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Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition 2024; 122:112390. [PMID: 38458063 DOI: 10.1016/j.nut.2024.112390] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Concurrent wasting and stunting (WaSt) in a child is a health problem that leads to detrimental effects. However, to our knowledge, there is limited research regarding the prevalence and determinants of WaSt, including in Indonesia. The aim of this study was to analyze the prevalence and determinants of WaSt in children 6 to 23 mo of age. METHODS This cross-sectional study was conducted with data sets from the Indonesia Nutritional Status Survey (INSS). Data was collected between January and December 2021. About 15 641 children, ages 23 mo, were included. A χ2 analysis examined the association between the dependent and independent variables. A multivariate test analyzed the risk for the independent variable to the dependent, seen through the adjusted odds ratio (aOR). RESULTS The prevalence of WaSt was 2.4%. Higher odds for WaSt were seen in the following: • Boys: 2.15 times (95% confidence interval [CI], 1.72-2.68); • Children ages 12 to 23 mo 3.15 times (95% CI, 2.33-4.25); • Those with low birth weight 3.11 times (95% CI, 2.33-4.15) • Those with small birth size: 2 times (95% CI, 1.59-2.54) • Babies born from mothers >35 y of age: 1.5 times (95% CI, 1.19-1.89); • Children who experienced infection: 1.43 times (95% CI, 1.16-1.76); • Children not using the Integrated Health and Nutrition Services (Posyandu): 1.17 times (95% CI; 1.29-2.27); • Children from middle- income families:2.54 times higher odds (95% CI, 1.75-3.7); and • Children from rural areas: 1.37 times (95% CI, 1.1-1.71). CONCLUSION WaSt is associated with multiple factors in Indonesia. Hence, policymakers need to address this problem comprehensively.
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Affiliation(s)
- Lidya Alwina Jokhu
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ahmad Syauqy
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
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Widjaja NA, Hamida A, Purnomo MT, Satjadibrata A, Sari PP, Handini LS, Novi T, Hanindita MH, Irawan R. Effect of high-calorie formula on weight, height increment, IGF-1 and TLC in growth faltering children: A quasi-experimental study. Heliyon 2024; 10:e28834. [PMID: 38623243 PMCID: PMC11016603 DOI: 10.1016/j.heliyon.2024.e28834] [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: 05/27/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
High-calorie formulas have been used to promote catch-up growth in undernourished children. The level of insulin-like growth factor 1 (IGF-1) is closely related to weight and nutritional intake, whereas low a total lymphocyte count (TLC) is associated with impaired immune system function in undernourished children. This study was conducted to investigate the effect of high-calorie formula as an intervention on weight, height increment, IGF-1 and TLC in children with growth faltering or undernutrition. A quasi-experimental study with pre- and post-design was conducted in the outpatient clinic of a private hospital during October 2021-July 2022 on children with growth failure and underlying infection. For 90 days, subjects were given a high-calorie formula. An enzyme-linked immunosorbent assay was then conducted to measure IGF-1, followed by a complete blood count examination. Subjects were divided into two groups based on age: Group 1 (12-24 months) and Group 2 (>24-60 months). There was a significant increment in body weight and body length/height after intervention but no significant difference between the groups. The increment of body length/height after intervention was greater in Group 1 than Group 2 (p = 0.000) and reduced the incidence of stunted/severely stunted and wasted/severely wasted children (p > 0.05). IGF-1 increased after the intervention but with no significant difference (1.42 ± 8.31 ng/ml; p = 0.144). There was a significant reduction in TLC after the intervention (1194.34 + 4400.34 cells/mm3; p = 0.002) that was reduced in Group 1 and slightly increased in Group 2 (p = 0.003). Being underweight/severely underweight increased the risk of a low TLC by 27.658-fold but this risk was reduced by 25.904-fold after nutritional intervention. High-calorie formula intervention increases body weight and body length/height, reduces the incidence of underweight, stunted and wasted children and improves IGF-1 levels.
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Affiliation(s)
- Nur Aisiyah Widjaja
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
- Child Health, Husada Utama Hospital, Surabaya, Indonesia
| | - Azizah Hamida
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Marisa Tulus Purnomo
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Azarina Satjadibrata
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Putri Permata Sari
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | | | - Theresia Novi
- Clinical Pathology, Husada Utama Hospital, Surabaya, Indonesia
| | - Meta Herdiana Hanindita
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
| | - Roedi Irawan
- Child Health Department, Airlangga/Dr.Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
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Ahmmed F, Hasan MN, Hossain MF, Khan MTF, Rahman MM, Hussain MP, Hossain MJ. Association between short birth spacing and child malnutrition in Bangladesh: a propensity score matching approach. BMJ Paediatr Open 2024; 8:e002240. [PMID: 38499349 PMCID: PMC10953308 DOI: 10.1136/bmjpo-2023-002240] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES This study aimed to explore the effects of short birth spacing (SBS), which is defined as a period of less than 33 months between two successive births, on multiple concurrent forms of child malnutrition (MCFCM) and at least one form of child malnutrition (ALOFCM) using propensity score matching (PSM). METHODS This study used data extracted from the 2017-18 Bangladesh Demographic and Health Survey. PSM with four different distance functions, including logistic regression, classification and regression tree, single hidden layer neural network and random forest, were performed to evaluate the effects of SBS on MCFCM and ALOFCM. We also explored how the effects were modified in different subsamples, including women's empowerment, education and economic status (women's 3E index)-constructed based on women's decision-making autonomy, education level, and wealth index, and age at marriage, and place of residence. RESULTS The prevalence of SBS was 22.16% among the 4652 complete cases. The matched samples of size 2062 generated by PSM showed higher odds of MCFCM (adjusted OR (AOR)=1.25, 95% CI=1.02 to 1.56, p=0.038) and ALOFCM (AOR=1.20, 95% CI=1.01 to 1.42, p=0.045) for the SBS children compared with their counterparts. In the subsample of women with 3E index≥50% coverage, the SBS children showed higher odds of MCFCM (AOR: 1.43, 95% CI=1.03 to 2.00, p=0.041] and ALOFCM (AOR: 1.33, 95% CI=1.02 to 1.74, p=0.036). Higher odds of MCFCM (AOR=1.27, 95% CI=1.02 to 1.58, p=0.036) and ALOFCM (AOR=1.23, 95% CI=1.02 to 1.51, p=0.032) for SBS children than normal children were also evident for the subsample of mothers married at age≤18 years. CONCLUSION SBS was significantly associated with child malnutrition, and the effect was modified by factors such as women's autonomy and age at marriage.
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Affiliation(s)
- Foyez Ahmmed
- Department of Statistics, Comilla University, Cumilla, Bangladesh
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Md Nahid Hasan
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
- Department of Mathematics, Texas A&M University-Commerce, Commerce, Texas, USA
| | - Md Faruk Hossain
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Md Tareq Ferdous Khan
- Department of Mathematics and Statistics, Cleveland State University, Cleveland, OH, USA
| | - Mohammod Mahmudur Rahman
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
| | - Md Parvej Hussain
- Department of Economics, University of Chittagong, Chittagong, Bangladesh
| | - Md Jamal Hossain
- Department of Pharmacy, School of Pharmaceutical Sciences, State University of Bangladesh, Dhaka, Bangladesh
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Mahmud I, Guesdon B, Kerac M, Grijalva-Eternod CS. Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis. Maternal & Child Nutrition 2024:e13635. [PMID: 38433606 DOI: 10.1111/mcn.13635] [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] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
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Affiliation(s)
- Imteaz Mahmud
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Public Health, North South University, Dhaka, Bangladesh
- The Power of Nutrition, London, UK
| | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Ararsa GG, Getachew MT, Diddana TZ, Alemayehu FR. Prevalence of undernutrition and associated factors among children aged 6-23 months: a cross-sectional analysis from South-East Ethiopia. J Nutr Sci 2023; 12:e127. [PMID: 38155807 PMCID: PMC10753458 DOI: 10.1017/jns.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
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Key Words
- 6–23 months aged children
- ANC, antenatal care
- AOR, adjusted odds ratio
- ARI, acute respiratory illness
- ASF, animal source food
- BF, breastfeeding
- CF, complementary feeding
- COR, crude odds ratio
- DDS, dietary diversity score
- EDHS, Ethiopian Demographic and Health Survey
- GMP, growth monitoring and promotion
- HAZ, height/length-for-age Z-score
- HIFAS, household food insecurity access score
- IYCFP, infant and young child feeding practices
- Lemubilbilo
- MAD, Minimum acceptable diet
- OFSP, orange fleshed sweet potato
- ORS, oral rehydration solution
- PNC, postnatal care
- South-east Ethiopia
- Undernutrition
- WAZ, weight-for-age Z-score
- WHO, World Health Organisation
- WHZ, weight-for-height/length Z-score
- mm, millimeter
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Affiliation(s)
- Gosa Girma Ararsa
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Meheret Tena Getachew
- Ethiopia Civil Society Coalition for Scaling Up Nutrition (ECSC-SUN), Scaling Up Nutrition (SUN), Civil Society Network, P.O. Box 384, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Fikadu Reta Alemayehu
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
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Thurstans S, Opondo C, Bailey J, Stobaugh H, Loddo F, Wrottesley SV, Seal A, Myatt M, Briend A, Garenne M, Mertens A, Wells J, Sear R, Kerac M. How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis. Matern Child Nutr 2023:e13596. [PMID: 38048342 DOI: 10.1111/mcn.13596] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023]
Abstract
Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non-response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72-0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39-0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27-0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24-59 months) had a shorter mean LOS than younger children (6-23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols.
