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Belayneh A, Chelkeba L, Amare F, Fisseha H, Abdissa SG, Kaba M, Patel SA, Ali MK. Investigation of non-communicable diseases prevalence, patterns, and patient outcomes in hospitalized populations: a prospective observational study in three tertiary hospitals. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:128. [PMID: 39164738 PMCID: PMC11337899 DOI: 10.1186/s41043-024-00599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/18/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Non-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there's limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia. METHODS A hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant. RESULTS In the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2-1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21-0.64, p < 0.001), concurrent infections (AOR: 0.36, 95% CI: 0.16-0.86, p < 0.001), chronic kidney diseases (CKD) (AOR: 0.35, 95% CI: 0.14-0.85, p = 0.02), and complications during hospitalization (AOR: 6.36, 95% CI: 3.45-11.71, p < 0.001). CONCLUSION Our study reveals a substantial prevalence of NCDs among hospitalized patients, affecting approximately one in four individuals, primarily with CVDs and cancer. Alarmingly, a significant proportion of these patients did not survive their hospitalization, emphasizing the urgent need for targeted interventions to enhance outcomes in this population.
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Affiliation(s)
- Alemu Belayneh
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Colleges of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Colleges of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Georgia, Atlanta, USA.
| | - Firehiwot Amare
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Colleges of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henok Fisseha
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Senbeta Guteta Abdissa
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- Department of Community Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Georgia, Atlanta, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Georgia, Atlanta, USA
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Melese M, Esubalew D, Malede A, Birhan TA, Azanaw J. Environmental Predictors of Undernutrition Among Under-5 Children at Dabat District Health Facilities, Northwest Ethiopia, 2023. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241252735. [PMID: 38756544 PMCID: PMC11097728 DOI: 10.1177/11786302241252735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024]
Abstract
Background In Ethiopia, undernutrition remains a significant public health concern throughout the year due to persistent household food insecurit. The intensifying conflict in the Dabat district, involving the Ethiopian government and the Tigray Liberation Front, has increased the threat of undernutrition among under-5 children. The cessation of humanitarian aid has worsened food insecurity, increasing the vulnerability of the children in the region. However,there was no data showing the prevalence and environmental pridictors of undernutrition in the Dabat district, northwestern Ethiopia. Therefore, the objective of this study was to determine the prevalence of undernutrition and identify environmental pridictors in this study setting. Methods This institutional-based cross-sectional study was conducted from January to March 2023. A total of 400 under-5 children were included in this study using systematic random sampling techniques with a 100% response rate. The study included all under-5 children who visited healthcare facilities during the data collection period. However, it excluded children under-5 who had physical deformities, were critically ill, or had congenital abnormalities or known chronic diseases such as HIV/AIDS, tuberculosis, or chronic heart diseases. Binary logistic regression was used to determine environmental predictors of undernutrition, with statistical significance at a P-value of ⩽.05. Results The overall prevalence of undernutrition was found to be 12% (95% CI: 8.72-21.5). Among those affected, 32.8% (95% CI: 21.5-39.8) were stunted, 37.9% (95% CI: 28.8-47.50) were underweight, and 29.3% (95% CI: 21.3-29.7) were wasted. The environmental predictors of undernutrition were latrine use, recent diarrhea episodes, mothers' occupation and place of residence, water treatment before consumption, water sources and storage, water extraction methods, and mothers' handwashing habits. Conclusions and recommendations The study found a higher prevalence of undernutrition among under-5 children compared to the 2019 Ethiopia Mini Demographic and Health Survey. This study recommended raising awareness about establishing private toilets, promoting water treatment, proper latrine use, and handwashing practices. Training on personal hygiene and economic support for households should also be provided. Healthcare providers should offer quality health services for under-5 children. Further research is needed to explore specific nutrient deficiencies using laboratory methods.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Asmamaw Malede
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tsegaye Adane Birhan
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jember Azanaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Amoadu M, Abraham SA, Adams AK, Akoto-Buabeng W, Obeng P, Hagan JE. Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:476. [PMID: 38671693 PMCID: PMC11049343 DOI: 10.3390/children11040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity.
