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The purpose of this research was to determine whether or not routine home visiting (by the Philani Maternal Child Health and Nutrition Project) influences the prevalence of stunted, wasted and underweight children in Cape Town peri-urban settlements. The study was a cross-sectional cohort in which weight and height measurements were collected for all children from 24 matched neighbourhoods; three years earlier 12 of these neighbourhoods were randomized to receive the home visiting intervention and 12 did not. The research took place at all households located within the 24 neighbourhoods in Khayelitsha and Mfuleni peri-urban settlements. Participants included 8715 children aged 0–6 years old (4694 intervention; 4021 control). A total of 41.3% of children were stunted, 3.1% were underweight and 1.4% were wasted. Children in the intervention group were significantly less likely to be underweight or severely underweight for age than children in the control group. While the rates of stunting were also significantly lower in intervention areas, the effect was not clinically significant, and no significant differences were found between the study arms on the prevalence of wasting. The Philani model is effective in the prevention and rehabilitation of underweight children. Philani could strengthen their intervention by focussing specifically on screening for child stunting in addition to underweight children. The results also suggests that efforts to address the long-term adverse effects of undernutrition require structural and economic transformation, in addition to socio-medical interventions.

Abstract Background Despite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally. Objective We aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters. Methods This is a post-interventional follow-up study of a maternal nutrition interventional study conducted between 2018 and 2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Pregnant women received a package of augmented interventions from study staff which supplemented those provided to them under the state-run programmes, that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. In the current follow-up study conducted in 2021, age-matched pregnant women from the same areas who were pregnant during the same period as in the original study and had received standard-of-care under the state-run programmes were recruited into a comparison group. Study staff collected data regarding maternal height and serial weights that were recorded at antenatal visits in 2018-19, and birth and infant characteristics. Child height and weight were measured during the follow-up visit in 2021, which were used to calculate the relative risks of stunting, wasting and underweight using generalized linear models, to understand the sustained impact of the intervention beyond infancy. Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed. Results Median age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kg, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88). Conclusions These results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period.

Abstract Background Worldwide, a significant number of girls become mothers during adolescence. In Bangladesh, adolescent childbirth is highly prevalent and has adverse effects on children’s health and undernutrition. We aimed to identify the relationship between the undernutrition of children and adolescent motherhood, the factors associated with adolescent mothers’ age at first birth, and to examine the programmatic factors and gaps influencing children’s undernutrition in Bangladesh. Methods We analysed the ‘Bangladesh Demographic and Health Survey’ BDHS-17-18 data and desk review. To examine the factors associated with adolescent motherhood and its impact on child undernutrition, data from 7,643 mother-child pairs were selected. Child stunting, wasting, and underweight were measured according to the World Health Organisation (WHO) median growth guidelines based on z-scores − 2. Univariate, bivariate, simple, and multiple logistic regressions were used for analyse. We followed the systematic procedures for the literature review. Results Approximately, 89% of adolescents aged ≤ 19 years were married and 71% of them gave their first childbirth. Children of adolescent mothers (≤ 19 years) were significantly 1.68 times more wasted (aOR: 1.68; 95% CI: 1.08 to 2.64), 1.37 times more underweight (aOR: 1.37; 95% CI: 1.01 to 1.86) and either form 1.32 times more stunting, wasting or underweight (aOR:1.32; 95% Cl: 1.05 to 1.66) compared to the children of adult mothers (> 19 years) after adjusting potential confounders. The factors associated with mothers’ first childbirth during adolescence were the age gap between husband and wife 5–10 years (aOR: 1.81; 95% Cl: 1.57–2.10) and age gap > 10 years (aOR: 2.41; 95% Cl: 1.96–2.97) compared with the age group

Background: Despite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters. Methods: This is a post-interventional follow-up study of a maternal nutrition interventional study conducted between 2018 and 2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Pregnant women received a package of augmented interventions from study staff which supplemented those provided to them under the state-run programmes, that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. In the current follow-up study conducted in 2021, age-matched pregnant women from the same areas who were pregnant during the same period as in the original study and had received standard-of-care under the state-run programmes were recruited into a comparison group. Study staff collected data regarding maternal height and serial weights that were recorded at antenatal visits in 2018-19, and birth and infant characteristics. Child height and weight were measured during the follow-up visit in 2021, which were used to calculate the relative risks of stunting, wasting and underweight using generalized linear models, to understand the sustained impact of the intervention beyond infancy. Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed. Results: Median age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kg, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88). Conclusions: These results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period. [ABSTRACT FROM AUTHOR]

Objective: To describe the scenario of child undernutrition in Brazil and its determinants. Data source: Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis: Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). Conclusion: Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards. [ABSTRACT FROM AUTHOR]

BackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.ObjectivesWe aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < -3) and severe stunting (length-for-age z score < -3).MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 0.55, 0.86; n = 34,373] and 17% in severe stunting (PR: 0.83; 95% CI: 0.78, 0.90; n = 36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded (PR: 0.74; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.ConclusionsIncluding SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Abstract Introduction Undernutrition is a major public health problem in developing countries, especially in Sub-Saharan Africa. Undernourished children are smaller and have low weight. To solve this issue, school feeding (corn-soya blend, vegetable oil) started in 1994 in Ethiopia. Thus, this scoping review aims to map the evidence relating to school feeding programs and their potential role in managing children`s nutrition in Ethiopia. Methods This scoping review is informed by the methodological framework of Arksey & O’Malley for scoping reviews and recommendations on the framework by Levac and colleagues. The databases searched included the Education Resources Information Centre, International Initiative for Impact Evaluation, Cochrane Library, MEDLINE, and Google Scholar. To ensure its comprehensive search, grey literature sources were searched. The search was undertaken on 26 April 2023. Studies on school feeding, such as coverage, and studies that evaluate the educational and nutritional impacts of school feeding in Ethiopia, regardless of study designs, were included. Reports (publications) about school feeding without scientific methodology were excluded. Result Twenty-seven studies were included in this review. It includes cross-sectional, prospective cohort, laboratory-based analysis, experimental, case study, and qualitative study designs. The school feeding program results were inconclusive, while some indicate a positive effect on body mass index, height, thinness, anemia, weight, dropout rate, class attendance, and enrollment. The others showed that the school feeding program did not affect stunting, thinness, weight, hemoglobin level, enrollment, attendance, dropout rate, and academic achievement. Factors affecting school feeding programs negatively include poor quality food and financial constraints. However, no literature on school feeding program coverage was found. Conclusion School feeding programs improved nutritional status, and academic performance, although some studies show any effect. Poor-quality food provisions and financial constraints affect school feeding programs. There are mixed findings, and further research is required to determine the effect of school feeding programs conclusively. To ensure the program's sustainability, it should be supported by a national policy, and budget allocation is needed. In addition, more evidence should be generated to show the coverage of school feeding programs in Ethiopia.

Changing environmental conditions constitutes one of the greatest threats to human health by reducing agricultural yields and exacerbating the burden of undernutrition. Mozambique is a region characterized by a high dependence on agricultural productivity and an increasing prevalence of climate shocks in the form of droughts and floods. Low food availability as a result of changing environmental conditions can impair child development and long-term agricultural productivity, thus necessitating e!orts to understand and protect children’s health. Women’s empowerment is strongly associated with children’s nutritional status, such that disparities in maternal autonomy and educational attainment may explain variations in climate-related vulnerabilities in this regional context. The purpose of this research is to determine the extent climate shocks are associated with child undernutrition among di!erent populations in Mozambique by focusing on droughts and floods during the main crop growing season. In addition, this research investigates the potential of women's empowerment for mitigating climate-related vulnerabilities of children. Demographic health data is linked with regional gridded climate data using a stratified regression analysis to provide information on the impact of climate shocks on child undernutrition among livelihood subgroups of croppers and fishers. This cross-sectional study found that exposure to climate shocks during the main rainy season, from November to May, increases the risk of stunting in children under age five and that women’s empowerment may not be a mitigating factor in the protection of children’s health from climate shocks. Identifying population groups most adversely a!ected by climate change will be important for reducing social inequities and achieving the Sustainable Development Goals within Mozambique.

Introduction: Undernutrition is a major public health problem in developing countries, especially in Sub-Saharan Africa. Undernourished children are smaller and have low weight. To solve this issue, school feeding (corn-soya blend, vegetable oil) started in 1994 in Ethiopia. Thus, this scoping review aims to map the evidence relating to school feeding programs and their potential role in managing children's nutrition in Ethiopia. Methods: This scoping review is informed by the methodological framework of Arksey & O'Malley for scoping reviews and recommendations on the framework by Levac and colleagues. The databases searched included the Education Resources Information Centre, International Initiative for Impact Evaluation, Cochrane Library, MEDLINE, and Google Scholar. To ensure its comprehensive search, grey literature sources were searched. The search was undertaken on 26 April 2023. Studies on school feeding, such as coverage, and studies that evaluate the educational and nutritional impacts of school feeding in Ethiopia, regardless of study designs, were included. Reports (publications) about school feeding without scientific methodology were excluded. Result: Twenty-seven studies were included in this review. It includes cross-sectional, prospective cohort, laboratory-based analysis, experimental, case study, and qualitative study designs. The school feeding program results were inconclusive, while some indicate a positive effect on body mass index, height, thinness, anemia, weight, dropout rate, class attendance, and enrollment. The others showed that the school feeding program did not affect stunting, thinness, weight, hemoglobin level, enrollment, attendance, dropout rate, and academic achievement. Factors affecting school feeding programs negatively include poor quality food and financial constraints. However, no literature on school feeding program coverage was found. Conclusion: School feeding programs improved nutritional status, and academic performance, although some studies show any effect. Poor-quality food provisions and financial constraints affect school feeding programs. There are mixed findings, and further research is required to determine the effect of school feeding programs conclusively. To ensure the program's sustainability, it should be supported by a national policy, and budget allocation is needed. In addition, more evidence should be generated to show the coverage of school feeding programs in Ethiopia. [ABSTRACT FROM AUTHOR]

