Rwanda: A spatial analysis of a population-based study

Background

In Northern Province, Rwanda, stunting is common among children aged under 5 years. However, previous studies on spatial analysis of childhood stunting in Rwanda did not assess its randomness and clustering, and none were conducted in Northern Province. We conducted a spatial-pattern analysis of childhood undernutrition to identify stunting clusters and hotspots for targeted interventions in Northern Province.

Methods

Using a household population-based questionnaire survey of the characteristics and causes of undernutrition in households with biological mothers of children aged 1-36 months, we collected anthropometric measurements of the children and their mothers and captured the coordinates of the households. Descriptive statistics were computed for the sociodemographic characteristics and anthropometric measurements. Spatial patterns of childhood stunting were determined using global and local Moran's I and Getis-Ord Gi* statistics, and the corresponding maps were produced.

Results

The z-scores of the three anthropometric measurements were normally distributed, but the z-scores of height-for-age were generally lower than those of weight-for-age and weight-for-height, prompting us to focus on height-for-age for the spatial analysis. The estimated incidence of stunting among 601 children aged 1-36 months was 27.1 %. The sample points were interpolated to the administrative level of the sector. The global Moran's I was positive and significant (Moran's I = 0.403, p < 0.001, z-score = 7.813), indicating clustering of childhood stunting across different sectors of Northern Province. The local Moran's I and hotspot analysis based on the Getis-Ord Gi* statistic showed statistically significant hotspots, which were strongest within Musanze district, followed by Gakenke and Gicumbi districts.

Conclusion

Childhood stunting in Northern Province showed statistically significant hotspots in Musanze, Gakenke, and Gicumbi districts. Factors associated with such clusters and hotspots should be assessed to identify possible geographically targeted interventions.

The interlink between chrono-nutrition and stunting: current insights and future perspectives

Stunting is the one factor that is responsible for the irretrievable damage to children's mental and physical health. Stunting imitates chronic undernutrition throughout the most extreme critical stages of growth and development of a child in their early life, and due to that stunted child does not completely develop and are too short for their age. Stunting is mainly linked with brain underdevelopment, along with lifelong damaging consequences, comprising weakened mental and learning capacity, deprived performance in school during childhood, and enhanced risks of nutrition linked to chronic long-lasting ailments, such as diabetes, hypertension, diabesity, and obesity in the future. In this review, the authors mainly summarize the latest studies related to chronic nutrition and how it is related to stunting. Optimal nutrition, particularly during pregnancy and the first 24 months of a child's life, is crucial in preventing stunting. Circadian rhythms play a significant role in maternal and fetal health, affecting outcomes such as premature birth and stunting. Maintaining a balanced diet, avoiding late-night carbohydrate-heavy meals during pregnancy, and promoting breastfeeding align with the body's biological clock, which can benefit newborns in various ways. Providing dedicated spaces for breastfeeding in public places is important to support infant health.

Intra-uterine exposure to lower maternal haemoglobin concentration is associated with impaired cognitive function in stunted adolescents: results from a 17-year longitudinal cohort study in Indonesia

The long-term impact of maternal anaemia on cognitive performance remains unknown. Indonesian longitudinal cohort data of 363 paired pregnant mothers and their 10-14-year-old offspring were used to investigate the association between maternal haemoglobin (Hb) concentration and their offspring's cognitive function (assessed by Raven's Progressive Matrices test) during adolescence. The weighted anaemia prevalence was 49.3% in pregnant mothers and 22.2% in adolescents. Adolescents who were stunted, anaemic, or living in a rural area had significantly lower cognitive scores than their counterparts. Maternal Hb was not associated with adolescent cognitive function (β: 0.14; 95%CI: -0.052-0.340). However, the effect of maternal Hb concentration on offspring's cognitive function was modified by stunting status (β, stunted: 0.44; 95%CI: 0.05-0.82; non-stunted: 0.01; 95%CI: -0.02-0.24). This study shows adverse cognitive outcomes at adolescent age are likely multi-causal and can be partially explained by intra-uterine exposure to low maternal Hb concentrations.

Correlation between gut microbiota composition, enteric infections and linear growth impairment: a case-control study in childhood stunting in Pidie, Aceh, Indonesia

BACKGROUND

Gut microbiota is pivotal in maintaining children's health and well-being. The ingestion of enteric pathogens and dysbiosis lead to Environmental Enteric Dysfunction (EED), which is essential in stunting pathogenesis. The roles of gut microbiome and enteric infections have not been explored comprehensively in relation to childhood stunting in Indonesia. This study aimed to determine the correlation between gut microbiota composition, enteric infections, and growth biomarker, Insulin-like Growth Factor 1 (IGF-1), in stunted children from Pidie, Aceh, Indonesia.