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Affiliation(s)
- Susan Thurstans
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | | | - Andy Seal
- UCL Institute for Global Health, London, UK
| | | | - André Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Michel Garenne
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
- 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
| | - Andrew Mertens
- University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Jonathan Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Anuradha K, Ketan G, Vaman K, Veena E. Greater Reduction in Stunting Than Underweight and Wasting in Indian Under-Five Children: A Comparison of Growth Indicators from 4 National Family Health Surveys. Indian J Pediatr 2023; 90:982-987. [PMID: 35713770 DOI: 10.1007/s12098-022-04143-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess change in nutritional status in Indian under-five children from four rounds of national surveys (round 1 to 4). METHODS National Family Health Survey data from 4 rounds (1992-2016) were analyzed. Height and weight for age (HAZ, WAZ), and weight for height (WHZ) z scores were calculated. Children under -2 z score were classified as malnourished by HAZ, WAZ and WHZ. RESULTS A greater reduction in stunting (from 54 to 38%, p < 0.05) than in underweight (from 44 to 34%, p < 0.05) and wasting (from 19 to 20%, p > 0.1) status over the period of 4 NFHS rounds was observed from 1992 to 2016. In line with this, combination of improved height for age (-2.1 ± 1.8 to -1.5 ± 1.7) but relatively less improved weight for age (-1.8 ± 1.4 to -1.5 ± 1.2), the change in wasting status was either nil or meagre (-0.8 ± 1.4 to -0.9 ± 1.4), (p < 0.05 for all). The percentage of children malnourished by all 3 indicators together reduced from 9 to 6% (p < 0.05). At the 4th NFHS round, higher percentage of boys (8%) than girls (6%) and rural (7%) than urban (5%) children were malnourished by all 3 indicators (p < 0.05). CONCLUSION Greater reduction in stunting than underweight and wasting was observed over the period of 4 rounds. There is a need for more focused efforts to combat malnutrition in rural children and boys.
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Affiliation(s)
- Khadilkar Anuradha
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Gondhalekar Ketan
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Khadilkar Vaman
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ekbote Veena
- Pediatric and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 31, Sassoon Road, Pune, Maharashtra, 411001, India
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Boua PR, Rouamba T, Bambara E, Kaboré S, Compaore EWR, Ouedraogo B, Tinto H, Newell ML, Ward K, Sorgho H. Undernutrition in children aged 0-59 months by region and over time: secondary analysis of the Burkina Faso 2012-2018 National Nutrition Surveys. BMJ Open 2023; 13:e066509. [PMID: 37673454 PMCID: PMC10496659 DOI: 10.1136/bmjopen-2022-066509] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
The global burden of undernutrition remains high, responsible for significant under-five mortality in resource-limited settings. Numerous sustainable development goals (SDGs) are linked to nutrition, and nationally representative nutrition surveillance is a key activity to track progress towards SDGs and guide efficient programmes. OBJECTIVES The aim of this study is to look at spatial and temporal trends in undernutrition in children under 5 years age in Burkina Faso. SETTING We used data from annual National Nutrition Surveys using Standardised Monitoring and Assessment of Relief and Transitions methodology (anthropometry, morbidity) over 7 years (2012-2018) in Burkina Faso. PARTICIPANTS Children of under 5 years from households selected through systemic sampling at countrywide level. MAIN OUTCOME MEASURES Prevalence of stunting (height-for-age z-score, <-2), underweight (weight-for-age z-score, <-2) and wasting (weight-for-height z-score, <-2) at regional and national. We used general linear mixed models, adjusted by age, survey year, sex, presence of fever and/or diarrhoea, and poverty index to quantify the risk of undernutrition over time and by region of residence. RESULTS Between 2012 and 2018, decreases were observed overall in the prevalence of growth retardation (stunting) decreased from 33.0% (95% CI 32.3 to 33.8) in 2012 to 26.7% (95% CI 26.2 to 27.3) in 2018. Underweight reduced from 24.4% (95% CI 23.7 to 25.1) to 18.7% (95% CI 18.2 to 19.2) for the same period and wasting decreased from 10.8% (95% CI 10.3 to 11.3) in 2012 to 8.4% (95% CI 8.1 to 8.8) in 2018. However, there was substantial variation across the country, with increased risk of undernutrition in the regions of Sahel, East and Cascades primarily. High-risk regions were characterised by a lower poverty index and limited access to healthcare services. CONCLUSIONS Our findings could inform national policymakers in refining and optimising resource allocation based on the identification of high-risk areas.
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Affiliation(s)
- Palwende Romuald Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
- Sydney Brenner Institute for Molecular Biosciences, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
| | - Estelle Bambara
- Direction de la Nutrition, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Saidou Kaboré
- Direction de la Nutrition, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Ella W R Compaore
- Laboratoire de Biochimie, Biotechnologie, Technologie Alimentaire et Nutrition (LABIOTAN), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Boureima Ouedraogo
- Institut National de Statistique et de la Démographie, Ouagadougou, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
| | - Marie-Louise Newell
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Kate Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Global Health Research Institute, University of Southampton, Southampton, UK
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
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Roba AA, Başdaş Ö. Multilevel analysis of trends and predictors of concurrent wasting and stunting among children 6-59 months in Ethiopia from 2000 to 2019. Front Nutr 2023; 10:1073200. [PMID: 37720379 PMCID: PMC10502729 DOI: 10.3389/fnut.2023.1073200] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Emerging evidence indicates that children can be concurrently wasted and stunted (WaSt), increasing their mortality risk. However, more is needed to know about WaSt in Ethiopia. Therefore, this study aimed to determine the trends and predictors of WaSt using Ethiopian Demographic and Health Survey datasets from 2000 and 2019. Methods The study included a total weighted sample of 34,930 children aged 6-59 months. Descriptive and weighted multilevel mixed-effects (fixed and random effects) logistic regression analyses were carried out. The Intraclass Correlation Coefficient (ICC) and the Median Odds Ratio (MOR) were calculated. Results The prevalence of WaSt was 1,682 (4.82%) with a significantly decreasing trend, yielding a percent change of -57.51% (-69.37% to -23.52%) from 2000 to 2019. In the adjusted model, the odds of WaSt increased in boys, children with a shorter preceding birth interval, small birth size, delayed initiation of complementary foods, diarrhea, fever, and anemia, mother's lack of formal education, and being a farmer, and poor/middle wealth index, and lack of mass media exposure. WaSt was inversely related to the child's age. Adjusted ICC and MOR were 31.16% and 3.20%, respectively. Conclusion and recommendations The study highlights the importance of considering individual and community-level factors to address WaSt, such as timely initiation of complementary foods, improving access to health services, quality diet, and prevention of communicable diseases. Furthermore, programs that have positive impacts on formal education and employment opportunities for girls, as well as that increase access to mass media, are required.
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Affiliation(s)
- Aklilu Abrham Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
| | - Öznur Başdaş
- Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye
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10
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Mertens A, Benjamin-Chung J, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF. Child wasting and concurrent stunting in low- and middle-income countries. Nature 2023; 621:558-567. [PMID: 37704720 PMCID: PMC10511327 DOI: 10.1038/s41586-023-06480-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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11
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Al-Taj MA, Al Serouri A, Al-Muradi AM, Al-Dharhani E, Al-faeq NN, Al-amodi FM, Abdulwahab MM, Nawfal AM, Alshemerry MH, Mujahed MA. Concurrent wasting and stunting among marginalised children in Sana'a city, Yemen: a cross-sectional study. J Nutr Sci 2023; 12:e91. [PMID: 37587974 PMCID: PMC10425760 DOI: 10.1017/jns.2023.72] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Concurrent wasting and stunting (WaSt) is a serious form of malnutrition among young children, particularly vulnerable groups affected by the conflict. Understanding the prevalence and risk factors of WaSt among vulnerable children is important to develop effective intervention measures to reduce the burden of WaSt. The present study aimed to identify the prevalence of and risk factors for WaSt among marginalised children aged 6-59 months in Sana'a city, Yemen. A community-based cross-sectional design was conducted on a total sample size of 450 marginalised children aged 6-59 months who lived at home with their mothers. Multivariable logistic regression analysis was performed and the prevalence of WaSt was found to be 10⋅7 %. Children aged 24-59 months were protected from WaSt (adjusted odds ratio (AOR) 0⋅40, 95 % confidence interval (CI) 0⋅21, 0⋅75). A higher prevalence of WaSt was associated with male sex (AOR 2⋅31, 95 % CI 1⋅13, 4⋅71), no history of being breastfed (AOR 3⋅57, 95 % CI 1⋅23, 10⋅39), acute diarrhoea (AOR 2⋅12, 95 % CI 1⋅12, 4⋅02) and family income sources of assistance from others (AOR 2⋅74, 95 % CI 1⋅08, 6⋅93) or salary work (AOR 2⋅22, 95 % CI 1⋅10, 4⋅47). Continued breast- and bottle-feeding were not associated with WaSt in children aged 6-23 months. Mothers' age, education and work status, family size and drinking water source were not associated with WaSt. Overall, we found that the prevalence of WaSt among marginalised children remained high. Interventions to improve household income, hygienic conditions and child feeding practices are necessary to promote child growth.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulwahed Al Serouri
- Field Epidemiology Training Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | - Nada Nabil Al-faeq
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Ali Mujahed Nawfal
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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12
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Getu BD, Azanaw KA, Zimamu LY, Adal GM, Tibebu NS, Emiru TD, Atalell KA. Wasting and its associated factors among children aged from 6 to 59 months in Debre Tabor town, Amhara region of Ethiopia, 2019: a multicentre community-based cross-sectional study. BMJ Open 2023; 13:e071679. [PMID: 37407062 DOI: 10.1136/bmjopen-2023-071679] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Wasting is acute malnutrition that has harmful short-term consequences for children and is determined by an inadequate diet. This study aimed to assess the prevalence and associated factors of wasting among children aged 6-59 months in Debre Tabor town, Ethiopia. DESIGN This study was a community-based cross-sectional. SETTING The study was conducted at Debre Tabor town, Ethiopia. PARTICIPANTS A total of 436 children aged 6-59 months participants were enrolled. OUTCOME MEASURES A weight-for-height z-score, which is below -2 SD of the WHO median standard curve, was used to measure wasting. Logistic regression analyses were done to see which independent variables have an association with the dependent variable and a p value of <0.05 was considered significant at the 95% CI. RESULTS The result revealed that wasting in children aged 6-59 months was 6.2%. Children in the age group of 6-11 months were 4.3 times more likely to have wasted than those in the age group of 24-59 months (adjusted OR (AOR): 4.3; 95% CI: 1.5 to 12.5). Similarly, parents who have poor wealth status in their family are 3.1 times more likely to have wasted children than those who have rich wealth status in their family (AOR: 3.1 (1.01 to 9.35)). Moreover, mothers who gave birth at the age group of 20-25 years were 4.3 times more likely to have wasted children than those who gave birth at an age group of greater than 30 years (AOR: 4.3 (4.3 (1.56 to 12.5)). CONCLUSION Wasting is still an important public health problem for children in the age group of 6-59 months. The age of the child, the wealth status of the family, and giving birth before 20 years of age were significantly associated with wasting. Therefore, the government of Ethiopia should pay further attention to the wealth status of the family; create awareness among the mothers regarding childhood undernutrition care, and design further nutritional intervention programmes.