Complementary feeding among children aged 6–23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal‐ source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Despite India's impressive economic growth and the implementation of a large-scale antimalnutrition program, the country continues to face the highest levels of child malnutrition globally. Among the affected children, half of those under the age of 3 years, in both tribal and nontribal populations, are underweight, while a third of the wealthiest children experience overnutrition. Economic inequality plays a significant role in contributing to malnutrition in both tribal and nontribal communities. Therefore, utilizing data from the fifth round of the National Family Health Survey (2019-21), the present study aims to examine the socioeconomic disparities in childhood malnutrition across all 640 districts of India, with a specific focus on tribal and nontribal populations. Methods: The analysis includes a sample of children aged 0 to 59 months from tribal and nontribal communities. Sociodemographic, personal, clinical, and environmental factors are considered as independent variables. The outcomes of interest include stunting, wasting, and underweight, which are assessed using binary variables. Linear modeling are used to determine the associations between the independent variables and child undernutrition. Results: The study reported a negative Z value (-4.763), indicating greater overall inequality in the tribal population compared to the nontribal population. In terms of odds ratios, females had lower odds of being underweight in both tribal and nontribal populations. Children aged 1 to 2 years had higher odds of being underweight compared to those aged 1 year. The duration of breastfeeding showed varying associations, with breastfeeding for 7 to 12 months increased the risk of underweight in nontribal areas, while longer durations (13-24 and >24 months) were associated with higher chances of wasting in nontribal areas. Higher maternal age at first birth, higher education levels, and sufficient antenatal care visits were protective factors against underweight in both populations. A higher wealth index consistently correlated with reduced odds of underweight in both tribal and nontribal populations. Institutional delivery was associated with higher odds of underweight in tribal areas but lower odds in nontribal areas. Conclusion: The study concludes that in order to address the socioeconomic disparities contributing to stunting, wasting, and undernutrition among tribal populations, targeted interventions are required. These interventions should focus on improving access to education, healthcare, and economic opportunities, particularly among tribal communities. Additionally, policies should aim to reduce income inequality and promote inclusive economic development, ensuring that the benefits of progress are equitably distributed across all population groups. By addressing these socioeconomic factors, it is possible to improve the nutritional status and overall well-being of tribal populations. [ABSTRACT FROM AUTHOR]

Objectives: To understand the complex interaction of structural inequalities, co-occurring health conditions, and child undernutrition among the Adivasi population in North Kerala, India. Methods: A mixed-method approach was employed in this study, which combined a cross-sectional survey and a case study design. A multistage cluster sampling method was used to select 167 children aged 24 to 60 mo from the study population. The mothers of these children were interviewed using a structured questionnaire to assess individual, parental, and household-level factors associated with child undernutrition. Two Paniya settlements, one with a high prevalence of child undernutrition (HPS) and the other with a low prevalence (LPS), were chosen as the primary units of the case study. Results: The study found that the absence of a kitchen garden with fruits and vegetables [adjusted odds ratio (AOR) 2.85; 95% confidence interval (CI): 1.04–7.81] and a history of cough and fever (AOR 2.93; 95% CI: 1.24–6.93) were both associated with a higher risk of undernutrition in children. The case studies revealed that Adivasi children are undernourished due to a complex set of factors that persist throughout their lives, including unequal access to social capital, healthcare, and food security, as well as differences in hygiene practices due to the lack of access to clean water and sanitation. Conclusions: The findings underscore the need for social interventions to complement the current focus almost entirely on food supplementation programmes. Equitable action on Adivasi child malnutrition requires urgent policy and programmatic attention to social inequalities and access to basic amenities in Adivasi areas. [ABSTRACT FROM AUTHOR]

The implications of young childhood undernutrition on health, development and productivity are grave. In the last two decades, global and Indian studies on undernutrition in under five years have concluded that stunting and underweight rate increases steadily between 0-24 mo, and then stabilises. The available evidence highlights the significance of concentrating interventions to tackle child undernutrition in the first 1000 d of life, which should aim at universal coverage of essential nutrition interventions (ENIs) and maternal-child health care package comprising maternal nutrition care, adoption of appropriate infant and young child feeding practices (IYCF), iron-folic acid supplementation, immunization, deworming, appropriate management of childhood illness etc. Additionally, it is critical to address context specific nutrition sensitive measures such as socio-economic empowerment of women, preventing domestic violence, adolescent conception, appropriate water -sanitation-hygiene and family planning services etc. Mapping of the 'at risk' households having a member falling in the 1000 d window needs special attention and is central to the ongoing efforts in India through the National Nutrition Mission/ POSHAN Abhiyaan. However, for effective implementation, there is an urgent need to consider to shift the lead responsibility of ENIs in the first 1000 d of life to the health care system in India and strategize to integrate maternal nutrition care interventions and establishing of IYCF practices by ensuring optimum use of contacts with antenatal care and routine child immunization services. [ABSTRACT FROM AUTHOR]

Objective: To describe the scenario of child undernutrition in Brazil and its determinants. Data source: Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis: Household surveys carried out from 1974 to 2019 indicate that undernutrition (

BackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (

BackgroundSmall-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development.ObjectivesWe aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024).ResultsIn 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11).ConclusionsChild SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.

