1
|
Khara T, Myatt M, Sadler K, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald C, Mertens A, Mwangome M, O’Brien K, Stobaugh H, Taneja S, West KP, Briend A. Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts. Public Health Nutr 2023; 26:1-17. [PMID: 36734049 PMCID: PMC10131149 DOI: 10.1017/s136898002300023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. DESIGN A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled. SETTING Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread. PARTICIPANTS Children aged 6 to 59 months. RESULTS Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC < 115 mm or WAZ < -3) and (WAZ < -3) had the highest informedness in predicting mortality. A combined case definition (MUAC < 115 mm or WAZ < -3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ < -3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC < 115 mm or WAZ < -3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC < 115 mm alone. CONCLUSIONS A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
Collapse
Affiliation(s)
- Tanya Khara
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Mark Myatt
- Brixton Health, Llwyngwril, Gwynedd, Wales, UK
| | - Kate Sadler
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université libre de Bruxelles
| | - James A Berkley
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Erin Boyd
- USAID/Bureau of Humanitarian Assistance, USA
| | - Michel Garenne
- IRD, UMI Résiliences, Paris, France
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
- FERDI, Université d’Auvergne, Clermont-Ferrand, France
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Epicentre, Paris, France
| | - Natasha Lelijveld
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Christine McDonald
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Nutrition, University of California, Davis, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | | | - Kieran O’Brien
- The F.I. Proctor Foundation, University of San Francisco, San Francisco, USA
| | - Heather Stobaugh
- Action Against Hunger USA, New York, NY, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sunita Taneja
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - André Briend
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Fredericksberg, Denmark
| |
Collapse
|
2
|
Thurstans S, Wrottesley SV, Fenn B, Khara T, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald CM, Mertens A, Mwangome M, O'Brien KS, Stobaugh H, Taneja S, West KP, Guerrero S, Kerac M, Briend A, Myatt M. Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis. Matern Child Nutr 2023; 19:e13431. [PMID: 36164997 PMCID: PMC9749608 DOI: 10.1111/mcn.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6-59 months by age and sex. We categorised children into younger (6-23 months) and older (24-59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < -2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.
Collapse
Affiliation(s)
- Susan Thurstans
- London School of Hygiene and Tropical MedicineLondonUK
- Emergency Nutrition NetworkKidlingtonUK
| | | | | | | | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of public HealthUniversité libre de BruxellesBrusselsBelgium
| | - James A. Berkley
- Centre for Tropical Medicine & Global HealthUniversity of OxfordOxfordUK
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Robert E. Black
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | - Erin Boyd
- USAID/Bureau of Humanitarian AssistanceWashington DCUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Michel Garenne
- IRDUMI RésiliencesParisFrance
- Institut PasteurEpidémiologie des Maladies EmergentesParisFrance
- FERDIUniversité d'AuvergneClermont‐FerrandFrance
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheila Isanaka
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- EpicentreParisFrance
| | | | - Christine M. McDonald
- Departments of Pediatrics, and Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NutritionUniversity of CaliforniaDavisUSA
| | - Andrew Mertens
- Division of Epidemiology & BiostatisticsUniversity of CaliforniaBerkeleyUSA
| | - Martha Mwangome
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Kieran S. O'Brien
- Francis I. Proctor FoundationUniversity of CaliforniaSan FranciscoUSA
| | - Heather Stobaugh
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- Action Against Hunger USANew YorkNew YorkUSA
| | - Sunita Taneja
- Center for Health Research and DevelopmentSociety for Applied StudiesNew DelhiIndia
| | - Keith P. West
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | | | - Marko Kerac
- London School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Center for Child Health Research, Faculty of Medicine and Medical TechnologyTampere UniversityTampereFinland
- Department of Nutrition, Exercise, and SportsUniversity of CopenhagenFredericksbergDenmark
| | - Mark Myatt
- Brixton Health, LlwyngwrilGwyneddWalesUK
| |
Collapse
|
3
|
Kundu RN, Hossain MG, Haque MA, Biswas S, Huq MM, Pasa MK, Sabiruzzaman M, Bharati P. Factor associated with anthropometric failure among under-five Bengali children: A comparative study between Bangladesh and India. PLoS One 2022; 17:e0272634. [PMID: 35930584 PMCID: PMC9355208 DOI: 10.1371/journal.pone.0272634] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Child undernutrition is a burden and the leading cause of child mortality in low-and middle-income countries like Bangladesh and India. Currently, this issue is a matter of great concern, inasmuch as achieving the Sustainable Development Goals (SDGs). The study intends to determine the factors of child undernutrition using a single composite index of anthropometric failure (CIAF) among the Bengali population. Methods Unit level data on 14055 under 5 children were extracted from the Bangladesh Demographic and Health Survey 2017–18 (BDHS) and the 4th National Family Health Survey of India (NFHS-4). To understand child undernutrition and generate CIAF, data on height-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight) were used by WHO guidelines. These three undernutrition indicators were combined into a single undernutrition indicator called anthropometric failure (anth-failure) using the CIAF concept. Explanatory factors of anth-failure included data on maternal health, socio-demographic and birth-related variables. Differences of frequency were determined by Z-proportional and Chi-square tests; predictors of anth-failure were determined by binary logistic regression. Cut off point of p-value was taken as 0.05 to test the significance. Results Inter-country disparities were revealed, about half of Bengali children in India and two-fifths in Bangladesh being prone to anth-failure. Stunting and underweight were more prevalent in both countries than wasting. Maternal undernutrition, lack of maternal education, and poor wealth index were common factors of anth-failure for both countries. Children in Bangladesh developed anth-failure after the end of breastfeeding period, indicating a lack of nutritious food. Lack of antenatal care was another significant factor in Bangladesh. In India, the first child suffered from anth-failure due to lack of maternal education. Conclusions This study provides a better understanding of multifactorial impact on child undernutrition. It is proposed that the emphasis should be on initiatives that improve maternal education and nutrition, child food security, boost household wealth index, and enhance mothers’ access to health care. The study strongly recommends that the governments of Bangladesh and India invest financially in preventing child malnutrition, which will contribute to achieving the first four SDGs.
Collapse
|
4
|
Spake L, Hoppa RD, Blau S, Cardoso HFV. Biological mortality bias in diaphyseal growth of contemporary children: Implications for paleoauxology. American Journal of Biological Anthropology 2022. [PMCID: PMC9306609 DOI: 10.1002/ajpa.24486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives Biological mortality bias is the idea that individuals who comprise skeletal samples (non‐survivors) are a specific subset of the overall population, who may have been exposed to greater stress during life. Because of this, it is possible that studying growth in a skeletal population misrepresents the growth and health of survivors in that population. Using a modern sample, this study investigates whether biological mortality bias in growth may be present in archaeological skeletal samples. Materials and methods Postmortem computed tomography scans of 206 children aged under 13 years were collected from two institutions in the United States and Australia. The sample was separated into children who died from natural causes as proxies for non‐survivors and from accidental causes as proxies for survivors. Differences in long bone length for age were assessed through analysis of covariance (ANCOVA) and z‐score analysis, and these results were compared with studies linking anthropometrics and mortality risk in nonindustrialized societies. Results Differences in growth favoring survivors were greater for girls than for boys and seemed to increase over age. The effect in nonindustrialized societies was 1.5 to 5 times the magnitude of that in our contemporary sample. Conclusions A greater growth delay in girls than in boys has been documented in historical identified collections, and skeletal samples consistently become more stunted relative to modern standards over the course of growth. Our findings on biological mortality bias could explain part of these growth delays and impact interpretations of past ontogenetic environments.
Collapse
Affiliation(s)
- Laure Spake
- Religion Programme and Centre for Research on Evolution, Belief and Behaviour University of Otago Dunedin New Zealand
- Department of Anthropology Western Washington University, Bellingham Washington USA
| | - Robert D. Hoppa
- Department of Anthropology University of Manitoba Winnipeg Canada
| | - Soren Blau
- Forensic Pathology The Victorian Institute of Forensic Medicine Southbank Victoria Australia
- Department of Forensic Medicine Monash University Melbourne Victoria Australia
| | - Hugo F. V. Cardoso
- Department of Archaeology and Centre for Forensic Research Simon Fraser University Burnaby Canada
| |
Collapse
|
5
|
Gausman J, Kim R, Subramanian S. Associations of single versus multiple anthropometric failure with mortality in children under 5 years: A prospective cohort study. SSM Popul Health 2021; 16:100965. [PMID: 34869820 PMCID: PMC8626676 DOI: 10.1016/j.ssmph.2021.100965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background/objectives Stunting, underweight, and wasting are used to monitor nutritional status in children, but they do not identify children with concurrent anthropometric failures (AF). Our study estimates the association between AF and mortality in children with single versus multiple failures, then calculates the percentage of child deaths attributable to AF. Subjects/methods Using data from a prospective, longitudinal study of 3605 children from age 1 to age 5 years in Ethiopia and India, we estimate the association between AF and mortality using conventional definitions (stunting, underweight, and wasting) and the mutually exclusive categories of stunted only underweight only, wasted only, stunted and underweight (SU), underweight and wasted, and stunted, underweight, and wasted (SUW), adjusting for socioeconomic status and other demographic variables. Last, we calculate the population attributable fraction. Results Children who were SU and SUW had 3.20 (95% CI: 1.69, 6.06; p < 0.001) and 5.52 (95% CI: 2.25, 13.56; p < 0.001) times the odds of death in fully adjusted models by Round 2 compared to children with no failure, while no increased mortality risk was found among children with other categories of failure. We estimate that 42.69% of child deaths can be attributed to children who are SUW (17.02%) or SU (25.67%), accounting for nearly 80% of child deaths from AF. Conclusions This study provides new insight to programs and policy to better identify children most at risk of malnutrition-related mortality.