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Affiliation(s)
- Bisrat Dessie Getu
- Department of Nursing, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
| | | | | | - Gashaw Mekete Adal
- Department of Nursing, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Desie Emiru
- Department of Pediatrics and Child Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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13
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Khura B, Mohanty P, Gandhi AP, Patnaik L, Mewara A, Pradhan K, Padhi BK. Mapping Concurrent Wasting and Stunting Among Children Under Five in India: A Multilevel Analysis. Int J Public Health 2023; 68:1605654. [PMID: 37350797 PMCID: PMC10282129 DOI: 10.3389/ijph.2023.1605654] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/05/2023] [Indexed: 06/24/2023] Open
Abstract
Objectives: The study aims to examine the coexisting forms, patterns, and predictors of concurrent wasting and stunting (WaSt) among children under five in India. Methods: We used data from the National Family Health Survey to understand the trend and association of WaSt among children under five-year-old in India. Univariate analysis and cross-tabulations were performed for WaSt cases. The association was determined using multilevel binary logistic regression and multilevel regression, and the results were provided as adjusted odds ratios (aOR) with 95% confidence intervals at the significance level of p < 0.05. Results: The prevalence of WaSt has decreased from 8.7% in 2005-06 to 5.2 percent in 2019-2020. The proportion of WaSt children grew rapidly from 6 to 18 months, peaked at 19 months (8%), then dropped after 24 months. The prevalence of concurrent wasting and stunting is higher among boys compared to girls. Compared to children of different birth orders, those in the higher birth order are 1.2 times more likely to be WaSt cases (aOR = 1.20, 95% CI = 1.09, 1.33). The education of the mother is strongly correlated with WaSt instances, and children of more educated mothers have a 47% lower chance of being WaSt cases (aOR = 0.63, 95% CI = 0.57, 0.71). Children from wealthy families are 52% less likely to be WaSt cases (aOR = 0.48, 95% CI = 0.43, 0.55). Conclusion: This study emphasizes the importance of concurrent wasting and stunting and its relationship with socioeconomic factors among children under five in India.
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Affiliation(s)
- Bikash Khura
- International Institute for Population Sciences, Mumbai, India
| | - Parimala Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to Be University, Bhubaneswar, India
| | - Aravind P Gandhi
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, India
| | - Lipilekha Patnaik
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to Be University, Bhubaneswar, India
| | - Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Khan MNA, Yunus RM. A hybrid ensemble approach to accelerate the classification accuracy for predicting malnutrition among under-five children in sub-Saharan African countries. Nutrition 2023; 108:111947. [PMID: 36641887 DOI: 10.1016/j.nut.2022.111947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The proper intake of nutrients is essential to the growth and maturation of youngsters. In sub-Saharan Africa, 1 in 7 children dies before age 5 y, and more than a third of these deaths are attributed to malnutrition. The main purpose of this study was to develop a majority voting-based hybrid ensemble (MVBHE) learning model to accelerate the prediction accuracy of malnutrition data of under-five children in sub-Saharan Africa. METHODS This study used available under-five nutritional secondary data from the Demographic and Health Surveys performed in sub-Saharan African countries. The research used bagging, boosting, and voting algorithms, such as random forest, decision tree, eXtreme Gradient Boosting, and k-nearest neighbors machine learning methods, to generate the MVBHE model. RESULTS We evaluated the model performances in contrast to each other using different measures, including accuracy, precision, recall, and the F1 score. The results of the experiment showed that the MVBHE model (96%) was better at predicting malnutrition than the random forest (81%), decision tree (60%), eXtreme Gradient Boosting (79%), and k-nearest neighbors (74%). CONCLUSIONS The random forest algorithm demonstrated the highest prediction accuracy (81%) compared with the decision tree, eXtreme Gradient Boosting, and k-nearest neighbors algorithms. The accuracy was then enhanced to 96% using the MVBHE model. The MVBHE model is recommended by the present study as the best way to predict malnutrition in under-five children.
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15
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Sahiledengle B, Agho KE, Petrucka P, Kumie A, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Mwanri L. Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects modelling. Matern Child Nutr 2023; 19:e13483. [PMID: 36757269 PMCID: PMC10019057 DOI: 10.1111/mcn.13483] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Kingsley E. Agho
- School of Health SciencesWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research Institute, School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- African Vision Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | | | - Abera Kumie
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Girma Beressa
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Daniel Atlaw
- Department of Human AnatomyMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Yohannes Tekalegn
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Demisu Zenbaba
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Fikreab Desta
- Department of Public HealthMadda Walabu University Goba Referral HospitalBale‐GobaEthiopia
| | - Lillian Mwanri
- Torrens University AustraliaAdelaideSouth AustraliaAustralia
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Mutonhodza B, Dembedza MP, Lark MR, Joy EJM, Manzeke-Kangara MG, Njovo H, Nyadzayo TK, Kalimbira AA, Bailey EH, Broadley MR, Matsungo TM, Chopera P. Anemia in children aged 6-59 months was significantly associated with maternal anemia status in rural Zimbabwe. Food Sci Nutr 2023; 11:1232-1246. [PMID: 36911837 PMCID: PMC10003031 DOI: 10.1002/fsn3.3157] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/26/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022] Open
Abstract
Globally, anemia is a public health problem affecting mostly women of reproductive age (WRA, n = 452) and children aged 6-59 months (n = 452) from low- and lower-middle-income countries. This cross-sectional study assessed the prevalence and determinants of anemia in WRA and children aged 6-59 months in rural Zimbabwe. The venous blood sample was measured for hemoglobin utilizing a HemoCue machine. Anthropometric indices were assessed and classified based on World Health Organization standards. Socioeconomic characteristics were assessed. The median (±inter quartile range (IQR)) age of WRA was 29 ± 12 years and that for children was 29 ± 14 months. The prevalence of anemia was 29.6% and 17.9% in children and WRA, respectively, while the median (±IQR) hemoglobin levels were 13.4 ± 1.8 and 11.7 ± 1.5 g/dl among women and children, respectively. Multiple logistic regression analysis was used to assess determinants of anemia. Anemia in children was significantly associated with maternal anemia (odds ratio (OR) = 2.02; 95% CI 1.21-3.37; p = .007) and being a boy (OR = 0.63; 95% CI 0.41-0.95; p = .029), while anemia in WRA was significantly associated with the use of unimproved dug wells as a source of drinking water (OR = 0.36; 95% CI 0.20-0.66; p = .001) and lack of agricultural land ownership (OR = 0.51; 95% CI 0.31-0.85; p = .009). Anemia is a public health problem in the study setting. The positive association between maternal and child anemia reflects the possibility of cross-generational anemia. Therefore, interventions that focus on improving preconceptual and maternal nutritional status may help to reduce anemia in low-income settings.
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Affiliation(s)
- Beaula Mutonhodza
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Mavis P Dembedza
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Murray R Lark
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK
| | - Edward J M Joy
- London School for Hygiene & Tropical Medicine London UK.,Rothamsted Research Harpenden UK
| | | | - Handrea Njovo
- National Nutrition Unit Ministry of Health and Child Care of Zimbabwe Harare Zimbabwe
| | - Tasiana K Nyadzayo
- National Nutrition Unit Ministry of Health and Child Care of Zimbabwe Harare Zimbabwe
| | - Alexander A Kalimbira
- Department of Human Nutrition and Health Lilongwe University of Agriculture and Natural Resources Lilongwe Malawi
| | - Elizabeth H Bailey
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK
| | - Martin R Broadley
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK.,Rothamsted Research Harpenden UK
| | - Tonderayi M Matsungo
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Prosper Chopera
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
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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.