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Affiliation(s)
- Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - Susanna Aba Abraham
- Department of Public Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Abdul Karim Adams
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - William Akoto-Buabeng
- Department of Education and Psychology, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Paul Obeng
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
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Janmohamed A, Baker MM, Doledec D, Ndiaye F, Konan ACL, Leonce A, Kouadio KL, Beye M, Danboyi D, Jumbe TJ, Ndjebayi A, Ombati C, Njenga BK, Dissieka R. Dietary Quality and Associated Factors among Women of Reproductive Age in Six Sub-Saharan African Countries. Nutrients 2024; 16:1115. [PMID: 38674806 PMCID: PMC11054593 DOI: 10.3390/nu16081115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The burden of micronutrient malnutrition is high among women of reproductive age (WRA) in sub-Saharan Africa. We examined the dietary quality and associated factors for WRA in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal, and Tanzania. Data were collected from women aged 15-49 years using representative Diet Quality Questionnaire surveys. The Minimum Dietary Diversity for Women (MDD-W), All-5 (key food group) consumption, noncommunicable disease risk (NCD-Risk), and Global Dietary Recommendation (GDR) indicators were assessed. Participants included N = 16,584 women [Cameroon: N = 2073; Côte d'Ivoire: N = 242; Kenya: N = 864; Adamawa State (Nigeria): N = 1283; Benue State (Nigeria): N = 1047; Nasarawa State (Nigeria): N = 1151; Senegal: N = 7232; Tanzania: N = 2692]. The MDD-W ranged from 43.0% in Tanzania to 81.4% in Côte d'Ivoire and was higher in urban, compared to rural, areas in Cameroon, Kenya, Nasarawa, Senegal, and Tanzania (p < 0.001). Increased education and wealth were positively associated with MDD-W in Kenya, Benue, Senegal, and Tanzania. Fewer than half of all women attained All-5 consumption. NCD-Risk scores ranged from 1.13 (95% CI: 1.08, 1.17) in Tanzania to 2.28 (95% CI: 2.16, 2.40) in Nasarawa, and women's GDR scores ranged from 10.47 (95% CI: 10.40, 10.54) in Cameroon to 11.45 (95% CI: 11.25, 11.64) in Côte d'Ivoire. Our findings highlight key aspects of women's diets in sub-Saharan African settings to enable greater awareness and more targeted responses to the specific areas needing the most improvement.
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Affiliation(s)
- Amynah Janmohamed
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - Melissa M. Baker
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - David Doledec
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | - Fatou Ndiaye
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
| | | | - Amoakon Leonce
- Helen Keller International, Abidjan BP 1334, Côte d’Ivoire
| | | | - Maguette Beye
- Helen Keller International, Yoff-Dakar BP 29898, Senegal
| | | | | | | | - Caleb Ombati
- Helen Keller International, Nairobi 00800, Kenya
| | | | - Romance Dissieka
- Helen Keller International, Vitamin A Supplementation Africa Regional Office, Nairobi 00800, Kenya
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Bofa A, Zewotir T. Key predictors of food security and nutrition in Africa: a spatio-temporal model-based study. BMC Public Health 2024; 24:885. [PMID: 38519902 PMCID: PMC11220996 DOI: 10.1186/s12889-024-18368-2] [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: 07/13/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
There is voluminous literature on Food Security in Africa. This study explicitly considers the spatio-temporal factors in addition to the usual FAO-based metrics in modeling and understanding the dynamics of food security and nutrition across the African continent. To better understand the complex trajectory and burden of food insecurity and nutrition in Africa, it is crucial to consider space-time factors when modeling and interpreting food security. The spatio-temporal anova model was found to be superior(employing statistical criteria) to the other three models from the spatio-temporal interaction domain models. The results of the study suggest that dietary supply adequacy, food stability, and consumption status are positively associated with severe food security, while average food supply and environmental factors have negative effects on Food Security and Nutrition. The findings also indicate that severe food insecurity and malnutrition are spatially and temporally correlated across the African continent. Spatio-temporal modeling and spatial mapping are essential components of a comprehensive practice to reduce the burden of severe food insecurity. likewise, any planning and intervention to improve the average food supply and environment to promote sustainable development should be regional instead of one size fit all.