BackgroundSmall-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.ResultsSQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin 12 mo and provided 9 (as opposed to

Abstract Complementary feeding among children aged 6–23 months is a key determinant of micronutrient deficiencies and childhood stunting, the burdens of which remain high in Kenya. This study examines the affordability of complementary foods to increase young children's nutrient consumption across eight provinces in Kenya. We combined data from household surveys, food composition tables and published sources to estimate the cost of portion sizes that could meet half of the children's daily iron, vitamin A, calcium, zinc, folate, vitamin B12 and protein requirements from complementary feeding. These costs were compared to current household food expenditures. The selection of foods and price and expenditure data were stratified by province. Our analysis indicates that vitamin A, vitamin B12 and folate are affordable to most households in Kenya via liver, beans and in some provinces, orange‐fleshed fruits and vegetables, avocado and small dried fish. Calcium, animal‐source protein, zinc and iron were less affordable and there was more provincial variation. In some provinces, small dried fish were an affordable source of calcium, protein and zinc. In others (North Eastern, Central, Eastern, parts of Rift Valley and Coast), small dried fish were not commonly consumed and other foods were less affordable. Future research should consider interventions aimed at reducing prices, increasing availability and changing behaviours related to these foods. Solutions such as supplementation and fortification may be needed for iron and zinc in some locations. Food affordability presented the greatest barriers in North Eastern province, which had lower dietary diversity and may require additional targeted interventions.

Childhood undernutrition and diarrhea remain a global health burden in the 21st century. We assessed the effect of access to basic drinking water and sanitation at home on reducing children's likelihood of being undernourished and experiencing diarrhea in Laos. We pooled two rounds of nationally representative cross-sectional household surveys: the Lao Social Indicator Surveys 2011/2012 and 2017, encompassing 23 070 children aged <5 years. We employed multivariate multilevel logistic regression for the analysis. The results showed that access to basic drinking water was associated with a reduced likelihood of undernutrition and was effective in improving child undernutrition. Moreover, access to basic sanitation reduced diarrhea in addition to undernutrition. Notably, sanitation facilities only mitigated childhood stunting and diarrhea when basic drinking water facilities were present in the household. We also confirmed that socio-economic disparities existed among children accessing basic drinking water and sanitation. Consequently, further efforts are needed toward equitable access to these facilities in Laos. [ABSTRACT FROM AUTHOR]

BackgroundLack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition.ObjectivesWe examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India.MethodsIn this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates.ResultsRelative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM.ConclusionsAn increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.

The purpose of this research was to determine whether or not routine home visiting (by the Philani Maternal Child Health and Nutrition Project) influences the prevalence of stunted, wasted and underweight children in Cape Town peri-urban settlements. The study was a cross-sectional cohort in which weight and height measurements were collected for all children from 24 matched neighbourhoods; three years earlier 12 of these neighbourhoods were randomized to receive the home visiting intervention and 12 did not. The research took place at all households located within the 24 neighbourhoods in Khayelitsha and Mfuleni peri-urban settlements. Participants included 8715 children aged 0–6 years old (4694 intervention; 4021 control). A total of 41.3% of children were stunted, 3.1% were underweight and 1.4% were wasted. Children in the intervention group were significantly less likely to be underweight or severely underweight for age than children in the control group. While the rates of stunting were also significantly lower in intervention areas, the effect was not clinically significant, and no significant differences were found between the study arms on the prevalence of wasting. The Philani model is effective in the prevention and rehabilitation of underweight children. Philani could strengthen their intervention by focussing specifically on screening for child stunting in addition to underweight children. The results also suggests that efforts to address the long-term adverse effects of undernutrition require structural and economic transformation, in addition to socio-medical interventions.

The global reduction in child undernutrition highlights the international and national commitment to prioritizing future generations' health. This study aims to find out the previous trends in nutrition and the key drivers of these changes in different regions of Pakistan. For empirical investigation, we employed a regression-based decomposition model by using two distinct rounds of demographic and health surveys: 2012-13 and 2017-18. Results showed children with stunted growth reduced substantially in Balochistan, while Punjab exhibited the highest progress for underweight children. Regression estimates showed that maternal nutritional status and household wealth were more pronounced in reducing all measures of child malnutrition. Some determinants, including mother age at marriage and prenatal visits to the hospital, are significant only for long-term nutritional status—stunting, while mother education contributed to reducing wasted and underweight children. The rest of the factors, like father education and household environment, appear to play a humble role in explaining nutritional improvements. From disaggregated analysis based on different regions, we found that modeled factors used in this study explained changes disproportionately. Thus, it is recommended to use multidimensional nutrition policies incorporating a broader range of sectors, and region-specific programs should be designed for more effective outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Undernutrition in children seems to be one of the major health issues in developing nations including India. Stunting, underweight, and wasting are the three most often used anthropometric indicators to evaluate childhood undernutrition. Children who exhibit one or more indicators of undernutrition are considered as anthropometric failure (AF). The present study aims to determine the distribution and determinants of anthropometric failure in children under the age of five in different regions of India. METHODS: NFHS-5 data, collected between 2019 and 2021, were utilized for the study. Pearson's chi-square (X²) test was used to look into the association between categorical variables. Binary logistic regression was used to find the explanatory factors that influence anthropometric failure. RESULTS: More than half of the under-five children (52.18%) in India are suffering from anthropometric failure, out of these West (57.88%), East (56.58%), and Central (53.94%) regions have covered half of the total occurrence. State-wise, Bihar (61.66%), followed by Gujarat (60.26%), and Jharkhand (58.05%) have recorded the highest rates of anthropometric failure. Anthropometric failure is higher among anemic children, boys, parent not alives, the higher number of birth order, lower educated mothers, rural dwellers, belonging to scheduled tribes and scheduled castes communities, living in nuclear families, and having lower household wealth indexes than their other counterparts. CONCLUSION: These aspects imply that regional determinants should be taken into consideration when implementing child nutrition development programs. [ABSTRACT FROM AUTHOR]