METHODS

This study was a case-control study involving 42 subjects aged 24 to 59 months, comprising 21 stunted children for the case and 21 normal children for the control group. The IGF-1 serum level was quantified using ELISA. The gut microbiome profiling was conducted using 16S rDNA amplicon sequencing. The expression of enteric pathogens virulence genes was determined using quantitative PCR (qPCR) assay. The correlations of observed variables were analysed using suitable statistical analyses.

RESULTS

The result showed that the IGF-1 sera levels in stunted were lower than those in normal children (p ≤ 0.001). The abundance of Firmicutes (50%) was higher than Bacteroidetes (34%) in stunted children. The gut microbiome profile of stunted children showed enriched genera such as Blautia, Dorea, Collinsella, Streptococcus, Clostridium sensu stricto 13, Asteroleplasma and Anaerostipes. Meanwhile the depleted genera comprised Prevotella, Lactococcus, Butyrivibrio, Muribaculaceae, Alloprevotella, Akkermansia, Enterococcus, Terrisporobacter and Turicibacter. The abundance of water biological contaminants such as Aeromonas, Stappiaceae, and Synechococcus was also higher in stunted children compared to normal children. The virulence genes expression of Enteroaggregative Escherichia coli (aaiC), Enterotoxigenic E. coli (estA), Enteropathogenic E. coli (eaeA), Shigella/Enteroinvasive E. coli (ipaH3) and Salmonella enterica (ompC) in stunted was higher than in normal children (p ≤ 0.001), which negatively correlated to height and level of IGF-1.

CONCLUSION

The present study showed the distinctive gut microbiome profile of stunted and normal children from Pidie, Aceh, Indonesia. The gut microbiota of stunted children revealed dysbiosis, comprised several pro-inflammatory, metabolic abnormalities and high-fat/low-fiber diet-related taxa, and expressed virulence genes of enteric pathogens. These findings provide evidence that it is imperative to restore dysbiosis and preserve the balance of gut microbiota to support linear growth in children.

Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania

Children born to mothers living with HIV may experience greater risk of poor growth and development outcomes than their HIV-unexposed peers. Few studies have examined the relationship between maternal depression and social support with infant growth and development in the context of HIV. We conducted a prospective cohort study of 2,298 pregnant women living with HIV in Dar es Salaam, Tanzania, assessing antenatal depression (Hopkins Symptoms Checklist-25) and social support (Duke-UNC Functional Social Support Questionnaire) at 12-27 weeks of gestation. At one-year age, infant anthropometry and caregiver-reported infant development were assessed. Generalized estimating equations were used to assess mean differences (MD) and relative risks (RR) for growth and developmental outcomes. Symptoms consistent with maternal antenatal depression had 67% prevalence and were associated with infant wasting (RR 2.61; 95% confidence interval (CI) 1.03-6.65; z = 2.02; p = 0.04), but no other growth or developmental outcomes. Greater maternal social support was not associated with infant growth outcomes. Greater affective support was associated with better cognitive (MD 0.18; CI 0.01-0.35; z = 2.14; p = 0.03) and motor (MD 0.16; CI 0.01-0.31; z = 2.04; p = 0.04) development scores. Greater instrumental support was associated with better cognitive (MD 0.26; CI 0.10-0.42; z = 3.15; p < 0.01), motor (MD 0.17; CI 0.02-0.33; z = 2.22; p = 0.03), and overall (MD 0.19; CI 0.03-0.35; z = 2.35; p = 0.02) development scores. Depressive symptoms were associated with greater risk of wasting, while social support was associated with better infant development scores. Strategies to improve mental health and social support for mothers living with HIV during the antenatal period may benefit infant growth and development.

Stunting among Children Aged 6 to 59 Months Visiting the Outpatient Department of Pediatrics in a Tertiary Care Centre

Introduction

Stunting refers to low height for age, resulting from chronic undernutrition, often linked to poor socio-economic conditions, maternal health, infant care, and nutrition. It hinders children's physical and cognitive development. In Nepal, over half of children under five suffer from malnutrition. Despite efforts, stunting remains high but has decreased from 57% in 1996 to 25% in 2022. The aim of the study was to find out the prevalence of stunting among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among children aged 6 to 59 months visiting the outpatient Department of Pediatrics in a tertiary care centre after obtaining ethical approval from the Institutional Review Committee from 27 April 2023 to 15 July 2023. Anthropometric measurements were taken. World health organization standard growth charts for Z score was used appropriately for the completed age in months and gender of the child. A pre-designed questionnaire was used for face-to-face interviews. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 320 children, 46 (14.38%) (10.54-18.22, 95% Confidence Interval) children had stunting. Among those 46 children with stunting, 20 (43.47%) had severe stunting.

