A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa

Indicators of Malnutrition Among School-Going Children in an Eastern State (West Bengal) of India

This study identified determinants of malnutrition among school children in West Bengal, India. A total of 896 children aged between 4 and 13 years in eight districts were evaluated. BMI, weight, and height-for-age z-scores were used to categorize the stages of malnutrition. The study results revealed that the average height of the boys and girls was as per the standards set by the National Council of Health Sciences. Body mass index of the children ranged between 14.4 and 21.42 kg/m2, and stunting was 56.77%. Age and stunting were positively correlated in 5- to 10-year-old children. The most common deficiency was of fluoride.

Determinants of central obesity in children and adolescents and associated complications in South Africa: a systematic review

Background

Central obesity in children is a global health concern associated with cardiovascular risk factors. In 2019 the World Obesity Federation predicted that in 2025, 206 million children and adolescents aged 5 to 19 will be obese, and the number is estimated to reach 254 million by 2030. There is limited literature on the factors that are associated with the development of central obesity in children. We report a systematic review, aimed to describe the current literature on determinants of central obesity and its associated health outcomes in children and adolescents in the South African population.

Methods

We searched for peer-reviewed studies in Google Scholar, PubMed, and Science Direct search engines, and about seven studies were included. This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42023457012). This systematic review was conducted and reported according to an updated version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The quality of the included studies was assessed by following guidelines from the Newcastle-Ottawa Scale (NOS). The method considered three main domains: selection, comparability, and outcome across different study designs.

Results

The prevalence of central obesity in children and adolescents by waist-to-height ratio (WHtR) ranged from 2.0 to 41.0%; waist-to-hip [WHR ranged from 10 to 25%; waist circumference (WC) ranged from 9 to 35%]. Central obesity was associated with age, physical inactivity, gender socio, and demographic profiles of the household. Central obesity in children was associated with cardiovascular diseases and mental health issues.

Conclusion

Central obesity in children and adolescents was determined by gender, pubertal development, and age of the parents, households with high socioeconomic status, dietary practices, and overweight/obesity. Given the high prevalence of central obesity in children which can ultimately result in cardiometabolic diseases, cardiovascular risk factors, and mental health issues. This highlights the need for systems, jointly initiated by healthcare providers, policymakers, and the general society aimed at reducing the burden of central obesity such as introducing children and adolescents to health-promoting lifestyles.

Nutritional Problems Among Special Needs Children in a Rural Special Needs Children Home Near Chennai

Background Special needs children have various health problems, and the most common problems are nutritional deficiency and malnourishment which leads to increased morbidity affecting their quality of life. This study aims to assess the nutritional status and health-seeking behaviour of special needs children. Methods The study was conducted among 46 special needs children at a special needs children's home. After collecting basic sociodemographic details, they were assessed for nutritional status and health-seeking behaviour using a semi-structured questionnaire followed by general and clinical examination. Results Out of these 46 special needs children, 69.6% were male and 30.4% were female. The mean age was 11.69±4.62 years. In this study, 65.22% were underweight; 6.52% were overweight; 10.87% were obese I; 4.35% were obese III; 13.04% were normal. Among them, 37% seek Government healthcare facilities for their healthcare needs. Referral advice was provided to all required children. Conclusion A high proportion of the special needs children were screened positive for nutritional deficiency and malnourishment which needs to be addressed. Interventions should be aimed at correcting the nutritional deficiency and malnourishment by involving the caretakers, mainly mothers of these children.

The effect of women's decision-making on child nutritional outcomes in South Africa

Women's decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women's decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15-2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women's decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child's weight-for-age and weight-for-height, the result was inconclusive on the child's height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.

Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys

BACKGROUND

Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021.

METHODS

Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios.

RESULTS

Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India.

CONCLUSIONS

The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.

