Search

Child wasting is defined as a weight‐for‐height/length z‐score (WLZ/WHZ) < −2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child's nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid‐upper arm circumference‐for‐age z‐score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut‐off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut‐off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ −2), a positive outcome, the optimal cut‐off point for the MUACZ was −1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child's MUACZ was correlated with WLZ, and a MUACZ below −1.27 appeared to accurately identify wasting among children aged 3–23 months. MUACZ < −1.27 might be another useful indicator of childhood wasting than a WLZ < −2. Key messages: We calculated the cut‐off point for a child's mid‐upper arm circumference‐for‐age z‐score (MUACZ) that MUACZ below −1.27 appears to accurately identify acute malnutrition among children aged 3–23 months with the highest sensitivity and specificity.Determinants of a child's MUACZ < −1.27 were estimated.Measurement of MUAC would be especially helpful when large numbers of children need to be screened quickly, particularly in humanitarian aid settings.MUACZ < −1.27 may represent a more useful indicator of childhood malnutrition than a weight‐for‐length z‐score < −2. [ABSTRACT FROM AUTHOR]

Women's experience of domestic violence has adverse consequences on women's health globally and is itself affected by several factors. This study aims to determine the factors that are associated with experience of any form of domestic violence in rural Bangladesh. Data were derived from the baseline survey database of Suchana, a large-scale nutrition program in Bangladesh. Data of 5,440 women from poor households in rural areas were analyzed. Descriptive statistics were used to summarize the data. Multilevel logistic regression analysis was conducted to determine the factors that were significantly associated with experiencing any form of domestic violence. The prevalence of women experiencing domestic violence was found to be 35% and household food insecurity was 86%. Of the women's characteristic domain, age at marriage, lack of any support from household members, visit from non-governmental organizations (NGO) health professionals, number of children, and decision-making power of women at the household level were significantly associated with reporting of domestic violence. Of the household characteristic domain, the associated factors were having a male household head, increased household size, low socio-economic status, having a loan, experience of at least one crisis event, and household food insecurity. The strength of association between household food insecurity and domestic violence was higher among poor families. Experience of domestic violence is inevitably associated with women's decision-making power and household food insecurity. Behavioral change communication interventions may help to positively affect decision-making power but a holistic approach needs to be undertaken to reduce food insecurity, for which the underlying mechanism of food insecurity in Bangladesh needs to be explored further. [ABSTRACT FROM AUTHOR]

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh. [ABSTRACT FROM AUTHOR]

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post‐natal combinations of lipid‐based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet‐based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age‐appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24‐h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non‐significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food‐secure and severely food‐insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes. [ABSTRACT FROM AUTHOR]

Malnutrition among women is a long‐standing public health concern that has significant adverse consequences on the survival and healthy development of children. Maternal mid‐upper arm circumference (MUAC) could potentially represent a simpler alternative to traditional nutritional indicators. This study aimed to investigate the factors associated with low maternal MUAC (as an indicator of being underweight) and address the research question of whether maternal MUAC is significantly associated with children's nutritional status among poor and very poor households in rural Bangladesh. Data on 5,069 households were extracted from the Suchana programme baseline survey, which was carried out in 80 randomly selected unions (the lowest administrative unit of Bangladesh) in Sylhet and Moulvibazar districts between November 2016 and February 2017. The outcome variables were three child nutritional status indicators: wasting, stunting and underweight. Mothers were classified as underweight if their MUAC was less than 23 cm. Separate multiple logistic regression analyses were used to determine the factors potentially associated with maternal underweight status and explore whether maternal underweight status is significantly associated with children's nutritional status. The prevalence of maternal underweight status was 46.7%, and the prevalence of wasting, stunting and underweight among children under two were 10.5%, 44.4% and 31.9%, respectively. After controlling for various socio‐economic and demographic characteristics, maternal MUAC was significantly associated with children's nutritional status in rural Bangladesh. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF) has significant effect on morbidity and mortality. EBF is established when breastmilk alone is exclusively fed from birth until 6 months of age. However, feeding during the first 3 days after birth is often ignored for various reasons. We aimed to assess the role of feeding during the first 3 days in respect of early cessation of EBF. Data of 1,040 children aged under 6 months was derived from the baseline survey of Suchana, a large‐scale nutrition program, conducted in Sylhet, Bangladesh, and subsequently analysed. Guidelines established by World Health Organization were used to define EBF and feeding during the first 3 days. The strength of the association between feeding during the first 3 days and early cessation of EBF was established using multiple logistic regression after adjusting for other covariates. Among all children, around 62% and 13% were exclusively breastfed and were fed something other than breastmilk within the first 3 days of birth, respectively. Feeding during the first 3 days was independently and significantly associated with early cessation of breastfeeding (adjusted odds ratio: 1.94, 95% confidence interval [1.31, 2.88], p =.001). Less than four antenatal care (ANC) visits, increased child's age and increased household size were also independently associated with early cessation of EBF. Feeding during the first 3 days of birth is a significant predictor of early cessation of EBF. Simple counselling activities to discourage feeding anything within the first few days of birth may increase the prevalence of EBF in rural Bangladesh without investing additional resources. [ABSTRACT FROM AUTHOR]

Mothers are often responsible for preparing nutritious foods in their households. However, the quality of mother's diets is often neglected, which may affect both mother's and child's nutrition. Because no single food contains all necessary nutrients, diversity in dietary sources is needed to ensure a quality diet. We aimed to study the association between mother's dietary diversity and stunting in children <2 years attending Dhaka Hospital of icddr,b, a diarrhoeal disease hospital in Dhaka, Bangladesh. A case–control study (n = 296) was conducted from November 2016 to February 2017. Data were collected from mothers of stunted children <2 years (length‐for‐age z score [LAZ] < −2) as "cases" and nonstunted (LAZ ≥ −1) children <2 years as "controls." Mothers were asked to recall consumption of 10 defined food groups 24 hr prior to the interview as per Guidelines for Minimum Dietary Diversity for Women. Among the mothers of cases, 58% consumed <5 food groups during the last 24 hr, compared with 45% in control mothers (P = 0.03). Children whose mothers consumed <5 food groups were 1.7 times more likely to be stunted than children whose mothers consumed ≥5 food groups (P = 0.04). Intake of food groups such as pulses, dairy, eggs, and vitamin A rich fruit was higher in control mothers. Proportion of mother's illiteracy, short stature, monthly family income

Globally, undernutrition affects nearly half of all children aged less than 5 years. It is more prominent in low- and middle-income countries. This study aimed to identify the age-specific risk factors for different categories of undernutrition among Bangladeshi children aged less than 2 years. Data of 10,291 children aged less than 2 years were collected between October 2011 to November 2013 through the Food Security Nutritional Surveillance Project in Bangladesh. Simple logistic regression established bivariate relationships between the categories of undernutrition and the relevant risk factors. Multiple logistic regression constructed the age-specific regression models depicting the independent association and effect size of the risk factors contributing to the various categories of undernutrition among study population. Stunting was prevalent among 30.9% of the study children, whereas 9.7% were wasted and 24.9% were underweight. Being a male child, increase in age, maternal body mass index and education, and household food insecurity were the strongest predictors for all categories of undernutrition in terms of effect size. Our study shows that the different categories of childhood undernutrition have different age-specific risk factors. Maternal body mass index and household food insecurity were the common age-specific risk factors for all categories of undernutrition. We expect our findings to enhance the existing evidence base for the risk factors of undernutrition among children aged less than 2 years. [ABSTRACT FROM AUTHOR]