Collapse
Affiliation(s)
- Jewel Gausman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, South Korea
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Corresponding author. Population Health and Geography, Harvard Center for Population & Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
| |
Collapse
|
6
|
Tesema GA, Seretew WS, Worku MG, Angaw DA. Trends of infant mortality and its determinants in Ethiopia: mixed-effect binary logistic regression and multivariate decomposition analysis. BMC Pregnancy Childbirth 2021; 21:362. [PMID: 33952208 PMCID: PMC8097868 DOI: 10.1186/s12884-021-03835-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs). METHODS This analysis was based on the data from four EDHSs (EDHS 2000, 2005, 2011, and 2016). A total weighted sample of 46,317 live births was included for the final analysis. The logit-based multivariate decomposition analysis was used to identify significantly contributing factors for the decrease in infant mortality in Ethiopia over the last 16 years. To identify determinants, a mixed-effect logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of a significant clustering effect. Deviance, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to identify the statistically significant determinants of infant mortality. RESULTS Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval < 24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI < 18.5 kg/m2 (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality. CONCLUSION This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia's declining infant mortality rate. Furthermore, improving the use of ANC services and maternal nutrition is crucial to reducing infant mortality and achieving the SDG targets in Ethiopia.
Collapse
Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Wullo Sisay Seretew
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia.
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
7
|
Bilal JA, Eltahir HG, Al-Nafeesah A, Al-Wutayd O, Adam I. Acute severe malnutrition treatment outcomes in children ages 6-59 months admitted to Singa Hospital, Sudan. Trans R Soc Trop Med Hyg 2020; 114:612-617. [PMID: 32484862 DOI: 10.1093/trstmh/traa033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/01/2020] [Accepted: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute malnutrition threatens the lives of 50.5 million children <5 y of age. Consequences of malnutrition include death, among other short-term sequelae. This study was conducted from April to October 2018 to determine the outcomes of children 6-59 months of age with acute severe malnutrition admitted to Singa Hospital in central Sudan. METHODS Clinical information for children with a mid-upper arm circumference (MUAC) <115 mm were collected. We measured children's weight and height and calculated weight-for-height z-scores. Treatment was offered according to World Health Organization (WHO) guidelines. Outcomes were recorded as recovered, discharged against medical advice or died. RESULTS This study included 376 malnourished children. The median age was 18 months (interquartile range [IQR] 12-24). The male:female ratio was 1:1. Among children with weight-for-height Z-scores of -4 and -3, 103 (27.3%) had oedematous malnutrition. There were 131 (34.8%) children with malaria parasites, 33 (8.7%) with pyuria and 24 (6.3%) with intestinal parasites. The recovery rate was 89.1%. The case fatality rate was 3.7%. Mortality was significantly increased with diarrhoea and dermatoses. There were no significant differences in the median of age (17.5 months [IQR 6-24] vs 18 [6-24], p = 0.595), MUAC (110 mm [IQR 104-111] vs 110 [100-111], p = 0.741) or sex (p = 0.991) between children who died and those who recovered. CONCLUSIONS The case fatality rate was 3.7% and it was associated with diarrhoea and dermatoses.
Collapse
Affiliation(s)
- Jalal Ali Bilal
- Department of Pediatrics, College of Medicine, Shaqra University, Shaqra, Kingdom of Saudi Arabia
| | | | - Abdullah Al-Nafeesah
- Department of Paediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Osama Al-Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| |
Collapse
|
8
|
Kambale RM, Ngaboyeka GA, Ntagazibwa JN, Bisimwa MHI, Kasole LY, Habiyambere V, Kubuya VB, Kasongo JK, André E, Van der Linden D. Severe acute malnutrition in children admitted in an Intensive Therapeutic and Feeding Centre of South Kivu, Eastern Democratic Republic of Congo: Why do our patients die? PLoS One 2020; 15:e0236022. [PMID: 32678837 PMCID: PMC7367457 DOI: 10.1371/journal.pone.0236022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe acute malnutrition (SAM) remains a serious public health concern in low- and middle-income countries. Little is known about treatment outcomes of child inpatients in Intensive Therapeutic and Feeding Units. This study aimed to assess treatment outcomes of SAM and identify factors associated with mortality among children treated at Saint Joseph Nutritional Center, South Kivu, Eastern Democratic Republic of Congo. METHODS A retrospective hospital-based cross-sectional study was conducted on medical records of 633 severely malnourished children followed as inpatients at Saint Joseph Nutritional Center from July 2017 to December 2018. Data were entered, thoroughly cleaned and analyzed in SPSS version 25. Univariable and multivariable logistic regression model were fitted to identify factors associated with mortality. RESULTS Among 633 patients admitted with SAM, 13.1% were lost to follow-up and 9.2% died while in hospital. Children with late referral to the health facility (> 14 days) after the onset of main external malnutrition signs had 2.03 times higher odds of death than those referred less than 14 days [AOR = 2.03 at 95%CI (1.12, 3.68)]. The odds of death was 1.91 times higher for children with MUAC < 115 mm than for those with MUAC ≥ 115 mm [AOR = 1.91 at 95% CI (1.05, 3.50)]. Children infected with HIV were 3.90 times more likely to die compared to their counterparts [AOR = 3.90 at 95% CI (2.80, 9.41)]. CONCLUSION Particular emphasis should be placed on partnering with communities to improve information on malnutrition signs and on critical importance of early referral to the health system. While HIV incidence in DRC is still low (0.21%), its impact on mortality among severely malnourished children is increased due to the limited access to HIV testing and antiretroviral therapy.
Collapse
Affiliation(s)
- Richard Mbusa Kambale
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Pediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Gaylord Amani Ngaboyeka
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Pediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Joseph Ntagerwa Ntagazibwa
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Pediatric Department, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | | | | | | | | | | | - Emmanuel André
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Dimitri Van der Linden
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
- Pediatric Infectious Diseases, General Pediatrics, Pediatric Department, Cliniques Universitaires Saint Luc, Brussels, Belgium
| |
Collapse
|
9
|
Ngwalangwa F, Phiri CHA, Dube Q, Langton J, Hildenwall H, Baker T. Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi. Am J Trop Med Hyg 2020; 101:670-675. [PMID: 31287044 PMCID: PMC6726928 DOI: 10.4269/ajtmh.19-0127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In low-resource settings, many children are severely ill at arrival to hospital. The risk factors for mortality among such ill children are not well-known. Understanding which of these patients are at the highest risk could assist in the allocation of limited resources to where they are most needed. A cohort study of severely ill children treated in the resuscitation room of the pediatric emergency department at Queen Elizabeth Central Hospital in Malawi was conducted over a 6-month period in 2017. Data on signs and symptoms, vital signs, blood glucose levels, and nutritional status were collected and linked with in-hospital mortality data. The factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Data for 1,359 patients were analyzed and 118 (8.7%) patients died. The following factors were associated with mortality: presence of any severely deranged vital sign, unadjusted odds ratio (UOR) 2.6 (95% CI 1.7–4.0) and adjusted odds ratio (AOR) 3.2 (95% CI 2.0–5.0); severe dehydration, UOR 2.6 (1.4–5.1) and AOR 2.8 (1.3–6.0); hypoglycemia glycemia (< 5 mmol/L), UOR 3.6 (2.2–5.8) and AOR 2.7 (1.6–4.7); and severe acute malnutrition, UOR 5.8 (3.5–9.6) and AOR 5.7 (3.3–10.0). This study suggests that among severely sick children, increased attention should be given to those with hypo/low glycemia, deranged vital signs, malnutrition, and severe dehydration to avert mortality among these high-risk patients.
Collapse
Affiliation(s)
- Fatsani Ngwalangwa
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Queen Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Helena Hildenwall
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Global Health-Health System and Policy Research Group, Stockholm, Sweden
| | - Tim Baker
- Department of Public Health Sciences, Karolinska Institutet, Global Health-Health System and Policy Research Group, Stockholm, Sweden.,Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|
10
|
Chellai F, Boudrissa N. Excess Infant Mortality of Twins Over Singletons in Arab Countries: The Evidence of Relative Survival Methods. Twin Res Hum Genet 2019; 22:255-64. [PMID: 31282317 DOI: 10.1017/thg.2019.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There are no studies and only limited data that compare the difference in mortality between twins and singletons in the Arab world. We studied the survival of 306,966 children, including 9,280 twins, over the period 1970-2013 in six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan and Tunisia) based on the Multiple Indicator Cluster Survey (MICS) database. With the use of relative survival models, we estimated the mortality of twins relative to singletons by including socioeconomic and demographic variables. This study confirms the results of previous studies on the excess risk of death of twins compared to singletons. There is evidence that excess mortality decreases with follow-up; in addition, male twins have a higher risk of death compared to females for all countries except Tunisia. Wealth index and education levels of women are factors that influence the risk of mortality. It is recommended that these findings are considered when performing future health and population strategies in these Arab countries.