Predicting and identifying factors associated with undernutrition among children under five years in Ghana using machine learning algorithms

BACKGROUND

Undernutrition among children under the age of five is a major public health concern, especially in developing countries. This study aimed to use machine learning (ML) algorithms to predict undernutrition and identify its associated factors.

METHODS

Secondary data analysis of the 2017 Multiple Indicator Cluster Survey (MICS) was performed using R and Python. The main outcomes of interest were undernutrition (stunting: height-for-age (HAZ) < -2 SD; wasting: weight-for-height (WHZ) < -2 SD; and underweight: weight-for-age (WAZ) < -2 SD). Seven ML algorithms were trained and tested: linear discriminant analysis (LDA), logistic model, support vector machine (SVM), random forest (RF), least absolute shrinkage and selection operator (LASSO), ridge regression, and extreme gradient boosting (XGBoost). The ML models were evaluated using the accuracy, confusion matrix, and area under the curve (AUC) receiver operating characteristics (ROC).

RESULTS

In total, 8564 children were included in the final analysis. The average age of the children was 926 days, and the majority were females. The weighted prevalence rates of stunting, wasting, and underweight were 17%, 7%, and 12%, respectively. The accuracies of all the ML models for wasting were (LDA: 84%; Logistic: 95%; SVM: 92%; RF: 94%; LASSO: 96%; Ridge: 84%, XGBoost: 98%), stunting (LDA: 86%; Logistic: 86%; SVM: 98%; RF: 88%; LASSO: 86%; Ridge: 86%, XGBoost: 98%), and for underweight were (LDA: 90%; Logistic: 92%; SVM: 98%; RF: 89%; LASSO: 92%; Ridge: 88%, XGBoost: 98%). The AUC values of the wasting models were (LDA: 99%; Logistic: 100%; SVM: 72%; RF: 94%; LASSO: 99%; Ridge: 59%, XGBoost: 100%), for stunting were (LDA: 89%; Logistic: 90%; SVM: 100%; RF: 92%; LASSO: 90%; Ridge: 89%, XGBoost: 100%), and for underweight were (LDA: 95%; Logistic: 96%; SVM: 100%; RF: 94%; LASSO: 96%; Ridge: 82%, XGBoost: 82%). Age, weight, length/height, sex, region of residence and ethnicity were important predictors of wasting, stunting and underweight.

CONCLUSION

The XGBoost model was the best model for predicting wasting, stunting, and underweight. The findings showed that different ML algorithms could be useful for predicting undernutrition and identifying important predictors for targeted interventions among children under five years in Ghana.

Factors associated with underweight, overweight, stunting and wasting among primary school-going children participating in a school health initiative in South Africa

BACKGROUND

The double burden of malnutrition among children remains a public health challenge in South Africa. In response, the government of South Africa developed the National Health Policy and Implementation Guidelines for school-going children in 2003. This policy was subsequently upgraded to 'The Integrated School Health Programme' in 2012. An element of the programme is the provision of a meal to school-going children on school days. However, evidence suggests that one-third of school-going children continue to have nutritional deficiencies. This study investigated the sociodemographic as well as the nutritional characteristics of school-going children participating in a school health initiative in KwaZulu-Natal Province, South Africa.

METHODS

This was a retrospective descriptive cross-sectional study involving 1,275 children (50.3% females and 49.7% males) aged 3 to 15 years. Epidemiological data on the screening of the children's nutritional characteristics by school health nurses and school health nutritionists under the integrated school health programme (ISHP) was reviewed and analysed for the study.

RESULTS

Nearly half (50.3%) and 49.7% of the population were females and males, respectively. The average age of participants was 8.4 years old. 'Underweight' (p = 0.000), 'overweight' (p = 0.000), 'at risk of overweight' (p = 0.000),'stunting' (p = 0.000),'severe stunting' (p = 0.005), 'wasting' (p = 0.010), and 'obesity' (p = 0.037) were associated with the 'schools that children attended'. School-going children' living conditions were significantly associated with 'normal weight' (p = 0.000), 'underweight' (p = 0.000), and 'underweight' (p = 0.028). However, the social grant to parents/guardians had some positive effects on the percentage of children who reported 'normal weight' (55.4%), 'wasting' (1.0%), 'underweight' (4.0%), and 'at risk of overweight' (20.2%).

