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Abdilahi SA, Osman MO, Abate KH. Epidemiology of stunting in children aged 6-59 months, an unresolved chronic nutritional problem in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2024; 12:20503121241259862. [PMID: 38881594 PMCID: PMC11179513 DOI: 10.1177/20503121241259862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
Background In developing countries as well as Ethiopia, stunting continues to be a major public health burden. Thus, the aim of this systematic review and meta-analysis is to synthesize the updated pooled prevalence and its determinants of stunting in Ethiopia. Methods This systematic review and meta-analysis follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The protocol has been registered with the International Prospective Register of Systematic Reviews, University of York Center for Reviews, and disseminated at https://www.crd.york.ac.uk/, with the registration number (CRD42024542984). A wide-ranging literature search was carried out using PubMed/Medline, Science Direct, Hinari, AJOL, and Google Scholar. All lists of qualified study references from 2013 to 2023 were recovered. The pooled estimate with a 95% CI was calculated using a random-effects model in STATA version 13 software. I 2 and meta-bias statistics were used to assess the heterogeneity of the incorporated studies. Results This study included 29 articles with a total of 23,511 participants from 29 qualified studies. The current study found that the pooled prevalence of stunting among children aged 6-59 months was 43% (95% CI: 42-44). Children who were not exclusively breastfed (OR = 2.39; 95% CI: 1.61-3.54), male children (OR = 1.61; 95% CI: 1.13-2.31), children whose mothers had no antenatal care follow-up (OR = 3.03; 95% CI: 1.36-6.76), and women who had no formal education (OR = 4.55; 95% CI: 2.29-9.05) were significantly associated with stunting. Conclusions In Ethiopia, nearly half of the children suffer from stunting, with those who are not breastfed, the sex of the child, children whose mothers had no antenatal care follow-up, and had no formal education having higher odds of stunting. To reduce the burden, strategies must be designed to intervene and improve maternal health literacy, focusing on children's nutrition and health-care utilization.
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Affiliation(s)
- Sahardiid Ali Abdilahi
- Departments of Public Health, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Departments of Public Health, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
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Asebe HA, Asmare ZA, Mare KU, Kase BF, Tebeje TM, Asgedom YS, Shibeshi AH, Lombebo AA, Sabo KG, Fente BM, Bezie MM, Seifu BL. The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis. Front Nutr 2024; 11:1336864. [PMID: 38903623 PMCID: PMC11187342 DOI: 10.3389/fnut.2024.1336864] [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: 11/11/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.
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Affiliation(s)
- Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanose Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Afewerk Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meklit Melaku Bezie
- Department of Public Health Officer, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia
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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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Feleke DG, Chanie ES, Wubet GM, Amare AT, Demelash AT, Desale AT, Yimer RD, Tesema AA. Magnitude of stunting and its determinant factors among children age 6-59 months at Debre Tabor comprehensive specialized hospital, South Gondar zone, North central Ethiopia, 2020. Afr Health Sci 2023; 23:508-523. [PMID: 38974300 PMCID: PMC11225437 DOI: 10.4314/ahs.v23i4.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction malnutrition continues to be a significant public health and development concern not only in the developing country but also in the world. It is a serious problem because it is causing the deaths of 3.5 million children under 5 years old per- year. Methods Institution based cross-sectional study design was employed using sample of 342 children selected through systematic simple random sampling technique from May 1st -July30 /2020. Bivariate and multivariate logistic regression analysis was used. The variables which had significant association were identified on the bases of P value<0.05 and AOR 95% CI. Result The analysis this study revealed that, 42.6% of children were stunted. The main associated factors of stunting were found to be birth order of the child, maternal occupation, frequency meal per day, mother who did not wash their hand before breastfeeding, (AOR=1.636:95%CI:1.00-2.674), children who were not vitamin A, supplemented (AOR=1.901, 95%CI: 1.162-3.109), and child whose mother were not use family planning (AOR=2.916, 95%CI: 1.064-7.989 were associated with outcome variable. Conclusion and recommendation From the findings of this study, it is concluded that stunting is still an important problem among children aged 6-59 months. Especial attention should be given on intervention of malnutrition.
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Affiliation(s)
- Dejen Getaneh Feleke
- Department of Pediatrics and Child Health nursing, college of Health Sciences Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health nursing, college of Health Sciences Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia
| | - Gashaw Mehiret Wubet
- Department of Medicine, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Ethiopia
| | - Abrham Tsedalu Amare
- Department of comprehensive nursing, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Ethiopia
| | - Agimasie Tigabu Demelash
- Department of comprehensive nursing, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw Desale
- Department of Epidemiology, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Ethiopia
| | - Reta Dewau Yimer
- Department of Epidemiology, College of Health Sciences Wollo University, P.O.Box 272, Wollo, Ethiopia
| | - Ayechew Ademas Tesema
- Department of Environmental, College of Health Sciences Wollo University, P.O.Box 272, Wollo, Ethiopia
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Mbae-Mugambi UK, Onyango AC, Okeyo DO. Food price perception, food and beverage marketing and the nutritional status of children 6-24 months in Obunga slums, Kisumu Kenya: a cross-sectional study. BMC Nutr 2023; 9:114. [PMID: 37803463 PMCID: PMC10559538 DOI: 10.1186/s40795-023-00772-3] [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: 10/13/2022] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Malnutrition is a significant problem in Africa. In Kenya, 26% of under-fives are stunted; slums are the hardest hit. Obunga slum has the highest prevalence at 40%. METHODS A cross-sectional study was adopted; simple random sampling techniques were used to identify 189 eligible households in the Obunga slum with children between 6-24 months. An interviewer-administered questionnaire collected data on food price perceptions and food and beverage marketing. An anthropometric data collection form gathered information on the children's height, weight and age. Scores for stunting, wasting and underweight were generated based on WHO Z-Score cut-off points. Binary logistic regression identified the relationship between food price perceptions, food and beverage marketing and the nutritional status of children between 6-24 months in Obunga slums. RESULTS Prevalence of wasting was 3.2%, stunting was 27.0%, underweight was at 7.4%, while overweight was at 13%. Food price perceptions: An increase in fruits prices was significantly associated with wasting (Adjusted O.R. = 10. 82, C.I. = 1.10-106.77, P < 0.05) and underweight (Adjusted O.R. = 5.44, C.I. = 1.35-21.61, P < 0.05). Food & Beverage Marketing: Feeding children on commercially produced complementary food products and commercially produced food was significantly associated with wasting at an (Adjusted O.R. = 7.82, C.I. = 1.29-47.46, p < 0.05, and adjusted O.R. = 5.96, C.I. = 1.06-33.60, p < 0.05) respectively. Stunting was significantly associated with listening/reading or watching advertisements on commercial food products (Crude O.R. = 0.49, C.I. = 0.24-0.998, p < 0.05.). Watching food-related adverts on television (Adjusted O.R. = 0.38 C.I. = 0.146- 0.10) and watching marketing on commercial foods (Adjusted O.R. = 0.21, C.I. = 0.07-0.61) and watching television (Adjusted O.R. = 9.30, C.I. = 2.31-37.40). While watching food-related adverts on television was associated with being underweight (Adjusted O.R. = 18.68 and at C.I. = 1.22-286.89). CONCLUSION The price perceptions of fruits, feeding children commercially produced food products and complementary foods, and Watching food-related adverts on television; had an impact on the nutritional status of children. Thus, a longitudinal study would be needed to understand the long-term effect of food prices and food and beverage marketing on nutritional status.
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Affiliation(s)
- Umotho Kinya Mbae-Mugambi
- School of Public Health & Community Development, Maseno University, Kisumu City, Kenya.
- Kenya Nutritionists and Dieticians Institute, Nairobi City, Kenya.
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Habimana JDD, Uwase A, Korukire N, Jewett S, Umugwaneza M, Rugema L, Munyanshongore C. Prevalence and Correlates of Stunting among Children Aged 6-23 Months from Poor Households in Rwanda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4068. [PMID: 36901076 PMCID: PMC10001740 DOI: 10.3390/ijerph20054068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19-23 months (AOR = 4.410, p-value = 0.01), and children aged 13-18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.
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Affiliation(s)
- Jean de Dieu Habimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
| | - Aline Uwase
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Noel Korukire
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
| | - Sara Jewett
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Maryse Umugwaneza
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
| | - Lawrence Rugema
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
| | - Cyprien Munyanshongore
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 4286, Rwanda
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Drew SD, Blake CE, Reyes LI, Gonzalez W, Monterrosa EC. Attributes of parenting identities and food practices among parents in Nairobi, Kenya. Appetite 2023; 180:106370. [PMID: 36375600 DOI: 10.1016/j.appet.2022.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Dramatic changes in daily life are leading to increased rates of obesity and non-communicable diseases (NCD) in Kenya, including among children. Parenting plays a vital role in helping children establish healthy eating habits to prevent obesity and NCDs. The objective of this study was to describe parenting identity and how attributes of parenting influence food parenting practices in an urban Kenyan context. A qualitative study design was employed with 18 participants recruited using quota sampling to include parents who were born in (n = 8) or migrated to Nairobi in the last five years (n = 10). In-depth qualitative interviews were conducted by an experienced ethnographic interviewer that inquired about parenting identity and food parenting practices. Transcripts were analyzed using thematic coding in a multi-step and emergent process. Parents described their parenting identities as an integration of tradition and personal experiences during their upbringing with the modern realities of daily life. Their own experiences with discipline, modern urban lifestyles, and social pressures were dominant influences on their identities. Parenting identities included four distinct but related attributes: good disciplinarian, trustworthy, protective, and balanced provider and nurturer. Food parenting practices were described as expressions of parenting identity and included the goals: children becoming better eaters; nourishing through food; impart joy; and bonding. The study findings illustrate the influence of modern urban lifestyles on food parenting identities and practices. Understanding emerging identities and practices in rapidly changing low- and middle-income countries (LMIC) contexts is essential for health promoting policies and programs.
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Affiliation(s)
- Shiny Deepika Drew
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Christine E Blake
- University of South Carolina, Arnold School of Public Health, Columbia, SC, 29208, USA.
| | - Ligia I Reyes
- Cornell University, Division of Nutritional Sciences, Ithaca, NY, 14850, USA.
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202, Geneva, Switzerland.
| | - Eva C Monterrosa
- Global Alliance for Improved Nutrition, Rue de Varembé 7, 1202, Geneva, Switzerland.
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Chege CGK, Onyango K, Kabach J, Lundy M. Effects of COVID-19 on dietary behavior of urban consumers in Nairobi, Kenya. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.718443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The disruptions wrought by the COVID-19 pandemic on food systems worldwide have endangered food and nutrition security for many consumers. The resource-poor, especially those in urban areas, are more susceptible to pandemic-related disturbances. This study uses primary data collected from 2,465 households located in and outside of informal settlements (slums) in Nairobi, Kenya to assess how COVID-19 and related public-health measures have influenced diets of urban consumers, their purchasing patterns and overall food security. Questions about food security and consumption behavior, including household dietary diversity scores, were used to capture the pre- and mid-pandemic situation. The data show that low-income households in the informal settlements were more affected than middle-income households. About 90% of slum households reported dire food insecurity situations, including being unable to eat preferred kinds of food, eating a limited variety of foods, consuming smaller portions than they felt they needed, and eating fewer meals in a day. With a score of four food groups out of nine, household in the informal settlements have lower dietary diversity than middle-income households, whose score is five out of nine. The consumption of nutritious foods, including fruits, vegetables, and animal products, fell among people living in slums during the pandemic. In addition to assessing dietary changes, this study highlights the factors associated with quality food consumption during the pandemic period such as household income levels and male-vs-female headed households. Our research demonstrates the need to attend to slums and vulnerable, poor consumers when enacting mitigation measures or designing and implementing policy.