Abstract Background A growing literature highlights the increased risk of stunting among children growing up in informal or slum settlements. Despite relatively high rates of female labor force participation in slums, there is limited evidence on relationship between mother’s work participation and nutritional outcomes of children in these settings. Methods We conducted a cross-sectional study in two large slums (Korail and Tongi) of Dhaka and Gazipur, Bangladesh to assess the association between maternal work and childhood stunting in a low-income urban context. Logistic regression models estimated unconditional and conditional associations between maternal work status and 1) child stunting, 2) child morbidity and dietary intake, and 3) health and hygiene behaviors. Subgroup analyses were done by type of child care support available. Results After adjusting for variations in individual and household level characteristics, we found that children of working mothers had nearly twice the odds of being stunted than children of non-working mothers (OR 1.84, 95%CI 1.05-3.23). Large differences in stunting were found by available care support: compared to children of non-working mothers, children of working mothers with nuclear-type family support had 4.5 times increased odds of stunting (OR 4.49, 95%CI 1.81-11.12), while no odds differential was found for children of working mothers with an extended-type family support (OR 0.69, 95%CI 0.30-1.59). Conclusions Maternal employment is associated with a substantial increase in the odds of child stunting in the slum areas studied. Given that these effects only appear to arise in the absence of adequate family support, integrating appropriate childcare support measures for low-income urban working mothers might be an effective strategy to help reduce the prevalence of chronic undernutrition among slum children.

Background and Objectives: South Asia hosts the largest proportion of undernourished children in the world. Hidden hunger and undernutrition continue to be a major global health concern in the region. A systematic review looking at factors and drivers for hidden hunger and child undernutrition was undertaken. Methods and Study Design: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Five computerized databases were searched: CINAHL, EMBASE, PubMed, PsycINFO and Scopus, in addition to various grey literature sources. Results: A total of 3601 articles were retrieved from databases and 25 studies from grey literature, 98 studies met our inclusion criteria. Included studies were assessed for quality by validated tools. A Meta-ethnographic narrative approach was used to analyse the findings. The most commonly reported factors for child undernutrition were maternal education, poor dietary diversity and rural residence. Conclusions: Based on findings we propose a model to mainstream context specific nutrition behavioural change along with nutrition specific and sensitive interventions aimed at targeting gender, social and cultural factors and norms. Findings from the review add to the extant literature of child undernutrition to inform policy and program. [ABSTRACT FROM AUTHOR]

Abstract Background Malnutrition is considered a major public health challenge and is associated with a range of health issues, including childhood stunting. Stunting is a reliable and well-recognized indicator of chronic childhood malnutrition. The objective of this study is to determine the risk factors associated with stunting among 17,490 children below five years of age in Bangladesh. Methods Correlates of child stunting were examined using data generated by a cross-sectional cluster survey conducted in Bangladesh in 2019. The data includes a total of 17,490 children (aged

Abstract Background Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania. Methods A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Results Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p =

Objectives: Child undernutrition among under 5 aged children is a prevalent global issue, especially in Bangladesh. This study aimed to explore relationships of household environmental conditions (HECs) with child under-nutrition in Bangladesh, with a specific focus on rural-urban differences., Design: We analysed children's data from the 2017/18 Bangladesh Demographic Health Survey (BDHS). The outcome variable considered were measures of child under-nutrition, including stunting, wasting, and underweight. The major exposure variable considered was indicators of HECs. We used a hierarchical Poisson regression model to explore the association between outcomes and exposures adjusted for potential confounders., Setting: Nationally representative cross-sectional survey., Participants: 8,057 under-5 aged children., Results: The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8% and 22%, respectively, with significant urban-rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1.17), exposed to household air pollution (HAP) (aPR: 1.37), had unimproved drinking water sources (aPR: 1.28), or had poor handwashing facilities (aPR: 1.24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, varying significantly across urban-rural areas., Conclusion: The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs. Therefore, policies and programs aimed at reducing child undernutrition need to account for household environmental conditions, with a particular focus on children in poor household environments.

