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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The extent, range and nature of quantitative nutrition research engaging with intersectional inequalities: A systematic scoping review. Adv Nutr 2024:100237. [PMID: 38710327 DOI: 10.1016/j.advnut.2024.100237] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the U.S. (n=35) and India (n=7), with just one in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n=20), and BMI and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n=26); two of 15 studies using non-linear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the U.S. and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings, and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this.
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Affiliation(s)
- Emily Fivian
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom.
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Claudia Offner
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Michele Zaman
- Queen's University, Department of Medicine, Ontario, Canada
| | - Bhavani Shankar
- The University of Sheffield, Department of Geography, Sheffield, United Kingdom
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Medical Statistics, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
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Rao N, Bala M, Ranganathan N, Anand U, Dhingra S, Costa JC, Weber AM. Trends in the prevalence and social determinants of stunting in India, 2005-2021: findings from three rounds of the National Family Health Survey. BMJ Nutr Prev Health 2023; 6:357-366. [PMID: 38618541 PMCID: PMC11009545 DOI: 10.1136/bmjnph-2023-000648] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021. Methods We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005-2006, NFHS-4: 2015-2016, NFHS-5: 2019-2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence. Results The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005-2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6-16% in 2005-2006 to 11-21% in 2015-2016 and 2020-2021. Being male was associated with 6% and 7% increased odds of stunting in 2015-2016 and 2019-2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021. Conclusions Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality.
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Affiliation(s)
- Nirmala Rao
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Manya Bala
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Utkarsh Anand
- School of Economic Sciences, Washington State University, Pullman, Washington, USA
| | | | - Janaina Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ann M Weber
- University of Nevada Reno, Reno, Nevada, USA
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N Srinivas P, Seshadri T, Velho N, Babu GR, Madegowda C, Channabasappa Y, Majigi SM, Bhat D. Response to correspondence article on the research protocol titled Towards Health Equity and Transformative Action on tribal health (THETA) studyto describe, explain and act on tribal health inequities in India: A health systems research study protocol. Wellcome Open Res 2023; 8:155. [PMID: 37766856 PMCID: PMC10521096 DOI: 10.12688/wellcomeopenres.19190.1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 09/29/2023] Open
Abstract
In this correspondence, we, co-authors and collaborators involved in the Towards Health Equity and Transformative Action on tribal health (THETA) study respond to a recent article published in Wellcome Open Research titled Correspondence article on the research protocol titled 'Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol' published in Wellcome Open Research in December 2019 In the first part, we provide overall clarifications on the THETA study and in the second part respond to specific comments by the authors of the aforementioned correspondence.
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Affiliation(s)
- Prashanth N Srinivas
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Tanya Seshadri
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | | | - Giridhar R Babu
- Indian Institute of Public Health, Bangalore, Karnataka, 560023, India
| | - C Madegowda
- Jilla Budakattu Girijana Abhivruddhi Sangha, Chamarajanagar, Karnataka, 571441, India
| | - Yogish Channabasappa
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Sumanth Mallikarjuna Majigi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, 570001, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, Mysore, Karnataka, 570015, India
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Ulahannan SK, Wilson A, Chhetri D, Soman B, Prashanth NS. Alarming level of severe acute malnutrition in Indian districts. BMJ Glob Health 2022; 7:e007798. [PMID: 35450860 PMCID: PMC9024259 DOI: 10.1136/bmjgh-2021-007798] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/20/2022] [Indexed: 12/01/2022] Open
Abstract
Over the last two decades, severe acute malnutrition (SAM) has been increasing in India despite favourable national-level economic growth. The latest round of the National Family Health Survey 5 (NFHS-5) results was released, allowing us to assess changes in the malnutrition trends. Analysis of the previous rounds of the NFHS (NFHS-4) has already shown disturbing levels of wasting, often co-occurring with other forms of anthropometric failures. These have been shown to occur in clusters of districts across India that already needed urgent policy and programmatic action. A rapid assessment of data from NFHS-5 for some of these districts for which data are now available shows an alarming increase in SAM in several malnutrition hotspot districts. Surprisingly, some districts outside hotspots and in states and regions that have previously not been known for high malnutrition too have shown increasing SAM prevalence in the latest round. The data from NFHS-5 was collected just before the COVID-19 pandemic and hence does not yet reflect the likely impact of the pandemic on food security, livelihoods and other social stressors among the most marginalised Indian households. Based on this emerging pattern of increasing SAM, we call for an urgent policy and programmatic action to strengthen the Anganwadi system, which caters to preschool children in India and community-based management of acute malnutrition based on recent evidence on their effectiveness.
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Affiliation(s)
- Sabu Kochupurackal Ulahannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
- Health Equity Cluster, Institute of Public Health, Bangalore, India
| | - Alby Wilson
- Health Equity Cluster, Institute of Public Health, Bangalore, India
| | - Deepshikha Chhetri
- Consultant, Headquarter, Department of Women and Child Development, Government of Haryana, India, Chandigarh, Haryana, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - N S Prashanth
- Health Equity Cluster, Institute of Public Health, Bangalore, India
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Anik AI, Chowdhury MRK, Khan HTA, Mondal MNI, Perera NKP, Kader M. Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh. BMC Public Health 2021; 21:2147. [PMID: 34814880 PMCID: PMC8611976 DOI: 10.1186/s12889-021-12038-3] [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: 04/07/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context. Methods This study extracted the children dataset from the 2017–18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis. Results The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children’s birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition. Conclusion Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12038-3.
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Affiliation(s)
- Asibul Islam Anik
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh.,Department of Research and Evaluation, SAJIDA Foundation, Gulshan-1, Dhaka, Bangladesh
| | | | - Hafiz T A Khan
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Md Nazrul Islam Mondal
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Nirmala K P Perera
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Manzur Kader
- Unit of Occupational Medicine, Institute of Environmental Medicine
- Karolinska Institutet, Solnavägen 4, Torsplan floor 10, 113 65, Stockholm, Sweden.
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