CONCLUSION

Chronic nutritional deficiencies persist among children. Therefore, ISHP implementation must retarget specific regions of the country to ensure that national goals and gains on school-going children nutrition, are met and maintained. Indeed, considering the positive impact of the government's social grant programme on the nutritional status of the children in this study, we recommend policy reforms that will increase parents' and carers' access to means of subsistence in order to meet the health and nutritional needs of children in the study communities.

Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa

The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.

Cultural and Contextual Drivers of Triple Burden of Malnutrition among Children in India

This study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-2021), the study identifies risk factors and assesses their contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% were overweight, and 66% were anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At the macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran's I: stunting-0.53, overweight-0.41, and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.

Suitability and Potential Nutrient Contribution of Underutilized Foods in Community-Based Infant Foods in Northern Ghana

In rural Ghana, infant feeding is largely home-based or community-based yet less is known about the kinds of community-based infant foods and the ability of families to create a range of recipes for baby feeding using context-specific ingredients particularly in northern Ghana which has a high prevalence of malnutrition. In this explorative study on mothers (15-49 years; n = 46), we investigated community-based infant foods' food group composition, enrichment, nutrient contribution, and acceptability. The identified community-based infant foods were mainly made of either corn or millet porridges in northern Ghana and had three nutrients with % RNI ≥ 70. We developed 38 recipes of enriched community-based infant foods adding underutilized foods (orange-fleshed sweet potato, pawpaw, cowpea, moringa, groundnut, Bambara beans, and soya beans) to increase the number of nutrients from three to at least five and at most nine nutrients with % RNI ≥ 70 based on the recipe combinations. The enriched community-based infant food recipes provided adequate caloric amounts and modest improvements in micronutrient content for infants (6-12 months). All recipes tested were deemed appropriate and acceptable for infants by mothers. Moringa and pawpaw emerged as the lowest-cost ingredients to add among the underutilized foods. Future research is necessary to assess the effectiveness of the new recipes at promoting linear growth and improving micronutrient status during the complementary feeding period.

Complementary Feeding Practices and Childhood Malnutrition in South Africa: The Potential of Moringa Oleifera Leaf Powder as a Fortificant: A Narrative Review

Poor complementary feeding is a common practice in developing regions, including South Africa (SA), and is one of the main contributing factors to childhood malnutrition. This paper reviews the literature on complementary feeding practices in SA and the potential of fortifying home-prepared complementary foods with Moringa oleifera to improve their nutritional composition. Studies that investigated complementary feeding practices, indigenous crops, nutritional benefits of Moringa oleifera, and the use of MOLP as a fortificant both locally and globally were included in this review. In SA, maize meal and commercial cereal are the most commonly used complementary infant foods. The diet consumed by children from vulnerable households commonly has insufficient nutrients. Foods consumed are generally high in starch and low in other essential nutrients, including good-quality protein. Impoverished individuals consume poor-quality foods as they are unable to afford a diversified diet with food from different food groups, such as protein, fruits, and vegetables. In SA, various programs have been implemented to reduce the incidence of childhood malnutrition. However, childhood malnutrition remains on the rise. This shows a need for complementary food-based strategies that can be implemented and sustained at a household level. This can be conducted through the use of accessible indigenous crops such as Moringa oleifera. Moringa oleifera contains essential nutrients such as proteins, amino acids, vitamins, and minerals. Therefore, it could possibly be used as a home-prepared complementary food fortificant to enhance nutritional composition. Before complementary foods can be fortified with Moringa oleifera, popular home-prepared complementary foods must be identified.

