Potential mediators of the link between wealth index and anthropometric indices of under-five children in Ethiopia

Background

Malnutrition of under-five children has adverse effects on child's health and development, such as growth failure and muscle wasting. The household wealth index has a direct contribution to child malnutrition despite little attention being given to its indirect effect through other factors. This study aimed to identify the potential mediators of the link between wealth index and malnutrition.

Methods

In this study, a cross-sectional study design was implemented based on the data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), which consists of a total of 3,918 under-five children. Mediation analysis of structural equation (SEM) was implemented to determine and estimate the effects of potential mediators of the link between wealth index and under-five children malnutrition.

Results

Among 3,918 under-five children involved in this study, 51.4% were male children and 20.2% were from urban areas. The place of delivery of the majority of mothers (56.1%) was at home, and the majority of children were from the poorest household (36.4%). The estimated effects of height-for-age of female children were higher (1.31:95% CI = 0.45, 0.200), indicating that female children had a lower likelihood of stunting than males. As compared to children in an urban area, children from rural areas were more likely to be stunted (-0.269; 95%CI = -0.388, -0.135). The estimated total indirect effects of wealth index on stunting and underweight was 0.69 (95% = 0.045, 0.094) and 0.036 (95% = 0.013, 0.054), respectively, and significant (p-value of <0.05).

Conclusion

Environmental, maternal, biological, and behavioral factors were the potential mediators of the link between the wealth index and the anthropometric indices. Besides, the total effects of the household wealth index had a significant effect on stunting, underweight, and wasting in which children from a household with low economic status were more likely to be malnourished.

Optimization of the preparation process of mung bean puffed infant rice cereal and evaluation of the structure and digestion characteristics of starch

The present study was carried out to produce a high quality puffed infant rice cereal from rice and mung bean through extrusion technology. Experiments were designed using 3 independent variables (i. e. 14–18% feed moisture, 400–550 r/min screw speed and 125–175 °C barrel temperature) and 3 response variables (i. e. bulk density, water solubility index and degree of gelatinisation) at five different levels of central composite rotatable design (CCRD). The results of optimization demonstrated that 14% feed moisture, 400 r/min screw speed and 175 °C barrel temperature could generate rice-mungbean extrudates with desirable functional properties. The selected extrudate samples were further examined using scanning electron microscope (SEM), rapid viscosity analyzer (RVA), Fourier transform infrared spectrometer (FTIR), X-ray diffraction (XRD) analysis, in vitro digestibility and fundamental nutrient analysis. Notably, the initial oval-shaped particle structure of starch in the raw materials disappeared, the surface debris and roughness increased, and the density decreased. The time required for the gelatinization of puffed infant rice cereal was the shortest, which was in agreement with the positioning of ready-to-eat weaning food for infants. Moreover, the puffed infant rice cereal displayed higher peak viscosity and breakdown value, smaller retrogradation value and greater top taste value compared to the commercial infant rice cereal. Besides maintaining the initial characteristic peak of starch, the puffed infant rice cereal demonstrated characteristic absorption peaks of COO- in the vicinity of 1546 cm−1 and 1437 cm−1, indicating the formation of carboxylate during extrusion. In addition, the puffed infant rice cereal exhibited firm diffraction peaks at the diffraction angles of 7.4°, 12.5° and 20.5°, indicating that a certain amount of starch changed from type A to type V. Furthermore, the digestive rate of puffed infant rice cereal was higher than that of commercial infant cereal (90.21 versus 86.96%, respectively; p < 0.05). Altogether, our findings reveal that the developed puffed infant rice cereal meets the standards set by the Codex Alimentarius Commission (CAC; 74-1981).