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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
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18
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Zubair A, Fatima S, Habib H, Nazli R, Shah I, Shah M. Effects of Oral Lipid-Based nutritional supplements on appetite, energy intake, and lipid profile of moderately underweight children. Food Sci Nutr 2023; 11:903-916. [PMID: 36789036 PMCID: PMC9922128 DOI: 10.1002/fsn3.3125] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
Oral lipid-based nutritional supplements (LNS) are designed to ensure dietary adequacy and to improve malnourishment in children. Therefore, this study investigated the effects of 4 weeks of LNS on appetite, energy intake, and lipid profile of moderately underweight children (5-10 years old) with BMI-Z score between -2 and - 3 SDS, recruited in a single-blind randomized control trial. In addition to the regular dietary intake, fasting blood samples, anthropometric measurements, energy intake, and appetite responses were obtained before and after 4 weeks of LNS (535 kcal) or PLACEBO (92 kcal). After 4 weeks of supplementation mean energy intake (kcal) (p < .001), body weight (kg) (p < .001), BMI (kg/m2) (p < .01), mid-upper arm circumference (cm) (p < .01), total cholesterol (mg/dl) (p < .01) and fasting glucose (mg/dl) (p < .01) were raised significantly in the LNS group as compared to the PLACEBO group. No significant changes were detected in appetite responses (p > 0.05). In conclusion, LNS increases the overall energy intake, but does not affect the appetite but may induce hyperglycemia and hyperlipidemia.
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Affiliation(s)
- Aqsa Zubair
- Department of BiochemistryInstitute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU)PeshawarPakistan
| | - Sadia Fatima
- Department of BiochemistryInstitute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU)PeshawarPakistan
| | - Hamid Habib
- Department of PhysiologyInstitute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU)PeshawarPakistan
| | - Rubina Nazli
- Department of BiochemistryInstitute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU)PeshawarPakistan
| | - Inayat Shah
- Department of PhysiologyInstitute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU)PeshawarPakistan
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19
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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.
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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
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20
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Odei Obeng‐Amoako GA, Stobaugh H, Wrottesley SV, Khara T, Binns P, Trehan I, Black RE, Webb P, Mwangome M, Bailey J, Bahwere P, Dolan C, Boyd E, Briend A, Myatt MA, Lelijveld N. How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies. Matern Child Nutr 2022; 19:e13434. [PMID: 36262055 PMCID: PMC9749592 DOI: 10.1111/mcn.13434] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/13/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review.
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Affiliation(s)
| | - Heather Stobaugh
- Action Against Hunger USANew York CityNew YorkUSA,Friedman School of Nutrition Science and Policy at Tufts UniversityBostonMassachusettsUSA
| | | | - Tanya Khara
- Emergency Nutrition Network (ENN)KidlingtonUK
| | | | - Indi Trehan
- Departments of Paediatrics, Global Health, and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Robert E. Black
- Institute for International ProgrammesJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy at Tufts UniversityBostonMassachusettsUSA,Emergency Nutrition Network (ENN)KidlingtonUK
| | - Martha Mwangome
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research‐CoastKilifiKenya
| | | | - Paluku Bahwere
- Center for Epidémiology, Biostatistics and Clinical Research (CR2), School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
| | | | - Erin Boyd
- Friedman School of Nutrition Science and Policy at Tufts UniversityBostonMassachusettsUSA,USAID/BHAWashingtonDistrict of ColumbiaUSA
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark,Center for Child Health Research, Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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21
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Namirembe G, Ghosh S, Ausman LM, Shrestha R, Zaharia S, Bashaasha B, Kabunga N, Agaba E, Mezzano J, Webb P. Child stunting starts in utero: Growth trajectories and determinants in Ugandan infants. Maternal & Child Nutrition 2022; 18:e13359. [PMID: 35488408 PMCID: PMC9218325 DOI: 10.1111/mcn.13359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023]
Abstract
Childhood stunting remains a public health burden worldwide. Although many studies have examined early life and in‐utero risk factors; most have been observational and have used analytic techniques that make inferences limited to population means, thereby obscuring important within‐group variations. This study addressed that important gap. Using data from a birth cohort of Ugandan infants (n = 4528), we applied group‐based trajectory modelling to assess diverse patterns of growth among children from birth to 1‐year old. A multinomial regression model was conducted to understand the relationship between risk factors and observed patterns across groups. We found that the onset of stunting occurred before birth and followed four distinct growth patterns: chronically stunted (Group 1), recovery (Group 2), borderline stunted (Group 3) and normal (Group 4). The average length‐for‐age z‐score (LAZ) at birth was −2.6, −3.9, −0.6 and 0.5 for Groups 1–4, respectively. Although both Groups 1 and 2 were stunted at birth, stunting persisted in Group 1 while children in Group 2 recovered by the fourth month. Group 3 exhibited mild stunting while Group 4 was normal. Wasting and underweight were observed in all groups, with the highest prevalence of underweight in Group 1. Wasting gradually increased among children born already stunted (Groups 1 and 2). This showed the importance of distinguishing children by their growth patterns rather than aggregating them and only comparing population averages against global growth standards. The design of nutrition interventions should consider the differential factors and potential for growth gains relative to different risks within each group. In a sample of Ugandan infants, the onset of stunting occurred in utero and set in motion a range of possible growth trajectories for the child after birth. Child growth can be characterised by diverse patterns that suggest temporal variations in children's growth. This provides an opportunity for policymakers to provide specialised and targeted nutrition interventions. Addressing low birth weight, preterm births and small‐for‐gestational‐age is critical to effectively reduce rates of stunting in rural Uganda.
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Affiliation(s)
- Grace Namirembe
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Shibani Ghosh
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Lynne M. Ausman
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Robin Shrestha
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Sonia Zaharia
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Nassul Kabunga
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Edgar Agaba
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Julieta Mezzano
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Patrick Webb
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
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22
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Montenegro CR, Gomez G, Hincapie O, Dvoretskiy S, DeWitt T, Gracia D, Misas JD. The pediatric global burden of stunting: Focus on Latin America. Lifestyle Medicine 2022. [DOI: 10.1002/lim2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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23
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Yazew T, Daba A, Formanowicz D. Associated Factors of Wasting among Infants and Young Children (IYC) in Kuyu District, Northern Oromia, Ethiopia. BioMed Research International 2022; 2022:1-8. [PMID: 35909485 PMCID: PMC9328999 DOI: 10.1155/2022/9170322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Wasting among infants and young children in underdeveloped countries including Ethiopia is one of the most serious public health issues. Therefore, this study was designed to assess the magnitude of wasting and the variables that associate with it among infants and young children in the Kuyu district of Northern Oromia, Ethiopia. A community-based cross-sectional study of 612 infants and young children aged 6-23 months was conducted. To select eligible infants and young children from each family in the Kuyu district, a multilevel sampling approach was used. The amount and determinants related to wasting were investigated using the Statistical Package for Social Sciences (SPSS) version 20.0. In the study area, 14.1% of infants and young children were found to be wasting. Maternal educational status (AOR = 1.8, 95% CI; 1.01, 4.32), diarrhoea (AOR = 2.3, 95% CI; 1.98, 4.56), exclusive breastfeeding (AOR = 2.46, 95% CI, 1.4, 4.58), antenatal care visits (AOR = 2.21; 95% CI, 1.32, 3.48), and wealth index (AOR = 1.66, 95% CI; 1.07, 4.47) were significantly associated with wasting. According to the findings of this study, mother educational status, the occurrence of diarrhoea, exclusive breastfeeding, antenatal care visits, and wealth index have an impact on infants and young children's wasting. Therefore, to lower the burden of wasting among infants and young children in the study, community-based schooling and nutritional interventions are urgently needed.
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24
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Sadler K, James PT, Bhutta ZA, Briend A, Isanaka S, Mertens A, Myatt M, O'Brien KS, Webb P, Khara T, Wells JC. How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project. J Nutr 2022; 152:2645-2651. [PMID: 35687496 PMCID: PMC9839990 DOI: 10.1093/jn/nxac091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023] Open
Abstract
Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.
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Affiliation(s)
| | | | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada,Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark,Center for Child Health Research, Tampere University, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Epicentre, Paris, France
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | - Mark Myatt
- Emergency Nutrition Network, Kidlington, United Kingdom,Brixton Health, Llwyngwril, Gwynedd, Wales, United Kingdom
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, United Kingdom
| | - Jonathan C Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, United Kingdom
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25
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Guha S, Das S, Baffour B, Chandra H. Multivariate small area modelling of undernutrition prevalence among under-five children in Bangladesh. Int J Biostat 2022:ijb-2021-0130. [PMID: 35624076 DOI: 10.1515/ijb-2021-0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022]
Abstract
District-representative data are rarely collected in the surveys for identifying localised disparities in Bangladesh, and so district-level estimates of undernutrition indicators - stunting, wasting and underweight - have remained largely unexplored. This study aims to estimate district-level prevalence of these indicators by employing a multivariate Fay-Herriot (MFH) model which accounts for the underlying correlation among the undernutrition indicators. Direct estimates (DIR) of the target indicators and their variance-covariance matrices calculated from the 2019 Bangladesh Multiple Indicator Cluster Survey microdata have been used as input for developing univariate Fay-Herriot (UFH), bivariate Fay-Herriot (BFH) and MFH models. The comparison of the various model-based estimates and their relative standard errors with the corresponding direct estimates reveals that the MFH estimator provides unbiased estimates with more accuracy than the DIR, UFH and BFH estimators. The MFH model-based district level estimates of stunting, wasting and underweight range between 16 and 43%, 15 and 36%, and 6 and 13% respectively. District level bivariate maps of undernutrition indicators show that districts in north-eastern and south-eastern parts are highly exposed to either form of undernutrition, than the districts in south-western and central parts of the country. In terms of the number of undernourished children, millions of children affected by either form of undernutrition are living in densely populated districts like the capital district Dhaka, though undernutrition indicators (as a proportion) are comparatively lower. These findings can be used to target districts with a concurrence of multiple forms of undernutrition, and in the design of urgent intervention programs to reduce the inequality in child undernutrition at the localised district level.