Collapse
|
11
|
Myatt M, Khara T, Dolan C, Garenne M, Briend A. Improving screening for malnourished children at high risk of death: a study of children aged 6-59 months in rural Senegal. Public Health Nutr 2019; 22:862-71. [PMID: 30501655 DOI: 10.1017/S136898001800318X] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic criteria are needed to identify children with a high risk of death and in need of treatment. Design Community-based cohort study, following 5751 children through time. Each child was visited up to four times at 6-month intervals. Anthropometric measurements were taken at each visit. Survival was monitored using a demographic surveillance system operating in the study villages. Setting Niakhar, a rural area of the Fatick region of central Senegal. Participants Children aged 6–59 months living in thirty villages in the study area. Results Weight-for-age Z-score (WAZ) and mid-upper arm circumference (MUAC) were independently associated with near-term mortality. The lowest WAZ threshold that, in combination with MUAC, detected all deaths associated with severe wasting or concurrent wasting and stunting was WAZ <−2·8. Performance for detecting deaths was best when only WAZ and MUAC were used. Additional criteria did not improve performance. Risk ratios for near-term death in children identified using WAZ and MUAC suggest that children identified by WAZ <−2·8 but with MUAC≥115 mm may require lower-intensity treatment than children identified using MUAC <115 mm. Conclusions A combination of MUAC and WAZ detected all near-term deaths associated with severe anthropometric deficits including concurrent wasting and stunting. Therapeutic feeding programmes may achieve higher impact if WAZ and MUAC admission criteria are used.
Collapse
|
12
|
Grellety E, Golden MH. Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson's paradox. Nutr J 2018; 17:79. [PMID: 30217205 PMCID: PMC6138885 DOI: 10.1186/s12937-018-0384-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND According to WHO childhood severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <-3Z of the WHO2006 standards, the mid-upper-arm circumference (MUAC) is < 115 mm, there is nutritional oedema or any combination of these parameters. Recently there has been a move to eliminate WHZ as a diagnostic criterion on the assertion that children meeting the WHZ criterion are healthy, that MUAC is universally a superior prognostic indicator of mortality and that adding WHZ to the assessment does not improve the prediction; these assertions have lead to a controversy concerning the role of WHZ in the diagnosis of SAM. METHODS We examined the mortality experience of 76,887 6-60 month old severely malnourished children admitted for treatment to in-patient, out-patient or supplementary feeding facilities in 18 African countries, of whom 3588 died. They were divided into 7 different diagnostic categories for analysis of mortality rates by comparison of case fatality rates, relative risk of death and meta-analysis of the difference between children admitted using MUAC and WHZ criteria. RESULTS The mortality rate was higher in those children fulfilling the WHO2006 WHZ criterion than the MUAC criterion. This was the case for younger as well as older children and in all regions except for marasmic children in East Africa. Those fulfilling both criteria had a higher mortality. Nutritional oedema increased the risk of death. Having oedema and a low WHZ dramatically increased the mortality rate whereas addition of the MUAC criterion to either oedema-alone or oedema plus a low WHZ did not further increase the mortality rate. The data were subject to extreme confounding giving Simpson's paradox, which reversed the apparent mortality rates when children fulfilling both WHZ and MUAC criteria were included in the estimation of the risk of death of those fulfilling either the WHZ or MUAC criteria alone. CONCLUSIONS Children with a low WHZ, but a MUAC above the SAM cut-off point are at high risk of death. Simpson's paradox due to confounding from oedema and mathematical coupling may make previous statistical analyses which failed to distinguish the diagnostic groups an unreliable guide to policy. WHZ needs to be retained as an independent criterion for diagnosis of SAM and methods found to identify those children with a low WHZ, but not a low MUAC, in the community.
Collapse
Affiliation(s)
- Emmanuel Grellety
- Research Center Health Policy and Systems - International Health, School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Michael H. Golden
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, Scotland
| |
Collapse
|
13
|
Du R, Jiao S, Dai Y, An J, Lv J, Yan X, Wang J, Han B. Probiotic Bacillus amyloliquefaciens C-1 Improves Growth Performance, Stimulates GH/IGF-1, and Regulates the Gut Microbiota of Growth-Retarded Beef Calves. Front Microbiol 2018; 9:2006. [PMID: 30210477 PMCID: PMC6120984 DOI: 10.3389/fmicb.2018.02006] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023] Open
Abstract
Growth retardation of calves is defined as a symptom of impaired growth and development, probably due to growth hormone disorder as well as natural and environmental factors in livestock. The growth-promoting effects of probiotics were determined in 50 growth-retarded growth calves. They were supplied with Bacillus amyloliquefaciens C-1 (Ba, 4 × 1010CFU/d, n = 16), B. subtilis (Bs, 4 × 1010CFU/d, n = 18), and negative control (NC, n = 16) for 30 days. Pre- and post-intervention, the growth performance (weight gain rate, feed intake and feed conversion rate) was analyzed, the serum GH, IGH-1 and immunoglobulin levels were assayed, and the fecal microbiota was detected. Calves in Ba and Bs groups demonstrated increased body weight gain, feed intake and GH/IGF-1 levels, as well as a more efficient feed conversion rate, compared with NC group (P < 0.05). Additionally, the abundances of bacteria contributing to the production of energy and SCFAs (short chain fatty acids), including Proteobacteria, Rhodospirillaceae, Campylobacterales, and Butyricimonas were increased compared with NC group (P < 0.05, FDR < 0.1); and the suspected pathogens, which included Anaeroplasma and Acholeplasma were decreased (P < 0.05, FDR < 0.1) in both the Bs and Ba groups. Akkermansia, which is involved in the intestinal mucosal immune response, was increased in Bs group after intervention (P < 0.05, FDR < 0.1), but exhibited no obvious difference in Ba group. The increased bacterial genera in Ba group were Sphaerochaeta and Treponema (P < 0.05, FDR < 0.1). These results indicate that the probiotics B. amyloliquefaciens and B. subtilis exhibited similar therapeutic potential in terms of growth performance by regulating hormones, and improving the intestinal and rumen development in growth-retarded animals.
Collapse
Affiliation(s)
- Renjia Du
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shengyin Jiao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yue Dai
- Institute of Food and Agriculture, China National Institute of Standardization, Beijing, China
| | - Jianbo An
- Xi'an Center for Disease Control and Prevention, Xi'an, China
| | - Jia Lv
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoni Yan
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Juan Wang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bei Han
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
14
|
Rathaur VK, Pathania M, Pannu C, Jain A, Dhar M, Pathania N, Goel R. Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India. J Family Med Prim Care 2018; 7:45-52. [PMID: 29915732 PMCID: PMC5958591 DOI: 10.4103/jfmpc.jfmpc_413_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: There is paucity of studies on infant feeding practices from the rural areas of garhwal Himalayas of the state of uttarakhand. The present study was designed to assess the infant feeding practices in Garhwal region. Infant feeding practices have significant implications on a child's health. Early nutritional status especially during the first year of life has been shown to have a significant effect on child health and development. Optimal infant feeding practices are crucial for nutritional status, growth, development, health, and ultimately the survival of infants and young children. The study of infant feeding practices is essential before formulation of any interventional programme. Settings and Design: A study was conducted in HNB Base Hospital and Teaching Institute with the aim to assess the infant feeding practices and the prevalence of malnutrition in the study population reporting at the hospital in garhwal region of uttarakhand. Methods and Material: This is an observational cross sectional study. 275 infants were included in the study. After taking informed consent, case study forms were filled by interviewing the infants' mothers. Weight, length and head circumference of each infant was also measured. The information thus obtained was compiled, tabulated and analysed statistically. Results: The study findings revealed that 46.4% infants in the age group 0-5 months were breastfed within 1 hour of birth. 52.8% infants aged 0-5 months of were exclusively breastfed. 33.6% infants in age group 0-5 months received prelacteal feeds. 53.12% infants in age group 6-8 months received solid, semi-solid or soft food, in addition to breast milk. 53.33% infants were partially or fully bottle fed. Age appropriate feeding was found in 56% infants. The percentage of wasting, stunting and underweight in 0-5 months was 33.6%,30.4% and 36.8% respectively . The percentage of wasting, stunting and underweight in 6-11 months was 28%, 26.5% and 30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age. Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI) in health facilities is recommended.