Objective: To assess the changes in child nutrition status, caregivers' knowledge, and water, sanitation, and hygiene (WASH) practices following the provision of Harvest Lentil Vegetable Blend to children and a nutrition education intervention to their caregivers., Design: Three-week pretest-posttest study., Setting: Turkana, Kenya., Participants: Children aged 6-59 months (n = 162) and their caregivers (n = 127) completed the intervention, representing > 70% retention., Interventions: Provision of Harvest Lentil Vegetable Blend to children and nutrition education intervention for caregivers on child feeding and WASH practices., Main Outcomes Measures: Children's anthropometric measurements, caregivers' nutrition knowledge, and WASH practices., Analysis: Wilcoxon signed rank and McNemar tests., Results: At baseline, 19%, 24%, and 35% of children were stunted, underweight, and wasted, respectively. At the endpoint, the weight-for-age z-scores increased by 0.61 (P = 0.04) for children 6-12 months and by 0.31 (P = 0.03) for children 13-47 months. Weight-for-height z-scores increased by 0.84 (P = 0.04) among children 6-12 months and by 0.42 (P = 0.04) among children 13-47 months. The proportion of caregivers who reported washing hands after defecation and before cooking increased by 37% and 26%, respectively (P = 0.001)., Conclusions and Implications: An on-site feeding program that used nutrient-dense supplemental food was associated with positive changes in children's nutrition status within a short duration. Nutrition education intervention increased the proportion of caregivers who practiced some key WASH practices., (Copyright © 2024. Published by Elsevier Inc.)

Background: Child undernutrition is a major public health problem in developing countries that contributes to increased incidence of morbidity and mortality. Stunting is a valid and widely acknowledged measure of chronic child malnutrition., Methods: This study extracted data of 7778 under-5 children from the 2017-2018 Bangladesh Demographic and Health Survey and aims to explore the relationship between socio-demographic factors and the nutritional status of children under the age of 5. The anthropometric indicator height-for-age z-score (HAZ) was used as the target variable. The quantile regression method was employed to examine the heterogeneous relationship between the covariates and the conditional HAZ distribution across five different quantiles., Results: This study found that 31.4% of children were severely to moderately stunted and a negative association between children's age and their HAZ. Additionally, children whose mothers had attained at least a secondary education exhibited a positive correlation with their HAZ. Another important factor was the mother's body mass index, which had a two-fold effect on the HAZ. Among the administrative divisions, children from the Sylhet division exhibited a negative association with the HAZ. Additionally, children with a high wealth index exhibited a positive association with the HAZ., Conclusions: Collaborative efforts from different organisations, as well as small and large communities in rural and urban areas, are necessary to improve nutritional status of children in Bangladesh., (© 2024 The British Dietetic Association Ltd.)

Background: A growing literature highlights the increased risk of stunting among children growing up in informal or slum settlements. Despite relatively high rates of female labor force participation in slums, there is limited evidence on relationship between mother's work participation and nutritional outcomes of children in these settings.Methods: We conducted a cross-sectional study in two large slums (Korail and Tongi) of Dhaka and Gazipur, Bangladesh to assess the association between maternal work and childhood stunting in a low-income urban context. Logistic regression models estimated unconditional and conditional associations between maternal work status and 1) child stunting, 2) child morbidity and dietary intake, and 3) health and hygiene behaviors. Subgroup analyses were done by type of child care support available.Results: After adjusting for variations in individual and household level characteristics, we found that children of working mothers had nearly twice the odds of being stunted than children of non-working mothers (OR 1.84, 95%CI 1.05-3.23). Large differences in stunting were found by available care support: compared to children of non-working mothers, children of working mothers with nuclear-type family support had 4.5 times increased odds of stunting (OR 4.49, 95%CI 1.81-11.12), while no odds differential was found for children of working mothers with an extended-type family support (OR 0.69, 95%CI 0.30-1.59).Conclusions: Maternal employment is associated with a substantial increase in the odds of child stunting in the slum areas studied. Given that these effects only appear to arise in the absence of adequate family support, integrating appropriate childcare support measures for low-income urban working mothers might be an effective strategy to help reduce the prevalence of chronic undernutrition among slum children. [ABSTRACT FROM AUTHOR]