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Agedew E, Misker D, Gelibo T, Tadelle A, Eyasu Makonnen, Worku S, Bekele A, Mekonnen Y, Belay A, Challa F, Awoke T, Gemeda N, Kerebih H, Shiberu S, Debella A. Does Moringa stenopetala based diet consumption decrease burden of under nutrition in under-five children, Southern Ethiopia? Heliyon 2022; 8:e10285. [PMID: 36046542 PMCID: PMC9421190 DOI: 10.1016/j.heliyon.2022.e10285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/11/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Moringa stenopetala is used for medicinal and nutritional purposes. This study was, therefore, conducted to assess the contribution of Moringa stenopetala based diet in reducing under nutrition in under-five children in four districts of Southern Ethiopia. Method A community-based comparative cross-sectional study design was employed from August to September 2016 in randomly selected comparative sites among 732 under five children. Anthropometric measurements of weight and height of children were measured based on the standard measurement protocol. Regarding moringa stenopetala diet, the consumption habit was collected by using a seven days food frequency questionnaire. Amount of moringa stenopetala leaf biomass portion size consumption was measured with local measurement and converted to kilograms. Anthropometric data were analyzed using WHO Anthro software to determine the nutritional status of the child. An independent t-test was conducted to compare the mean difference of WHO-Z score of child nutritional index. Statistical mean significance difference was measured based on p-value less than 0.05 with 95% confidence level. In addition chi-square test with a p-value, less than 0.05 with a 95% confidence level was used to compare the prevalence of stunting, wasting, and underweight in moringa stenopetala based diet and non-moringa stenopetala based diet consuming area. Result The prevalence of stunting was 19% vs. 28.8%, wasting 4.7% vs. 9.6%, and underweight 12.19% vs 13.71% in moringa stenopetala based diet consuming and non-consuming participants respectively. There was a significant difference in stunting and wasting (p < 0.05) among moringa stenopetala based diet-consuming and non-consuming participants. Conclusion: The present study showed that moringa stenopetala based diet consumption had a significant contribution in reducing under-nutrition in under-five children.
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Affiliation(s)
- Eskeziyaw Agedew
- Debre Markos University, College of Health Sciences, Debre Markos, Ethiopia
| | | | - Terefe Gelibo
- Columbia University, Mailman School of Public Health, Addis Ababa, Ethiopia
| | | | - Eyasu Makonnen
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Worku
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yelmtsehay Mekonnen
- College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Belay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feyissa Challa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Temsgen Awoke
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Negero Gemeda
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Haregewoyin Kerebih
- Debre Markos University, School of Medicen, Biomedical Department, Debre Markos, Ethiopia
| | | | - Asfaw Debella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Zivkovic A, Merchant EV, Nyawir T, Hoffman DJ, Simon JE, Downs S. Strengthening Vegetable Production and Consumption in a Kenyan Informal Settlement: A Feasibility and Preliminary Impact Assessment of a Sack Garden Intervention. Curr Dev Nutr 2022; 6:nzac036. [PMID: 35542383 PMCID: PMC9071549 DOI: 10.1093/cdn/nzac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Over 85% of Kibera's population, an informal settlement in Nairobi, Kenya, is food insecure. Nutrition-sensitive agriculture interventions, such as sack gardens, have the potential to diversify diets-in turn, improving household food security and diet quality. Furthermore, the sale of extra vegetables may provide an income for program participants. Objectives The aim of this paper was to conduct a feasibility assessment and preliminary impact assessment of a nutrition-sensitive urban agriculture intervention that used sack gardens for women in Kibera. Methods Women, from a women's empowerment program, in Kibera (n = 36; n = 21 full program participants, n = 11 withdrawn, n = 4 new members) were engaged in a sack garden intervention in June 2018. A mixed-method approach was used to assess the feasibility and preliminary impact of the program. Qualitative semi-structured interviews (n = 25; n = 18 full program participants, n = 5 withdrawn, n = 2 new members), administered at the end of the pilot phase (March 2019), identified barriers and facilitators (e.g., preferences, inputs, group dynamics) to the production, consumption, and sale of self-produced vegetables. Quantitative surveys (n = 21 full program participants), administered in June 2018 and March 2019, were conducted to evaluate preliminary intervention impact on food security and diet quality through analysis of the Household Hunger Scale (HHS) and Minimum Dietary Diversity for Women (MDD-W). Results Key barriers included insufficient inputs and group work difficulties, particularly around communication. Facilitators included positive intervention feedback, social bonds and teamwork, participants' self-sufficiency, and preference for sack garden vegetables over market vegetables. Post-intervention, participants reported reduced household food insecurity. Recommendations for program scale-up include investment in additional inputs, a water-collection/irrigation system, additional training, and placing sack gardens closer to women's homes to reduce time constraints. Conclusions This study suggests that sack gardens may provide partial solutions to improve diet quality; however, further research is needed to assess any impact on household income.
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Affiliation(s)
- Alexandra Zivkovic
- Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, USA
| | - Emily V Merchant
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
| | - Thomas Nyawir
- Mirror of Hope Community Based Organization (C.B.O.) , Nairobi, Kenya
| | - Daniel J Hoffman
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
- Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Education and Research, Program in International Nutrition, Rutgers University, New Brunswick, NJ, USA
| | - James E Simon
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
| | - Shauna Downs
- Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, USA
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ, USA
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11
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Gebreayohanes M, Dessie A. Prevalence of stunting and its associated factors among children 6-59 months of age in pastoralist community, Northeast Ethiopia: A community-based cross-sectional study. PLoS One 2022; 17:e0256722. [PMID: 35113874 PMCID: PMC8812981 DOI: 10.1371/journal.pone.0256722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/16/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Globally, stunting is a significant public health concern and it is very critical in Ethiopia. This research aims to determine the prevalence of stunting and its correlates among children in the pastoral community. METHODS A community-based cross-sectional study was conducted in Dubti District, Afar Region, North East Ethiopia from 2-31 January 2018. A total of 554 children were recruited using a multi-stage sampling technique and participated in this study. A binary logistic regression analysis was performed to determine factors linked to stunting. The significance of the associations was determined at a p-value < 0.05 and the adjusted odds ratio at 95% CI was calculated to evaluate the strength of the associations. RESULTS The prevalence of stunting was 39.5% (95% CI: 35.4-43.5%). The odds of stunting were increased, so does the age of the child increased as compared to 6-11 months of children. Initiating breastfeeding after 1 hour after birth (AOR = 1.99; 95% CI: 1.22, 3.23), not exclusively breastfeeding for at least 6 months (AOR = 2.57; 95% CI: 1.49, 4.42), poor dietary diversity (AOR = 1.93; 95% CI: 1.03, 3.62), and using unprotected water for drinking (AOR = 1.68; 95% CI: 1.21, 2.94) were significant factors. CONCLUSION Among children aged 6-59 months, the level of stunting in the pastoral community was significantly high. The study found that stunting was associated with multiple nutritional and non-nutritional factors. To tackle stunting, inter-sectoral cooperation is needed by enhancing the clean water supply of the community, optimal breastfeeding practice, food diversity, and economic status.
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Affiliation(s)
- Mulugeta Gebreayohanes
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Awrajaw Dessie
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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12
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Tadele TT, Gebremedhin CC, Markos MU, Fitsum EL. Stunting and associated factors among 6-23 month old children in drought vulnerable kebeles of Demba Gofa district, southern Ethiopia. BMC Nutr 2022; 8:9. [PMID: 35078514 PMCID: PMC8790906 DOI: 10.1186/s40795-022-00501-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stunting is impaired linear growth of children: they experience stunting in the first 1000 days after conception and is an indication of chronic malnutrition. Children under the age of two are regarded as the most vulnerable to malnutrition due to their rapid growth and greater exposure to infectious disease. OBJECTIVE To assess the magnitude and associated factors of stunting among 6 to 23-month-old children in drought-vulnerable kebeles of the Demba Gofa district, southern Ethiopia. METHODS A community-based cross-sectional study was conducted from February to March 2021. Systematic random sampling was used to select pairs of mothers/caregivers with children aged 6 to 23 months. A semistructured questionnaire and anthropometric measurement were used to collect the data. The data were checked coded and entered into Epi-data version 3.1 and exported to SPSS for Windows version 20.0 for analysis. Simple and multivariable linear regressions were conducted. The level of significance was declared at 95% CI and p-value < 0.05. RESULTS The magnitude of stunting in the study area was 79(21.82%). Household dietary diversity [β = 0.217, 95% CI, 0.093-0.342], early initiation of complementary feeding [β = 0.444, 95% CI, 0.344-0.543], frequency of breastfeeding within 24 h [β = 0.217, 95% CI, 0.179-0.263] and child eating animal source food [β = 0.351, 95% CI, 0.196-0.506] were positively significant predictors of child height/length-for-age (HAZ). CONCLUSION The extent of stunting in the study area is relatively lower than that in regional and national reports, but one out of five children were still stunted. Therefore, health education on infant and young child feeding practices should be provided to mothers to reduce the problem.
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Affiliation(s)
- Tuba Tringo Tadele
- College of Engineering and Agro-Processing Technology, Arbaminch University, Arba minch, Ethiopia
| | | | - Makiso Urugo Markos
- College of Agricultural Sciences, Wachemo University, P.O.BOX: 667, Hosaena, Ethiopia. .,College of Agriculture and Veterinary Medicine, Jimma University, P.O.BOX: 307, Jimma, Ethiopia.
| | - Endale Liben Fitsum
- College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
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13
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Rougeaux E, Miranda JJ, Fewtrell M, Wells JCK. Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017. BMC Public Health 2022; 22:37. [PMID: 34991546 PMCID: PMC8734138 DOI: 10.1186/s12889-021-12452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children's growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration. METHODS Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p]. RESULTS In 1991-2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (- 1.0 vs - 1.2; p < 0.001) and WAZ (- 0.3 vs - 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration. CONCLUSIONS Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.