Collapse
Affiliation(s)
- Vyas Kumar Rathaur
- Department of Pediatrics, Doon Medical College, Dehradun, Uttarakhand, India
| | - Monika Pathania
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Charu Pannu
- Department of Pediatrics, Tirth Ram Shah Hospital, New Delhi, India
| | - Anand Jain
- Department of Pediatrics, VCSGGMS and RI, Srinagar, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Nitish Pathania
- Department of Kaya Chikitsa, Sri Sri College of Ayurvedic Science and Research, Bengaluru, India
| | - Rahul Goel
- Department of Biochemistry, KD Medical College, Mathura, Uttar Pradesh, India
| |
Collapse
|
15
|
Hu XF, Liu GG, Fan M. Long-Term Effects of Famine on Chronic Diseases: Evidence from China's Great Leap Forward Famine. Health Econ 2017; 26:922-936. [PMID: 27311596 DOI: 10.1002/hec.3371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 04/28/2016] [Accepted: 05/19/2016] [Indexed: 06/06/2023]
Abstract
We evaluate the long-term effects of famine on chronic diseases using China's Great Leap Forward Famine as a natural experiment. Using a unique health survey, we explore the heterogeneity of famine intensity across regions and find strong evidence supporting both the adverse effect and the selection effect. The two offsetting effects co-exist and their magnitudes vary in different age cohorts at the onset of famine. The selection effect is dominant among the prenatal/infant famine-exposed cohort, while the adverse effect appears dominant among the childhood/puberty famine-exposed cohort. The net famine effects are more salient in rural residents and non-migrants subsamples. Gender differences are also found, and are sensitive to smoking and drinking behaviors. Our conclusion is robust to various specifications. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Xue Feng Hu
- Department of Biology, University of Ottawa, Canada
| | - Gordon G Liu
- National School of Development, Beijing University, China
| | - Maoyong Fan
- Department of Economics, Ball State University, USA
| |
Collapse
|
16
|
|
17
|
Sachdeva S, Dewan P, Shah D, Malhotra RK, Gupta P. Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age. Public Health Nutr 2016; 19:2513-20. [PMID: 27049813 DOI: 10.1017/S1368980016000719] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age. DESIGN Diagnostic test accuracy study. SETTING Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India. SUBJECTS Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome. RESULTS One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<-3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<-3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually. CONCLUSION MUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<-3. It should be measured in all emergency settings to identify the children at higher risk of death.
Collapse
|
18
|
Hu R, Wang Z, Peng Q, Zou H, Wang H, Yu X, Jing X, Wang Y, Cao B, Bao S, Zhang W, Zhao S, Ji H, Kong X, Niu Q. Effects of GHRP-2 and Cysteamine Administration on Growth Performance, Somatotropic Axis Hormone and Muscle Protein Deposition in Yaks (Bos grunniens) with Growth Retardation. PLoS One 2016; 11:e0149461. [PMID: 26894743 PMCID: PMC4760683 DOI: 10.1371/journal.pone.0149461] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/31/2016] [Indexed: 12/02/2022] Open
Abstract
The objective of this study was to investigate the effects of growth hormone-releasing peptide-2 (GHRP-2) and cysteamine (CS) administration on growth performance in yaks with growth retardation and try to elucidate its regulatory mechanisms. Trial 1, thirty-six 1-year-old Qinghai high plateau yaks (body weight 38–83.2 kg) were randomly chosen for body weight and jugular blood samples collection. The relationship between body weight and serum GHRH (P < 0.05, R = 0.45), GH (P < 0.05, R = 0.47), IGF-1 (P < 0.05, R = 0.62) was significantly correlated in yaks colonies with lighter body weights. Trial 2, fifteen 1-year-old Qinghai high plateau yaks with growth retardation (average body weight 54.8 ± 8.24 kg) were randomly selected and assigned to negative control group (NG), GHRP-2 injection group (GG) and cysteamine feeding group (CG), with 5 yaks per group. Another five 1-year-old Qinghai high plateau yaks with normal growth performance (average body weight 75.3 ± 2.43 kg) were selected as positive control group (PG). The average daily gain (ADG) of the GG and CG were significantly higher than those in the PG and NG (P < 0.05). Both GHRP-2 and CS administration significantly enhanced the myofiber diameter and area of skeletal muscle (P<0.05). GHRP-2 significantly enhanced the serum GH and IGF-1 levels (P < 0.05), and up-regulated GHR, IGF-1 and IGF-1R mRNA expression in the liver and skeletal muscle (P < 0.05), enhanced the mRNA expression of PI3K, AKt and mTOR in the skeletal muscle (P<0.05). CS significantly reduced the serum SS levels and the hypothalamus SS mRNA expression (P < 0.05), and enhanced GHR and IGF-1 mRNA expression in the liver (P < 0.05), decreased the mRNA expression of muscle atrophy F-box (Atrogin-1) and muscle ring finger 1 (MuRF1) mRNA (P < 0.05). Conclusions: Growth retardation in yaks was primarily due to somatotropic axis hormones secretion deficiency. Both GHRP-2 and CS administration can accelerate growth performance and GH, IGF-1 secretion in yaks with growth retardation. GHRP-2 enhanced muscle protein deposition mainly by up-regulated the protein synthesis pathways, whereas CS worked mainly by down-regulated the ubiquitin-proteasome pathway.
Collapse
Affiliation(s)
- Rui Hu
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Zhisheng Wang
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
- * E-mail:
| | - Quanhui Peng
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Huawei Zou
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Hongze Wang
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Xiaoqiang Yu
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Xiaoping Jing
- Institute of Animal Nutrition, Sichuan Agricultural University, Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Chengdu, Sichuan, P.R. China
| | - Yixin Wang
- Institute of Animal Genetics and Breeding, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, Sichuan, P.R. China
| | - Binghai Cao
- College of Animal Science and Technology, State Key Laboratory of Animal Nutrition, China Agricultural University, Beijing, P.R. China
| | - Shanke Bao
- Animal Husbandry and Veterinary Institute, Haibei, Qinghai, P.R. China
| | - Wenhua Zhang
- Ningxia Xiahua Muslim Food Co. Ltd., Zhongwei, Ningxia, P.R. China
| | - Suonan Zhao
- Animal Husbandry and Veterinary Institute, Haibei, Qinghai, P.R. China
| | - Hanzhong Ji
- Animal Husbandry and Veterinary Institute, Haibei, Qinghai, P.R. China
| | - Xiangying Kong
- Animal Husbandry and Veterinary Institute, Haibei, Qinghai, P.R. China
| | - Quanxi Niu
- Ningxia Xiahua Muslim Food Co. Ltd., Zhongwei, Ningxia, P.R. China
| |
Collapse
|
19
|
Kim K, Lee J, Paik HY, Yoon J, Ryu B, Shim JE. Effects of multiple herb formula SEC-22 supplementation on dietary intake, picky eating behaviors, and growth indices in thin preschool children. Nutr Res Pract 2015; 9:393-9. [PMID: 26244078 PMCID: PMC4523483 DOI: 10.4162/nrp.2015.9.4.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/05/2015] [Accepted: 04/05/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/OBJECTIVES Thin children may have insufficient intake of energy and nutrients, resulting in reduced immune function and growth. This study aimed to identify the effects of multiple herb formula SEC-22 supplementation on growth, dietary changes, and picky eating behaviors in thin children. SUBJECTS/METHODS A double-blind, randomized clinical trial was conducted on 79 children aged 2-5 years with poor appetites, BMI percentile < 25, and without any illness. Subjects were given either SEC-22 (n = 35) or placebo (n = 44) for 2 months and followed for an additional 2 months. Three-day dietary records, questionnaires on picky eating behaviors, and anthropometric measures were collected. RESULTS Energy, carbohydrate intake, and feeding difficulty improved in both groups during the intervention period. However, changes were maintained only in the SEC-22 group after 2 months of follow-up post-supplementation. 'Frequency of trying to feed' was improved in the SEC-22 group compared to the placebo group after the first month of follow-up (P < 0.05). Intakes of potassium and thiamine were improved in the SEC-22 group compared to the placebo group after the first month of intervention (P < 0.05). 'Frequency of food reward', eating amount, and intakes of carbohydrate, potassium, and vitamin C showed significant improvement compared to the placebo group after the second month of follow-up (P < 0.05). CONCLUSIONS These results suggest that SEC-22 supplementation can improve parental feeding difficulty resulting from insufficient eating amount or picky eating as well as increase nutrient intake in thin children. Although these improvements were observable at least 2 months after supplementation, effects beyond this time frame need to be confirmed.
Collapse
Affiliation(s)
- Kijoon Kim
- Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea
- BOM Research Institute, Seoul National University, Seoul 151-742, Korea
| | - Joonsuk Lee
- BOM Research Institute, Seoul National University, Seoul 151-742, Korea
| | - Hee Young Paik
- Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea
| | - Jihyun Yoon
- Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea
| | - Bongha Ryu
- 3rd department of Internal Medicine, College of Oriental Medicine, Kyung-Hee University, Seoul 130-701, Korea
| | - Jae Eun Shim
- Department of Food and Nutrition, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 300-716, Korea
| |
Collapse
|
20
|
Bentley A, Das S, Alcock G, Shah More N, Pantvaidya S, Osrin D. Malnutrition and infant and young child feeding in informal settlements in Mumbai, India: findings from a census. Food Sci Nutr 2015; 3:257-71. [PMID: 25988001 PMCID: PMC4431794 DOI: 10.1002/fsn3.214] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/20/2015] [Accepted: 01/30/2015] [Indexed: 11/21/2022] Open
Abstract
Childhood malnutrition remains common in India. We visited families in 40 urban informal settlement areas in Mumbai to document stunting, wasting, and overweight in children under five, and to examine infant and young child feeding (IYCF) in children under 2 years. We administered questions on eight core WHO IYCF indicators and on sugary and savory snack foods, and measured weight and height of children under five. Stunting was seen in 45% of 7450 children, rising from 15% in the first year to 56% in the fifth. About 16% of children were wasted and 4% overweight. 46% of infants were breastfed within the first hour, 63% were described as exclusively breastfed under 6 months, and breastfeeding continued for 12 months in 74%. The indicator for introduction of solids was met for 41% of infants. Only 13% of children satisfied the indicator for minimum dietary diversity, 43% achieved minimum meal frequency, and 5% had a minimally acceptable diet. About 63% of infants had had sugary snacks in the preceding 24 h, rising to 78% in the second year. Fried and salted snack foods had been eaten by 34% of infants and 66% of children under two. Stunting and wasting remain unacceptably common in informal settlements in Mumbai, and IYCF appears problematic, particularly in terms of dietary diversity. The ubiquity of sugary, fried, and salted snack foods is a serious concern: substantial consumption begins in infancy and exceeds that of all other food groups except grains, roots, and tubers.
