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Bahwere P, Funnell G, Qarizada AN, Woodhead S, Bengnwi W, Le MT. Effectiveness of a nonweight-based daily dosage of ready-to-use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan. MATERNAL & CHILD NUTRITION 2024; 20:e13641. [PMID: 38627974 PMCID: PMC11168373 DOI: 10.1111/mcn.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 06/13/2024]
Abstract
Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready-to-use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight-for-height z-score ≥ -3 or mid-upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight-based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per-protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (-0.9; 7.2) %] and length-of-stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of -10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = -1.5 (-1.8, -1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight-based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource-constrained contexts.
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Affiliation(s)
- Paluku Bahwere
- Center for Epidemiology, Biostatistics and Clinical Research (CR2), School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
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Maw AA, Thwin T, Owino VO, Ward LC. Development of a bioelectrical impedance analysis-based prediction equation for body composition of rural children aged 4-8 years in Myanmar. Nutr Health 2024:2601060241260983. [PMID: 38860329 DOI: 10.1177/02601060241260983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background: Reliable and accurate estimates of body composition are essential when studying the various health correlates of disease. Bioelectrical impedance analysis (BIA) is an affordable and feasible body composition assessment technique for clinical and field settings. Total body water (TBW) and hence fat-free mass is estimated by predictive regression algorithms using anthropometric measurements plus the resistance index. Aim: The study aimed to develop a BIA prediction equation for TBW in children in Myanmar using the deuterium dilution technique as the reference method. Methods: The study design was cross-sectional in a school setting with convenience sampling of participants. One hundred and two healthy children (57 boys and 45 girls) with aged 4 and 8 years participated; randomly divided into the prediction group (29 boys and 22 girls) and cross-validation group (28 boys and 23 girls). Whole-body impedance, anthropometric and TBW (by D2O dilution) measurements. The prediction equation was cross-validated using a split-group design and compared to published equations for contemporaneous populations. Results: TBW could be predicted by the following equation. TBW = 0.4597 * Weight (kg) + 0.1564 * Impedance index + 0.6075 (R2 = 0.891, P < 0.0001) with a correlation coefficient of 0.942 and limits of agreement of 0.98 kg TBW on cross-validation. Conclusions: This equation can be used to predict body composition in young (aged 4-8 years) children in Myanmar but because the age range of the participants in the present study was relatively narrow, more research in different age groups is required to establish its broader applicability.
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Affiliation(s)
- Aye Aye Maw
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Theingi Thwin
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Victor O Owino
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Bustos M, Lau LL, Kirkpatrick SI, Dubin JA, Manguerra H, Dodd W. Examining the Association Between Household Enrollment in the Pantawid Pamilyang Pilipino Program (4Ps) and Wasting and Stunting Status Among Children Experiencing Poverty in the Philippines: A Cross-Sectional Study. Asia Pac J Public Health 2023; 35:420-428. [PMID: 37501321 PMCID: PMC10510302 DOI: 10.1177/10105395231189570] [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] [Indexed: 07/29/2023]
Abstract
This study assessed whether enrollment in a national conditional cash transfer program was associated with wasting and stunting among children experiencing extreme poverty in the Philippines. Data were drawn from cross-sectional surveys collected from 10 regional areas in the Philippines between April 2018 and May 2019. A total of 2945 children aged between six months and 12 years comprised the analytical sample. Multilevel logistic regression was conducted to estimate the association between enrollment in Pantawid Pamilyang Pilipino Program (4Ps) and stunting and wasting, controlling for sociodemographic factors and clustering by region. There was no meaningful association between household enrollment in 4Ps and the wasting status of children, but enrollment in 4Ps was associated with lower odds of stunting and differed by geography type. Findings suggest that the current design of 4Ps may not address sudden shocks that contribute to wasting, but may address the underlying socioeconomic risk factors associated with stunting.
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Affiliation(s)
- Monica Bustos
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lincoln L. Lau
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- International Care Ministries, Manila, Philippines
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Joel A. Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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4
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Mertens A, Benjamin-Chung J, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF. Child wasting and concurrent stunting in low- and middle-income countries. Nature 2023; 621:558-567. [PMID: 37704720 PMCID: PMC10511327 DOI: 10.1038/s41586-023-06480-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Jaisamrarn U, Esteban-Habana MA, Padolina CS, Decena DCD, Dee MT, Damodaran P, Bhaskaran V, Garg V, Dorado E, Hu H. Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion. SAGE Open Med 2023; 11:20503121231173377. [PMID: 37223672 PMCID: PMC10201185 DOI: 10.1177/20503121231173377] [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: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.