The Relationship between Childcare-Giving Arrangements and Children's Malnutrition Status in South Africa

Multiple caregiving arrangements have become common for childcare globally, and South Africa is no exception. Previous childcare studies mainly focused on the caregiver and household characteristics. Evidence on the influence of childcare on malnutrition is sparse. This study aimed to examine the relationship between exposure to secondary and multiple forms of care and child malnutrition, with a particular focus on child stunting and overweight among children. A cross-sectional study of a sample of 2966 dyads of mothers and children under five were analysed from the 2017 National Income Dynamics Study (NIDS) Wave 5. Descriptive and inferential statistics were used to analyse the data. The results indicated that 22.16% of the children were stunted and that 16.40% were overweight. Most children were mainly cared for at home (67.16%) during the day. Some results of the obtained multivariable analyses show that lack of being cared for in a crèche or school during the day was significantly associated with stunting (odds ratio (OR) 2; confidence interval (CI) 1.10-3.62, p < 0.05) and overweight (OR) 3.82; (CI) 1.60-9.08, p < 0.05). Furthermore, in this study, 69.88% of children who were cared for at home by the primary caregiver had no other forms of multiple care arrangements. The results showing high stunting and overweight rates among children cared for at home suggest that the government needs to look into supporting caregiver parenting. The high unemployment rates in the country highlight the importance of socioeconomic status in childcare and its implication for children's nutritional outcomes. The study's findings suggest the need for innovative strategies to address the challenges associated with multi-caregiving which negatively affects children's nutritional outcomes.

Analysis of dynamic change of nutrition status in primary school children of Furong District of Changsha City from 2019 to 2020

OBJECTIVE

To analyze the nutritional status of primary school children in Furong District of Changsha from 2019 to 2020.

METHODS

The physical examination data of students from 35 primary schools (grade 1-6) in Furong District of Changsha in Hunan Provincial People's Hospital from September 2019 to October 2020 were analyzed retrospectively. General information of all children was collected for statistical analysis of malnutrition among children of different gender and age groups.

RESULT

The overnutrition rate was 32.73% in 2020. This was 7.42% higher than 25.31% in 2019. The undernourishment rate was 4.70% in 2020. This was 3.94% lower than 8.64% in 2019. In 2019 and 2022, the obesity and overweight rates of boys were higher than those of girls (both P < 0.05). The rates of growth retardation (0.36%, 0.37%) for boys were higher than those for girls (0.27%, 0.24%). The rates of mild wasting (4.31%, 2.36%) were lower than those for girls (4.00%, 2.39%) in 2020 and 2019. The rates of moderate and severe wasting (4.06%, 1.98%) were higher than those for girls (2.75%, 1.47%). In 2020, the undernourishment rate for boys decreased by 4.02% compared to 2019. The undernourishment rate for girls decreased by 2.91% compared to 2019. The growth retardation rate for boys increased by 0.01% compared to 2019. The growth retardation rate for girls decreased by 0.03% compared to 2019. The mild wasting rate for boys decreased by 1.95% as compared to 2019. The mild wasting rate for girls decreased by 1.61% as compared to 2019. The moderate to severe emaciation rate in boys was 2.08% lower in 2020 than in 2019 and 1.28% lower in girls than in 2019. The malnutrition rates of children aged 6-11 decreased by 4.20%, 4.85%, 3.83%, 9.45%, 6.65%, and 6.45% in 2020 compared with that of 2019.

CONCLUSION

Compared to 2019, the primary school students in Furong District had abnormal nutritional status in 2020. It is necessary to strengthen the management of children's health care to ensure the healthy growth of children.