Collapse
Affiliation(s)
- Abigail Bentley
- UCL Institute for Global Health, Institute of Child Health 30 Guilford Street, London, WC1N 1EH, UK
| | - Sushmita Das
- SNEHA (Society for Nutrition, Education and Health Action), Urban Health Centre, Chota Sion Hospital 60 Feet Road, Shahunagar, Dharavi, Mumbai, 400017, Maharashtra, India
| | - Glyn Alcock
- UCL Institute for Global Health, Institute of Child Health 30 Guilford Street, London, WC1N 1EH, UK
| | - Neena Shah More
- SNEHA (Society for Nutrition, Education and Health Action), Urban Health Centre, Chota Sion Hospital 60 Feet Road, Shahunagar, Dharavi, Mumbai, 400017, Maharashtra, India
| | - Shanti Pantvaidya
- SNEHA (Society for Nutrition, Education and Health Action), Urban Health Centre, Chota Sion Hospital 60 Feet Road, Shahunagar, Dharavi, Mumbai, 400017, Maharashtra, India
| | - David Osrin
- UCL Institute for Global Health, Institute of Child Health 30 Guilford Street, London, WC1N 1EH, UK
| |
Collapse
|
21
|
Abstract
Risk factors which interfere with cognitive function are especially important during the first 2 years of life - a period referred to as early child development and a time during which rapid growth and essential development occur. Malnutrition, a condition whose effect on cognitive function is well known, has been shown to be part of a vicious cycle with diarrhoeal diseases, and the two pathologies together continue to be the leading cause of illness and death in young children in developing countries. This paper reviews the burden of early childhood diarrhoeal diseases globally and the emerging evidence of their relationship with global disparities in neurocognitive development. The strength of evidence which indicates that the severe childhood diarrhoeal burden may be implicated in cognitive impairment of children from low- and middle-income counties is discussed. Findings suggest that greater investment in multi-site, longitudinal enteric infection studies that assess long-term repercussions are warranted. Furthermore, economic analyses using the concept of human capital should play a key role in advancing our understanding of the breadth and complexities of the health, social and economic ramifications of early childhood diarrhoeal diseases and enteric infections. This broadened awareness can serve to help advocate for more effective interventions, particularly in developing economies.
Collapse
|
22
|
Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi WW, Caulfield LE, Danaei G. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS One 2013; 8:e64636. [PMID: 23734210 PMCID: PMC3667136 DOI: 10.1371/journal.pone.0064636] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies. METHODS Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1). RESULTS 53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality. CONCLUSIONS All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.
Collapse
Affiliation(s)
- Ibironke Olofin
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Christine M. McDonald
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- MRC-HPA Center for Environmental Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Seth Flaxman
- School of Computer Science and Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Robert E. Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Laura E. Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Goodarz Danaei
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | |
Collapse
|
23
|
Nhampossa T, Sigaúque B, Machevo S, Macete E, Alonso P, Bassat Q, Menéndez C, Fumadó V. Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique. Public Health Nutr 2013; 16:1565-74. [PMID: 23635423 DOI: 10.1017/S1368980013001080] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. DESIGN Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. SETTING Rural Mozambican district hospital. SUBJECTS All children aged <5 years admitted with severe malnutrition. RESULTS During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence. CONCLUSIONS Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.
Collapse
|
24
|
McDonald CM, Olofin I, Flaxman S, Fawzi WW, Spiegelman D, Caulfield LE, Black RE, Ezzati M, Danaei G. The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr 2013; 97:896-901. [PMID: 23426036 DOI: 10.3945/ajcn.112.047639] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits. OBJECTIVE The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age. DESIGN We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weight-for-height, and weight-for-age were calculated by using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as < -2 z scores). We calculated study-specific mortality HRs using Cox proportional hazards models and used a random-effects model to pool HRs across studies. RESULTS The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality HRs were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight but not stunted; and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight. CONCLUSION Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions.
Collapse
Affiliation(s)
- Christine M McDonald
- Departments of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Powis KM, Smeaton L, Ogwu A, Lockman S, Dryden-Peterson S, van Widenfelt E, Leidner J, Makhema J, Essex M, Shapiro RL. Effects of in utero antiretroviral exposure on longitudinal growth of HIV-exposed uninfected infants in Botswana. J Acquir Immune Defic Syndr 2011; 56:131-8. [PMID: 21124227 DOI: 10.1097/QAI.0b013e3181ffa4f5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of in utero exposure to highly active antiretroviral therapy (HAART) on longitudinal growth of HIV-uninfected infants is unknown. METHODS The Mashi and Mma Bana PMTCT intervention trials enrolled HIV-infected pregnant women at four sites in Botswana. Breast-fed (BF), HIV-uninfected infants born at 37 weeks or greater were included in this analysis. Weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z-scores were calculated using World Health Organization Child Growth Standards. Mean z-scores were compared between in utero antiretroviral exposure groups using Student t test, response profiles analysis, and general linear mixed effects modeling. RESULTS Growth of 619 HAART-exposed and 440 zidovudine-exposed, HIV-uninfected infants was evaluated. Mean birth weights were 3.01 kg for HAART and 3.15 kg for zidovudine-exposed infants (P < 0.001) with lower mean birth WAZ, length-for-age (LAZ), and weight-for-length (WLZ) among HAART-exposed infants (all P < 0.001). HAART-exposed infants had greater improvement in WAZ and weight-for-length (WLZ) from birth through 2 months (P = 0.03, P < 0.001, respectively). The WAZ did not differ between groups from 3 through 6 months (P = 0.26). Length-for-age (LAZ) remained lower in HAART-exposed infants but the incidence of wasting or stunting did not differ between exposure groups. CONCLUSIONS Lower weights in HAART-exposed uninfected infants at birth were rapidly corrected during the first 6 months of life.
Collapse
|
26
|
Bhagowalia P, Chen SE, Masters WA. Effects and determinants of mild underweight among preschool children across countries and over time. Econ Hum Biol 2011; 9:66-77. [PMID: 20554484 DOI: 10.1016/j.ehb.2010.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 05/02/2010] [Accepted: 05/02/2010] [Indexed: 05/29/2023]
Abstract
Research on malnutrition typically focuses on extreme cases which pose the greatest individual health risks, but researchers comparing populations might find that variation in mild malnutrition conveys valuable information about public health. This paper constructs and compares new measures of the prevalence, depth and severity of both mild and extreme underweight in children from three months to three years of age, as measured by 130 DHS surveys for 53 countries over a period from 1986 to 2006. We find that variance in mild underweight has a larger and more robust correlation with child mortality than variance in severe underweight, and is itself more closely correlated with local agricultural output, over a wide range of regression specifications. We conclude that the prevalence of mild underweight deserves greater attention as a useful signal of changing public health conditions among preschool children in developing countries.
Collapse
Affiliation(s)
- Priya Bhagowalia
- Department of Policy Studies, TERI University, New Delhi, India.
| | | | | |
Collapse
|
27
|
Graham TW, Breher JE, Farver TB, Cullor JS, Kehrli ME, Oberbauer AM. Biological markers of neonatal calf performance: the relationship of insulin-like growth factor-I, zinc, and copper to poor neonatal growth. J Anim Sci 2010; 88:2585-93. [PMID: 20382870 DOI: 10.2527/jas.2009-2610] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Raising a heifer calf to reproductive age represents an enormous cost to the producer. Poor neonatal growth exacerbates the costs incurred for rearing, and use of blood variables that may be associated with poorly growing calves may offer predictive value for growth and performance. Thus, the principal objective of the present study was to describe changes in serum IGF-I, zinc, and copper from birth to 90 d in Holstein calves, while accounting for sex and twin status, in poorly growing calves and calves growing well. A second objective was to test the hypothesis that an association exists between these serum variables and morphometric indicators of growth. Measurements of BW, length, and height were recorded at birth and at 30, 60, and 90 d of age. Jugular blood (12 mL) was collected from each calf on d 1 to determine serum total protein, serum IgG, packed cell volume, serum zinc, serum copper, serum IGF-I, and CD18 genotype for bovine leukocyte adhesion deficiency; serum zinc, serum copper, and serum IGF-I (predictor variables) were also determined for each calf on d 2 through 10 and on d 30, 60, and 90. Stepwise multiple regression and logistic regression analyses were used to examine the relationships between the predictor variables and the dependent variables (BW, height, and length at d 30, 60, and 90 of life). Birth weight, sex, serum IGF-I (at all ages), serum copper, and the serum copper-to-zinc ratio were associated, to varying degrees, with the dependent growth variables. Birth weight was consistently the dominant predictor. In conclusion, these results suggest that lighter birth weight, reduced serum IGF-I, and inflammation may be important causes of poor growth in neonatal Holstein dairy calves.