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Affiliation(s)
- Adusei Bofa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Westville campus, Durban, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu Natal, Westville campus, Oliver Tambo Building, Durban, South Africa
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Mekonnen S, Birhanu D, Menber Y, Gebreegziabher ZA, Belay MA. Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design. Front Nutr 2024; 11:1340382. [PMID: 38445209 PMCID: PMC10912183 DOI: 10.3389/fnut.2024.1340382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia. Method In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed. Results The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write. Conclusions and recommendation The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.
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Affiliation(s)
| | - Dereje Birhanu
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yonatan Menber
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mahider Awoke Belay
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia
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Diakité D, Sidibé S, Kolié F, Camara F, Camara DM, Kourouma M, Délamou A. Prevalence and factors associated with the coexistence of overweight/obesity and anaemia among women of reproductive age in Guinea. Public Health Nutr 2023; 26:2748-2757. [PMID: 37855236 PMCID: PMC10755430 DOI: 10.1017/s1368980023002197] [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: 01/05/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To determine the prevalence and associated factors of the coexistence of overweight or obesity (OWOB) and anaemia among non-pregnant Guinean women aged 15-49 years. DESIGN The analysis was performed using data from the 2018 Guinean Demographic and Health Survey. Multivariate logistic regression was used to identify factors associated with the coexistence of OWOB and anaemia (OWOB + anaemia) among non-pregnant Guinean women. SETTING Guinea. PARTICIPANTS A total of 4783 non-pregnant women aged 15-49 years with valid data on the nutritional status (BMI and Hb level) were included in the analysis. RESULTS The prevalence of coexistence of OWOB and anaemia among non-pregnant women was 11·16 % (95% CI: 10·05, 12·37). The following variables were associated with OWOB + anaemia in multivariate models (adjusted OR (AOR) 95% CI): higher wealth index (AOR = 4·69; 95% CI: 2·62, 8·39), middle wealth index (AOR = 1·96; 95% CI: 1·31, 2·93), four or more antenatal visits (AOR = 1·62; CI: 1·16, 2·28), having four or more children (AOR = 2·47; 95% CI: 1·37, 4·43) and the rural areas (AOR = 0·59; 95% CI: 0·37, 0·95). CONCLUSION The current study's findings reveal that OWOB + anaemia concerned one-tenth of non-pregnant women. Associated factors were household wealth index, multiparity, antenatal visits and rural areas. Thus, there is a need to design specific interventions to prevent the double burden of malnutrition among women of reproductive age. Interventions should include promoting physical exercise, family planning, healthy eating and raising awareness of behavioural change.