Attitudes of Caregivers of Children under Five Years Regarding Growth Monitoring and Promotion in Polokwane, Limpopo Province

Growth monitoring and promotion (GMP) is critical in tracking child growth to address widespread malnutrition and health status. Attitudes influence behaviour change, including attendance of GMP, and negative attitudes are linked to non-attendance. Moreover, negative attitudes correlate with low socioeconomic position. South Africa is characterized by inequality, which may lead to negative attitudes towards GMP among caregivers with a poor socioeconomic status. Hence, this study seeks to explore the attitudes of caregivers of children under five towards GMP. A qualitative exploratory study design was used. Caregivers of children under five were purposively sampled. Twenty-three participants were interviewed one-on-one, and the data were recorded using voice recorders and field notes. Tesch's eight steps and inductive, descriptive, and open coding techniques were used to analyse the data. Participants understood the significance of GMP and were confident their children would benefit from it; hence, they attended sessions out of love for their children. The inconsistent availability of GMP services and the behaviour of health workers affected participants' attitude. Despite these challenges, participants felt good about GMP. Caregivers' love for their children/grandchildren helped them overcome challenges experienced at the health facilities. Good feelings about GMP boosted caregivers' attitudes and aided in adherence. An intervention to address element impacting attitudes of caregivers is recommended.

Drivers of socioeconomic inequalities of child hunger during COVID-19 in South Africa: evidence from NIDS-CRAM Waves 1–5

Background

Child hunger has long-term and short-term consequences, as starving children are at risk of many forms of malnutrition, including wasting, stunting, obesity and micronutrient deficiencies. The purpose of this paper is to show that the child hunger and socio-economic inequality in South Africa increased during her COVID-19 pandemic due to various lockdown regulations that have affected the economic status of the population.

Methods

This paper uses the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM WAVES 1–5) collected in South Africa during the intense COVID-19 pandemic of 2020 to assess the socioeconomic impacts of child hunger rated inequalities. First, child hunger was determined by a composite index calculated by the authors. Descriptive statistics were then shown for the investigated variables in a multiple logistic regression model to identify significant risk factors of child hunger. Additionally, the decomposable Erreygers' concentration index was used to measure socioeconomic inequalities on child hunger in South Africa during the Covid-19 pandemic.

Results

The overall burden of child hunger rates varied among the five waves (1–5). With proportions of adult respondents indicated that a child had gone hungry in the past 7 days: wave 1 (19.00%), wave 2 (13.76%), wave 3 (18.60%), wave 4 (15, 68%), wave 5 (15.30%). Child hunger burden was highest in the first wave and lowest in the second wave. The hunger burden was highest among children living in urban areas than among children living in rural areas. Access to electricity, access to water, respondent education, respondent gender, household size, and respondent age were significant determinants of adult reported child hunger. All the concentrated indices of the adult reported child hunger across households were negative in waves 1–5, suggesting that children from poor households were hungry. The intensity of the pro-poor inequalities also increased during the study period. To better understand what drove socioeconomic inequalites, in this study we analyzed the decomposed Erreygers Normalized Concentration Indices (ENCI). Across all five waves, results showed that race, socioeconomic status and type of housing were important factors in determining the burden of hunger among children in South Africa.

Conclusion

This study described the burden of adult reported child hunger and associated socioeconomic inequalities during the Covid-19 pandemic. The increasing prevalence of adult reported child hunger, especially among urban children, and the observed poverty inequality necessitate multisectoral pandemic shock interventions now and in the future, especially for urban households.