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Affiliation(s)
- Emeline Rougeaux
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
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14
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Takeuchi R, Njomo DW, Njenga SM, Tomokawa S, Mutua A, Kazama H, Walema B, Akiyama T, Asakura T, Kamiya Y, Kobayashi J. Has the double burden of malnutrition reached pupils in rural western Kenya? Pediatr Int 2022; 64:e14729. [PMID: 33829604 PMCID: PMC9298995 DOI: 10.1111/ped.14729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/25/2021] [Accepted: 03/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Undernutrition and overnutrition have been considered separate challenges caused by the distinct factors in distinct settings. The double burden of malnutrition is defined as the coexistence of both undernutrition and overnutrition, which has now spread globally, especially in low- and middle-income countries. In Kenya, the double burden of malnutrition is present in the capital city but the situation in rural areas currently remains unknown. The aim of this study was therefore to analyze nutritional status in rural Kenya. METHODS Data from height and weight measurements conducted by teachers in the third term of school year 2013 were collected from primary schools. Teachers were trained by experts before starting the measurements. The Z-scores of height-for-age, weight-for-age, and body mass index-for-age were calculated using AnthroPlus, and nutritional status was defined according to the World Health Organization guidelines. RESULTS Data analyzed from 7,447 pupils (3,763 boys and 3,684 girls) showed that 12.4% were stunted and 7.8% were underweight among those ≤120 months old, and 11.7% were thin among those >120 months old. Boys were more likely to be stunted than girls. Boys were more likely to be underweight and girls were more likely to be overweight in the older age group. CONCLUSION The double burden of malnutrition was not found, and undernutrition was still common among schoolchildren in the study area. However, it is important to monitor nutritional status due to adverse effects of rapid urbanization. Height and weight measurements in schools may be useful for monitoring the nutritional status of schoolchildren.
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Affiliation(s)
- Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan.,Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki City, Nagasaki, Japan.,Japanese Consortium for Global school Health and Research, Okinawa, Japan
| | - Doris W Njomo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sachi Tomokawa
- Japanese Consortium for Global school Health and Research, Okinawa, Japan.,Department of Sports and Health Sciences, Faculty of Education, Shinshu University, Nagano City, Nagano, Japan
| | | | - Haruki Kazama
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki City, Nagasaki, Japan
| | | | - Takeshi Akiyama
- Japanese Consortium for Global school Health and Research, Okinawa, Japan.,Department of Health Science, Nagano College of Nursing, Nagano City, Nagano, Japan
| | - Takashi Asakura
- Department of Education, Tokyo Gakugei University, Koganei City, Tokyo, Japan
| | - Yasuhiko Kamiya
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki City, Nagasaki, Japan
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan.,Japanese Consortium for Global school Health and Research, Okinawa, Japan
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15
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Downs SM, Fox EL, Zivkovic A, Mavros T, Sabbahi M, Merchant EV, Mutuku V, Okumu-Camerra K, Kimenju S. Drivers of food choice among women living in informal settlements in Nairobi, Kenya. Appetite 2021; 168:105748. [PMID: 34637773 DOI: 10.1016/j.appet.2021.105748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Suboptimal diets drive the multiple burdens of malnutrition among women living in informal settlements. Women's food choices have important implications for their health, as well as that of their families. The purpose of this study was to examine how food choice decisions might differ across different age groups of women living in informal settlements in Nairobi, Kenya. Using in-depth interviews which incorporated a free-listing task, we determined the factors influencing food choice decisions in women in two informal settlements, Kibera and Mukuru. Among women in all age groups, we found income and food price to be the most salient factors influencing food choice decisions. Differences across age groups regarding food choice considerations included individual preference and quality being more salient factors amongst younger women while household preferences were more salient among older women. Women also reported making trade-offs between food affordability and other factors including time and nutrition, which led to sub-optimal diets. Our findings suggest that interventions in these settings may need to be tailored to specific age groups. Additionally, interventions may need to target both individual factors and the external food environment to help women overcome the trade-offs they often find themselves making in food choice decisions.
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Affiliation(s)
- Shauna M Downs
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, NJ, USA; Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, NJ, USA.
| | - Elizabeth L Fox
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Alexandra Zivkovic
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, NJ, USA
| | - Theodora Mavros
- School of Environmental and Biological Sciences, Rutgers University, NJ, USA
| | - Minna Sabbahi
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, NJ, USA
| | - Emily V Merchant
- Center for Agricultural Food Ecosystems, The New Jersey Institute for Food, Nutrition, and Health, Rutgers University, NJ, USA; School of Environmental and Biological Sciences, Rutgers University, NJ, USA
| | | | - Kedeen Okumu-Camerra
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, NJ, USA
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16
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Kariuki S, Dyson ZA, Mbae C, Ngetich R, Kavai SM, Wairimu C, Anyona S, Gitau N, Onsare RS, Ongandi B, Duchene S, Ali M, Clemens JD, Holt KE, Dougan G. Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya. eLife 2021; 10:67852. [PMID: 34515028 PMCID: PMC8494480 DOI: 10.7554/elife.67852] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/08/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control. Methods: In a 3-year case-control study, we investigated typhoid among children aged <16 years (4670 febrile cases and 8549 age matched controls) living in an informal settlement, Nairobi, Kenya. Results: 148 S. Typhi isolates from cases and 95 from controls (stool culture) were identified; a carriage frequency of 1 %. Whole-genome sequencing showed 97% of cases and 88% of controls were genotype 4.3.1 (Haplotype 58), with the majority of each (76% and 88%) being multidrug-resistant strains in three sublineages of the H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled. Conclusions: The high rate of multidrug-resistant H58 S. Typhi, and the close phylogenetic relationships between cases and controls, provides evidence for the role of carriers as a reservoir for the community spread of typhoid in this setting. Funding: National Institutes of Health (R01AI099525); Wellcome Trust (106158/Z/14/Z); European Commission (TyphiNET No 845681); National Institute for Health Research (NIHR); Bill and Melinda Gates Foundation (OPP1175797).
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Zoe A Dyson
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom.,Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ronald Ngetich
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Susan M Kavai
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Celestine Wairimu
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen Anyona
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Naomi Gitau
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Sanaya Onsare
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Beatrice Ongandi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sebastian Duchene
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mohamed Ali
- Department of International Health, John's Hopkins University, Baltimore, United States
| | | | - Kathryn E Holt
- London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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17
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Shupler M, Mwitari J, Gohole A, Anderson de Cuevas R, Puzzolo E, Čukić I, Nix E, Pope D. COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs. RENEWABLE & SUSTAINABLE ENERGY REVIEWS 2021; 144:None. [PMID: 34276242 PMCID: PMC8262075 DOI: 10.1016/j.rser.2021.111018] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 05/12/2023]
Abstract
This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.
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Affiliation(s)
- Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - James Mwitari
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Arthur Gohole
- School of Public Health, Amref International University, Nairobi, Kenya
| | | | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), 654 Madison Avenue, New York, United States
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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18
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Shupler M, Mwitari J, Gohole A, Anderson de Cuevas R, Puzzolo E, Čukić I, Nix E, Pope D. COVID-19 impacts on household energy & food security in a Kenyan informal settlement: The need for integrated approaches to the SDGs. RENEWABLE & SUSTAINABLE ENERGY REVIEWS 2021. [PMID: 34276242 DOI: 10.1101/2020.05.27.20115113v1.full.pdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This longitudinal study presents the joint effects of a COVID-19 community lockdown on household energy and food security in an informal settlement in Nairobi, Kenya. Randomly administered surveys were completed from December 2019-March 2020 before community lockdown (n = 474) and repeated in April 2020 during lockdown (n = 194). Nearly universal (95%) income decline occurred during the lockdown and led to 88% of households reporting food insecurity. During lockdown, a quarter of households (n = 17) using liquefied petroleum gas (LPG), a cleaner cooking fuel typically available in pre-set quantities (e.g. 6 kg cylinders), switched to polluting cooking fuels (kerosene, wood), which could be purchased in smaller amounts or gathered for free. Household size increases during lockdown also led to participants' altering their cooking fuel, and changing their cooking behaviors and foods consumed. Further, households more likely to switch away from LPG had lower consumption prior to lockdown and had suffered greater income loss, compared with households that continued to use LPG. Thus, inequities in clean cooking fuel access may have been exacerbated by COVID-19 lockdown. These findings demonstrate the complex relationship between household demographics, financial strain, diet and cooking patterns, and present the opportunity for a food-energy nexus approach to address multiple Sustainable Development Goals (SDGs): achieving zero hunger (SDG 2) and universal affordable, modern and clean energy access (SDG 7) by 2030. Ensuring that LPG is affordable, accessible and meets the dietary and cooking needs of families should be a policy priority for helping improve food and energy security among the urban poor.
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Affiliation(s)
- Matthew Shupler
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - James Mwitari
- School of Public Health, Amref International University, Nairobi, Kenya
| | - Arthur Gohole
- School of Public Health, Amref International University, Nairobi, Kenya
| | | | - Elisa Puzzolo
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Global LPG Partnership (GLPGP), 654 Madison Avenue, New York, United States
| | - Iva Čukić
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Emily Nix
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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19
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Reynolds EC, Onyango D, Mwando R, Oele E, Misore T, Agaya J, Otieno P, Tippett Barr BA, Lee GO, Akelo V. Mothers' Perspectives of Complementary Feeding Practices in an Urban Informal Settlement in Kisumu County, Western Kenya. Curr Dev Nutr 2021; 5:nzab065. [PMID: 34095736 PMCID: PMC8171250 DOI: 10.1093/cdn/nzab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In informal settlements, the benefits of urban dwelling are diminished by conditions of poverty that exacerbate child undernutrition. The Child Health and Mortality Prevention Surveillance (CHAMPS) project has identified malnutrition as the leading underlying cause of death in children under 5 in the Manyatta urban informal settlement in Kisumu County, Kenya. OBJECTIVE This qualitative study, nested within the CHAMPS project, aimed to understand community perspectives on complementary feeding practices in this settlement. METHODS In-depth interviews were conducted with 20 mothers who lived in the urban informal settlement and had a child 6-23 months old. Two focus group discussions were conducted, 1 with mothers and 1 with community health workers (CHWs), to further explore themes related to complementary feeding. RESULTS Mothers were knowledgeable about globally recommended feeding practices, but such practices were often not implemented due to 1) the community/household water and sanitation environment, 2) the community/household food environment, 3) a lack of income and employment opportunities for women, and 4) sociocultural factors. Together, these create an environment that is not conducive to optimal child feeding practices. CONCLUSIONS To improve complementary feeding practices and child nutritional outcomes in Kenya's informal urban settings, both community- and individual-level factors should be addressed. Possible interventions include investment in water infrastructure and social protection programs, such as cash transfers.