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Affiliation(s)
- Djiba Diakité
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Sidikiba Sidibé
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Fassou Kolié
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Facely Camara
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | - Mory Kourouma
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alexandre Délamou
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Alamnia TT, Sargent GM, Kelly M. Dietary patterns and associations with metabolic risk factors for non-communicable disease. Sci Rep 2023; 13:21028. [PMID: 38030642 PMCID: PMC10687098 DOI: 10.1038/s41598-023-47548-0] [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: 06/09/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Unhealthy dietary habit is a major contributor to the burden of non-communicable diseases such as cardiovascular diseases, diabetes, and hypertension, especially the increased burden in low- and middle-income countries. Evidence of the association between specific dietary patterns and health outcomes is scarce in sub-Saharan African countries. This study aimed to identify principal dietary patterns and evaluate associations with metabolic risk factors including hypertension, overweight/obesity, and abdominal obesity in Northwest Ethiopia. A community-based cross-sectional survey was conducted among adults in Bahir Dar, Northwest Ethiopia, from 10 May 2021 to 20 June 2021. Dietary intake was collected using a validated food frequency questionnaire. Anthropometric (weight, height, hip/waist circumference) and blood pressure measurements were performed using standardized tools. Principal component analysis was conducted to derive dietary patterns. Chi-square and logistic regression analyses were used to examine the association between dietary patterns and metabolic risk factors and with sociodemographic and individual risk factors. This study derives two types of dietary patterns: 'westernized' dietary pattern, which is positively correlated with consumption of meat, dairy, fast foods, alcohol, fish, sweet/sugary foods, and fruits, and 'traditional' dietary pattern, which is positively correlated with intake of cereals, vegetables, legumes, roots/tubers, coffee, and oils. The prevalence of hypertension was significantly lower in adults with higher quantiles of westernized dietary pattern (AOR = 0.28, 95% CI 0.13 to 0.60; p < 0.01; quantile three); and (AOR = 0.35, 95% CI 0.17, 0.75; p < 0.01; quantile four). Younger, married, and middle-income adults were associated with the highest quantile of the westernized pattern. Being females and having middle income associated with the highest quantile of traditional dietary patterns (p < 0.05). This study suggested two types of dietary patterns, westernized and traditional, among adults in Northwest Ethiopia and revealed a significant association with metabolic risk factors like hypertension. Identifying the main dietary patterns in the population could be informative to consider local-based dietary recommendations and interventions to reduce metabolic risk factors.
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Affiliation(s)
- Tilahun Tewabe Alamnia
- National Centre for Epidemiology and Population Health, Australian National University, 62 Mills RD, Acton ACT 2601, Canberra, Australia.
- College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, 62 Mills RD, Acton ACT 2601, Canberra, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, 62 Mills RD, Acton ACT 2601, Canberra, Australia
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Magano NN, Tuorila H, De Kock HL. Food choice drivers at varying income levels in an emerging economy. Appetite 2023; 189:107001. [PMID: 37591447 DOI: 10.1016/j.appet.2023.107001] [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: 03/28/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/19/2023]
Abstract
The purpose of this work was to explore and compare food choice drivers of low (LI), middle (MI) and high (HI) income urban people in an emerging economy (South Africa). Here, 13 focus group (FG) discussions [six LI, n = 36, 67% women; four MI, n = 22, 100% women and three HI, n = 17, 76% women; total n = 75) were transcribed, coded inductively and deductively and 17 food choice categories emerged. Eight of these, i.e., aspects related to: plant vs animal protein, food waste, food preparation, availability of resources, food exploration, social aspects and food spoilage, are not typically (e.g., sensory appeal, mood, health, convenience etc.) measured with established food choice questionnaires. Economic factors and Availability of food and resources were mentioned the most by LI participants compared to MI and HI. Whereas, Health; Familiarity and Food exploration were mostly mentioned by MI and HI participants. This study yielded a mixture of individual and environment based motives which add to our understanding of the "why" aspects underlying food choice in an urban and emerging economy. The fact that these aspects are compared by income group provides interesting information on the similarities and differences of how the food choice process unfolds across varying income groups. The insights from this study are useful for the development of an updated, quantitative food choice questionnaire for application in this and other emerging economies.
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Affiliation(s)
- Nomzamo N Magano
- Department of Consumer and Food Sciences, University of Pretoria, South Africa
| | - Hely Tuorila
- Department of Consumer and Food Sciences, University of Pretoria, South Africa; Department of Food and Nutrition, University of Helsinki, Finland.
| | - Henrietta L De Kock
- Department of Consumer and Food Sciences, University of Pretoria, South Africa
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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11
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Russel WA, Perry J, Bonzani C, Dontino A, Mekonnen Z, Ay A, Taye B. Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1150619. [PMID: 38455884 PMCID: PMC10910994 DOI: 10.3389/fepid.2023.1150619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/20/2023] [Indexed: 03/09/2024]
Abstract
Introduction Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors. Methods This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets. Results Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods. Discussion Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.