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Affiliation(s)
- Saurav Guha
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India.,Health Analytics Network, Pittsburgh, PA, USA
| | - Sumonkanti Das
- School of Demography, Australian National University, Canberra, Australia
| | - Bernard Baffour
- School of Demography, Australian National University, Canberra, Australia
| | - Hukum Chandra
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
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26
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Das S, Baffour B, Richardson A. Prevalence of child undernutrition measures and their spatio-demographic inequalities in Bangladesh: an application of multilevel Bayesian modelling. BMC Public Health 2022; 22:1008. [PMID: 35585516 PMCID: PMC9118603 DOI: 10.1186/s12889-022-13170-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/15/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this regard district-representative data were collected in the Bangladesh Multiple Indicator Cluster Survey 2019 for identifying localised disparities. However, district-level estimates of undernutrition indicators - stunting, wasting and underweight - remain largely unexplored. This study aims to estimate district-level prevalence of these indicators as well as to explore their disparities at sub-national (division) and district level spatio-demographic domains cross-classified by children sex, age-groups, and place of residence. Bayesian multilevel models are developed at the sex-age-residence-district level, accounting for cross-sectional, spatial and spatio-demographic variations. The detailed domain-level predictions are aggregated to higher aggregation levels, which results in numerically consistent and reasonable estimates when compared to the design-based direct estimates. Spatio-demographic distributions of undernutrition indicators indicate south-western districts have lower vulnerability to undernutrition than north-eastern districts, and indicate significant inequalities within and between administrative hierarchies, attributable to child age and place of residence. These disparities in undernutrition at both aggregated and disaggregated spatio-demographic domains can aid policymakers in the social inclusion of the most vulnerable to meet the sustainable development goals by 2030.
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Affiliation(s)
- Sumonkanti Das
- School of Demography, Australian National University, Ellery Crescent, Canberra, 2601, ACT, Australia.
| | - Bernard Baffour
- School of Demography, Australian National University, Ellery Crescent, Canberra, 2601, ACT, Australia
| | - Alice Richardson
- Statistical Support Network, Australian National University, Science Road, Canberra, 2601, ACT, Australia
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27
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Affiliation(s)
- Osafu Augustine Egbon
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
- Department of Statistics, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Asrat Mekonnen Belachew
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
- Department of Mathematics, Ambo University, Ambo, Ethiopia
| | - Mariella Ananias Bogoni
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
- Department of Statistics, Universidade Federal de São Carlos, São Carlos, Brazil
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28
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Gausman J, Kim R, Li Z, Tu L, Rajpal S, Joe W, Subramanian SV. Comparison of Child Undernutrition Anthropometric Indicators Across 56 Low- and Middle-Income Countries. JAMA Netw Open 2022; 5:e221223. [PMID: 35275168 PMCID: PMC8917428 DOI: 10.1001/jamanetworkopen.2022.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The United Nations' Sustainable Development Goal Target 2.2 seeks to end all forms of malnutrition by 2030 by meeting targets, including the elimination of stunting and wasting in all children younger than 5 years. Such indicators are used to monitor childhood undernutrition but may not provide a complete picture at a population level. OBJECTIVE To compare global estimates of the prevalence of undernutrition using conventional indicators of anthropometric failure (AF; stunting, underweight, and wasting); the Composite Index of Anthropometric Failure (CIAF); and a proposed classification system called Categories of Anthropometric Failure (CAF) as well as to investigate the association of the conventional indicators, CIAF, and CAF with diarrheal disease as an assessment of the validity of each measure. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the prevalence of undernutrition among children in 56 low- and middle-income countries using data from the nationally representative Demographic and Health Surveys. The study included 530 906 children younger than 5 years. Data were collected from June 2005 to December 2018 and analyzed from September 27, 2020, to February 4, 2021. MAIN OUTCOMES AND MEASURES Undernutrition identified according to conventional indicators (stunting, underweight, and wasting), the CIAF, and the proposed CAF classification system was estimated and compared. Six logistic regression models were used to examine the association between different classifications of anthropometric failure (AF) and morbidity. RESULTS A total of 530 906 children (mean [SD] age, 29.0 [17.2] months; 272 355 [51.3%] boys and 258 551 [48.7%] girls) from 56 low- and middle-income countries were included in the analysis. Estimates of undernutrition generated using the conventional indicators of stunting, underweight, and wasting were lower than estimates generated using the CIAF in all countries. The CAF classification system pointed to considerable variation across countries in children with multiple AFs, which does not correspond to the overall prevalence of undernutrition. For example, 7.5% of children in Niger and 7.1% of children in Timor-Leste were stunted, underweight, and wasted, while 56.0% of children in Niger and 71.1% of children in Timor-Leste were undernourished according to the CIAF. In addition, children who had stunting, underweight, and wasting had 1.52 (95% CI, 1.45-1.61) times the odds of diarrhea compared with children who exhibited no AFs. CONCLUSIONS AND RELEVANCE The results of this study highlight the importance of using different approaches to aid understanding of the entire spectrum of AF with regard to research and development of policies and programs to address AF. The use of the CIAF and the CAF classification system may be useful for treatment to prevent AFs and could accelerate progress in meeting targets for the Sustainable Development Goal.
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Affiliation(s)
- Jewel Gausman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Zhihui Li
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lucia Tu
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Sunil Rajpal
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Department of Economics, FLAME University, New Delhi, India
| | - William Joe
- Population Research Centre, Institute of Economic Growth, Delhi University Enclave, North Campus, Delhi, India
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Samuel A, Osendarp SJM, Feskens EJM, Lelisa A, Adish A, Kebede A, Brouwer ID. Gender differences in nutritional status and determinants among infants (6–11 m): a cross-sectional study in two regions in Ethiopia. BMC Public Health 2022; 22:401. [PMID: 35219315 PMCID: PMC8881837 DOI: 10.1186/s12889-022-12772-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A limited number of studies suggest that boys may have a higher risk of stunting than girls in low-income countries. Little is known about the causes of these gender differences. The objective of the study was to assess gender differences in nutritional status and its determinants among infants in Ethiopia.
Methods
We analyzed data for 2036 children (6–11 months old) collected as the baseline for a multiple micronutrient powders effectiveness study in two regions of Ethiopia in March–April 2015. Child, mother, and household characteristics were investigated as determinants of stunting and wasting. Multiple logistic regression models were used separately for boys and girls to check for gender differences while adjusting for confounders. The study is registered at http://www.clinicaltrials.gov/ with the clinical trials identifier of NCT02479815.
Results
Stunting and wasting prevalence is significantly higher among boys compared to girls, 18.7 vs 10.7% and 7.9 vs 5.4%, respectively. Untimely initiation of breastfeeding, not-exclusive breastfeeding at the age of 6 months, region of residence, and low maternal education are significant predictors of stunting in boys. Untimely introduction to complementary food and low consumption of legumes/nuts are significant predictors of stunting in both boys and girls, and low egg consumption only in girls. Region of residence and age of the mother are significant determinants of wasting in both sexes. Analysis of interaction terms for stunting, however, shows no differences in predictors between boys and girls; only for untimely initiation of breastfeeding do the results for boys (OR 1.46; 95%CI 1.02,2.08) and girls (OR 0.88; 95%CI 0.55,1.41) tend to be different (p = 0.12).
Conclusion
In Ethiopia, boys are more malnourished than girls. Exclusive breastfeeding and adequate dietary diversity of complementary feeding are important determinants of stunting in boys and girls. There are no clear gender interactions for the main determinants of stunting and wasting. These findings suggest that appropriate gender-sensitive guidance on optimum infant and young child feeding practices is needed.
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Thurstans S, Opondo C, Seal A, Wells JC, Khara T, Dolan C, Briend A, Myatt M, Garenne M, Mertens A, Sear R, Kerac M. Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients 2022; 14:nu14050948. [PMID: 35267923 PMCID: PMC8912557 DOI: 10.3390/nu14050948] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 01/27/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/27/2022] Open
Abstract
Complementing a recent systematic review and meta-analysis which showed that boys are more likely to be wasted, stunted, and underweight than girls, we conducted a narrative review to explore which early life mechanisms might underlie these sex differences. We addressed different themes, including maternal and newborn characteristics, immunology and endocrinology, evolutionary biology, care practices, and anthropometric indices to explore potential sources of sex differences in child undernutrition. Our review found that the evidence on why sex differences occur is limited but that a complex interaction of social, environmental, and genetic factors likely underlies these differences throughout the life cycle. Despite their bigger size at birth and during infancy, in conditions of food deprivation, boys experience more undernutrition from as early as the foetal period. Differences appear to be more pronounced in more severe presentations of undernutrition and in more socioeconomically deprived contexts. Boys are more vulnerable to infectious disease, and differing immune and endocrine systems appear to explain some of this disadvantage. Limited evidence also suggests that different sociological factors and care practices might exert influence and have the potential to exacerbate or reverse observed differences. Further research is needed to better understand sex differences in undernutrition and the implications of these for child outcomes and prevention and treatment programming.