Conclusions

The prevalence of stunting among children aged 6 to 59 months was found to be lower than other studies done in similar settings.

Keywords

children; prevalence; stunting; undernutrition.

Exploring Factors Associated with Stunting in 6-Month-Old Children: A Population-Based Cohort Study in Sulawesi, Indonesia

Stunting in children under the age of two is a significant global concern, particularly in low- and middle-income countries like Indonesia. Intervention efforts often come too late as many of the underlying causal factors have already occurred earlier. While antenatal multiple micronutrient supplements (MMS) have demonstrated positive effects on pregnancy outcomes, their impact on infant growth in the first six months remains inadequately explored in epidemiological studies. This study aims to identify factors associated with stunting at six months in infants whose mothers received MMS. A population-based cohort study was conducted in four subdistricts of Banggai, Indonesia. Pregnant women were recruited in their third trimester and followed up until their children were six months of age. Validated questionnaires were employed to gather data on social determinants of health and diet, and standardised methods were utilised for anthropometric measurements. Stunting was determined based on the WHO child growth standards. The analysis comprised data from 152 mother-child pairs. The prevalence of stunting during early infancy (first two months) was 18.4%, which decreased to 15.8% in later infancy (at six months). Factors such as small-for-gestational-age (AOR = 11.29; 2.73-46.66), preterm birth (AOR = 6.33; 1.25-31.97), short birth length (AOR = 4.31; 1.11-16.78), maternal mid-upper arm circumference (MUAC) below 23.5 cm, and female infants (AOR = 3.27; 95%CI: 1.04-10.27) were associated with stunting at six months. This study highlights that stunting in the first six months is present at birth, with small-for-gestational-age (SGA) as a strong predictor. In addition, there was a trend to improved growth (-0.30 [-0.79 to 0.18]) in infants born to mothers who received MMS supplementation pre-pregnancy rather than during pregnancy, although it was not statistically significant.

Tools for assessing child and adolescent stunting: Lookup tables, growth charts and a novel appropriate-technology "MEIRU" wallchart - a diagnostic accuracy study

Stunting affects 149 million children worldwide and is a form of chronic malnutrition defined by low height-for-age. Surveys and intervention programmes depend on effective assessment and identification of affected individuals. Gold standard assessment is based on height-for-age Z-score (HAZ): HAZ <-2 defines stunting; HAZ <-3 defines severe stunting. However, a major problem for field-based programmes is that Z-scores can be time-intensive and challenging to calculate. We thus developed a novel wallchart that we have coined 'MEIRU wallchart' to easily and accurately identify stunted children and adolescents. Our study aim was to evaluate its performance and acceptability against other methods used in current clinical/field practice. We undertook a non-interventional diagnostic accuracy study in Malawi. We recruited 244 participants aged 8-19 years and determined each individual's stunting status using, in varying order: the MEIRU wallchart, traditional lookup tables, and traditional growth charts. All were compared against 'gold standard' HAZ, calculated using AnthroPlus WHO software. Local community healthcare workers performed all the assessments. The wallchart method was strongly preferred by both participants and staff. It had an overall accuracy of 95.5%(kappa = 0.91) and was faster than lookup tables by an average of 62.5%(41.4sec; p<0.001) per measurement. Lookup tables and growth charts had overall agreements of 59.4%(kappa = 0.36) and 61.9%(kappa = 0.31) respectively. At the HAZ-2 cut-off, the wallchart had a sensitivity of 97.6%(95%CI: 91.5-99.7) and specificity of 96.3%(95%CI: 92.1-98.6). We conclude that the MEIRU wallchart performs well and is acceptable for screening and identification of stunted children/adolescents by community-level health workers. It fulfils key criteria that justify a role in future screening programmes: easy to perform and interpret; acceptable; accurate; sensitive and specific. Potential future uses include: conducting rapid stunting prevalence surveys; identifying affected individuals for interventions. Current field methods, lookup tables and growth charts performed poorly and should be used with caution.

Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda

INTRODUCTION

Stunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age.

METHODS

This retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ <-3 based on the 2006 WHO child growth standards. Stunting recovery at 24 months of age was defined as the child's LAZ changing from <-2 to > -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother's socio-demographic and clinical characteristics.

RESULTS

Of the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07-0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16-0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1-0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model.

CONCLUSION

A substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.

Analysis of Saliva Composition: Parathyroid Hormone-Related Protein, Total Protein, and Secretory Immunoglobulin A (sIgA) in Rattus norvegicus with Stunted Growth

OBJECTIVE

 This study aimed to determine total protein, secretory immunoglobulin A (sIgA) and parathyroid hormone-related protein (PTHrP) levels in the saliva of rats with stunted growth.

MATERIALS AND METHODS

 Experimental laboratory research with a pre-and posttest control group design was conducted. Seventeen albino rats (Rattus norvegicus) were divided into the control group (eight rats) and the treatment group (nine rats). Rats in the treatment group were exposed to aflatoxin B1 5µg/kg orally for 5 weeks. Anthropometry data (body length, body weight) and saliva of R. norvegicus were collected. The levels of PTHrP and sIgA in the saliva were measured using an enzyme-linked immunosorbent assay kit for rats and the Bradford test for total protein and analyzed using SPSS 25.0.

RESULTS

 Aflatoxin caused stunted growth in rats in the treatment group. There was a significant difference in body length, salivary flow, PTHrP, sIgA, and total protein in the treatment group compared with the control group. The average rat's body length change in the control group was 6.4 ± 1.1mm/5 weeks, while in the treatment group, the change was 3.7 ± 0.9 mm /5 weeks. There was no significant weight gain in the treatment group compared with the normal group. The average values of PTHrP, sIgA, and total protein in the control group were x̄0.9, x̄18, and x̄0.7 m./L, respectively, while in the treatment group, they measured x̄0.4, x̄10.7, and x̄0.5 mg/L, respectively.

CONCLUSION

 This study showed that salivary flow, PTHrP, sIgA, and total protein levels in the saliva were significantly lower in stunted rats compared with normal rats.

The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enroled in an egg intervention trial

Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low- and middle-income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6-15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N-oxide) were measured at baseline and 6-month follow-up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross-sectional covariate-adjusted models, each 1 SD higher plasma choline was associated with lower length-for-age z-score (-0.09 SD [95% confidence interval, CI -0.17 to -0.01]), slower IOWA response time (8.84 ms [1.66-16.03]) and faster processing speed on the VPC task (-203.5 ms [-366.2 to -40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z-score at 6-month follow-up (-0.13 SD [-0.22 to -0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N-oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development.

The association of birthweight with fine particle exposure is modifiable by source sector: Findings from a cross-sectional study of 17 low- and middle-income countries

BACKGROUND

Low birthweight attributable to fine particulate matter (PM_2.5) exposure is a global issue affecting infant health, especially in low- and middle-income countries (LMICs). However, large-population studies of multiple LMICs are lacking, and little is known about whether the source of PM_2.5 is a determinant of the toxic effect on birthweight.

OBJECTIVE

We examined the effect on birthweight of long-term exposure to PM_2.5 from different sources in LMICs.

METHODS

The birthweights of 53,449 infants born between September 16, 2017 and September 15, 2018 in 17 LMICs were collected from demographic and health surveys. Long-term exposure to PM_2.5 in 2017 produced by 20 different sources was estimated by combining chemical transport model simulations with satellite-based concentrations of total mass. Generalized linear regression models were used to investigate the associations between birthweight and each source-specific PM_2.5 exposure. A multiple-pollutant model with a ridge penalty on the coefficients of all 20-source-specific components was employed to develop a joint exposure-response function (JERF) of the PM_2.5 mixtures. The estimated JERF was then used to quantify the global burden of birthweight reduction attributable to PM_2.5 mixtures and to PM_2.5 from specific sources.