Collapse
Affiliation(s)
- T W Graham
- Veterinary Consulting Services, Davis, CA 95618, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Patel D, Bland R, Coovadia H, Rollins N, Coutsoudis A, Newell ML. Breastfeeding, HIV status and weights in South African children: a comparison of HIV-exposed and unexposed children. AIDS 2010; 24:437-45. [PMID: 19915445 DOI: 10.1097/QAD.0b013e3283345f91] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine growth of children by maternal and infant HIV status allowing for infant feeding mode. DESIGN Women enrolled into a nonrandomized intervention cohort. METHODS Children of HIV-infected and uninfected women weighed and assessed for HIV status, monthly: from birth to 9 months; quarterly: 10-24 months. Daily infant feeding practices recorded at weekly intervals. Weight-for-age z-scores of children born to HIV-infected mothers compared with the reference population of children of HIV-uninfected mothers. Changes in z-scores over age were examined by HIV infection status and infant feeding practice using linear mixed effects models. RESULTS The 1261 children of HIV-infected mothers grew as well as the reference group of 1061 children of HIV-uninfected mothers, irrespective of feeding mode. z-scores for HIV-infected children were consistently lower than those of HIV-exposed but uninfected children: a difference of 420 g for male children and 405 g for female children at 52 weeks of age. Breastfed HIV-infected infants had consistently higher z-scores for weight, especially during first 6 weeks (difference of 130 g for male children; 110 g for female children). In an adjusted regression analysis, maternal mid-upper arm circumference, CD4 cell count, infant birth weight and HIV status had the biggest impact on infant growth (z-score coefficient: 0.38 for mid-upper arm circumference > or =28.35 vs. <25.7 cm; P < 0.001; -0.32 for CD4 cell count <200 vs. > or =500; P = 0.001; -2.01 for birth weight <2500 vs. > or =2500 g; P < 0.001; -0.20 for infected vs. uninfected children; P < 0.001). CONCLUSION Optimal early feeding practices ameliorate the effect of being born to an HIV-infected mother and strengthen the recommendation of exclusive breastfeeding for HIV-infected women in terms of long-term child health.
Collapse
|
29
|
Vesel L, Bahl R, Martines J, Penny M, Bhandari N, Kirkwood BR. Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality. Bull World Health Organ 2010; 88:39-48. [PMID: 20428352 PMCID: PMC2802434 DOI: 10.2471/blt.08.057901] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 04/27/2009] [Accepted: 06/03/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. METHODS A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. FINDINGS The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). CONCLUSION Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.
Collapse
|
30
|
Arpadi S, Fawzy A, Aldrovandi GM, Kankasa C, Sinkala M, Mwiya M, Thea DM, Kuhn L. Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia. Am J Clin Nutr 2009; 90:344-53. [PMID: 19553300 PMCID: PMC2709311 DOI: 10.3945/ajcn.2009.27745] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of breastfeeding on growth in HIV-exposed infants is not well described. OBJECTIVE The objective was to evaluate the effect of early breastfeeding cessation on growth. DESIGN In a trial conducted in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 mo followed by rapid weaning to replacement foods or exclusive breastfeeding for 6 mo followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for-length z score (WLZ) and the self-reported breastfeeding practices of 593 HIV-uninfected singletons were analyzed. Generalized estimating equations were used to adjust for confounders. RESULTS WAZ scores declined precipitously between 4.5 and 15 mo. The decline was slower in the breastfed infants. At 9, 12, and 15 mo, mean WAZs were, respectively, -0.74, -0.92, and -1.06 in infants who were reportedly breastfed and were -1.07, -1.20, and -1.31 in the weaned infants (P = 0.003, 0.007, and 0.02, respectively). No differences were observed past 15 mo. Breastfeeding practice was not associated with LAZ, which declined from -0.98 to -2.24 from 1 to 24 mo. After adjustment for birth weight, maternal viral load, body mass index, education, season, and marital and socioeconomic status, not breastfeeding was associated with a 0.28 decline in WAZ between 4.5 and 15 mo (P < 0.0001). During the rainy season, not breastfeeding was associated with a larger WAZ decline (0.33) than during the dry season (0.22; P for interaction = 0.02). CONCLUSIONS Early growth is compromised in uninfected children born to HIV-infected Zambian mothers. Continued breastfeeding partially mitigates this effect through 15 mo. Nutritional interventions to complement breastfeeding after 6 mo are urgently needed. This trial was registered at clinicaltrials.gov as NCT00310726.
Collapse
Affiliation(s)
- Stephen Arpadi
- Columbia University Gertrude H Sergievsky Center, College of Physicians and Surgeons and Mailman School of Public Health, New York, NY 10030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Lapidus N, Minetti A, Djibo A, Guerin PJ, Hustache S, Gaboulaud V, Grais RF. Mortality risk among children admitted in a large-scale nutritional program in Niger, 2006. PLoS One 2009; 4:e4313. [PMID: 19177169 PMCID: PMC2629565 DOI: 10.1371/journal.pone.0004313] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 12/23/2008] [Indexed: 11/18/2022] Open
Abstract
Background In 2006, the Médecins sans Frontières nutritional program in the region of Maradi (Niger) included 68,001 children 6–59 months of age with either moderate or severe malnutrition, according to the NCHS reference (weight-for-height<80% of the NCHS median, and/or mid-upper arm circumference<110 mm for children taller than 65 cm and/or presence of bipedal edema). Our objective was to identify baseline risk factors for death among children diagnosed with severe malnutrition using the newly introduced WHO growth standards. As the release of WHO growth standards changed the definition of severe malnutrition, which now includes many children formerly identified as moderately malnourished with the NCHS reference, studying this new category of children is crucial. Methodology Program monitoring data were collected from the medical records of all children admitted in the program. Data included age, sex, height, weight, MUAC, clinical signs on admission including edema, and type of discharge (recovery, death, and default/loss to follow up). Additional data included results of a malaria rapid diagnostic test due to Plasmodium falciparum (Paracheck®) and whether the child was a resident of the region of Maradi or came from bordering Nigeria to seek treatment. Multivariate logistic regression was performed on a subset of 27,687 children meeting the new WHO growth standards criteria for severe malnutrition (weight-for-height<−3 Z score, mid-upper arm circumference<110 mm for children taller than 65 cm or presence of bipedal edema). We explored two different models: one with only basic anthropometric data and a second model that included perfunctory clinical signs. Principal Findings In the first model including only weight, height, sex and presence of edema, the risk factors retained were the weight/height1.84 ratio (OR: 5,774; 95% CI: [2,284; 14,594]) and presence of edema (7.51 [5.12; 11.0]). A second model, taking into account supplementary data from perfunctory clinical examination, identified other risk factors for death: apathy (9.71 [6.92; 13.6]), pallor (2.25 [1.25; 4.05]), anorexia (1.89 [1.35; 2.66]), fever>38.5°C (1.83 [1.25; 2.69]), and age below 1 year (1.42 [1.01; 1.99]). Conclusions Although clinicians will continue to perform screening using clinical signs and anthropometry, these risk indicators may provide additional criteria for the assessment of absolute and relative risk of death. Better appraisal of the child's risk of death may help orientate the child towards either hospitalization or ambulatory care. As the transition from the NCHS growth reference to the WHO standards will increase the number of children classified as severely malnourished, further studies should explore means to identify children at highest risk of death within this group using simple and standardized indicators.
Collapse
|
32
|
Bejon P, Mohammed S, Mwangi I, Atkinson SH, Osier F, Peshu N, Newton CR, Maitland K, Berkley JA. Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr 2008; 88:1626-31. [PMID: 19064524 PMCID: PMC2635111 DOI: 10.3945/ajcn.2008.26510] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 08/15/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Malnutrition is common in the developing world and associated with disease and mortality. Because malnutrition frequently occurs among children in the community as well as those with acute illness, and because anthropometric indicators of nutritional status are continuous variables that preclude a single definition of malnutrition, malnutrition-attributable fractions of admissions and deaths cannot be calculated by simply enumerating individual children. OBJECTIVE We determined the malnutrition-attributable fractions among children admitted to a rural district hospital in Kenya, among inpatient deaths and among children with the major causes of severe disease. DESIGN We analyzed data from children between 6 and 60 mo of age, comprising 13,307 admissions, 674 deaths, 3068 admissions with severe disease, and 562 community controls by logistic regression, using anthropometric z scores as the independent variable and admission or death as the outcome, to calculate the probability of admission as a result of "true malnutrition" for individual cases. Probabilities were averaged to calculate attributable fractions. RESULTS Z scores < -3 were insensitive for malnutrition-attributable deaths and admissions, and no single threshold was both specific and sensitive. The overall malnutrition-attributable fraction for in-hospital deaths was 51% (95% CI: 42%, 61%) with midupper arm circumference. Similar malnutrition-attributable fractions were seen for the major causes of severe disease (severe malaria, gastroenteritis, lower respiratory tract infection, HIV, and invasive bacterial disease). CONCLUSIONS Despite global improvements, malnutrition still underlies half of the inpatient morbidity and mortality rates among children in rural Kenya. This contribution is underestimated by using conventional clinical definitions of severe malnutrition.