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Affiliation(s)
- Susan Thurstans
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.S.); (M.K.)
- Correspondence:
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Andrew Seal
- UCL Institute for Global Health, London WC1E 6BT, UK;
| | - Jonathan C. Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Tanya Khara
- Emergency Nutrition Network, Oxford OX5 2DN, UK; (T.K.); (C.D.)
| | - Carmel Dolan
- Emergency Nutrition Network, Oxford OX5 2DN, UK; (T.K.); (C.D.)
| | - André Briend
- Center for Child Health Research, School of Medicine, Tampere University, 33520 Tampere, Finland;
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Mark Myatt
- Brixton Health, Llwyngwril, Gwynedd LL37 2JD, Wales, UK;
| | - Michel Garenne
- Institut de Recherche pour le Développement, UMI Résiliences, 93140 Bondy, France;
- Institut Pasteur, Epidémiologie des Maladies Emergentes, 75015 Paris, France
- Senior Fellow, FERDI, Université d’Auvergne, 63000 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 2193, South Africa
| | - Andrew Mertens
- School of Public Health, University of California, Berkeley, CA 94720-7360, USA;
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.S.); (M.K.)
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.S.); (M.K.)
- Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Sanjeev RK, Nuggehalli Srinivas P, Krishnan B, Basappa YC, Dinesh AS, Ulahannan SK. Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets. Wellcome Open Res 2022; 5:118. [PMID: 35720193 PMCID: PMC9194519 DOI: 10.12688/wellcomeopenres.15934.4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The previous round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence at six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of wheat. In multivariable analysis, wasting was positively associated with women’s body mass index and stunting with women’s short stature. Conclusions: Well-designed intervention studies will be required to confirm causal pathways contributing to ecogeographic patterns of child malnutrition. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
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Affiliation(s)
- Rama Krishna Sanjeev
- Pediatrics, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | | | - Bindu Krishnan
- Physiology, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | - Yogish Channa Basappa
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | | | - Sabu K. Ulahannan
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
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Zaba T, Conkle J, Nyawo M, Foote D, Myatt M. Concurrent wasting and stunting among children 6-59 months: an analysis using district-level survey data in Mozambique. BMC Nutr 2022; 8:15. [PMID: 35180886 PMCID: PMC8855563 DOI: 10.1186/s40795-022-00508-9] [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: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the past it was believed that wasting and stunting were independent of each other. Recent work has shown that they can occur concurrently in a child and that increases considerably the risk of mortality. Concurrent wasting and stunting (WaSt) is currently defined as WHZ < -2 AND HAZ < -2. Wasting is measured by WHZ and MUAC and evidence shows that they tend to identify different sets of children. Our study aimed to look at the effect of adding MUAC on the prevalence and burden of WaSt, and to assess diagnosis of WaSt with a single measurement. Methods We analyzed population-based anthropometric surveys from 37 districts in Mozambique conducted by the Government of Mozambique between 2017 and 2019. We proposed a new case-definition for WaSt that includes MUAC in acknowledgement of the different children with wasting diagnosed by WHZ and MUAC. We estimated how many WaSt cases are eligible to be included in the existing treatment program in Mozambique by calculating the True Positive and False Positive Values of WaSt using our proposed case-definition against the wasting admission criteria. AUC of ROC curves used for MUAC and WAZ and optimal cut-offs were determined using Youden’s Index. Results Including MUAC in the concurrent WaSt case-definition identified more children with WaSt compared to the original case-definition and more younger children and girls were identified. Using both MUAC and WHZ and enrolling severe and moderate wasting is already picking up most of the WaSt cases: 100% in health facilities and 79.40% with MUAC mass screenings at community level. Cut-off values from the ROC curve for the proposed case-definition were MUAC ≤133 mm and WAZ ≤ 2.145 Z-scores, however, they yielded many false positive values. Conclusion WaSt case-definition should include MUAC. WaSt should commence to be reported in surveys and Mozambique should also start monitoring and treating children with WaSt. A cost-effective approach to identify all children with WaSt without adding too many false positive is needed, as well as understanding how to achieve optimal treatment outcomes within existing programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00508-9.
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Affiliation(s)
- Tomás Zaba
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique.
| | - Joel Conkle
- United Nations Children's Fund, 1st Floor UN House, 38-44 Stein St, Klein Windhoek, Namibia
| | - Mara Nyawo
- United Nations Children's Fund, Eastern and Southern Africa Regional Office, PO Box 44145-00100, Nairobi, Kenya
| | - Dorothy Foote
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique
| | - Mark Myatt
- Brixton Health, Cilfach Greigiog, Llwyngwril, Gwynedd, Wales, LL37 2JD 5RJ, UK
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Abstract
CONTEXT Child stunting has increasingly become the focus of large-scale global health efforts with the inclusion of stunting eradication as one of the Sustainable Development Goals of the United Nations. Child sex has been identified as a biological risk factor for stunting, and sex-specific approaches to stunting prevention have been proposed. OBJECTIVE This paper examines four pathways, developmental sensitivity, energetics, caretaking and measurement, proposed to contribute to sex differences in linear growth faltering and stunting risk. METHODS Anthropological, public health and clinical literature on sex differences in stunting and the mechanisms contributing to variability across contexts are reviewed. RESULTS The direction of sex differences in stunting prevalence varies across countries and between households. Sex differences in growth trajectories and immune function beginning prenatally place boys at greater risk of infection and undernutrition, but these biological differences are interpreted by parents and within household contexts that are shaped by social and cultural norms which, in turn, influence care and feeding practices. CONCLUSION A perspective that incorporates an examination of the social and environmental factors shaping child growth in specific contexts is needed to understand sex-based vulnerability to stunting and to develop context-appropriate interventions.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hjellbakk VK, Hailemariam H, Reta F, Engebretsen IMS. Diet and nutritional status among hospitalised children in Hawassa, Southern Ethiopia. BMC Pediatr 2022; 22:57. [PMID: 35062911 PMCID: PMC8781358 DOI: 10.1186/s12887-022-03107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Undernutrition constitutes a major problem among children in Hawassa, Ethiopia, and the literature on nutritional status in hospitalised children is scarce. The aim of this study was to investigate dietary diversity, nutritional practices, and the frequencies of undernutrition and the factors associated with severe acute malnutrition (SAM) in a hospitalised paediatric population in Hawassa, Southern Ethiopia. Methods A hospital-based cross-sectional study was carried out among hospitalised children in Hawassa, Southern Ethiopia. Children aged 6 to 59 months and their caregivers admitted for >24 hours from two public hospitals in Hawassa between November 2019 and January 2020 were included. Dietary diversity was assessed using World Health Organization (WHO) guidelines. Weight and height/length of the children were measured, and z-scores were calculated using the WHO growth standards. The definition of SAM was a weight-for-height z-score (WHZ) less than –3 or a clinically confirmed SAM diagnosis with higher WHZ. Results A total of 188 caregiver-child pairs were assessed in the two public hospitals. The majority of the patients were admitted with SAM (N = 70/188, 37%) or respiratory tract infections (N = 44/188, 23%). There was a similar number of boys and girls with SAM. Of all the children, 59% reported to have consumed foods from fewer than four food groups, while 40% reported eating foods from four or more food groups. The rate of malnutrition was high, and 35.8% of the children were classified as wasted (WHZ < –2) and 41% were stunted (height-for-age z-score < –2). Nearly 30% of the SAM patients were also stunted. Conclusion This study revealed that hospitalised children in this setting had poor dietary diversity and nutritional status, a high degree of morbidity, and extreme poverty. There is thus a need to focus on nutrition patterns in clinical settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03107-6.
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Thurstans S, Sessions N, Dolan C, Sadler K, Cichon B, Isanaka S, Roberfroid D, Stobaugh H, Webb P, Khara T. The relationship between wasting and stunting in young children: A systematic review. Matern Child Nutr 2022; 18:e13246. [PMID: 34486229 PMCID: PMC8710094 DOI: 10.1111/mcn.13246] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near-term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z score might effectively identify children at most risk of near-term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.