Association of Malnutrition With Weaning Practices Among Infants in Pakistan

Background An appropriate diet is critical for the growth and development of infants, especially in the first two years of life. Despite considerable efforts made by government and local authorities to raise awareness, mothers still lack basic knowledge of weaning practices; as a result, infants face a growing number of health problems in their later years of life. This research aims to investigate the association between malnutrition and knowledge of different weaning practices among mothers and to study the factors influencing it. Methodology The current study was a cross-sectional study conducted at Mayo Hospital, Services Hospital, and Jinnah Hospital, Lahore, Pakistan between November 2019 and May 2020. A total of 200 infants of both genders aged between one and 12 months were included in the study. Knowledge and practices of complementary feeding by the mothers were assessed using a close-ended, pre-tested questionnaire. Results Mothers of 200 infants were interviewed and it was found that 79.5% of the infants were being breastfed while 24% never received breast milk. Among those who never received breast milk were given liquids (25%) and semi-solid foods (64.5%). Of the mothers, 8% started weaning at an early age (less than six months old) while the remaining started weaning at the age of six months or later and reported that their infants were either underweight or had reduced heights for that age. Based on the medical reports obtained from the hospital after getting parental consent, it was also found that the infants had distinct signs of deficiency of vitamins A and D, iron, and folate. Conclusions The majority of infants were breastfed, and, in most cases, weaning started at an age of less than six months. Most of the infants were fed semi-solid food as their first complementary food. Two-thirds of the infants were underweight for that age, and one-fifth had reduced heights. Based on deficiency statistics, mothers should be encouraged to start weaning at six months to have minimized malnourishment instances in infants.

Nutritional status and related factors among ethnic preschool children in Northern Thailand: a cross-sectional study

Purpose: This study investigated the nutritional status of ethnic (belonging to minority groups) preschool children in Northern Thailand.Methods: In this cross-sectional descriptive study, the sample group included 147 parents and 147 preschool children (2-6 years old). Participants volunteered to complete a questionnaire on the personal information of children and parents, as well as family- and school-related factors. Data were analyzed using descriptive statistics, a nutritional status calculator, and logistic regression analysis.Results: A birth weight of less than 2,500 g was related to weight-for-age and weight-for-height. Not having been breastfed and having been breastfed for less than 6 months were related to weight-for-height. An elementary school education level among parents was related to children's height-for-age. Familial unhealthy food consumption for 1-2 days per week was related to weight-for-age and height-for-age.Conclusion: This study reflects the importance of nutritional care for children at the beginning of pregnancy and continuing to the preschool age, as well as the importance of breastfeeding. Families were found to be a key factor in supporting good nutrition among children.

The Burden of Undernutrition and Its Associated Factors Among Children Below 5 Years of Age in Bambao Region, Comoros

Background

Undernutrition remains a major public health problem in low- and middle-income countries and Comoros is no exception. This study aimed to examine the prevalence and identify the risk factors of undernutrition among children under-five years in Bambao region, Comoros.

Methods

This cross-sectional study was conducted in Bambao region among 837 under-five years and their caregivers. Analyses were conducted using both descriptive and logistic regression to examine the magnitude and factors associated with stunting, wasting and underweight.

Results

Prevalence of stunting, wasting and underweight were 21.6, 13.7, and 13.6% respectively. Factors associated with stunting were caregiver's secondary education level compared to no education (AOR = 1.89, 95% CI: 1.04–3.43, P < 0.04), age of child between 13–24 months compared to 0–12 months (AOR = 2.69, 95% CI: 1.44–5.01, P < 0.001), and food insecurity (AOR = 2.55, 95% CI: 1.20–5.41, P < 0.02). Children aged 25–59 months were 78% less likely to have wasting compared to those with 0–12 months (AOR = 0.22, 95% CI: 0.10–0.51, P < 0.001). Wasting was also associated with food insecurity (AOR = 2.70, 95% CI: 1.12–6.49, P < 0.03), and low birthweight (AOR = 3.21, 95% CI: 1.73–5.94, P < 0.001). Children aged between 25–59 months were 86% less likely to have underweight compared to those aged 0–12 months (AOR = 0.14, 95% CI: 0.06–0.36, P < 0.001). Food insecurity (AOR = 2.65, 95% CI: 1.08–6.54, P < 0.03), low birthweight (AOR = 3.15, 95% CI: 1.67–5.93, P < 0.001), and non-exclusively breastfeeding (AOR = 2.37, 95% CI: 1.15–4.90, P < 0.02) were also associated with underweight.