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Affiliation(s)
- Elise C Reynolds
- University of Michigan School of Public Health, Ann Arbor,
MI, USA
- University of California, Davis, Davis, CA, USA
| | | | - Rael Mwando
- Kisumu County Department of Health, Kisumu, Kenya
| | | | | | - Janet Agaya
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Beth A Tippett Barr
- US Centers for Disease Control and Prevention–Kenya, Kisumu and
Nairobi , Kenya
| | - Gwenyth O Lee
- University of Michigan School of Public Health, Ann Arbor,
MI, USA
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu and
Nairobi , Kenya
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20
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Undernutrition and associated factors among children under 2 years of age in Jimma Zone, Southwest Ethiopia. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01515-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Omulo S, Lofgren ET, Lockwood S, Thumbi SM, Bigogo G, Ouma A, Verani JR, Juma B, Njenga MK, Kariuki S, McElwain TF, Palmer GH, Call DR. Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors. Antimicrob Resist Infect Control 2021; 10:18. [PMID: 33482919 PMCID: PMC7821723 DOI: 10.1186/s13756-021-00886-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between antibiotic use and antimicrobial resistance varies with cultural, socio-economic, and environmental factors. We examined these relationships in Kibera, an informal settlement in Nairobi-Kenya, characterized by high population density, high burden of respiratory disease and diarrhea. METHODS Two-hundred households were enrolled in a 5-month longitudinal study. One adult (≥ 18 years) and one child (≤ 5 years) participated per household. Biweekly interviews (n = 1516) that included questions on water, sanitation, hygiene, and antibiotic use in the previous two weeks were conducted, and 2341 stool, 2843 hand swabs and 1490 drinking water samples collected. Presumptive E. coli (n = 34,042) were isolated and tested for susceptibility to nine antibiotics. RESULTS Eighty percent of presumptive E. coli were resistant to ≥ 3 antibiotic classes. Stool isolates were resistant to trimethoprim (mean: 81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%) and tetracycline (55%). Ninety-seven households reported using an antibiotic in at least one visit over the study period for a total of 144 episodes and 190 antibiotic doses. Enrolled children had five times the number of episodes reported by enrolled adults (96 vs. 19). Multivariable linear mixed-effects models indicated that children eating soil from the household yard and the presence of informal hand-washing stations were associated with increased numbers of antimicrobial-resistant bacteria (counts increasing by 0·27-0·80 log10 and 0·22-0·51 log10 respectively, depending on the antibiotic tested). Rainy conditions were associated with reduced carriage of antimicrobial-resistant bacteria (1·19 to 3·26 log10 depending on the antibiotic tested). CONCLUSIONS Antibiotic use provided little explanatory power for the prevalence of antimicrobial resistance. Transmission of resistant bacteria in this setting through unsanitary living conditions likely overwhelms incremental changes in antibiotic use. Under such circumstances, sanitation, hygiene, and disease transmission are the limiting factors for reducing the prevalence of resistant bacteria.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA. .,Washington State University Global Health-Kenya, Nairobi, Kenya. .,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Eric T Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Svetlana Lockwood
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA
| | - Samuel M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | - M Kariuki Njenga
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Samuel Kariuki
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Terry F McElwain
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Guy H Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Douglas R Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Washington State University Global Health-Kenya, Nairobi, Kenya.,Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
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Fouts HN, Bader LR, Neitzel CL, Salinas DA. Ethnicity as a predictor of gender segregation among young children in an informal urban settlement in Kenya. SOCIAL DEVELOPMENT 2021. [DOI: 10.1111/sode.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hillary N. Fouts
- Psychological Sciences Department Western Oregon University Monmouth OR USA
| | | | - Carin L. Neitzel
- School of Education Black Hills State University Spearfish SD USA
| | - Daniela A. Salinas
- Department of Child and Family Studies University of Tennessee Knoxville TN USA
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Determinants of nutrition status in children aged 6–59 months, in Kiandutu informal settlement, Thika, Kenya. Proc Nutr Soc 2021. [DOI: 10.1017/s0029665121000045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dinku AM, Mekonnen TC, Adilu GS. Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:11. [PMID: 33298197 PMCID: PMC7771062 DOI: 10.1186/s41043-020-00219-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To investigate the relation of child dietary diversity and household food insecurity along with other socio-demographic with child anthropometric indices in north-central Ethiopia, an area with a high level of food insecurity and inadequate diet quality. DESIGN A community-based cross-sectional study was used. SETTINGS The study was conducted in Dessie and Combolcha towns of north-central Ethiopia from April to May 2018. PARTICIPANTS Randomly selected 512 mother-child pairs with child's age range of 6-59 months. RESULTS The mean (± SD) scores of weight-for-height/length, height/length-for-age, weight-for-age, and BMI-for-age Z-scores were 1.35 (± 2.03), - 1.89 (± 1.79), 0.05 (± 1.54), and 1.39 (± 2.06), respectively. From all anthropometric indicators, stunting and overweight/obesity remained the severe public issues hitting 43% and 42% of the children, respectively. In the model, mothers' age and education and child's age, sex, and dietary diversity were significantly related with child height-for-age Z-score while place of residence, sex of household head, child's age, and dietary diversity score were the predictors of child BMI-for-age Z-score in the urban contexts of the study area. Nevertheless, food insecurity was not related to any of the child anthropometric indices. CONCLUSION The double burden of malnutrition epidemics (stunting and obesity) coexisted as severe public health concerns in urban settings. Anthropometric statuses of children were affected by multidimensional factors and seek strong integration and immediate intervention of multiple sectors.
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Affiliation(s)
- Amare Molla Dinku
- Researcher at the Department of Rural Development and Agricultural Extension, College of Agriculture, Wollo University, Dessie, Ethiopia
| | - Tefera Chane Mekonnen
- Researcher at the School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Shumye Adilu
- Researchr at the Department of Plant Science, College of Agriculture, Wollo University, Dessie, Ethiopia
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Hirose A, Kajungu D, Tusubira V, Waiswa P, Alfven T, Hanson C. Postneonatal under-5 mortality in peri-urban and rural Eastern Uganda, 2005-2015. BMJ Glob Health 2020; 5:e003762. [PMID: 33334903 PMCID: PMC7747610 DOI: 10.1136/bmjgh-2020-003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Community and individual sociodemographic characteristics play an important role in child survival. However, a question remains how urbanisation and demographic changes in sub-Saharan Africa affect community-level determinants for child survival. METHODS Longitudinal data from the Iganga/Mayuge Health and Demographic Surveillance Site was used to obtain postneonatal under-5 mortality rates between March 2005 and February 2015 in periurban and rural areas separately. Multilevel survival analysis models were used to identify factors associated with mortality. RESULTS There were 43 043 postneonatal under-5 children contributing to 116 385 person years of observation, among whom 1737 died. Average annual crude mortality incidence rate (IR) differed significantly between periurban and rural areas (9.0 (8.1 to 10.0) per 1000 person-years vs 18.1 (17.1 to 19.0), respectively). In periurban areas, there was evidence for decreasing mortality from IR=11.3 (7.7 to 16.6) in 2006 to IR=4.5 (3.0 to 6.9) in 2015. The mortality fluctuated with no evidence for reduction in rural areas (IR=19.0 (15.8 to 22.8) in 2006; IR=15.5 (13.0 to 18.6) in 2015). BCG vaccination was associated with reduced mortality in periurban and rural areas (adjusted rate ratio (aRR)=0.45; 95% CI 0.30 to 0.67 and aRR=0.56; 95% CI 0.41 to 0.76, respectively). Maternal education level within the community was associated with reduced mortality in both periurban and rural sites (aRR=0.83; 95% CI 0.70 to 0.99; aRR=0.90; 95% CI 0.81 to 0.99). The proportion of households in the poorest quintile within the community was associated with mortality in rural areas only (aRR=1.08; 95% CI 1.00 to 1.18). In rural areas, a large disparity existed between the least poor and the poorest (aRR=0.50; 95% CI 0.27 to 0.92). CONCLUSION We found evidence for a mortality decline in peri-urban but not rural areas. Investments in the known key health (eg, vaccination) and socio-economic interventions (education, and economic development) continue to be crucial for mortality declines. Focused strategies to eliminate the disparity between wealth quintiles are also warranted. There may be equitable access to health services in peri-urban areas but improved metrics of socioeconomic position suitable for peri-urban residents may be needed.
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Affiliation(s)
- Atsumi Hirose
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, Imperial College London, London, UK
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Valerie Tusubira
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
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Mengiste LA, Worku Y, Aynalem YA, Shiferaw WS. Prevalence of Stunting and Its Associated Factors Among Children Aged 6–59 Months in Angolela Tera District, Northeast Ethiopia. NUTRITION AND DIETARY SUPPLEMENTS 2020. [DOI: 10.2147/nds.s287232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kassaw MW, Abebe AM, Abate BB, Kassie AM, Açık M. Association between birth interval and wasting in children under 5 years of age in Ethiopia: a systematic review and meta-analysis protocol. BMJ Open 2020; 10:e037976. [PMID: 33172943 PMCID: PMC7656953 DOI: 10.1136/bmjopen-2020-037976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION According to the UNICEF, WHO and World Bank joint estimation, 1 in every 13 children suffered from wasting globally. The highest burden of undernutrition recorded in Asia and Africa. Wasting remains a considerable public health problem in Ethiopia despite the introduction of exhaustive nutritional programmes. As reported in the literature, the prevalence of wasting in Ethiopia has remained high over the last four decades. In Ethiopia, more than one-third of child deaths are associated with malnutrition. The current nutritional interventions implemented in Ethiopia need to be evidence based. For this purpose, systematic review is preferable as it can present a more reliable and precise estimate than individual studies. The aim of this review is to assess the pooled prevalence of wasting and its association with birth interval in Ethiopia. METHODOLOGY Studies published after 20 January 2012 will be retrieved from databases, mainly PubMed/Medline, Scopus, Embase, CINAHL and HINARI. The articles retrieved from databases will be selected after reading the title, abstract and full text. Three reviewers will independently assess the quality of each study using both the Joanna Briggs Institute and Ottawa Scale critical appraisal checklists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to maintain scientific strength. Funnel plots, Egger's test and Begg's test will be used to deal with publication bias, and I2, forest plots and Cochrane's Q square statistics will be used for heterogeneity. Potential causes of heterogeneity will be explored through sensitivity and subgroup analyses. Because heterogeneity among studies is inevitable, given the wide geographical area and variety of study designs, the Der-Simonian and Laird random-effects model will be used. The presence of a statistical association between birth interval and wasting will be declared if the p value is <0.05 with the 95% CI. ETHICS AND DISSEMINATION Ethical issues will not be applicable to this review and meta-analysis. This review and meta-analysis will report the pooled prevalence of wasting and its association with birth interval in Ethiopia. Effort will be made to publish the findings in a peer-reviewed journal such as the Ethiopian Journal of Health and Development, and the findings will be presented at national conferences. A hard copy will also be sent to Woldia University and Debre Berhan University.
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Affiliation(s)
| | - Ayele Mamo Abebe
- Nursing, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | | | | | - Murat Açık
- Nutrition and Dietetics, Ankara University, Ankara, Turkey
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Mkhize M, Sibanda M. A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7973. [PMID: 33142965 PMCID: PMC7662515 DOI: 10.3390/ijerph17217973] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022]
Abstract
Malnutrition is a considerable contributor to child mortality and morbidity. Child malnutrition further affects the country's economic development. Child malnutrition in South Africa is persistent, continuing to be an alarming burden. The nutritional status of kids under the age of five years is a critical indicator of the country's economic condition and health status. An understanding of the influencers of the nutritional status of children can act as a catalyst in combatting all forms of malnutrition. The purpose of this paper was to review selected studies concerning the factors that affect the nutritional status of children in South Africa. Studies were selected from electronic databases, which were PubMed, Google Scholar, Science Direct, Sabinet African Journals, and the University of Zululand library catalog. The keywords that were used to search studies and articles from the selected database were: risk factors, child nutritional status, children under the age of five years, South Africa, malnutrition, underweight, stunted, wasting, and over-nutrition. Studies and surveys published from 2010-2019 that reported on the factors influencing the nutritional status of children under the age of five years were included in this review. Twenty-seven articles met the inclusion criteria of the study. The 27 articles were made up of 21 cross-sectional articles and six longitudinal articles. The finding from this review highlights that there is a lack of studies conducted in urban areas. The results show that the nutritional status of children is affected by several factors. These include household food insecurity, low household income, illiterate caregivers, unemployment, inadequate dietary intake, low birth weight, consumption of monotonous diets, poor caregiver's nutritional knowledge, poor access to water and sanitation, poor weaning practices, age of the caregiver, and demographic characteristics of a child (age and gender). It is critical to have an understanding of the factors that affect the nutritional status of children. Such knowledge can significantly contribute to formulating policies that can enhance nutrition security and the country's economy. Moreover, insights into strategic interventions to eradicate all forms of malnutrition can be made.