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Affiliation(s)
- Susan Thurstans
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited KingdomUK
- Emergency Nutrition NetworkOxfordUK
| | | | | | | | | | - Sheila Isanaka
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of ResearchEpicentreParisFrance
| | - Dominique Roberfroid
- Faculty of MedicineUniversity of NamurNamurBelgium
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
| | - Heather Stobaugh
- Action Against Hunger USANew YorkNew YorkUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Patrick Webb
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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Amadu I, Seidu AA, Duku E, Boadu Frimpong J, Hagan Jnr JE, Aboagye RG, Ampah B, Adu C, Ahinkorah BO. Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries. BMJ Open 2021; 11:e052267. [PMID: 34930735 PMCID: PMC8689177 DOI: 10.1136/bmjopen-2021-052267] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA). DESIGN Data of 127, 487 under-5 children from 31 countries in SSA were pooled from the Demographic and Health Surveys collected between 2010 and 2019. We examined the risk of coexistence of stunting, underweight, and wasting using multinomial logistic regression models. The results were presented using relative risk ratios (RRR) with corresponding confidence intervals (CIs). SETTING Thirty-one sub-Saharan African countries. PARTICIPANTS Children under age 5. OUTCOME MEASURES The outcome variables were three child anthropometrics: stunting (height-for-age z-scores); underweight (weight-for-age z-scores) and wasting (weight-for-height z-scores). RESULTS The prevalence of coexistence of stunting, underweight, and wasting varied across countries, with the highest (12.14%) and lowest (0.58%) prevalences of coexistence of stunting, underweight and wasting in Benin and Gambia respectively. The risk of coexistence of the three indicators of undernutrition was higher among children aged 1 year (RRR=3.714; 95% CI 3.319 to 4.156) compared with those aged 0. The risk of coexistence of the three dimensions was lower among female children (RRR=0.468 95% CI 0.420 to 0.51), but higher for those with small size at birth (RRR=3.818; CI 3.383 to 4.308), those whose mothers had no education (RRR=3.291; 95% CI 1.961 to 5.522), not working (RRR=1.195; 95% CI 1.086 to 1.314), had no antenatal visits during pregnancy (RRR=1.364; 95% CI 1.20 to 1.541), children delivered at home (RRR=1.372; CI 1.232 to 1.529), those from poor households (RRR=1.408; 95% CI 1.235 to 1.605), those whose mothers had no access to media (RRR=1.255; 95% CI 1.144 to 1.377) and living in households with an unimproved toilet facility (RRR=1.158; 95% CI 1.032 to 1.300). CONCLUSIONS Findings suggest the urgent need for consideration of the coexistence of stunting, wasting and underweight among under-5 children in policy design and programming of interventions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics.
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Affiliation(s)
- Iddrisu Amadu
- Africa Centre of Excellence in Coastal Resilience, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
- Emperiks Research, Tamale, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Eric Duku
- Africa Centre of Excellence in Coastal Resilience, University of Cape Coast, Cape Coast, Ghana
- Department of Fisheries and Aquatic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - James Boadu Frimpong
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Central, Ghana
| | - John Elvis Hagan Jnr
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Central, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Belinda Ampah
- Department of Academics, Nursing and Midwifery Training College, Esiama, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Ultimo NSW, Australia
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Chowdhury MRK, Khan HTA, Rashid M, Kabir R, Islam S, Shariful Islam M, Kader M. Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting or underweight) among children under 5 in Bangladesh: a nationally representative cross-sectional study. BMJ Open 2021; 11:e052814. [PMID: 34903543 PMCID: PMC8672009 DOI: 10.1136/bmjopen-2021-052814] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh. DESIGN A nationally representative cross-sectional study. SETTING Bangladesh. RESPONDENTS Children age under 5 years of age. OUTCOME MEASURE This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition. STATISTICAL ANALYSIS Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis. RESULTS Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24-35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24-35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father's occupation, children's age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition. CONCLUSION One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father's occupation, children's age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children.
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Affiliation(s)
| | - Hafiz T A Khan
- College of Nursing, Midwifery and Healthcare, University of West London, Brentford, London, UK
| | - Mamunur Rashid
- Department of Public Health and Sports Sciences, University of Gävle, Gavle, Gävleborg, Sweden
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, London, UK
| | - Sazin Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Md Shariful Islam
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
| | - Manzur Kader
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Naga Rajeev L, Saini M, Kumar A, Sinha S, Osmond C, Sachdev HS. Weight-for-height is associated with an overestimation of thinness burden in comparison to BMI-for-age in under-5 populations with high stunting prevalence. Int J Epidemiol 2021; 51:1012-1021. [PMID: 35020895 DOI: 10.1093/ije/dyab238] [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] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thinness at <5 years of age, also known as wasting, is used to assess the nutritional status of populations for programmatic purposes. Thinness may be defined when either weight-for-height or body-mass-index-for-age (BMI-for-age) are below -2 SD of the respective World Health Organization standards. These definitions were compared for quantifying the burden of thinness. METHODS Theoretical consequences of ignoring age were evaluated by comparing, at varying height-for-age z-scores, the age- and sex-specific cut-offs of BMI that would define thinness with these two metrics. Thinness prevalence was then compared in simulated populations (short, intermediate and tall) and real-life data sets from research and the National Family Health Survey-4 (NFHS-4) in India. RESULTS In short (-2 SD) children, the BMI cut-offs with weight-for-height criteria were higher in comparison to BMI-for-age after 1 year of age but lower at earlier ages. In Indian research and NFHS-4 data sets (short populations), thinness prevalence with weight-for-height was lower from 0.5 to 1 years but higher at subsequent ages. The absolute difference (weight-for-height - BMI-for-age) for 0.5-5 years was 4.6% (15.9-11.3%) and 2.2% (19.2-17.0%), respectively; this attenuated in the 0-5 years age group. The discrepancy was higher in boys and maximal for stunted children, reducing with increasing stature. In simulated data sets from intermediate and tall populations, there were no meaningful differences. CONCLUSIONS The two definitions produce cut-offs, and hence estimates of thinness, that differ with the age, sex and height of children. The relative invariance, with age and stature, of the BMI-for-age thinness definition favours its use as the preferred index for programmatic purposes.
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Affiliation(s)
- L Naga Rajeev
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India.,Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Monika Saini
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India
| | - Ashish Kumar
- Department of Mathematics and Statistics, Manipal University Jaipur, Jaipur, Rajasthan, India
| | - Sikha Sinha
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Harshpal Singh Sachdev
- Division of Clinical Epidemiology and Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
- * E-mail:
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Neherta M, Nurdin Y. Primary Prevention of Neglect in Children through Health Education for Adolescent Girls in West Sumatra, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: High cases of stunting in toddlers require an effective and efficient primary prevention model. One of the efforts that can be done is to increase the knowledge of female adolescents to prevent anemia.
AIM: The aim of the study was to produce a model that can be used as primary prevention of stunting in children.
METHODS: Pre-test-Post-test Group Design. This research was conducted from March to November 2019 in Talamau District, West Pasaman Regency, involving 370 female adolescents as respondents. The intervention was carried out 3 times, followed by four separate evaluations. The intervention consists of engaging the respondents with various learning activities such as interactive lectures, group discussions, video screenings, messages through WhatsApp, and demonstrations. Data analysis was performed using GLM repeated measure.
RESULTS: Health education interventions on anemia prevention can improve knowledge and attitudes among female adolescents; anemia prevention got a p-value of 0.00.
CONCLUSION: The primary prevention model of stunting can increase knowledge and attitudes in female adolescents. It is recommended that parents, teachers, and health workers jointly provide health education regularly to prevent anemia so that stunting cases in toddlers no longer exist.
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Gonete AT, Alemu TG, Mekonnen EG, Takele WW. Malnutrition and contributing factors among newborns delivered at the University of Gondar Hospital, Northwest Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e053577. [PMID: 34740934 PMCID: PMC8573658 DOI: 10.1136/bmjopen-2021-053577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of various indicators of malnutrition (stunting, wasting, low birth weight, concurrent stunting and wasting, overweight/obesity and double burden malnutrition) among newborns and to investigate factors associated with these nutritional disorders. METHODS A hospital-based cross-sectional study was conducted from 10 March through to May 2020. A total of 419 newborns were recruited into the study to estimate the prevalence of low birth weight and stunting. After excluding 28 newborns whose length was less than 45 cm, 394 newborn-mother dyads were approached to estimate wasting and overweight/obesity. A systematic random sampling technique was used to select participants. All independent variables were entered into the multivariable logistic regression model and variables that had significant associations were identified based on a p value. RESULTS A very small proportion of the newborns 2.5% (0.9% to 4.1%) were concurrently wasted and stunted. The prevalence rates of low birth weight and wasting were 20.8% (16.8% to 24.6%) and 10.9% (7.82% to 14.01%), respectively. The magnitude of overweight/obesity was 12.7% (9.3% to 15.9%) where 2.8% (1.1% to 4.4%) of newborns have the double burden of malnutrition. Having a father with a primary level of education 2.82 (1.19 to 6.65) and being stunted at birth 3.17 (1.6 to 6.0) were variables that were associated with increased odds of low birth weight. The odds of being overweight/obese are significantly higher among newborns born to mothers who are urban dwellers 0.35 (0.12 to 0.99). CONCLUSIONS The study underscores that malnutrition is a pressing public health concern that demands due emphasis. Fathers' educational status (low level) and being stunted are associated with a high burden of low birth weight. Mothers' residency (being urban) is associated with an elevated risk of overweight/obesity among newborns. Thus, improving the health literacy of fathers and preventing stunting at birth are recommended to mitigate low birth weight.