Home gardening is promoted as an adaptation strategy to ameliorate the increasing food insecurity from climate change impacts among subsistence farming families in rural sub‐Saharan Africa. Yet, the geographic distribution of home gardens, their setup, management, and the effects on nutrition outcomes have not been fully described. This scoping review aimed to map and synthesize recent evidence on home gardening for two exemplar countries: Burkina Faso and Kenya. Between June and August 2020, we searched, screened, and extracted evidence about home garden projects in both countries, following the PRISMA guidelines for scoping reviews. Peer‐reviewed scientific publications, and gray literature in English and French that reported about subsistence horticulture in rural settings of Burkina Faso or Kenya were included. The characteristics of the documents and the data pertaining to our research objectives were extracted into predefined spreadsheets. The data were synthesized in the form of a narrative review. Our search yielded 949 documents, of which 20 documents were included in the synthesis (Burkina Faso: 8, Kenya: 12). While the gardens varied in composition and size, the majority provided green leafy vegetables and indigenous horticultural crops. The challenges for successful home garden implementation comprised unfavorable climatic conditions, access to and affordability of inputs, water and land, and lack of know‐how. We identified trends for improved food security, diet quality, and nutritional status among the target populations. This scoping review found that there is limited evidence on home garden practices in rural Burkina Faso and Kenya. To enhance the sustainability of home gardens, research and resources should be invested in codesigning context‐specific home gardening projects. Pending rigorous impact evaluation, home gardens appear to be a promising tool for climate change adaptation while simultaneously improving food security and the nutritional situation among women and young children in these two exemplar countries of sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Abstract Background Conventional indicators used to access the nutritional status of children tend to underestimate the overall undernutrition in the presence of multiple anthropometric failures. Further, factors contributing to the rich-poor gap in the composite index of anthropometric failure (CIAF) have not been explored. This study aims to estimate the prevalence of CIAF and quantify the contribution of factors that explain the rich-poor gap in CIAF. Methods The present study used data of 38,060 children under the age of five years and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey of children and adolescents aged 0–19 years in India. The CIAF outcome variable in this study provide an overall prevalence of undernutrition, with six mutually exclusive anthropometric measurements of height-for-age, height-for-weight, and weight-for-age, calculated using the World Health Organization (WHO) Multicenter Growth Reference Study. Multivariate regression and decomposition analysis were used to examine the association between covariates with CIAF and to estimate the contribution of different covariates in the existing rich-poor gap. Results An overall CIAF prevalence of 48.2% among children aged aged under 5 years of age was found in this study. 6.0% children had all three forms of anthropometric failures. The odds of CIAF were more likely among children belonging to poorest households (AOR: 2.41, 95% CI: 2.12–2.75) and those residing in urban area (AOR: 1.06, 95% CI 1.00–1.11). Children of underweight mothers and those with high parity were at higher risk of CIAF (AOR: 1.51, 95% CI: 1.42–1.61) and (AOR: 1.15, 95% CI: 1.08–1.22), respectively. Children of mother exposed to mass media were at lower risk of CIAF (AOR: 0.87, 95% CI: 0.81–0.93). Conclusion This study estimated a composite index to assess the overall anthropometric failure, which also provides a broader understanding of the extent and pattern of undernutrition among children. Findings show that maternal covariates contribute the most to the rich-poor gap. As well, the findings suggest that intervention programs with a targeted approach are crucial to reach the most vulnerable groups and to reduce the overall burden of undernutrition.

Abstract Home gardening is promoted as an adaptation strategy to ameliorate the increasing food insecurity from climate change impacts among subsistence farming families in rural sub‐Saharan Africa. Yet, the geographic distribution of home gardens, their setup, management, and the effects on nutrition outcomes have not been fully described. This scoping review aimed to map and synthesize recent evidence on home gardening for two exemplar countries: Burkina Faso and Kenya. Between June and August 2020, we searched, screened, and extracted evidence about home garden projects in both countries, following the PRISMA guidelines for scoping reviews. Peer‐reviewed scientific publications, and gray literature in English and French that reported about subsistence horticulture in rural settings of Burkina Faso or Kenya were included. The characteristics of the documents and the data pertaining to our research objectives were extracted into predefined spreadsheets. The data were synthesized in the form of a narrative review. Our search yielded 949 documents, of which 20 documents were included in the synthesis (Burkina Faso: 8, Kenya: 12). While the gardens varied in composition and size, the majority provided green leafy vegetables and indigenous horticultural crops. The challenges for successful home garden implementation comprised unfavorable climatic conditions, access to and affordability of inputs, water and land, and lack of know‐how. We identified trends for improved food security, diet quality, and nutritional status among the target populations. This scoping review found that there is limited evidence on home garden practices in rural Burkina Faso and Kenya. To enhance the sustainability of home gardens, research and resources should be invested in codesigning context‐specific home gardening projects. Pending rigorous impact evaluation, home gardens appear to be a promising tool for climate change adaptation while simultaneously improving food security and the nutritional situation among women and young children in these two exemplar countries of sub‐Saharan Africa.

BackgroundEarly women's marriage is associated with adverse outcomes for mothers and their offspring, including reduced human capital and increased child undernutrition and mortality. Despite preventive efforts, it remains common in many populations and is often favored by cultural norms. A key question is why it remains common, given such penalties. Using an evolutionary perspective, a simple mathematical model was developed to explore women's optimal marriage age under different circumstances, if the sole aim were to maximize maternal or paternal lifetime reproductive fitness (surviving offspring).MethodsThe model was based on several assumptions, supported by empirical evidence, regarding relationships between women's marital age and parental and offspring outcomes. It assumes that later marriage promotes women's autonomy, enhancing control over fertility and childcare, but increases paternity uncertainty. Given these assumptions, optimal marriage ages for maximizing maternal and paternal fitness were calculated. The basic model was then used to simulate environmental changes or public health interventions, including shifts in child mortality, suppression of women's autonomy, or promoting women's contraception or education.ResultsIn the basic model, paternal fitness is maximized at lower women's marriage age than is maternal fitness, with the paternal optimum worsening child undernutrition and mortality. A family planning intervention delays marriage age and reduces child mortality and undernutrition, at a cost to paternal but not maternal fitness. Reductions in child mortality favor earlier marriage but increase child undernutrition, whereas ecological shocks that increase child mortality favor later marriage but reduce fitness of both parents. An education intervention favors later marriage and reduces child mortality and undernutrition, but at a cost to paternal fitness. Efforts to suppress maternal autonomy substantially increase fitness of both parents, but only if other members of the household provide compensatory childcare.ConclusionEarly women's marriage maximizes paternal fitness despite relatively high child mortality and undernutrition, by increasing fertility and reducing paternity uncertainty. This tension between the sexes over the optimal marriage age is sensitive to ecological stresses or interventions. Education interventions seem most likely to improve maternal and child outcomes, but may be resisted by males and their kin as they may reduce paternal fitness.