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Affiliation(s)
- William A. Russel
- Department of Biology, Colgate University, Hamilton, NY, United States
| | - Jim Perry
- Department of Computer Science, Colgate University, Hamilton, NY, United States
| | - Claire Bonzani
- Department of Mathematics, Colgate University, Hamilton, NY, United States
| | - Amanda Dontino
- Department of Biology, Colgate University, Hamilton, NY, United States
| | - Zeleke Mekonnen
- Institute of Health, School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Ahmet Ay
- Department of Biology, Colgate University, Hamilton, NY, United States
- Department of Mathematics, Colgate University, Hamilton, NY, United States
| | - Bineyam Taye
- Department of Biology, Colgate University, Hamilton, NY, United States
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12
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Alaba OA, Chiwire P, Siya A, Saliu OA, Nhakaniso K, Nzeribe E, Okova D, Lukwa AT. Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085489. [PMID: 37107770 PMCID: PMC10138555 DOI: 10.3390/ijerph20085489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/09/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. METHODS This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). RESULTS The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206). CONCLUSIONS This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.
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Affiliation(s)
- Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- Correspondence:
| | - Plaxcedes Chiwire
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Western Cape Department: Health, Western Cape Province, P.O. Box 2060, Cape Town 8000, South Africa
| | - Aggrey Siya
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Oluremi A. Saliu
- Department of Environmental Health Science, Faculty of Health Sciences, National Open University of Nigeria, Abuja 901101, Nigeria
| | - Karen Nhakaniso
- Business School, University of the People, 595 E Colorado Blvd Suite 623, Pasadena, CA 91101, USA
| | - Emmanuella Nzeribe
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi GPS AK-448-4944, Ghana
| | - Denis Okova
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa
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13
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Getacher L, Wondafrash Ademe B, Belachew T. Lived Experience and Perceptions of Adolescents on Prevention, Causes and Consequences of Double Burden of Malnutrition in Debre Berhan City, Ethiopia: A Qualitative Study. Int J Gen Med 2023; 16:337-356. [PMID: 36726362 PMCID: PMC9885773 DOI: 10.2147/ijgm.s398330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Background The coexistence of undernutrition, overweight, and obesity within the same households and populations is recognized as the Double Burden of Malnutrition (DBM). A paradigm shift thinking is needed to mitigate its impact. School adolescents are the most vulnerable groups to DBM. However, lived experiences and perceptions on prevention, causes, and consequences of DBM were not well studied. Therefore, this study aims to explore the lived experiences and perceptions of adolescents about the prevention, causes, and consequences of DBM in Ethiopia. Methods A qualitative research method using phenomenology design was conducted among 20 purposively selected participants from private and government schools from June 3 to July 10, 2022. The further sampling process was guided by a saturation of ideas. In-depth and key informant interviews were conducted to collect the data. The most recent version of Open code 4.03 was utilized to generate meaningful codes, subthemes, and themes. The results were displayed using thematic analysis and respondents' well-spoken verbatims. Results The study explored the perceptions of adolescents on the causes, prevention, and consequences of DBM. The main causes of DBM identified were poor dietary and drinking habits, poor knowledge and attitude about nutrition, low financial income, unemployment, food insecurity, poor feeding culture, physical inactivity, poor food management, educational and school-related issues, national-related issues, frequent use of ultra-processed foods, and frequent out of home eating. The majority of students were not aware of how DBM will affect their health and academic performance over the long run. Conclusion The findings showed that despite school adolescents' variations in knowledge, lived experience, attitude, and perceptions, most of them have a poor understanding of the causes, consequences, and prevention mechanisms of the double burden of malnutrition. The results suggest the need for instituting double-duty interventions that have a double impact on the prevention of DBM.
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Affiliation(s)
- Lemma Getacher
- School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Beyene Wondafrash Ademe
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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14
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Dolley D, Du Randt R, Pühse U, Gerber M, Bosma J, Aerts A, Adams L, Arnaiz P, Joubert N, Müller I, Nqweniso S, Seelig H, Steinmann P, Utzinger J, Walter C. Relationship between Body Mass Index and Physical Activity among Children from Low-Income Communities in Gqeberha, South Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1428. [PMID: 36674182 PMCID: PMC9864586 DOI: 10.3390/ijerph20021428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8-13 years (x̄ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40-2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18-6.93; girls: OR = 1.78, 95% CI: 1.13-2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and theduration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.