Conclusion

More than one in five children under-five is stunted in Bambao region, Comoros. Moreover, more than 13% are underweight or wasted calling for streamlined efforts to address poor feeding practices, food insecurity, low birthweight, and socio-demographic disadvantages in this and other areas with similar context.

Distribution of wealth quintiles and risk factors of non-communicable diseases in Ghana: evidence from the Ghana demographic and health survey 2014 using concentration curves model

INTRODUCTION

in recent times, the assertion of non-communicable diseases afflicting the rich has been demystified but cuts across the rich and the poor. Individuals in all categories of wealth quintiles are affected by the risk factors of non-communicable diseases such as alcohol consumption, tobacco use, unhealthy dietary practices and physical inactivity. However, information on the distribution of these risk factors across different socio-economic status is scanty. This study assessed the distribution of wealth quintiles and the risk factors of non-communicable diseases, using the concentration curve model.

METHODS

it was a quantitative study with analytical design using the Ghana Demographic and Health Survey (GDHS), 2014 data. The variables of interest were income status of respondents and risk factors of non-communicable diseases. In the analysis, income levels were categorized into wealth quintiles with assigned percentages (25%, 50%, 75% and 100%) denoting poor, rich, richer and richest respectively. The risk factors of non-communicable diseases were also categorized and assigned percentages (relatively exposed 25%, exposed 50%, more exposed 75% and most exposed 100%). A concentration table was employed to assess the risk factors of non-communicable diseases labelled X-axis and wealth quintiles labelled Y-axis. The cumulative percentage of the wealth quintiles (Y-axis) were plotted against the cumulative percentage of the risk factors of non-communicable diseases on the X-axis.

RESULTS

the study found moderate concentration of alcohol consumption among the middle to upper wealth quintiles (richest). Again, the study revealed that, wealth quintiles are practically indifferent to tobacco use and that both the rich and poor equally and minimally use tobacco as the concentration curve is very close to the perfect line of equality (45°). This study found near equal distribution of unhealthy dietary practices among the rich and poor in Ghana. It was found that, 40% - 80% of rich people were physically inactive with the application of a physical activity level of 100%. It was noticed that, 40% of the rich people only performed 20% of physical activities.

CONCLUSION

the study concludes that; wealth quintiles have implications for the risk factors of non-communicable diseases.

Caregivers' Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers’ knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver–child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers’ knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.

Malnutrition in children under the age of 5 years in a primary health care setting

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

A Scoping Review of Selected Studies on Predictor Variables Associated with the Malaria Status among Children under Five Years in Sub-Saharan Africa

Background/Purpose: In recent times, Sub-Saharan Africa (SSA) had been rated by the World Health Organization (WHO) as the most malaria-endemic region in the world. Evidence synthesis of the factors associated with malaria among children aged under-five in SSA is urgently needed. This would help to inform decisions that policymakers and executors in the region need to make for the effective distribution of scarce palliative resources to curb the spread of the illness. This scoping review is aimed at identifying studies that have used multivariate classical regression analysis to determine the predictors associated with malaria among children under five years old in SSA. Methods/Design: The search terms followed population, intervention, comparator, outcome, timing, setting (PICOTS), and were used in searching through the following databases: PubMed, MEDLINE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Measure DHS. The databases were searched for published articles from January 1990 to December 2020. Results: Among the 1154 studies identified, only thirteen (13) studies met the study’s inclusion criteria. Narrative syntheses were performed on the selected papers to synchronize the various predictors identified. Factors ranging from child-related (age, birth order and use of a bed net), parental/household-related (maternal age and education status, household wealth index) and community-related variables (community wealth status, free bed net distribution) were some of the identified significant predictors. Conclusions: It is timely to have a synthesis of predictors that influence the malaria status of children under-five in SSA. The outcome of the review will increase the knowledge of the epidemiology of morbidity that will form the basis for designing efficient and cost-effective distribution of palliatives and control of malaria in SSA.