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Affiliation(s)
| | - Melusi Sibanda
- Department of Agriculture, University of Zululand, Private Bag X1001, KwaDlangezwa 3886, South Africa;
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Idowu OS, Akindolire AE, Adebayo BE, Adebayo AM, Ariyo O. Determinants of anthropometric characteristics of under-five children in internally displaced persons´ camps in Abuja municipal area council, Abuja, Nigeria. Pan Afr Med J 2020; 36:313. [PMID: 33193967 PMCID: PMC7603821 DOI: 10.11604/pamj.2020.36.313.21221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/19/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION displacement predisposes to deprivation and hunger and consequently malnutrition. In Nigeria, information on anthropometric characteristics and associated factors among displaced under-five children is important to strengthen strategies to ameliorate malnutrition and promote child health. This study was conducted to identify the determinants on anthropometric indices among under-five children in internally displaced persons' camps in Abuja, Nigeria. METHODS this cross-sectional study involved 317 mother-child (0-59 months) pairs selected using two-stage simple random sampling technique. Information on socio-demographic, care practices (infant feeding, immunization, deworming) and anthropometric characteristics of index children was obtained using semi-structured, interviewer-administered questionnaire. Weight and length/height were assessed using standard procedure and analysed using World Health Organization (WHO) Anthro software. Data were analysed using descriptive statistics and logistic regression at p<0.05. RESULTS median age was 24 months, 50.8% were male and 42.3% were delivered at health facility. Only 45.4% were exclusively breastfed, 28.8% were fed complementary foods too early, 45.4% were dewormed in the preceding six months and 43.9% had complete/up-to-date immunisation. Prevalence of underweight, stunting and wasting was 42%, 41% and 29.3%, respectively. Poor anthropometric indices were higher among male than female children, except wasting. Having good anthropometric index was 2.5 times higher among children <12 months than children ≥37 months (CI: 1.08-5.8), 2.4 times higher among 1st birth order than 5th orders (CI: 0.19-0.93), 1.7 times higher among female than male children (CI: 1.08-2.82). CONCLUSION malnutrition is a major health problem among under-five children in internally displaced camps and major determinants include age, birth order, gender and deworming status.
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Affiliation(s)
| | | | | | - Ayodeji Matthew Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwaseun Ariyo
- Department of Human Nutrition, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Socio-demographic risk factors for severe malnutrition in children aged under five among various birth cohorts in Bangladesh. J Biosoc Sci 2020; 53:590-605. [PMID: 32787991 DOI: 10.1017/s0021932020000425] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were 'only one form' and 'multiple forms' of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother's education, father's occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.
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Vulnerability and everyday health risks of urban informal settlements in Sub-Saharan Africa. GLOBAL HEALTH JOURNAL 2020. [DOI: 10.1016/j.glohj.2020.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Aheto JMK. Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana. BMC Public Health 2020; 20:644. [PMID: 32380990 PMCID: PMC7206751 DOI: 10.1186/s12889-020-08782-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under-five malnutrition is a major public health issue contributing to mortality and morbidity, especially in developing countries like Ghana where the rates remain unacceptably high. Identification of critical risk factors of under-five malnutrition using appropriate and advanced statistical methods can help formulate appropriate health programmes and policies aimed at achieving the United Nations SDG Goal 2 target 2. This study attempts to develop a simultaneous quantile regression, an in-depth statistical model to identify critical risk factors of under-five severe chronic malnutrition (severe stunting). METHODS Based on the nationally representative data from the 2014 Ghana Demographic and Health Survey, height-for-age z-score (HAZ) was estimated. Multivariable simultaneous quantile regression modelling was employed to identify critical risk factors for severe stunting based on HAZ (a measure of chronic malnutrition in populations). Quantiles of HAZ with focus on severe stunting were modelled and the impact of the risk factors determined. Significant test of the difference between slopes at different selected quantiles of severe stunting and other quantiles were performed. A quantile regression plots of slopes were developed to visually examine the impact of the risk factors across these quantiles. RESULTS Data on a total of 2716 children were analysed out of which 144 (5.3%) were severely stunted. The models identified child level factors such as type of birth, sex, age, place of delivery and size at birth as significant risk factors of under-five severe stunting. Maternal and household level factors identified as significant predictors of under-five severe stunting were maternal age and education, maternal national health insurance status, household wealth status, and number of children under-five in households. Highly significant differences exist in the slopes between 0.1 and 0.9 quantiles. The quantile regression plots for the selected quantiles from 0.1 to 0.9 showed substantial differences in the impact of the covariates across the quantiles of HAZ considered. CONCLUSION Critical risk factors that can aid formulation of child nutrition and health policies and interventions that will improve child nutritional outcomes and survival were identified. Modelling under-five severe stunting using multivariable simultaneous quantile regression models could be beneficial to addressing the under-five severe stunting.
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Affiliation(s)
- Justice Moses K Aheto
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon-Accra, Ghana.
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Yaya S, Odusina EK, Uthman OA, Bishwajit G. What does women's empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries. Glob Health Res Policy 2020; 5:1. [PMID: 31956697 PMCID: PMC6961273 DOI: 10.1186/s41256-019-0129-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023] Open
Abstract
Background The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries. The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development, labour supply, productivity, economic growth and development. This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries. Methods The study utilized secondary datasets of women in their child bearing age (15–49 years) from the latest Demographic and Health Survey (DHS) conducted in 2011–2017 across 30 sub Saharan Africa countries. The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence. Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status. Results Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status (stunted and underweight) at p < 0.001. These characteristics were also statistically significantly associated with empowerment status of women (Decision-making, Violence attitudes and Experience of violence) at p < 0.001 except for child age and sex. The association between childhood nutritional statuses and women’s empowerment (all three empowerment measures) was significant after controlling for other covariates that could also influence childhood nutrition statuses at p < 001. Two of the empowerment measures (attitudes towards violence and experience of violence) showed positive association with childhood nutritional statuses while the third (decision-making) showed negative association. Conclusion There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries. Women’s empowerment was found to be related to childhood nutritional status. Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.
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Affiliation(s)
- Sanni Yaya
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada.,2The George Institute for Global Health, The University of Oxford, Oxford, UK
| | | | - Olalekan A Uthman
- 4Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Ghose Bishwajit
- 1School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON K1N 6N5 Canada
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Mumma J, Simiyu S, Aseyo E, Anderson J, Czerniewska A, Allen E, Dreibelbis R, Baker KK, Cumming O. The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial. BMC Infect Dis 2019; 19:1066. [PMID: 31856747 PMCID: PMC6923833 DOI: 10.1186/s12879-019-4657-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya. METHODS This is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean. RESULTS The primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination. CONCLUSION To our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children. TRIAL REGISTRATION The trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).
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Affiliation(s)
- Jane Mumma
- Center of Research, Great Lakes University Kisumu, P.O. Box 2224-40100, Kisumu, Kenya
| | - Sheillah Simiyu
- Urbanisation and Well Being Unit, African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya
| | - Evalyne Aseyo
- Center of Research, Great Lakes University Kisumu, P.O. Box 2224-40100, Kisumu, Kenya
| | - John Anderson
- Independent Research Consultant, TX78702, Austin, USA
| | - Alexandra Czerniewska
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Kelly K. Baker
- Department of Occupational and Environmental Health College of Public Health, University of Iowa, Iowa City, IA 52333 USA
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
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Jude CK, Chukwunedum AU, Egbuna KO. Under-five malnutrition in a South-Eastern Nigeria metropolitan city. Afr Health Sci 2019; 19:3078-3084. [PMID: 32127883 PMCID: PMC7040336 DOI: 10.4314/ahs.v19i4.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Malnutrition (under and overnutrition) presents significant threats to child health. The co-existence of under and overnutrition in a population is increasingly being described in the literature. Objective To identify the prevalence of malnutrition among under-five children in Enugu metropolis. Methods A cross-sectional study of pre-primary school children conducted from January to May 2016. using stratified sampling technique. Caregiver-administered questionnaire was used to obtain relevant information. Weights and heights were measured using a standard weight scale and stadiometer/ length mat respectively. Wasting, stunting, overweight and obesity were determined based on the recommended WHO Growth Standard. Data analysis was done with SPSS version 20.0. The associations between nutritional status on one hand, and categorical variables such as age grouping, sex, socio-economic status, and maternal education were determined using chi square. P-value < 0.05 were reported as statistically significant. Results Eighteen (2.4%) and 26 (3.5%) subjects were wasted and stunted respectively. Eleven (1.5%) subjects were overweight while another 11(1.5%) subjects were obese. Risk factors for undernutrition were maternal education and low socioeconomic class while risk factor for overnutrition was upper socioeconomic class.. Conclusion There is a low rate of malnutrition in the area of study. However, sustained efforts must continue to prevent further rise and possibly eliminate the scourge of malnutrition.
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Affiliation(s)
| | - Agozie Ubesie Chukwunedum
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu
- Department of Paediatrics, College of Medicine, University of Nigeria, Enugu Campus
| | - Kunle Obidike Egbuna
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu
- Department of Paediatrics, College of Medicine, University of Nigeria, Enugu Campus
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Faye CM, Fonn S, Kimani‐Murage E. Family influences on child nutritional outcomes in Nairobi's informal settlements. Child Care Health Dev 2019; 45:509-517. [PMID: 30986888 PMCID: PMC6563089 DOI: 10.1111/cch.12670] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improving child nutritional status is an important step towards achieving the Sustainable Development Goals 2 and 3 in developing countries. Most child nutrition interventions in these countries remain variably effective because the strategies often target the child's mother/caregiver and give limited attention to other household members. Quantitative studies have identified individual level factors, such as mother and child attributes, influencing child nutritional outcomes. METHODS We used a qualitative approach to explore the influence of household members on child feeding, in particular, the roles of grandmothers and fathers, in two Nairobi informal settlements. Using in-depth interviews, we collected data from mothers of under-five children, grandmothers, and fathers from the same households. RESULTS Our findings illustrate that poverty is a root cause of poor nutrition. We found that mothers are not the sole decision makers within the household regarding the feeding of their children, as grandmothers appear to play key roles. Even in urban informal settlements, three-generation households exist and must be taken into account. Fathers, however, are described as providers of food and are rarely involved in decision making around child feeding. Lastly, we illustrate that promotion of exclusive breastfeeding for 6 months, as recommended by the World Health Organization, is hard to achieve in this community. CONCLUSIONS These findings call for a more holistic and inclusive approach for tackling suboptimal feeding in these communities by addressing poverty, targeting both mothers and grandmothers in child nutrition strategies, and promoting environments that support improved feeding practices such as home-based support for breastfeeding and other baby-friendly initiatives.