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Affiliation(s)
- Danielle Dolley
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Rosa Du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Jacob Bosma
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Ann Aerts
- Novartis Foundation, 4056 Basel, Switzerland
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Nandi Joubert
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4052 Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha 77000, South Africa
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15
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Dietary Diversity and Dietary Patterns in School-Aged Children in Western Kenya: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159130. [PMID: 35897495 PMCID: PMC9368572 DOI: 10.3390/ijerph19159130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
Inadequate diet among children has both immediate and long-term negative health impacts, but little is known about dietary diversity and dietary patterns of school-aged children in rural Kenya. We assessed dietary diversity and identified dietary patterns in school-aged children in Western Kenya using a latent class approach. We collected dietary intake using a 24 h dietary recall among students in elementary schools in two rural villages (hereafter village A and B) in Western Kenya in 2013. The mean (SD) age was 11.6 (2.2) years in village A (n = 759) and 12.6 (2.2) years in village B (n = 1143). We evaluated dietary diversity using the 10-food-group-based women’s dietary diversity score (WDDS) and found a mean (SD) WDDS of 4.1 (1.4) in village A and 2.6 (0.9) in village B. We identified three distinct dietary patterns in each village using latent class analysis. In both villages, the most diverse pattern (28.5% in A and 57.8% in B) had high consumption of grains, white roots and tubers, and plantains; dairy; meat, poultry, and fish; and other vegetables. Despite variation for some children, dietary diversity was relatively low for children overall, supporting the need for additional resources to improve the overall diet of children in western Kenya.
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16
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Arnaiz P, Müller I, Seelig H, Gerber M, Bosma J, Dolley D, Adams L, Degen J, Gall S, Joubert N, Nienaber M, Nqweniso S, Aerts A, Steinmann P, du Randt R, Walter C, Utzinger J, Pühse U. Practice Change Needed for the Identification of Pediatric Hypertension in Marginalized Populations: An Example From South Africa. Front Pediatr 2022; 10:877431. [PMID: 35633959 PMCID: PMC9130957 DOI: 10.3389/fped.2022.877431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hypertension in children has increased globally over the past 20 years; yet, little is known about this issue among disadvantaged communities from low- and middle-income countries. Age-, sex-, and height-adjusted normative tables are the "gold" standard for the diagnosis and estimation of pediatric hypertension worldwide, but it is unclear whether the use of international standards is appropriate for all contexts. The purpose of this study was to evaluate and compare different international references to identify hypertension among South African school-aged children from disadvantaged communities. METHODS Blood pressure, weight, and height were measured in a cohort of 897 children aged 8-16 years from eight peri-urban schools in the Eastern Cape of South Africa. Cross-sectional prevalence of hypertension was calculated according to American, German, and global normative tables, as well as pseudo-normative data from the own study population. Isolated systolic hypertension and body mass index (BMI) were considered markers for cardiovascular disease. Multinomial logistic regression was used to compare the likelihood of blood pressure categorization with increasing BMI levels. RESULTS Hypertension prevalence ranged from 11.4% with the pseudo-normative study tables to 28.8% based on the German reference. Global guidelines showed the highest agreement both among international standards (92.5% with American guidelines) and with the study reference (72.5%). While the global and the American references presented higher systolic over diastolic hypertension rates (23.6 vs. 10.6% and 24.2 vs. 14.7%, respectively), the American guidelines predicted the highest increased risk for hypertension stage 2 [odds ratio, 1.72 (95% confidence interval: 1.43-2.07)] with raising levels of BMI. CONCLUSION Our results support the heterogeneity of blood pressure estimates found in the South African literature, and highlight the underrepresentation of African children in international guidelines. We call for caution in the use of international standards in different contexts and advocate for the development of normative tables that are representative of the South African pediatric population necessary to ensure an accurate identification of hypertension both from the clinical and epidemiological perspective.
