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Ndagijimana A, Nduwayezu G, Kagoyire C, Elfving K, Umubyeyi A, Mansourian A, Lind T. Childhood stunting is highly clustered in Northern Province of Rwanda: A spatial analysis of a population-based study. Heliyon 2024; 10:e24922. [PMID: 38312557 PMCID: PMC10835355 DOI: 10.1016/j.heliyon.2024.e24922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
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.
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Affiliation(s)
- Albert Ndagijimana
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Gilbert Nduwayezu
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
- University of Rwanda, College of Sciences and Technology, Centre for Geographic Information Sciences, Kigali, Rwanda
| | - Clarisse Kagoyire
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
- University of Rwanda, College of Sciences and Technology, Centre for Geographic Information Sciences, Kigali, Rwanda
| | - Kristina Elfving
- School of Public Health and Community Medicine, Gothenburg University and the Queen Silvia's Children Hospital, Gothenburg, Sweden
| | - Aline Umubyeyi
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Ali Mansourian
- Department of Physical Geography and Ecosystem Science, Centre for Geographical Information Systems, Lund University, Lund, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Socio-economic, demographic, and contextual predictors of malnutrition among children aged 6-59 months in Nigeria. BMC Nutr 2024; 10:1. [PMID: 38167375 PMCID: PMC10762859 DOI: 10.1186/s40795-023-00813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Malnutrition has remained a global public health issue, particularly in low- and middle-income countries (LMICs). Researchers have committed to studying malnutrition (especially in children under the age of five) to address the nine malnutrition targets, set by the WHO to be achieved by 2025. This study seeks to evaluate the prevalence, the individual and contextual predictors of malnutrition among children aged 6-59 months across Nigeria and its states. Two separates, independently collected, nationally representative cross-sectional surveys, the National Human Development Report (NHDR 2018) and the 2018 Nigeria Demographic and Health Survey (2018 NDHS) were linked for this study. Spatial map was used to describe the prevalence of malnutrition, a 3-level multivariate multilevel logistic regression models were fitted where children/individuals (at level 1) were nested in communities/clusters (at level 2) and nested in states (at level 3). A weighted sample of 7,770 children 6-59 months were considered in this study. The results showed that an estimated 43.6% of children aged 6-59 months are poorly nourished in Nigeria. The proportions of poorly nourished children were generally highest in the Northern Nigeria. Child's gender, age, birth size, preceding birth order, anaemia status, maternal education, work status, body weight, household wealth status, number of bedrooms were among individual/household predictors of malnutrition. On the community level, being from community with high wealth index, distance to nearest health facilities is no big problem. Regional variations and gender inequality index were the state level predictors of malnutrition among children in Nigeria. This study has shown that two-third of children aged 6-59 months in Nigeria were poorly nourished, an indication of a growing concern of double burden of malnutrition in Nigeria.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK.
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, 912231, Bida, Nigeria.
| | - Stephen J Walters
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Jacques
- Sheffiield Centre of Health and Related Research (SCHARR), A Division of Population Health, University of Sheffield, Sheffield, S1 4DA, UK
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, S10 2BP, Sheffield, UK
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Baffour B, Aheto JMK, Das S, Godwin P, Richardson A. Geostatistical modelling of child undernutrition in developing countries using remote-sensed data: evidence from Bangladesh and Ghana demographic and health surveys. Sci Rep 2023; 13:21573. [PMID: 38062092 PMCID: PMC10703913 DOI: 10.1038/s41598-023-48980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Childhood chronic undernutrition, known as stunting, remains a critical public health problem globally. Unfortunately while the global stunting prevalence has been declining over time, as a result of concerted public health efforts, there are areas (notably in sub-Saharan Africa and South Asia) where progress has stagnated. These regions are also resource-poor, and monitoring progress in the fight against chronic undernutrition can be problematic. We propose geostatistical modelling using data from existing demographic surveys supplemented by remote-sensed information to provide improved estimates of childhood stunting, accounting for spatial and non-spatial differences across regions. We use two study areas-Bangladesh and Ghana-and our results, in the form of prevalence maps, identify communities for targeted intervention. For Bangladesh, the maps show that all districts in the south-eastern region are identified to have greater risk of stunting, while in Ghana the greater northern region had the highest prevalence of stunting. In countries like Bangladesh and Ghana with limited resources, these maps can be useful diagnostic tools for health planning, decision making and implementation.