Collapse
Affiliation(s)
- Philip Bejon
- Kenyan Medical Research Institute Centre for Geographic Medicine Research, Kilifi, Kenya.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Khawaja M, Dawns J, Meyerson-Knox S, Yamout R. Disparities in child health in the Arab region during the 1990s. Int J Equity Health 2008; 7:24. [PMID: 19021903 PMCID: PMC2603010 DOI: 10.1186/1475-9276-7-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 11/20/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Arab countries showed an impressive decline in child mortality rates during the past few decades, gaps in mortality by gender and socioeconomic status persisted. However, large socioeconomic disparities in child health were evident in almost every country in the region. METHODS Using available tabulations and reliable micro data from national household surveys, data for 18 Arab countries were available for analysis. In addition to infant and child mortality, child health was measured by nutritional status, vaccination, and Acute Respiratory Infection (ARI). Within-country disparities in child health by gender, residence (urban/rural) and maternal educational level were described. Child health was also analyzed by macro measures of development, including per capita GDP (PPP), female literacy rates, urban population and doctors per 100,000 people. RESULTS Gender disparities in child health using the above indicators were less evident, with most showing clear female advantage. With the exception of infant and child survival, gender disparities demonstrated a female advantage, as well as a large urban advantage and an overall advantage for mothers with secondary education. Surprisingly, the countries' rankings with respect to disparities were not associated with various macro measures of development. CONCLUSION The tenacity of pervasive intra-country socioeconomic disparities in child health calls for attention by policy makers and health practitioners.
Collapse
Affiliation(s)
- Marwan Khawaja
- Center for Research on Population and Health, American University of Beirut, Van Dyck Hall, Box 11-0236, Riad El-Solh1107 2020, Beirut, Lebanon
| | - Jesse Dawns
- Center for Research on Population and Health, American University of Beirut, Van Dyck Hall, Box 11-0236, Riad El-Solh1107 2020, Beirut, Lebanon
| | - Sonya Meyerson-Knox
- Center for Research on Population and Health, American University of Beirut, Van Dyck Hall, Box 11-0236, Riad El-Solh1107 2020, Beirut, Lebanon
| | - Rouham Yamout
- Center for Research on Population and Health, American University of Beirut, Van Dyck Hall, Box 11-0236, Riad El-Solh1107 2020, Beirut, Lebanon
| |
Collapse
|
34
|
Chatterjee A, Bosch RJ, Hunter DJ, Fataki MR, Msamanga GI, Fawzi WW. Maternal disease stage and child undernutrition in relation to mortality among children born to HIV-infected women in Tanzania. J Acquir Immune Defic Syndr 2007; 46:599-606. [PMID: 18043314 DOI: 10.1097/QAI.0b013e31815a5703] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether maternal HIV disease stage during pregnancy and child malnutrition are associated with child mortality. DESIGN Prospective cohort study in Tanzania. METHODS Indicators of disease stage were assessed for 939 HIV-infected women during pregnancy and at delivery, and children's anthropometric status was obtained at scheduled monthly clinic visits after delivery. Children were followed up for survival status until 24 months after birth. RESULTS Advanced maternal HIV disease during pregnancy (CD4 count <350 vs. >or=350 cells/mm) was associated with increased risk of child mortality through 24 months of age (hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.32 to 2.30). CD4 count <350 cells/mm was also associated with an increased risk of death among children who remained HIV-negative during follow-up (HR = 2.00, 95% CI: 1.36 to 2.94). Low maternal hemoglobin concentration and child undernutrition were related to an increased risk of mortality in this cohort of children. CONCLUSIONS Low maternal CD4 cell count during pregnancy is related to increased risk of mortality in children born to HIV-infected women. Care and treatment for HIV disease, including highly active antiretroviral therapy to pregnant women, could improve child survival. Prevention and treatment of undernutrition in children remain critical interventions in settings with high HIV prevalence.
Collapse
|
35
|
Jingxiong J, Toschke AM, von Kries R, Koletzko B, Liangming L. Vitamin A status among children in China. Public Health Nutr 2006; 9. [DOI: 10.1017/s136898000600944x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Abstract
AbstractObjectiveThe objective of this study was to assess the prevalence of vitamin A deficiency (VAD) in children under 6 years old in China and to identify risk groups for VAD.DesignA cross-sectional survey was conducted in 14 provinces from coastal, inland and western geographic areas in China.SettingOne city (urban) and two counties (rural) were randomly selected from each province as survey areas.SubjectsAbout 200 children aged 0–6 years were randomly selected in each survey area. A blood sample was collected from each child. Data on sociodemographics and nutrition were obtained by interview of the mother or principal caregiver. Fluorescence microanalysis was used to analyse serum retinol concentration.ResultsVAD (serum retinol < 0.7 μmol l− 1) was observed in 957 out of 7826 children aged 0–6 years (12.2% of the entire study population), whereas severe VAD (serum retinol < 0.35 μmol l− 1) was found in 39 children (0.5%). The highest prevalences of VAD at >1 year of age were observed among children of mothers with minority ethnicity (22.7%) or poor education (19.8%) and in the poor western area (17.4%).ConclusionsVAD is a nutritional problem in children in China. Children living in the poor western area, having a mother with minority ethnicity or a mother with poor education have a high risk of VAD.
Collapse
Affiliation(s)
- Jingxiong Jiang
- Department of Child Health Care, National Center for Women's and Children's Health, Chinese CDC, Chaoyang District, Beijing, China.
| | | | | | | | | |
Collapse
|
37
|
Roberfroid D, Kolsteren P, Hoerée T, Maire B. Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical analysis based on a systematic review. Trop Med Int Health 2005; 10:1121-33. [PMID: 16262737 DOI: 10.1111/j.1365-3156.2005.01498.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Growth Monitoring and Promotion programs (GMP) have been intensively promoted to improve children's health in developing countries. It has been hoped that regularly weighing children would result in the early detection of growth falterers, and that the growth chart would serve as an educational tool to make that state apparent to both health workers and caretakers in order to trigger improved caring practices. Our objective was to review whether GMP answers the theoretical grounds of a screening and intervention program. METHOD A systematic literature review was performed. The WHO framework developed by Wilson and Jungner for planning and evaluating screening programs guided the analysis. RESULTS Sixty-nine studies were retrieved. Overall, evidence is weak on the performance of GMP as a screening program for malnutrition through early detection of growth falterers. The main results are: (1) malnutrition remains a public health problem, but its importance is context specific; (2) the value of a low weight velocity to predict malnutrition is unknown and likely to vary in different contexts; (3) the performance of GMP for improving nutrition status of children and in reducing mortality and morbidity is unknown; (4) the performance of the screening is affected by the unreliability of weight measurements; (5) the promotional and educational effectiveness of GMP is low, in particular the growth chart is poorly understood by mothers; (6) the acceptability seems low in regards of low attendance rates; (7) evidence is lacking regarding cost-effectiveness. CONCLUSIONS We conclude that there is too little scientific evidence to indiscriminately support international promotion of GMP. However GMP could constitute a valid strategy of public nutrition in specific situations. We indicate paths for further research and how prevention programs could be developed.
Collapse
Affiliation(s)
- D Roberfroid
- Department of Public Health, Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | |
Collapse
|
38
|
Reyes H, Pérez-Cuevas R, Sandoval A, Castillo R, Santos JI, Doubova SV, Gutiérrez G. The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study. BMC Public Health 2004; 4:57. [PMID: 15571622 PMCID: PMC539253 DOI: 10.1186/1471-2458-4-57] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 11/30/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities.Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives.
Collapse
Affiliation(s)
- Hortensia Reyes
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Ricardo Pérez-Cuevas
- Coordinación de Políticas de Salud, Dirección de Prestaciones Medicas, Instituto Mexicano del Seguro Social, México City, México
| | - Araceli Sandoval
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Raúl Castillo
- Departamento de Epidemiología, Secretaría de Salud Estado de Guerrero, Chilpancingo, México
| | - José Ignacio Santos
- Dirección General, Hospital Infantil de México "Federico Gómez", México City, México
| | - Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, México
| | - Gonzalo Gutiérrez
- Unidad de Salud Pública. Dirección de Prestaciones Medicas, Instituto Mexicano del Seguro Social, México City, México
| |
Collapse
|
39
|
Caulfield LE, de Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 2004; 80:193-8. [PMID: 15213048 DOI: 10.1093/ajcn/80.1.193] [Citation(s) in RCA: 506] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight. OBJECTIVES The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight. DESIGN Data were obtained from investigators of 10 cohort studies with both weight-for-age category (<-3 SDs, -3 to <-2 SDs, -2 to <-1 SD, and >-1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition. RESULTS The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea. CONCLUSION A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
Collapse
Affiliation(s)
- Laura E Caulfield
- Department of International Health, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
40
|
Abstract
OBJECTIVE To examine the relation between household water and sanitation, and the risk of stunting and reversal of stunting in Khartoum and Crezira regions, Sudan. DESIGN Prospective cohort study. SETTING A total of 25 483 children aged 6-72 months from rural Sudan enrolled in an 18-month field trial in 1988 to study the effect of vitamin A supplementation on child health and survival. RESULTS The mean height-for-age z-scores at baseline and the end of study were -1.66 and -1.55, respectively, for the group with water and sanitation facilities, and -2.03 and -1.94 for the group without water and sanitation, after adjustment for age, region, gender, mother's literacy, intervention group (vitamin A vs placebo), family wealth, breastfeeding and cleanliness. Among children of normal height-for-age at baseline, the risk of stunting (<-2 height-for-age z-score) was lowest in the group that came from homes that had both water and sanitation compared to children from homes without these facilities (multivariate RR=0.79, 95% CI 0.69-0.90). Among children stunted at baseline, those coming from homes with water and sanitation had a 17% greater chance of reversing stunting than those coming from homes without either facility (adjusted RR=1.17, 95% CI 0.99-1.38). We did not detect a synergistic association between access to water and sanitation. CONCLUSIONS Water and sanitation are independently associated with improved growth of children. SPONSORSHIP None.