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Affiliation(s)
- Cheikh Mbacké Faye
- Research DivisionAfrican Population and Health Research CenterNairobiKenya,School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sharon Fonn
- School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
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Goudet SM, Bogin BA, Madise NJ, Griffiths PL. Nutritional interventions for preventing stunting in children (birth to 59 months) living in urban slums in low- and middle-income countries (LMIC). Cochrane Database Syst Rev 2019; 6:CD011695. [PMID: 31204795 PMCID: PMC6572871 DOI: 10.1002/14651858.cd011695.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low- and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. Urban slums are complex environments in terms of biological, social, and political variables and the outcomes of nutritional interventions need to be assessed in relation to these variables. For the purposes of this review, we followed the UN-Habitat 2004 definitions for low-income informal settlements or slums as lacking one or more indicators of basic services or infrastructure. OBJECTIVES To assess the impact of nutritional interventions to reduce stunting in infants and children under five years old in urban slums from LMIC and the effect of nutritional interventions on other nutritional (wasting and underweight) and non-nutritional outcomes (socioeconomic, health and developmental) in addition to stunting. SEARCH METHODS The review used a sensitive search strategy of electronic databases, bibliographies of articles, conference proceedings, websites, grey literature, and contact with experts and authors published from 1990. We searched 32 databases, in English and non-English languages (MEDLINE, CENTRAL, Web of Science, Ovid MEDLINE, etc). We performed the initial literature search from November 2015 to January 2016, and conducted top up searches in March 2017 and in August 2018. SELECTION CRITERIA Research designs included randomised (including cluster-randomised) trials, quasi-randomised trials, non-randomised controlled trials, controlled before-and-after studies, pre- and postintervention, interrupted time series (ITS), and historically controlled studies among infants and children from LMIC, from birth to 59 months, living in urban slums. The interventions included were nutrition-specific or maternal education. The primary outcomes were length or height expressed in cm or length-for-age (LFA)/height-for-age (HFA) z-scores, and birth weight in grams or presence/absence of low birth weight (LBW). DATA COLLECTION AND ANALYSIS We screened and then retrieved titles and abstracts as full text if potentially eligible for inclusion. Working independently, one review author screened all titles and abstracts and extracted data on the selected population, intervention, comparison, and outcome parameters and two other authors assessed half each. We calculated mean selection difference (MD) and 95% confidence intervals (CI). We performed intervention-level meta-analyses to estimate pooled measures of effect, or narrative synthesis when meta-analyses were not possible. We used P less than 0.05 to assess statistical significance and intervention outcomes were also considered for their biological/health importance. Where effect sizes were small and statistically insignificant, we concluded there was 'unclear effect'. MAIN RESULTS The systematic review included 15 studies, of which 14 were randomised controlled trials (RCTs). The interventions took place in recognised slums or poor urban or periurban areas. The study locations were mainly Bangladesh, India, and Peru. The participants included 9261 infants and children and 3664 pregnant women. There were no dietary intervention studies. All the studies identified were nutrient supplementation and educational interventions. The interventions included zinc supplementation in pregnant women (three studies), micronutrient or macronutrient supplementation in children (eight studies), nutrition education for pregnant women (two studies), and nutrition systems strengthening targeting children (two studies) intervention. Six interventions were adapted to the urban context and seven targeted household, community, or 'service delivery' via systems strengthening. The primary review outcomes were available from seven studies for LFA/HFA, four for LBW, and nine for length.The studies had overall high risk of bias for 11 studies and only four RCTs had moderate risk of bias. Overall, the evidence was complex to report, with a wide range of outcome measures reported. Consequently, only eight study findings were reported in meta-analyses and seven in a narrative form. The certainty of evidence was very low to moderate overall. None of the studies reported differential impacts of interventions relevant to equity issues.Zinc supplementation of pregnant women on LBW or length (versus supplementation without zinc or placebo) (three RCTs)There was no evidence of an effect on LBW (MD -36.13 g, 95% CI -83.61 to 11.35), with moderate-certainty evidence, or no evidence of an effect or unclear effect on length with low- to moderate-certainty evidence.Micronutrient or macronutrient supplementation in children (versus no intervention or placebo) (eight RCTs)There was no evidence of an effect or unclear effect of nutrient supplementation of children on HFA for studies in the meta-analysis with low-certainty evidence (MD -0.02, 95% CI -0.06 to 0.02), and inconclusive effect on length for studies reported in a narrative form with very low- to moderate-certainty evidence.Nutrition education for pregnant women (versus standard care or no intervention) (two RCTs)There was a positive impact on LBW of education interventions in pregnant women, with low-certainty evidence (MD 478.44g, 95% CI 423.55 to 533.32).Nutrition systems strengthening interventions targeting children (compared with no intervention, standard care) (one RCT and one controlled before-and-after study)There were inconclusive results on HFA, with very low- to low-certainty evidence, and a positive influence on length at 18 months, with low-certainty evidence. AUTHORS' CONCLUSIONS All the nutritional interventions reviewed had the potential to decrease stunting, based on evidence from outside of slum contexts; however, there was no evidence of an effect of the interventions included in this review (very low- to moderate-certainty evidence). Challenges linked to urban slum programming (high mobility, lack of social services, and high loss of follow-up) should be taken into account when nutrition-specific interventions are proposed to address LBW and stunting in such environments. More evidence is needed of the effects of multi-sectorial interventions, combining nutrition-specific and sensitive methods and programmes, as well as the effects of 'up-stream' practices and policies of governmental, non-governmental organisations, and the business sector on nutrition-related outcomes such as stunting.
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Affiliation(s)
- Sophie M Goudet
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
| | - Barry A Bogin
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
| | | | - Paula L Griffiths
- Loughborough UniversityCentre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughboroughLeicestershireUKLE11 3TU
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Seghiri R, Essamri A. Ethno-nutraceutical survey of dietary seaweeds used in unconventional therapy in Morocco. An emerging practice for a renovated pharmacopeia. Heliyon 2019; 5:e01559. [PMID: 31183427 PMCID: PMC6488537 DOI: 10.1016/j.heliyon.2019.e01559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
In Morocco, like in many developing countries, people usually tend to turn to unconventional therapies. An ethnophycological survey was realized to inventory seaweeds used in complementary Moroccan medicine. One hundred ninety-one (191) consumers and thirty-one (31) traditional healers were interviewed on seaweed food-related diseases using standardized questionnaires. The survey was conducted in some cities in Morocco. After gathering all the information, the data obtained were analyzed and summarized. The investigation has displayed emerging phycotherapy in Morocco. Consumers' knowledge about seaweeds is complex and various. Yet, most of them are convinced of their nutraceutical benefits for a healthy lifestyle. The healers strongly support the reliability of their recommendations in treating health problems according to what the literature shows. The present study has made a contribution in giving a clear picture of the status quo of dietary seaweeds therapies in Morocco, which is revealed as an emerging practice needed to renovate pharmacopeia. Therefore, it has allowed us to list some seaweeds that haven't been considered in any scientific investigation before, which will be subject afterward to pharmacological tests to prove the claimed uses.
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Affiliation(s)
- R Seghiri
- Laboratory of Agro Resources Polymers and Process Engineering (LAR2PE), Team of Agro Resources and Process Engineering, Department of Chemistry, Faculty of Sciences, Ibn Tofail University, BP 133, 14000, Kenitra, Morocco
| | - A Essamri
- Laboratory of Agro Resources Polymers and Process Engineering (LAR2PE), Team of Agro Resources and Process Engineering, Department of Chemistry, Faculty of Sciences, Ibn Tofail University, BP 133, 14000, Kenitra, Morocco
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Gebre A, Reddy PS, Mulugeta A, Sedik Y, Kahssay M. Prevalence of Malnutrition and Associated Factors among Under-Five Children in Pastoral Communities of Afar Regional State, Northeast Ethiopia: A Community-Based Cross-Sectional Study. J Nutr Metab 2019; 2019:9187609. [PMID: 31275645 PMCID: PMC6589243 DOI: 10.1155/2019/9187609] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malnutrition among children remains one of the most important causes of morbidity and mortality in the world. In Ethiopia, malnutrition is one of the most serious public health problem and the biggest in the world. This study aimed to assess the prevalence of malnutrition and associated factors among under-five children in pastoral communities of Afar Regional state, Northeast Ethiopia. METHODS A community-based cross-sectional study was conducted on 840 children aged 6-59 months from March 01-25, 2017. A multistage cluster sampling method was used to select the study participants. A structured questionnaire was used and anthropometric measurements were taken to collect data. EPI Data 3.1 and SPSS version 20.0 were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression analysis was used to identify the factors associated with malnutrition. The statistical significance was declared at p value < 0.05 with 95% confidence intervals in the final model. RESULT The study found the prevalence of wasting, stunting, and underweight was 16.2% (95% CI: 13.8-18.8%), 43.1% (95% CI: 39.8-46.5%), and 24.8% (95% CI: 21.9-27.8%), respectively. Family size (AOR = 2.72, 95% CI: 1.62-4.55), prelacteal feeding (AOR = 3.81, 95% CI: 1.79-5.42), and diarrhoea in the past two weeks (AOR = 4.57, 95% CI: 2.56-8.16) were associated with wasting. And sex of child (AOR = 1.98, 95% CI: 1.46-2.72), age of child ((12-23 months: AOR = 3.44, 95% CI: 2.24-5.29); (24-35 months: AOR = 3.58, 95% CI: 2.25-5.69); and (36-59 months: AOR = 4.42, 95% CI: 2.79-6.94)), and immunization status of child (AOR = 3.34, 95% CI: 1.31-4.81) were predictors for stunting. Moreover, mother's education (AOR = 4.06, 95% CI: 2.01-8.19), sex of child (AOR = 1.83, 95% CI: 1.29-2.94), prelacteal feeding (AOR = 2.81, 95% CI: 1.64-3.72), and immunization status of child (AOR = 3.17, 95% CI: 2.14-4.99) were significantly associated with underweight. CONCLUSIONS This study indicated that child malnutrition was high among under-five children. Family size of five and above, receiving prelacteal feeding, and diarrhoea in the past two weeks were positively associated with wasting. Male child, increasing age of child, and not fully immunized child were positive predictors for increasing stunting. Maternal illiteracy, male child, prelacteal feeding, and not fully immunized child were factors affecting underweight. Promoting use of family planning, preventing diarrhoeal diseases, and vaccinating children integrated with the access of nutrition education programs are vital interventions to improve nutritional status of the children.