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Affiliation(s)
- Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Reproductive Health, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara Regional State, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, University of Gondar, Gondar, Ethiopia
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Wells JCK, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ, Haisma HH, Raubenheimer D. The future of human malnutrition: rebalancing agency for better nutritional health. Global Health 2021; 17:119. [PMID: 34627303 PMCID: PMC8500827 DOI: 10.1186/s12992-021-00767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/10/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Gabriel Amable
- Department of Geography, University of Cambridge, Cambridge, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hinke H Haisma
- Population Research Centre, Department of Demography, University of Groningen, Groningen, the Netherlands
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Abbas F, Kumar R, Mahmood T, Somrongthong R. Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach. Sci Rep 2021; 11:19932. [PMID: 34620917 PMCID: PMC8497567 DOI: 10.1038/s41598-021-98924-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Low Birth Weight (LBW) is considered as a major public health issue and leading cause of neonatal death. Almost one in four newborns are reported as underweight in Pakistan. Children born with low birth weight are highly vulnerable to develop diseases and death and/or remain undernourished (i.e., stunted and wasted). This study determines the LBW newborns are more prone to develop stunting and wasting in province of Sindh, Pakistan. Moreover, regression-based estimation of the impact of LBW on the child health outcomes of under five years of age, may be prone to selection bias because of the nature of non-experimental data set, thus, propensity score matching methods are used in this study. Data for this study was used from Multiple Indicators Cluster Survey (MICS-2014). MICS is a two-stage, stratified cluster sampling household level data covering urban and rural areas and consists of 19,500 households from five administrative divisions and 28 districts of Sindh province of Pakistan. The total sample size of children less than five years of age after cleaning the data are 7781, of which 2095 are LBW having birth weight categorized as "smaller than average and very small" and 5686 are normal birth weight (NBW) having birth weight very large, larger than average, and average. This study employed propensity score matching (PSM) regression methods to understand whether the children born as low birth weight are more prone to stunting and wasting and/or both. In province of Sindh, moderate wasting children under five years were 21%, severe wasting 6% and both wasting and stunting 10%. The propensity score results are shown significant in all groups. Specifically, all four types of PSM methods confirm a significant difference in the potential outcome variables-meaning that a child born with LBW has a significant adverse effect on the potential child health outcome variables (stunting, wasting and both). Thus, the propensity score matching findings confirm a significant and adverse effect of LBW on potential health outcomes of under five children. Similarly, low birth weight children are significantly more likely to be moderately wasted (OR = 1.5, CI = 1.3-1.6) and severely wasted (OR = 1.6, CI = 1.3-2.0) and both (stunted and wasted, OR = 2.0, CI = 1.7-2.3) as compared to children with normal birth weight. Male children, if born with low birth weight, are significantly more likely to be moderately wasted (OR = 1.3, CI = 1.1-1.5) and both (wasted and stunted, OR = 1.3, CI = 1.1-1.5) than girls. This large data analysis finding proved that the LBW newborns are on higher risk to develop wasting and stunting in Pakistan.
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Affiliation(s)
- Faisal Abbas
- Department of Economics, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Ramesh Kumar
- Department of Public Health, Health Services Academy, Islamabad, Pakistan.
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Tahir Mahmood
- Department of Economics, University of Chitral, Chitral, Pakistan
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Kohlmann K, Sudfeld CR, Garba S, Guindo O, Grais RF, Isanaka S. Exploring the relationships between wasting and stunting among a cohort of children under two years of age in Niger. BMC Public Health 2021; 21:1713. [PMID: 34548050 PMCID: PMC8454021 DOI: 10.1186/s12889-021-11689-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/10/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger. METHODS From August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < - 2 and stunted if they had a length-for-age Z-score < - 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations. RESULTS Half of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age. CONCLUSIONS These data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02145000 .
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Affiliation(s)
- Kristin Kohlmann
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | | | | | | | - Sheila Isanaka
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, USA.
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
- Epicentre, 14-34 Avenue Jean Jaurès, 75019, Paris, France.
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Garenne M, Thurstans S, Briend A, Dolan C, Khara T, Myatt M, Seal A, Wells JC. Changing sex differences in undernutrition of African children: findings from Demographic and Health Surveys. J Biosoc Sci 2021;:1-11. [PMID: 34488914 DOI: 10.1017/S0021932021000468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <-2.0); 1.01 for wasting (weight-for-height Z-score <-2.0); 1.05 for underweight (weight-for-age Z-score <-2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <-2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0-23 months and lower values for children age 24-59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-2006), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.
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Wright CM, Macpherson J, Bland R, Ashorn P, Zaman S, Ho FK. Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan. J Nutr 2021; 151:2022-2028. [PMID: 33830247 PMCID: PMC8245889 DOI: 10.1093/jn/nxab054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have had sufficient longitudinal data to track how different malnourished states relate to mortality at different ages and interrelate over time. OBJECTIVES This study aims to describe the RRs and proportions of mortality associated with wasting and stunting and the pathways into and out of these nutritional states. METHODS Longitudinal growth data sets collected for children ages 0-24 months from Malawi, South Africa, and Pakistan were combined (n = 5088). Children were classified as deceased, wasted (weight for height < -2 SD; 1-4%), stunted (length < -2SD; 20-47%), or wasted and stunted (WaSt; 2-5%) at ages 3, 6, 9, 12, 18, and 24 months. Mixed-effects Cox models were used to study the association between nutritional status and mortality. RESULTS By age 3 months, 20% of children were already stunted, rising to 49% by 24 months, while wasting (4.2% and 2.2% at 3 months, respectively) and WaSt (0.9% and 3.7% at 24 months, respectively) were less common. The HR for mortality in WaSt was 9.5 (95% CI, 5.9-15), but 60% of WaSt-associated mortality occurred at 3-6 months. Wasting or WaSt was associated with 10-23% of deaths beyond 6 months, but in the second year over half of deaths occurred in stunted, nonwasted children. Stunting persisted in 82% of children and wasting persisted in 44%. Wasted children were more likely than nonwasted, nonstunted children to become stunted (RR, 1.93; 95% CI, 1.7-2.2), but 94% of children who progressed to stunting had not been wasted in the prior period. CONCLUSIONS WaSt greatly increased the risk of death, particularly in very young infants, but more deaths overall were associated with stunting. Most stunting appeared to be either intrauterine in origin or arose in children without prior wasting. Either stunting and wasting represent alternative responses to restricted nutrition, or stunting also has other, nonnutritional causes.
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, School of Medicine, Nursing and Dentistry, University of Glasgow, Glasgow, United Kingdom
| | - John Macpherson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Bland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Public Health, University of Witwatersrand, Witwatersrand, South Africa
| | - Per Ashorn
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences, Lahore, Pakistan
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C, Briend A, Myatt M, Garenne M, Sear R, Kerac M. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Health 2021; 5:bmjgh-2020-004030. [PMID: 33328202 PMCID: PMC7745319 DOI: 10.1136/bmjgh-2020-004030] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [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: 09/23/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. METHODS We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0-59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random-effects model. RESULTS 74 studies were identified: 44/74 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13 to 1.40). 38 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.29 95% CI 1.22 to 1.37). 23 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.14, 95% CI 1.02 to 1.26). There was some limited evidence that the female advantage, indicated by a lower risk of stunting and underweight, was weaker in South Asia than other parts of the world. 43/74 (58%) studies discussed possible reasons for boy/girl differences; 10/74 (14%) cited studies with similar findings with no further discussion; 21/74 (28%) had no sex difference discussion. 6/43 studies (14%) postulated biological causes, 21/43 (49%) social causes and 16/43 (37%) to a combination. CONCLUSION Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice.
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Affiliation(s)
- Susan Thurstans
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Seal
- Institute for Global Health, University College London, London, UK
| | - Jonathan Wells
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanya Khara
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - Carmel Dolan
- Emergency Nutrition Network, Kidlington, Oxfordshire, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Kobenhavn, Denmark.,School of Medicine, Center for Child Health Research
| | | | - Michel Garenne
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, 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
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for MARCH (Maternal, Adolescent & Reproductive Child Health), London School of Hygiene and Tropical Medicine, London, UK
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48
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Iversen PO, Ngari M, Westerberg AC, Muhoozi G, Atukunda P. Child stunting concurrent with wasting or being overweight: A 6-y follow up of a randomized maternal education trial in Uganda. Nutrition 2021; 89:111281. [PMID: 34090214 PMCID: PMC7613431 DOI: 10.1016/j.nut.2021.111281] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Objectives There is paucity of longitudinal data on combined anthropometric deficiencies in children. Herein, we present data on child stunting concurrent with wasting or being overweight among children in a 6-y follow-up study of a maternal education trial in rural Uganda. Methods We previously performed a randomized controlled trial where half of 511 mothers of 6- to 8-mo children were given a 6-mo education concerning nutrition, hygiene, and child stimulation. Anthropometry and prevalence of stunting with wasting or being overweight were determined. We applied multilevel mixed-effect logistic regression models and χ2 statistic to assess the effects of the intervention and trend in prevalence over time, respectively. Results Complete data sets were obtained from 307 of 511 children (60%). The prevalence of stunting and wasting or being overweight was <7% both, and did not change significantly over time. Notably, the prevalence of concurrent stunting and being overweight was significantly reduced in the intervention group compared with the controls among children age 36 mo and 60 to 72 mo, with corresponding odds ratios at 0.24 (95% confidence interval, 0.06−0.90) and 0.10 (95% confidence interval, 0.01−0.82), respectively. Conclusions The prevalence of stunting concurrent with wasting or being overweight remained low during the observation period. The intervention may have reduced concurrent stunting and being overweight over time.
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Affiliation(s)
- Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway
| | - Grace Muhoozi
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
| | - Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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49
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Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet 2021; 397:1388-1399. [PMID: 33691094 PMCID: PMC7613170 DOI: 10.1016/s0140-6736(21)00394-9] [Citation(s) in RCA: 237] [Impact Index Per Article: 79.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022]
Abstract
13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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50
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Bailey J, Lelijveld N, Khara T, Dolan C, Stobaugh H, Sadler K, Lino Lako R, Briend A, Opondo C, Kerac M, Myatt M. Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6-59 Months in the ComPAS Cluster Randomized Controlled Trial. Nutrients 2021; 13:1054. [PMID: 33805040 DOI: 10.3390/nu13041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.
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