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Affiliation(s)
- Bernard Baffour
- School of Demography, Australian National University, 146 Ellery Crescent, Canberra, ACT, 2600, Australia
| | - Justice Moses K Aheto
- Department of Biostatistics, University of Ghana, P.O. Box LG13, Accra, Ghana
- WorldPop, University of Southampton, Southampton, SO17 1BJ, Hampshire, UK
| | - Sumonkanti Das
- School of Demography, Australian National University, 146 Ellery Crescent, Canberra, ACT, 2600, Australia.
| | - Penelope Godwin
- School of Demography, Australian National University, 146 Ellery Crescent, Canberra, ACT, 2600, Australia
| | - Alice Richardson
- Statistical Support Network, Australian National University, 110 Ellery Crescent, Canberra, ACT, 2600, Australia
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Kassaw A, Kassie YT, Kefale D, Azmeraw M, Arage G, Asferi WN, Munye T, Demis S, simegn A, Agimas MC, Zeleke S. Pooled prevalence and its determinants of stunting among children during their critical period in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0294689. [PMID: 38019780 PMCID: PMC10686443 DOI: 10.1371/journal.pone.0294689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Stunting is a major public health concern, particularly in low and middle-income countries. Globally, nearly 149 million under-five children are suffering from stunting. Despite it can occur in all age groups, the impact is more severe among children age less than 24 months as this period is critical time of very rapid growth and development. Therefore, this review aimed to determine the pooled prevalence and determinants of stunting among children during this critical period in Ethiopia. METHODS The literature search was conducted using international electronic data bases (pumed, Google scholar, CINHAL, Hinari, open Google) and the hand search of reference lists of eligible articles. The presence of heterogeneity between studies was evaluated using Cochrane Q-test and I2 test statistics and sensitivity analysis was also checked. Small study effect was checked through graphical and statistical test. Sub-group analysis was performed to handle heterogeneity. RESULTS This study included 14 studies with a total sample size of 8,056 children. The overall pooled estimate of stunting was 35.01(95% CI: 24.73-45.28, I2 = 98.98%) in the country with the highest prevalence in Amhara region. Increased Child's age (OR = 3.83; 95% CI: 2.47-5.18, I2 = 97.76%), no maternal education (OR = 2.90; 95%CI: 1.59-4.20, I2 = 89.73%), no maternal postnatal follow up (OR = 1.81; 95% CI:1.51-2.10) less than four food diversity of the child (OR = 2.24;95%CI; 1.94-2.55,I2 = 21.55%), low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were significant factors of stunting. CONCLUSION AND RECOMMENDATIONS The pooled prevalence of stunting among children during their critical time is high. Increased Child's age, no maternal education and no maternal postnatal follow up, less than four food diversity of the child, low maternal body mass index, failure to colostrum and exclusive breast feeding, two and more under five children in the household and poor wealth index of the family were determinants of stunting. Therefore, providing continuous maternal postnatal follow up, increase awareness of mothers on importance of colostrum and exclusive breast feeding, feeding of children the recommended variety of foods and at large to improve the wealth status of the households are crucial interventions to meet national and international targets of zero stunting in children less than 2 years.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferi
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare simegn
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Bitew FH, Sparks CS, Nyarko SH, Apgar L. Spatiotemporal Variations and Determinants of Under-Five Stunting in Ethiopia. Food Nutr Bull 2023; 44:27-38. [PMID: 36824032 DOI: 10.1177/03795721231158503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context. OBJECTIVE This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016). METHODS Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses. RESULTS The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting. CONCLUSIONS Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.
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Affiliation(s)
- Fikrewold H Bitew
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Corey S Sparks
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Samuel H Nyarko
- Department of Demography, College for Health, Community & Policy, The University of Texas at San Antonio, San Antonio, TX, USA.,Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Lauren Apgar
- Institutional Research, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
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Brou AM, Djalega FA, Tokpa V, Seri ECG, Anoua ALF, Robinson JA. Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire. Front Public Health 2023; 10:1035488. [PMID: 36699902 PMCID: PMC9868242 DOI: 10.3389/fpubh.2022.1035488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
Background Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school. Method Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI). Results A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness. Conclusion Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.
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Affiliation(s)
- Abenin Mathieu Brou
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire,*Correspondence: Abenin Mathieu Brou ✉
| | - Franck Adjé Djalega
- Laboratory of Nutrition and Food Security of the Department of Food Science and Technology, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Venance Tokpa
- Department of Language Sciences, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Edy Constant Gbala Seri
- Ivorian Center for Studies and Research in Applied Psychology, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Apie Léa Fabienne Anoua
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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