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Affiliation(s)
- Abel Gebre
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Semera, Afar Region, Ethiopia
| | - P. Surender Reddy
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Semera, Afar Region, Ethiopia
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray Region, Ethiopia
| | - Yayo Sedik
- Afar Regional Health Bureau, Semera, Afar Region, Ethiopia
| | - Molla Kahssay
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Semera, Afar Region, Ethiopia
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Fantay Gebru K, Mekonnen Haileselassie W, Haftom Temesgen A, Oumer Seid A, Afework Mulugeta B. Determinants of stunting among under-five children in Ethiopia: a multilevel mixed-effects analysis of 2016 Ethiopian demographic and health survey data. BMC Pediatr 2019; 19:176. [PMID: 31153381 PMCID: PMC6544992 DOI: 10.1186/s12887-019-1545-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Childhood stunting is the most widely prevalent among under-five children in Ethiopia. Despite the individual-level factors of childhood stunting are well documented, community-level factors have not been given much attention in the country. This study aimed to identify individual- and community-level factors associated with stunting among under-five children in Ethiopia. METHODS Cross-sectional data from the 2016 Ethiopian Demographic and Health Survey was used. A total of 8855 under-five children and 640 community clusters were included in the current analysis. A multilevel logistic regression model was used at 5% level of significance to determine the individual- and community-level factors associated with childhood stunting. RESULTS The prevalence of stunting was found to be 38.39% in Ethiopian under-five children. The study showed that the percentage change in variance of the full model accounted for about 53.6% in odds of childhood stunting across the communities. At individual-level, ages of the child above 12 months, male gender, small size of the child at birth, children from poor households, low maternal education, and being multiple birth had significantly increased the odds of childhood stunting. At community-level, children from communities of Amhara, Tigray, and Benishangul more suffer from childhood stunting as compared to Addis Ababa's community children. Similarly, children from Muslim, Orthodox and other traditional religion followers had higher log odds of stunting relative to children of the protestant community. CONCLUSIONS This study showed individual- and community-level factors determined childhood stunting in Ethiopian children. Promotion of girl education, improving the economic status of households, improving maternal nutrition, improving age-specific child feeding practices, nutritional care of low birth weight babies, promotion of context-specific child feeding practices and narrowing rural-urban disparities are recommended.
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Affiliation(s)
- K Fantay Gebru
- Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia
| | - W Mekonnen Haileselassie
- Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - A Haftom Temesgen
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - A Oumer Seid
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - B Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Zeray A, Kibret GD, Leshargie CT. Prevalence and associated factors of undernutrition among under-five children from model and non-model households in east Gojjam zone, Northwest Ethiopia: a comparative cross-sectional study. BMC Nutr 2019; 5:27. [PMID: 32153940 PMCID: PMC7050904 DOI: 10.1186/s40795-019-0290-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Developing countries, undernutrition remains significant public health attention, as it was a combined consequence of poor dietary consumption and recurrent infectious illness especially in countries same Ethiopia. Undernutrition is associated with morbidity and mortality among children. This study, therefore, was conducted to assess the prevalence and associated factors of undernutrition among under-five children from the model and non-model households at Eastern Gojjam administrative Zone, northwest Ethiopia. Methods A community-based comparative cross-sectional study was conducted from 1st July 2015 to 30th August 2015 in East Gojjam Zone among 507 households (170 from model-household and 337 from non-model household) selected using a multistage sampling technique. Data were collected using questionnaire and nutritional anthropometric measurement. The Emergency Nutrition Assessment for Standardized Monitoring and Assessment of Relief and Transition was used to convert raw anthropometric data into Z-scores. The collected data were entered into EpiData, and analysis was conducted using Statistical Package for Social Sciences (SPSS) version 22. The Emergency Nutrition Assessment for Standardized Monitoring and Assessment of Relief and Transition was used to convert raw anthropometric data into Z scores. Descriptive statistics were used to report the prevalence of outcome variable, undernutrition (intermesh of underweight, stunting, and wasting). In addition, results were presented using narration, tables, and figures including frequency and percentage. Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) was computed. Univariate and multivariate logistic regression analyses were done. A p-value less than 0.05 of was considered to declare a result as statistically significant. Results This study found that the prevalence of undernutrition explained by stunting (height-for-age Z-score (HAZ) < − 2), underweight (weight-for-age Z-score (WAZ) < − 2) and wasting (weight-for-height Z-score (WHZ) < − 2) were 44.7% [95%CI 41.11, 48.29%]c, 15.3% [95%CI: 12.17, 18.43%] and 10% [95% CI 8.0, 12.0%], and 52.5% [95% CI: 48.62, 56.98%], 24.3% [95% CI: 20.22, 28.38%] and 11.3% [95% CI: 8.45, 14.15%] in under-five children among model household and non-model respectively. Protected water (AOR = 0.08, 95% CI: 0.03, 0.18) and less than three times daily intake of food (AOR = 4.06, 95% CI: 1.53, 10.82) were predictors for undernutrition among under-five model household. Protected source of drinking water (AOR = 0.07, 95% CI: 0.03, 0.13), households that ever-had education on complementary feeding (AOR = 0.19, 95% CI: 0.09, 0.25) and starting complementary feeding on 6 month after birth (AOR = 0.19, 95% CI: 0.09, 0.25) were significant predictors for under-five undernutrition among non-model households. Conclusion The prevalence of undernutrition explained by stunting, underweight and wasting among under-five children in both model and non-model households were high. The prevalence of all the three parameters (stunting, underweight and wasting) was higher among the non-model households compared to the models, even if the differences were not statistically significant. Use of an unprotected source of drinking water and less than three times daily intake of food were found to be associated with undernutrition among under-five children in the model households. On the other hand, having educational exposure on complementary feeding, using drinking water from protected sources and initiation of complementary feedings at age of 6 months were found to be associated with undernutrition among children in the non-model households. Therefore, the concerned bodies must access safe and adequate water supply, works on information dissemination using mass media on timely initiation of complementary feeding, save water and on meal frequency should be strengthened. Electronic supplementary material The online version of this article (10.1186/s40795-019-0290-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abrehet Zeray
- Department of Public Health, College of Health Science, Debre Markos University, PO box: 269, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Department of Public Health, College of Health Science, Debre Markos University, PO box: 269, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, PO box: 269, Debre Markos, Ethiopia
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Analysing child linear growth trajectories among under-5 children in two Nairobi informal settlements. Public Health Nutr 2019; 22:2001-2011. [PMID: 30940271 DOI: 10.1017/s1368980019000491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We sought to identify factors associated with linear growth among under-5 children in two urban informal settlements in Nairobi. DESIGN We used longitudinal data for the period 2007-2012 from under-5 children recruited in the two sites between birth and 23 months and followed up until they reached 5 years of age. We fitted a generalized linear model on height-for-age Z-scores using the generalized estimating equations method to model linear growth trajectories among under-5 children. Known for its flexibility, the model provides strong parameter estimates and accounts for correlated observations on the same child. SETTING Two urban informal settlements in Nairobi, Kenya.ParticipantsUnder-5 children (n 1917) and their mothers (n 1679). RESULTS The findings show that child weight at birth, exclusive breast-feeding and immunization status were key determinants of linear growth among under-5 children. Additionally, maternal characteristics (mother's age, marital status) and household-level factors (socio-economic status, size of household) were significantly associated with child linear growth. There were biological differences in linear growth, as female children were more likely to grow faster than males. Finally, the model captured significant household-level effects to investigate further. CONCLUSIONS Findings from the study point to the need to improve the targeting of child health programmes directed at the urban poor population in Nairobi. Specific modifiable determinants of child linear growth, particularly child weight at birth, exclusive breast-feeding, immunization status and mother's background characteristics, should be considered when designing interventions aiming at addressing child health inequities in these settings.
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Abera SF, Kantelhardt EJ, Bezabih AM, Gebru AA, Ejeta G, Lauvai J, Wienke A, Scherbaum V. Nutrition-specific and sensitive drivers of poor child nutrition in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Northern Ethiopia: implications for public health nutrition in resource-poor settings. Glob Health Action 2019; 12:1556572. [PMID: 31154991 PMCID: PMC6338276 DOI: 10.1080/16549716.2018.1556572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/21/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Child undernutrition is a prevalent health problem and poses various short and long-term consequences. Objective: This study seeks to investigate the burden of child undernutrition and its drivers in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, northern Ethiopia. Methods: In 2015, cross-sectional data were collected from 1,525 children aged 6-23 months. Maternal and child nutritional status was assessed using the mid upper arm circumference. Child's dietary diversity score was calculated using 24-hours dietary recall method. Log-binomial regression and partial proportional odds model were fitted to examine the drivers of poor child nutrition and child dietary diversity (CDD), respectively. Results: The burden of undernutrition and inadequate CDD was 13.7% (95% CI: 12.1-15.5%) and 81.3% (95%CI: 79.2-83.1%), respectively. Maternal undernutrition (adjusted prevalence ratio, adjPR = 1.47; 95%CI: 1.14-1.89), low CDD (adjPR = 1.90; 95%CI: 1.22-2.97), and morbidity (adjPR = 1.83; 95%CI: 1.15-2.92) were the nutrition-specific drivers of child undernutrition. The nutrition-sensitive drivers were poverty (compared to the poorest, adjPR poor = 0.65 [95%CI:0.45-0.93], adjPR medium = 0.64 [95%CI: 0.44-0.93], adjPR wealthy = 0.46 [95%CI: 0.30-0.70], and adjPR wealthiest = 0.53 [95%CI: 0.34-0.82]), larger family size (adjPR = 1.10; 95%CI: 1.02-1.18), household head's employment insecurity (adjPR = 2.10; 95%CI: 1.43-3.09), and residing in highlands (adjPR = 1.93; 95%CI: 1.36-2.75). The data show that higher CDD was positively associated with wealth (OR wealthy = 3.06 [95%CI: 1.88-4.99], OR wealthiest = 2.57 [95%CI: 1.53-4.31]), but it was inversely associated with lack of diverse food crops production in highlands (OR = 0.23; 95%CI: 0.10-0.57]). Conclusions: Our findings suggest that the burden of poor child nutrition is very high in the study area. Multi-sectoral collaboration and cross-disciplinary interventions between agriculture, nutrition and health sectors are recommended to address child undernutrition in resource poor and food insecure rural communities of similar settings.
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Affiliation(s)
- Semaw Ferede Abera
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
- Department of Gynaecology, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Afewrok Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Alemseged Aregay Gebru
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Judith Lauvai
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
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Spatial Video Health Risk Mapping in Informal Settlements: Correcting GPS Error. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010033. [PMID: 30586861 PMCID: PMC6339035 DOI: 10.3390/ijerph16010033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
Informal settlements pose a continuing health concern. While spatial methodologies have proven to be valuable tools to support health interventions, several factors limit their widespread use in these challenging environments. One such technology, spatial video, has been used for fine-scale contextualized mapping. In this paper, we address one of the limitations of the technique: the global positioning system (GPS) coordinate error. More specifically, we show how spatial video coordinate streams can be corrected and synced back to the original video to facilitate risk mapping. Past spatial video collections for the Mathare informal settlement of Kenya are used as an illustration as these data had been previously discarded because of excessive GPS error. This paper will describe the bespoke software that makes these corrections possible, and then will go on to investigate patterns in the coordinate error.