RESULTS

The fully adjusted single-pollutant model indicated that exposure to a 10 μg/m³ increase in total PM_2.5 was significantly associated with a -6.6 g (95% CI -11.0 to -2.3) reduction in birthweight. In single- and multiple-pollutant models, significant birthweight changes were associated with exposure to PM_2.5 produced by international shipping (SHP), solvents (SLV), agricultural waste burning (GFEDagburn), road transportation (ROAD), waste handling and disposal (WST), and windblown dust (WDUST). Based on the global average exposure to PM_2.5 mixtures, the JERF showed that the overall change in birthweight could mostly be attributed to PM_2.5 produced by ROAD (-37.7 g [95% CI -49.2 to -24.4] for a global average exposure of 2.2 μg/m³), followed by WST (-27.5 g [95% CI -42.6 to -10.7] for a 1.6-μg/m³ exposure), WDUST (-19.5 g [95% CI -26.7 to -12.6] for a 8.6-μg/m³ exposure), and SHP (-19.0 g [95% CI -32.3 to -5.7] for a 0.2-μg/m³ exposure), which, with the exception of WDUST, are anthropogenic sources. The changes in birthweight varied geographically and were co-determined by the concentration as well as the source profile of the PM_2.5 mixture.

CONCLUSION

PM_2.5 exposure is associated with a reduction in birthweight, but our study shows that the magnitude of the association differs depending on the PM_2.5 source. A source-targeted emission-control strategy that considers local features is therefore critical to maximize the health benefits of air quality improvement, especially with respect to promoting maternal and child health.

Study design and rationale for the PAASIM project: a matched cohort study on urban water supply improvements and infant enteric pathogen infection, gut microbiome development and health in Mozambique

INTRODUCTION

Despite clear linkages between provision of clean water and improvements in child health, limited information exists about the health impacts of large water infrastructure improvements in low-income settings. Billions of dollars are spent annually to improve urban water supply, and rigorous evaluation of these improvements, especially targeting informal settlements, is critical to guide policy and investment strategies. Objective measures of infection and exposure to pathogens, and measures of gut function, are needed to understand the effectiveness and impact of water supply improvements.

METHODS AND ANALYSIS

In the PAASIM study, we examine the impact of water system improvements on acute and chronic health outcomes in children in a low-income urban area of Beira, Mozambique, comprising 62 sub-neighbourhoods and ~26 300 households. This prospective matched cohort study follows 548 mother-child dyads from late pregnancy through 12 months of age. Primary outcomes include measures of enteric pathogen infections, gut microbiome composition and source drinking water microbiological quality, measured at the child's 12-month visit. Additional outcomes include diarrhoea prevalence, child growth, previous enteric pathogen exposure, child mortality and various measures of water access and quality. Our analyses will compare (1) subjects living in sub-neighbourhoods with the improved water to those living in sub-neighbourhoods without these improvements; and (2) subjects with household water connections on their premises to those without such a connection. This study will provide critical information to understand how to optimise investments for improving child health, filling the information gap about the impact of piped water provision to low-income urban households, using novel gastrointestinal disease outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Emory University Institutional Review Board and the National Bio-Ethics Committee for Health in Mozambique. The pre-analysis plan is published on the Open Science Framework platform (https://osf.io/4rkn6/). Results will be shared with relevant stakeholders locally, and through publications.

Citrulline and kynurenine to tryptophan ratio: potential EED (environmental enteric dysfunction) biomarkers in acute watery diarrhea among children in Bangladesh

Two emerging biomarkers of environmental enteric dysfunction (EED) include plasma citrulline (CIT), and the kynurenine (KYN): tryptophan (TRP)/ (KT) ratio. We sought to investigate the plasma concentration of CIT and KT ratio among the children having dehydrating diarrhea and examine associations between concentrations of CIT and KT ratio with concurrent factors. For this analysis, we used cross-sectional data from a total of 102, 6-36 months old male children who suffered from non-cholera acute watery diarrhea and had some dehydration admitted to an urban diarrheal hospital, in Bangladesh. CIT, TRP, and KYN concentrations were determined at enrollment from plasma samples using ELIZA. At enrollment, the mean plasma CIT concentration was 864.48 ± 388.55 µmol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (× 1000) were 6.93 ± 3.08 µmol/L, 33.44 ± 16.39 µmol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: - 0.26; 95%CI: - 0.49, - 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: - 0.01; 95% CI: - 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: - 0.6; 95% CI: - 1.18, - 0.02; p = 0.042) after adjusting for potential covariates. The CIT concentration was associated with blood neutrophils (coef.: 0.02; 95% CI: 0.01, 0.03; p < 0.001), lymphocytes (coef.: - 0.02; 95% CI: - 0.03, - 0.02; p < 0.001) and monocyte (coef.: 0.06; 95% CI: 0.01, 0.11; p = 0.021); KYN concentration was negatively associated with basophil (coef.: - 0.62; 95% CI: - 1.23, - 0.01; p = 0.048) after adjusting for age. In addition, total stool output (gm) increased (coef.: 793.84; 95% CI: 187.16, 1400.52; p = 0.011) and also increased duration of hospital stay (hour) (coef.: 22.89; 95% CI: 10.24, 35.54; p = 0.001) with increasing CIT concentration. The morphological changes associated with EED may increase the risk of enteric infection and diarrheal disease among children. Further research is critically needed to better understand the complex mechanisms by which EED biomarkers may impact susceptibility to dehydrating diarrhea in children.