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Affiliation(s)
- Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jacob Bosma
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Danielle Dolley
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Jan Degen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nandi Joubert
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Madeleine Nienaber
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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17
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Olatunji E, Obonyo C, Wadende P, Were V, Musuva R, Lwanga C, Turner-Moss E, Pearce M, Mogo ERI, Francis O, Foley L. Cross-Sectional Association of Food Source with Food Insecurity, Dietary Diversity and Body Mass Index in Western Kenya. Nutrients 2021; 14:nu14010121. [PMID: 35010996 PMCID: PMC8747304 DOI: 10.3390/nu14010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022] Open
Abstract
The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption (‘own livestock’) had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.
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Affiliation(s)
- Elizabeth Olatunji
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
- Correspondence:
| | - Charles Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Pamela Wadende
- Faculty of Education and Human Resources, Kisii University, Kisii 40200, Kenya;
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Charles Lwanga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 40100, Kenya; (C.O.); (V.W.); (R.M.); (C.L.)
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Ebele R. I. Mogo
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Oliver Francis
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0SL, UK; (E.T.-M.); (M.P.); (E.R.I.M.); (O.F.); (L.F.)
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18
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Bromage S, Zhang Y, Holmes MD, Sachs SE, Fanzo J, Remans R, Sachs JD, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries. J Nutr 2021; 151:119S-129S. [PMID: 34689197 PMCID: PMC8542095 DOI: 10.1093/jn/nxab161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.
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Affiliation(s)
- Sabri Bromage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Sonia E Sachs
- The Earth Institute, Columbia University, New York, NY, USA
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | - Roseline Remans
- The Alliance of Biodiversity International and the International Center for Tropical Agriculture (CIAT), Geneva, Switzerland
| | | | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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19
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Leocádio PCL, Lopes SC, Dias RP, Alvarez-Leite JI, Guerrant RL, Malva JO, Oriá RB. The Transition From Undernutrition to Overnutrition Under Adverse Environments and Poverty: The Risk for Chronic Diseases. Front Nutr 2021; 8:676044. [PMID: 33968973 PMCID: PMC8102690 DOI: 10.3389/fnut.2021.676044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paola Caroline L Leocádio
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Nutrition, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Synara C Lopes
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ronaldo P Dias
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Jacqueline I Alvarez-Leite
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Richard L Guerrant
- Center for Global Health, University of Virginia, Charlottesville, VA, United States
| | - João O Malva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Reinaldo B Oriá
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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20
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Mendham AE, Lundin-Olsson L, Goedecke JH, Micklesfield LK, Christensen DL, Gallagher IJ, Myburgh KH, Odunitan-Wayas FA, Lambert EV, Kalula S, Hunter AM, Brooks NE. Sarcopenic Obesity in Africa: A Call for Diagnostic Methods and Appropriate Interventions. Front Nutr 2021; 8:661170. [PMID: 33937309 PMCID: PMC8085278 DOI: 10.3389/fnut.2021.661170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
This perspective aims to highlight the lack of current knowledge on sarcopenic obesity in Africa and to call for diagnostic methods and appropriate interventions. Sarcopenic obesity has been defined as obesity that occurs in combination with low muscle mass and function, which is typically evident in older adults. However, there has been no clear consensus on population-specific diagnostic criterion, which includes both gold-standard measures that can be used in a more advanced health care system, and surrogate measures that can be used in low-income settings with limited resources and funding. Importantly, low and middle-income countries (LMICs) across Africa are in an ongoing state of economic and social transition, which has contributed to an increase in the aging population, alongside the added burden of poverty, obesity, and associated co-morbidities. It is anticipated that alongside the increased prevalence of obesity, these countries will further experience an increase in age-related musculoskeletal diseases such as sarcopenia. The developmental origins of health and disease (DOHaD) approach will allow clinicians and researchers to consider developmental trajectories, and the influence of the environment, for targeting high-risk individuals and communities for treatment and/or prevention-based interventions that are implemented throughout all stages of the life course. Once a valid and reliable diagnostic criterion is developed, we can firstly assess the prevalence and burden of sarcopenic obesity in LMICs in Africa, and secondly, develop appropriate and sustainable interventions that target improved dietary and physical activity behaviors throughout the life course.