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Affiliation(s)
- Unnop Jaisamrarn
- Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand
| | | | - Christia S Padolina
- University of the East Ramon Magsaysay
Memorial Medical Center, Quezon City, Philippines
| | | | - Marlyn T Dee
- UST Faculty of Medicine and Surgery,
Manila, Philippines
| | - Premitha Damodaran
- Pantai Hospital Kuala Lumpur, Wilayah
Persekutuan Kuala Lumpur, Malaysia
| | | | - Vandana Garg
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Egbert Dorado
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
| | - Henglong Hu
- Haleon (formerly GSK Consumer
Healthcare), Singapore, Singapore
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Harvey CM, Newell ML, Padmadas S. Maternal socioeconomic status and infant feeding practices underlying pathways to child stunting in Cambodia: structural path analysis using cross-sectional population data. BMJ Open 2022; 12:e055853. [PMID: 36328394 PMCID: PMC9639063 DOI: 10.1136/bmjopen-2021-055853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting. DESIGN, SETTING AND PARTICIPANTS We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients. OUTCOME MEASURE The primary outcome measure was height-for-age Z-scores as a continuous measure. RESULTS Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding. CONCLUSION We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.
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Affiliation(s)
| | - Marie-Louise Newell
- Faculty of Medicine, School of Human Development and Health, Global Health Research Institute, University of Southampton, Southampton, UK
- Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Sabu Padmadas
- Social Statistics and Demography, University of Southampton, Southampton, UK
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Lead exposure and stunting incidents in children aged 3–5 years in Pontianak City, West Kalimantan, Indonesia. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Phulkerd S, Rachmi CN, Sameeha MJ, Borazon EQ, Thow AM, Trevena H, Saptari AF, Cheah YK, Wel CAC, Marquez VT, Sakulsri T, Thongcharoenchupong N, Poh BK. Identifying Opportunities for Strategic Policy Design to Address the Double Burden of Malnutrition through Healthier Retail Food: Protocol for South East Asia Obesogenic Food Environment (SEAOFE) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:528. [PMID: 35010789 PMCID: PMC8744775 DOI: 10.3390/ijerph19010528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 01/27/2023]
Abstract
Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers' and retailers' perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | | | - Mohd Jamil Sameeha
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Elaine Q. Borazon
- International Graduate Program of Education and Human Development (IGPEHD), College of Social Sciences, National Sun Yat-Sen University, Kaohsiung City 80424, Taiwan;
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney 2006, Australia; (A.-M.T.); (H.T.)
| | - Helen Trevena
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney 2006, Australia; (A.-M.T.); (H.T.)
| | | | - Yong Kang Cheah
- School of Economics, Finance and Banking, Universiti Utara Malaysia, Sintok 06010, Malaysia;
| | - Che Aniza Che Wel
- Faculty of Economics and Management, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia;
| | - Vanessa T. Marquez
- School of Economics, University of the Philippines-Diliman, Quezon City 1101, Philippines;
| | - Teeranong Sakulsri
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | - Natjera Thongcharoenchupong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand; (S.P.); (T.S.); (N.T.)
| | - Bee Koon Poh
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
- * E-mail:
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Gonete AT, Alemu TG, Mekonnen EG, Takele WW. Malnutrition and contributing factors among newborns delivered at the University of Gondar Hospital, Northwest Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e053577. [PMID: 34740934 PMCID: PMC8573658 DOI: 10.1136/bmjopen-2021-053577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of various indicators of malnutrition (stunting, wasting, low birth weight, concurrent stunting and wasting, overweight/obesity and double burden malnutrition) among newborns and to investigate factors associated with these nutritional disorders. METHODS A hospital-based cross-sectional study was conducted from 10 March through to May 2020. A total of 419 newborns were recruited into the study to estimate the prevalence of low birth weight and stunting. After excluding 28 newborns whose length was less than 45 cm, 394 newborn-mother dyads were approached to estimate wasting and overweight/obesity. A systematic random sampling technique was used to select participants. All independent variables were entered into the multivariable logistic regression model and variables that had significant associations were identified based on a p value. RESULTS A very small proportion of the newborns 2.5% (0.9% to 4.1%) were concurrently wasted and stunted. The prevalence rates of low birth weight and wasting were 20.8% (16.8% to 24.6%) and 10.9% (7.82% to 14.01%), respectively. The magnitude of overweight/obesity was 12.7% (9.3% to 15.9%) where 2.8% (1.1% to 4.4%) of newborns have the double burden of malnutrition. Having a father with a primary level of education 2.82 (1.19 to 6.65) and being stunted at birth 3.17 (1.6 to 6.0) were variables that were associated with increased odds of low birth weight. The odds of being overweight/obese are significantly higher among newborns born to mothers who are urban dwellers 0.35 (0.12 to 0.99). CONCLUSIONS The study underscores that malnutrition is a pressing public health concern that demands due emphasis. Fathers' educational status (low level) and being stunted are associated with a high burden of low birth weight. Mothers' residency (being urban) is associated with an elevated risk of overweight/obesity among newborns. Thus, improving the health literacy of fathers and preventing stunting at birth are recommended to mitigate low birth weight.
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Affiliation(s)
- Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Reproductive Health, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara Regional State, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, University of Gondar, Gondar, Ethiopia
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11
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Looking Back, Looking Forward: Progress and Prospect for Spatial Demography. SPATIAL DEMOGRAPHY 2021; 9:1-29. [PMID: 34036151 PMCID: PMC8136374 DOI: 10.1007/s40980-021-00084-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
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12
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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014-2018): Analysis of Demographic Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094578. [PMID: 33925898 PMCID: PMC8123503 DOI: 10.3390/ijerph18094578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.
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