Infant and young child feeding practices are associated with childhood anaemia and stunting in sub-Saharan Africa

BACKGROUND

The co-occurrence of anaemia and stunting (CAS) presents acute development and morbidity challenges to children particularly in sub-Saharan Africa (SSA). Evidence on the effect of child feeding recommendations on CAS is scarce.

METHODS

We used data from 22 recent Demographic and Health Surveys in SSA countries to examine the association between caregivers' implementation of recommendations on infant and young child feeding and the CAS in their 6- to 23-mo-old children.

RESULTS

Overall, in multiple logistic regression models, child feed index score, high wealth of household, increasing household size, household head with at least secondary school education, improved sanitation of household, an increase in caregiver's age and caregiver's with at least secondary education were associated with lower odds of CAS (i.e.

, AOR

0.86; 95% CI; 0.84 - 0.88: 0.75; 0.69 - 0.82: 0.98, 0.98 - 0.99: 0.76, 0.70 - 0.83: 0.81, 0.74 - 0.87: 0.87, 0.81 - 0.94: 0.69, 0.62 - 0.77 respectively). Having a diarrhoea in the past 2 weeks and having fever in the past month were associated with higher odds of CAS (AOR:1.1, 95% CI; 1.0 - 1.2: 1.1, 1.0 - 1.2, respectively). Results from the decision tree analysis showed that the educational level of women was the most important predictor of CAS, followed by child feeding score, the level of education of the family head and state of drinking water.

CONCLUSION

The results buttress the importance of interventions aimed at improving feeding practices and parental educational as a vehicle to improve children's nutritional status.

Derivation and external validation of clinical prediction rules identifying children at risk of linear growth faltering

Background

Nearly 150 million children under-5 years of age were stunted in 2020. We aimed to develop a clinical prediction rule (CPR) to identify children likely to experience additional stunting following acute diarrhea, to enable targeted approaches to prevent this irreversible outcome.

Methods

We used clinical and demographic data from the Global Enteric Multicenter Study (GEMS) to build predictive models of linear growth faltering (decrease of ≥0.5 or ≥1.0 in height-for-age z-score [HAZ] at 60-day follow-up) in children ≤59 months presenting with moderate-to-severe diarrhea, and community controls, in Africa and Asia. We screened variables using random forests, and assessed predictive performance with random forest regression and logistic regression using fivefold cross-validation. We used the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study to (1) re-derive, and (2) externally validate our GEMS-derived CPR.

Results

Of 7639 children in GEMS, 1744 (22.8%) experienced severe growth faltering (≥0.5 decrease in HAZ). In MAL-ED, we analyzed 5683 diarrhea episodes from 1322 children, of which 961 (16.9%) episodes experienced severe growth faltering. Top predictors of growth faltering in GEMS were: age, HAZ at enrollment, respiratory rate, temperature, and number of people living in the household. The maximum area under the curve (AUC) was 0.75 (95% confidence interval [CI]: 0.75, 0.75) with 20 predictors, while 2 predictors yielded an AUC of 0.71 (95% CI: 0.71, 0.72). Results were similar in the MAL-ED re-derivation. A 2-variable CPR derived from children 0-23 months in GEMS had an AUC = 0.63 (95% CI: 0.62, 0.65), and AUC = 0.68 (95% CI: 0.63, 0.74) when externally validated in MAL-ED.

Conclusions

Our findings indicate that use of prediction rules could help identify children at risk of poor outcomes after an episode of diarrheal illness. They may also be generalizable to all children, regardless of diarrhea status.

Funding

This work was supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award NIH T32AI055434 and by the National Institute of Allergy and Infectious Diseases (R01AI135114).

Nutritional status of under-five aged children of ready-made garment workers in Bangladesh: A cross-sectional study

BACKGROUND

The ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country's GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh.

METHODS

The study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors.

RESULTS

The study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother's education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother's education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother's education level increased from no education to primary or secondary level, the child would be 0.211 (0.071-0.627) and 0.384 (0.138-1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted.

CONCLUSION

The study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.