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Kejo D, Mosha TCE, Petrucka P, Martin H, Kimanya ME. Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania. Food Sci Nutr 2018; 6:2264-2272. [PMID: 30510726 PMCID: PMC6261180 DOI: 10.1002/fsn3.798] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/07/2022] Open
Abstract
Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community‐based cross‐sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio‐economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z‐scores indices below −2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among underfive children in Arusha District.
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Affiliation(s)
- Dyness Kejo
- Nelson Mandela African Institution of Science and Technology (NM‐AIST)ArushaTanzania
- Tanzania Agriculture Research Institute (TARI)ArushaTanzania
| | | | | | - Haikael Martin
- Nelson Mandela African Institution of Science and Technology (NM‐AIST)ArushaTanzania
| | - Martin E. Kimanya
- Nelson Mandela African Institution of Science and Technology (NM‐AIST)ArushaTanzania
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Marinda PA, Genschick S, Khayeka-Wandabwa C, Kiwanuka-Lubinda R, Thilsted SH. Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia. PLoS One 2018; 13:e0204009. [PMID: 30248126 PMCID: PMC6152956 DOI: 10.1371/journal.pone.0204009] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 08/31/2018] [Indexed: 01/03/2023] Open
Abstract
Background This study examines socio-economic determinants of food consumption patterns amongst women of reproductive age and children aged 6–59 months from urban poor settlements of Lusaka and their implications for nutritional status. Particular emphasis was placed on the role of fish in their diets and nutritional status. Methods A cross-sectional survey design was applied, in which 714 mother-child dyads, with children aged 6–59 months were enrolled. A three-stage randomized cluster sampling approach was applied. Results The mean dietary diversity score among children aged 6–23 and 24–59 months was 2.98 (±1.27) and 3.478 (±1.07), respectively. In children aged 6–23 months, there was a significant difference in their nutritional status, based on fish consumption (χ2 = 10.979, df = 2, p = 0.004). Children from poorer households consumed mostly small fish (Kapenta). The quantity of fish consumed by children was significantly associated with stunting in both age groups, odds ratio = 0.947 (95% CI: 0.896, 1.000) for children aged 6–23 months and odds ratio = 1.038 (95% CI: 1.006, 1.072) for children aged 24–59 months old. Other significant risk factors for stunting in children aged 6–23 months were the child’s age, mother’s body mass index, access to treated water and child morbidity. Child’s age, mother’s educational level and wealth status were determinants of dietary diversity in children aged 6–59 months as shown by the Poisson regression. Conclusion Nutritional status of children aged 6–23 months is associated with fish consumption, with children consuming fish less likely to be stunted. Small fish (Kapenta) is an animal-source food that is particularly important in the diet of children in urban poor households in Zambia and contributes to better nutritional outcomes. As all small fish stem from capture fisheries, sustainable one health environmental integration, monitoring and management strategies are desirable.
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Affiliation(s)
- Pamela A. Marinda
- The University of Zambia, School of Agricultural Sciences, Department of Food Science and Nutrition, Lusaka, Zambia
- * E-mail:
| | | | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, Tianjin city, Nankai District, China
| | - Rebecca Kiwanuka-Lubinda
- The University of Zambia, School of Agricultural Sciences, Department of Agricultural Economics and Extension, Lusaka, Zambia
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Gelu A, Edris M, Derso T, Abebe Z. Undernutrition and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia: a cross-sectional study. Pediatric Health Med Ther 2018; 9:81-88. [PMID: 30215624 PMCID: PMC6118270 DOI: 10.2147/phmt.s172317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people, especially in developing countries such as Ethiopia, are migrating to cities. The majority of these people have settled in slum areas, which often have poor sanitation and housing conditions. Therefore, this study was conducted to gather evidence on nutritional status and associated factors among children aged 6-59 months living in slum areas of Gondar city, northwest Ethiopia. METHODS A community-based cross-sectional study was carried out from 3 to 28 May 2017. A total of 593 children from the slum areas aged 6-59 months were included in the study. Bivariable and multivariable logistic regression analyses were carried out to identify the independent determinants of stunting and wasting. RESULTS The overall prevalences of stunting and wasting were 42.3% (95% CI 38.34, 46.3%) and 7.3% (95% CI 5.3, 9.4%), respectively. Poor wealth status (adjusted odds ratio [AOR] =1.79; 95% CI 1.19, 2.70) and age of child 24-35 months (AOR=2.56; 95% CI 1.32, 4.96), 36-47 months (AOR=2.27; 95% CI 1.14, 4.54) and 48-59 months (AOR=2.69; 95% CI 1.35, 5.32) were independently associated with stunting. Similarly, presence of a fever in the previous 2 weeks (AOR=2.29; 95% CI 1.20, 4.38) and paternal control over resources (AOR=3.66; 95% CI 1.12, 11.04) were associated with wasting. Children of uneducated mothers (AOR=3.30; 95% CI 1.29, 8.46) were also more likely to be wasted. CONCLUSION This study illustrates that undernutrition is prevalent in the slum areas of Gondar city and is a critical public health problem. Therefore, attention should be targeted at economically disadvantaged children living in slum areas. In addition, there is a need to improve medical awareness of families with young children in these areas and increase the health-seeking behavior of these families, primarily by focusing on maternal education. Increasing women's decision-making autonomy over household resources is also recommended to address the problem.
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Affiliation(s)
- Atanaw Gelu
- Comprehensive Specialized Hospital, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkie Edris
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,
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Abera L, Dejene T, Laelago T. Magnitude of stunting and its determinants in children aged 6-59 months among rural residents of Damot Gale district; southern Ethiopia. BMC Res Notes 2018; 11:557. [PMID: 30075824 PMCID: PMC6076418 DOI: 10.1186/s13104-018-3666-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study is assessing magnitude of stunting and its predictors among children aged 6-59 months in Damot Gale district, South Ethiopia. Community based cross sectional study was done at Damot Gale district. About 398 children aged 6-59 months were included in the study. Kebele (small administrative unit) and household were chosen by two-phase cluster sample design. Structured questionnaire was used to gather the data. Anthropometric measurement was also used to get the data. SPSS version 20 was used to analysis the data. RESULTS About 41.7% of children were stunted. Children aged 36-47 months [AOR 6.22; 95% CI (1.81-21.36)], and 48-59 months [AOR 7.27; 95% CI (1.22-43.19)], sex of the child [AOR 20.79; 95% CI (7.50-57.65)], birth order [AOR 6.42; 95% CI (1.68-24.48)], mother education [AOR 0.06; 95% CI (0.02-0.14)], having toilet facility [AOR 0.059; 95% CI (0.02-0.18)], washing hand by soap [AOR 16.21; 95% CI (5.11-51.4)] and ANC [AOR 0.045; 95% CI (0.01-0.13)] were associated with stunting.
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Affiliation(s)
| | - Tariku Dejene
- Department of Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tariku Laelago
- Department of Health Information Technology, Hossana College of Health Science, P.O. Box 159, Hossana, Ethiopia
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Ntenda PAM, Chuang YC. Analysis of individual-level and community-level effects on childhood undernutrition in Malawi. Pediatr Neonatol 2018; 59:380-389. [PMID: 29295806 DOI: 10.1016/j.pedneo.2017.11.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/25/2017] [Accepted: 11/30/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Undernutrition is a major global public health problem among children under the age of 5 years. We aimed to untangle the effects of a wide range of individual- and community-level socioeconomic factors on the risks of childhood undernutrition in Malawi. METHODS We analyzed 6384 women-infant pairs from the 2004 and 2010 Malawi Demographic and Health Surveys (MDHSs). The undernutrition status was assessed by three domains of stunted (height-for-age), wasted (weight-for-height), and underweight (weight-for-age). We constructed generalized estimating equation logistic models to analyze associations of individual- and community-level characteristics with childhood undernutrition. RESULTS About 48.4% of the children were stunted, 4.5% were wasted, and 14.4% were underweight. At the individual level, the risk of childhood undernutrition was significantly higher in males, children with a small birth size, children with a diarrheal episode in the last 2 weeks, children that were a product of multiple births, children born to mothers with either a low socioeconomic status, or a poor education, or who were underweight, and children born in the year 2004. At community level, children born in communities with low and medium wealth, and in communities with low and medium female educational attainment were more likely to be undernourished. Unexpectedly, the maternal HIV status was not associated with childhood undernutrition at either the individual or community level. CONCLUSION This study provides evidence of the importance of both individual- and community-level factors in determining childhood undernutrition. Interventions against childhood undernutrition should consider the various predictors discussed in this study in order to reduce undernutrition in children and contribute to their well-being.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, 250, Wu-Hsing St, Taipei 110, Taiwan
| | - Ying-Chih Chuang
- School of Public Health, College of Public Health, Taipei Medical University, 250, Wu-Hsing St, Taipei 110, Taiwan.
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Debnath SC, Haque ME, Hasan DMM, Samin S, Rouf MA, Rabby MF. Undernutrition and Morbidity Profile of Exclusively Breastfeeding Children: A Cross-sectional Study. Int J Prev Med 2018; 9:55. [PMID: 30050666 PMCID: PMC6036768 DOI: 10.4103/ijpvm.ijpvm_201_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/02/2017] [Indexed: 11/26/2022] Open
Abstract
Background: Undernutrition is common and has been recognized as a public health problem in Bangladesh. It has devastating effects on any population as it increases morbidity children and reduces the quality of life of all affected. The study was done with the objective to assess the undernutrition and morbidity profile in children who have completed exclusive breastfeeding. Methods: This was a descriptive cross-sectional study, which was carried out among children aged 6–12 completed months attending a tertiary level hospital in Bangladesh. A total of 251 children were selected through convenient sampling from January to December 2015. Nutritional assessment was done in terms of underweight, stunting, and wasting. Results: One hundred and forty-three (57.0%) were boys while 108 (43.0%) were girls. The prevalence of undernutrition (Z-score ≤−2) was observed in 11.2%, 16.3%, and 12.0% based on stunting, underweight, and wasting. Among 251 children, 16.7% were not suffering any diseases, whereas majorities (69.7%) were suffering from single disease and 13.5% were suffering from multiple diseases. Cough and fever (55.0%), pneumonia (18.3%), measles (9.9%), and diarrhea (8.3%) were the most common cause of infectious morbidity observed in children. Conclusions: The prevalence of undernutrition was high in the study population, and it continues to be a public health burden because of its major effect on morbidity and impairment of intellectual and physical development in long-term. Increasing the practice of exclusive breastfeeding, the introduction of timely complementary feeding, and standard case management of morbidities would be beneficial to combat the problem of undernutrition.
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Affiliation(s)
| | - Md Ekramul Haque
- Communicable Disease Control (CDC), DGHS, Mohakhali, Dhaka, Bangladesh
| | | | - Sharraf Samin
- TB/HIV Control Program, BRAC, BRAC Centre, Mohakhali, Dhaka, Bangladesh
| | - Md Abdur Rouf
- Aichi Medical College and Hospital, Dhaka, Bangladesh
| | - Md Fazlay Rabby
- Associates for Community and Population Research, Dhaka, Bangladesh
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