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Affiliation(s)
- Amy E Mendham
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Health through Physical Activity and Lifestyle Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Julia H Goedecke
- Health through Physical Activity and Lifestyle Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Non-communicable Diseases Research Unit, South African Medical Research Council Tygerberg, Cape Town, South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Health through Physical Activity and Lifestyle Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Iain J Gallagher
- Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Kathryn H Myburgh
- Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Feyisayo A Odunitan-Wayas
- Health through Physical Activity and Lifestyle Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Health through Physical Activity and Lifestyle Research Centre & Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sebastiana Kalula
- Division of Geriatric Medicine, University of Cape Town, Cape Town, South Africa
| | - Angus M Hunter
- Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Naomi E Brooks
- Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
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21
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Yang Q, Yang J, Zheng L, Song W, Yi L. Impact of Home Parenting Environment on Cognitive and Psychomotor Development in Children Under 5 Years Old: A Meta-Analysis. Front Pediatr 2021; 9:658094. [PMID: 34650937 PMCID: PMC8505983 DOI: 10.3389/fped.2021.658094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
This study aims to evaluate the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old by using meta-analysis. A systematic search of the Chinese and English databases including Pubmed, Embase, the Cochrane Library, CNKI, Weipu, Wanfang, and CBMdisc databases from January 1, 1990, to July 31, 2021, was performed. Articles concerning the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old were included. Review Manager 5.4 was used for meta-analysis. Subgroup analysis in terms of age and region were performed. A total of 12 articles were included, including 11 in English and 1 in Chinese. Meta-analysis showed that there was significant relationship between home parenting environment and the cognitive and psychomotor development of children (r = 0.31; r = 0.21). Subgroup analysis showed that correlation between home parenting environment and the cognitive and psychomotor development of children was stronger in children over 18 months compared to those under 17 months [(r = 0.33, r = 0.21) vs. (r = 0.28, r = 0.17)]. The converted summary r value between home parenting environment and cognitive development in developing and developed countries was both 0.32. Conclusively, there is a positive correlation between the home parenting environment and the cognitive and psychomotor development of children under 5 years old. Improving the home parenting environment of children is beneficial to promote their early development.
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Affiliation(s)
- Qing Yang
- Department of Pediatrics, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, China.,Nursing College, Hunan University of Medicine, Huaihua, China
| | - Jinlian Yang
- Department of Child Health Care, Huaihua Maternal and Child Health Hospital, Huaihua, China
| | - Liming Zheng
- Nursing College, Hunan University of Medicine, Huaihua, China
| | - Wei Song
- Nursing College, Hunan University of Medicine, Huaihua, China
| | - Lilan Yi
- Nursing College, Hunan University of Medicine, Huaihua, China
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22
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Lin X, Li H. Obesity: Epidemiology, Pathophysiology, and Therapeutics. Front Endocrinol (Lausanne) 2021; 12:706978. [PMID: 34552557 PMCID: PMC8450866 DOI: 10.3389/fendo.2021.706978] [Citation(s) in RCA: 375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022] Open
Abstract
Obesity is a complex multifactorial disease that accumulated excess body fat leads to negative effects on health. Obesity continues to accelerate resulting in an unprecedented epidemic that shows no significant signs of slowing down any time soon. Raised body mass index (BMI) is a risk factor for noncommunicable diseases such as diabetes, cardiovascular diseases, and musculoskeletal disorders, resulting in dramatic decrease of life quality and expectancy. The main cause of obesity is long-term energy imbalance between consumed calories and expended calories. Here, we explore the biological mechanisms of obesity with the aim of providing actionable treatment strategies to achieve a healthy body weight from nature to nurture. This review summarizes the global trends in obesity with a special focus on the pathogenesis of obesity from genetic factors to epigenetic factors, from social environmental factors to microenvironment factors. Against this background, we discuss several possible intervention strategies to minimize BMI.
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23
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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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