Collapse
Affiliation(s)
- A T Merchant
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
UNLABELLED Stunting is common among children under 5 y of age in sub-Saharan Africa. Several risk factors have been associated with poor growth but few studies have prospectively addressed the development of linear growth faltering and stunting during the first year of life. The present study was designed to analyse typical growth among rural Malawian infants, focusing particularly on the impact of birth size, adherence to feeding guidelines and morbidity in the development of severe stunting during infancy. A community-based cohort of 613 singleton newborns was prospectively followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal size and weight gain during pregnancy, birth events, morbidity, breastfeeding and complementary feeding, growth and mortality. Univariate and multivariate analyses were used to determine associations between predictor variables and poor linear growth. The proportions of stunted infants (Height-for-age Z-score < -2) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, respectively. At I y of age, over two-thirds (71%) of the infants were at least moderately (HAZ < -2) and 31% severely stunted (HAZ < -3). CONCLUSION The strongest predictor of severe stunting at 12 mo of age was small birth size. Other variables independently associated with this outcome included inappropriate complementary feeding, high morbidity, maternal short stature, male gender, and home delivery. Faltering of linear growth started soon after birth and continued throughout infancy. Interventions increasing birth size could have a significant role in the prevention of early childhood stunting. The ideal strategy should also emphasize the importance of appropriate infant feeding and decreasing the number of illness episodes amongst the infants.
Collapse
Affiliation(s)
- M Espo
- Medical School, University of Tampere, Finland
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
OBJECTIVE For years it has been shown that more children die from moderate malnutrition (MM) than severe. Till yet few studies deal specifically with identifying these children. This study attempts to statistically determine the appropriate anthropometric measures and cut-off points for diagnosing moderate malnutrition in preschool children. METHODS Anthropometric measurements were obtained from 609 preschool children from the cities of Adigrat, Ethiopia; Janampet, India; San Paulo, Brazil. The values were used to determine the sensitivity, specificity, positive predictive value (PPV) and likelihood ratio (LR) of each index studied. The optimum cutoff point for each index was considered to be the cutoff point with the maximum Kappa coefficient for efficiency. The McNemar Test for the significance of changes was used to determine if these findings were in agreement when applied to this data. RESULTS Weight for height (WFH) at each site had the highest PPV and LR of 4 but was not signficant by the McNemar Test. Mid-upper arm circumference (MUAC) in India had the same PPV (77%) as WFH but a LR of 2. MUAC in India, Brazil and Ethiopia tested significantly for the McNemar Test. The cut-off point for MUAC in India and Brazil was determined to be <15.5 cm in India and Brazil but was <15 cm in Ethiopia. Waist circumference in India tested a significantly PPV of 64%, and a LR of 2. CONCLUSION These results show that WFH and MUAC could be used with WFA to identify the MM child. The cut-off points for MUAC may vary per location. WC positive data suggests further study is warranted. The McNemar findings yielded significant evidence that statistically determined indicators can be established to identify MM. With further study these methods may prove to be an important component in the efforts to improve child survival.
Collapse
|
43
|
Pascal N, Amouzou EKS, Sanni A, Namour F, Abdelmouttaleb I, Vidailhet M, Guéant JL. Serum concentrations of sex hormone binding globulin are elevated in kwashiorkor and anorexia nervosa but not in marasmus. Am J Clin Nutr 2002; 76:239-44. [PMID: 12081841 DOI: 10.1093/ajcn/76.1.239] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Customary blood protein markers for malnutrition are of limited value in the diagnosis of protein-energy malnutrition or anorexia nervosa in children and in the follow-up to refeeding in such children. OBJECTIVES For these diseases, we compared the diagnostic value of sex hormone binding globulin (SHBG) with that of albumin, transferrin, transthyretin, and retinal binding protein and determined the relations between concentrations of insulin, insulin-like growth factor I, and SHBG. DESIGN SHBG was assayed in children with protein-energy malnutrition (29 children with kwashiorkor and 28 with marasmus), in 29 anorectic girls (before and after refeeding), and in age- and sex-matched control subjects. RESULTS Mean (+/-SE) serum SHBG concentrations were higher in the children with kwashiorkor (0.18 +/- 0.07 micromol/L) than in the children with marasmus (0.11 +/- 0.05 micromol/L, P < 0.0001) or the control subjects (0.11 +/- 0.03 micromol/L, P < 0.0005). In the children with anorexia nervosa before weight gain, serum SHBG concentrations were significantly higher (0.10 +/- 0.04 micromol/L) than in the age-matched control subjects (0.06 +/- 0.03 micromol/L, P < 0.001) and decreased significantly after 30 d of refeeding (0.04 +/- 0.01 micromol/L, P < 0.0001). This decrease was negatively correlated with insulin-like growth factor I but not with insulin. Mean serum SHBG concentrations were influenced neither by inflammation, as indicated when C-reactive protein was used as a marker (0.27 +/- 0.27, 0.34 +/- 0.42, and <0.04 micromol/L in the children with marasmus, kwashiorkor, and anorexia nervosa, respectively), nor by glomerular filtration, as indicated when cystatin-C was used as a marker (68.46 +/- 23.08, 66.90 +/- 43.08, and 49.23 +/- 7.69 micromol/L, respectively). CONCLUSIONS The high SHBG concentration observed in anorexia nervosa and kwashiorkor seems to be of multifactorial origin. For these 2 diseases, SHBG is a reliable marker of nutritional status, is unrelated to either C-reactive protein or cystatin-C, and may be helpful in distinguishing kwashiorkor from marasmus and as a follow-up marker after refeeding.
Collapse
Affiliation(s)
- Nathalie Pascal
- Laboratoire de Pathologie Cellulaire et Moléculaire en Nutrition, EMI INSERM 0014 et URM IFREMER 20, Faculté de Médecine, Vandoeuvre, France
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Increasing data link micronutrient deficiencies to excess childhood morbidity and mortality, and similar relationships have been noted in the study of nutrition and HIV infection. We review epidemiologic studies that have examined the relationship between micronutrient deficiencies and health outcomes in childhood and HIV infection, as well as clinical trials of micronutrient supplementation. Vitamin A supplementation among communities at risk of deficiency effectively reduces mortality and morbidity in children younger than age 5, and vitamin A may be especially effective in HIV-infected children. Vertical transmission of HIV has not to date been affected by maternal micronutrient supplementation. In children with poor dietary zinc intake and/or bioavailability, zinc supplementation reduces the incidence and severity of diarrheal diseases, as well as the occurrence of pneumonia. Vitamin A therapy has not been associated with improved growth, whereas some trials have shown that zinc supplementation is associated with greater increments in height. Further trials of micronutrient supplementation are warranted.
Collapse
Affiliation(s)
- C Duggan
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | | |
Collapse
|
45
|
Simondon KB, Bénéfice E. Nutritional status and irrigated rice cultivation in northern Senegal: A five‐year follow‐up. Ecol Food Nutr 2001. [DOI: 10.1080/03670244.2001.9991636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Abstract
Both morbidity and mortality are consistently reported to be higher in males than in females in early life, but no explanation for these findings has been offered. This paper argues that the sex difference in early vulnerability can be attributed to the natural selection of optimal maternal strategies for maximizing lifetime reproductive success, as modelled previously by Trivers and Willard. These authors theorized that males and females offer different returns on parental investment depending on the state of the environment. Natural selection has therefore favoured maternal ability to manipulate offspring sex in response to environmental conditions in early life, as shown in variation in the sex ratio at birth. This argument can be extended to the whole period of parental investment until weaning. Male vulnerability in response to environmental stress in early life is predicted to have been favoured by natural selection. This vulnerability is most evident in the harsh conditions resulting from pre-term birth, but can also be seen in term infants, and manifests as greater morbidity and mortality persisting into early childhood. Malnutrition, interacting with infection after birth, is suggested as the fundamental trigger mechanism. The model suggests that whatever improvements are made in medical care, any environmental stress will always affect males more severely than females in early life.
Collapse
Affiliation(s)
- J C Wells
- Childhood Nutrition Research Centre, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, U.K.
| |
Collapse
|
47
|
Banajeh SM, Hussein RF. The impact of breastfeeding on serum electrolytes in infants hospitalized with severe dehydrating diarrhoea in Yemen. Ann Trop Paediatr 1999; 19:371-6. [PMID: 10716032 DOI: 10.1080/02724939992220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The effect of breastfeeding on serum electrolytes and case fatality was studied in a group of 430 children admitted with severe dehydrating diarrhoea. Hyponatraemia and hypokalaemia were significantly more prevalent in infants who were exclusively bottle-fed (37.3% and 46.3%) compared with exclusively breastfed (12.2% and 16.7%) and among bottle-fed weaning children (46.3% and 62.6%) compared with weaning children who continued to breastfeed (24.7% and 36.7%, respectively). Mortality was lower in exclusively breastfed children (4.4%) than in those receiving formula feeds (16.4%); it was also lower in weaning children who continued to receive breast-milk (6%) than in bottle-fed weaning children (13.8%). Breastfeeding significantly reduces case fatality and the likelihood of electrolyte disturbances among infants hospitalized with severe dehydrating diarrhoea.
Collapse
Affiliation(s)
- S M Banajeh
- Department of Paediatrics, Sana'a University, Yemen.
| | | |
Collapse
|
48
|
|