Abstract Background Conflict regions bear the heaviest brunt of food insecurity and undernutrition. South Sudan is one of the fragile countries following years of conflict that led to large displacements. Moderate to severe undernutrition among under-five children has been associated with elevated morbidity and mortality. This study, therefore, was conducted to assess the magnitude and factors influencing undernutrition (wasting, underweight and stunting) among children aged 6 to 59 months in Yambio County, South Sudan. Methods A cross-sectional study was conducted from 26 October to 6 November 2018 in Yambio County, South Sudan among 630 children aged 6–59 months from the 348 households surveyed in 39 clusters using two-stage cluster sampling design. Data were collected using questionnaires and nutritional anthropometric measurements. The Standardized Monitoring and Assessment of Relief and Transitions (SMART) Methodology was followed to obtain the prevalence of wasting, underweight and stunting based on respective z scores and according to the 2006 world health organization child growth standards. Data were exported to Stata version 16 for further analysis. Bivariate analysis of independent variables and undernutrition was done using binary logistic regression. Mixed effects logistic regression analysis was conducted to control for possible confounders and account for random effects at household and cluster levels. Unadjusted and adjusted odds ratios (cOR and aOR) with 95% confidence intervals (CI) and p-values were computed. P-values of ≤0.05 were considered statistically significant. Results The prevalence of undernutrition explained by wasting (weight-for-height Z-score (WHZ)

Background: Malnutrition is considered a major public health challenge and is associated with a range of health issues, including childhood stunting. Stunting is a reliable and well-recognized indicator of chronic childhood malnutrition. The objective of this study is to determine the risk factors associated with stunting among 17,490 children below five years of age in Bangladesh. Methods: Correlates of child stunting were examined using data generated by a cross-sectional cluster survey conducted in Bangladesh in 2019. The data includes a total of 17,490 children (aged < 5 years) from 64,400 households. Multiple logistic regressions were used to determine the risk factors associated with child stunting and severe stunting. Results: The prevalence of stunting and severe stunting for children was 25.96% and 7.97%, respectively. Children aged 24 to < 36 months [Odds Ratio (OR) = 2.65, 95% CI: 2.30, 3.05] and aged 36 to < 48 months [OR = 2.33, 95% CI: 2.02, 2.69] had more risk of stunting compared to the children aged < 6 months. Children from Sylhet division had the greatest risk of stunting of all the eight divisions [OR = 1.26, 95% CI: 1.09, 1.46]. Children of secondary complete or higher educated mothers were less likely to develop stunting [OR = 0.66, 95% CI: 0.56, 0.79] compared with children of mothers having no education at all. Similarly, children of secondary complete or higher educated father [OR = 0.74, 95% CI: 0.63, 0.87] were found to have lower risk of stunting compared with children whose father hadn't any education. Substantially lower risk of stunting was observed among children whose mother and father both completed secondary education or above [OR = 0.59, 95% CI: 0.52, 0.69]. Children from the richest households [OR = 0.49, 95% CI: 0.41, 0.58] had 51% lower odds of stunting compared to children from the poorest households. Conclusions: After controlling for socioeconomic and demographic factors, parental education and household position in the wealth index were found to be the most important determinants of child stunting in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania. Methods: A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Results: Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p = <.0001), and 1.511 (p = 0.0002), respectively. Mothers who saw a TV spot about IYCFP were more likely to have greater odds of knowing when to begin complementary feeding, feeding their child a minimally diverse diet (4 food groups or more), and serving a minimum acceptable diet with odds ratios of 1.335 (p = 0.0081), 1.360 (p = 0.0003), and 1.268 (p = 0.0156), respectively. Conclusion: Exposure to behavior change communication in Tanzania was generally associated with some increased knowledge of optimal IYCFP as well as practicing IYCF behaviors. Behavior change communication planners and implementers may want to consider conducting similar campaigns as an important component of behavior change to reduce undernutrition and poor health outcomes in developing settings. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this study was to identify the predictors of child undernutrition and anemia among children 6–24 months old in the East Mamprusi district, Northern region, Ghana. Design/methodology/approach – This cross-sectional study recruited 153 children and their mothers. Weight, height and hemoglobin levels of the children were measured. A structured questionnaire based on the World Health Organization's indicators for assessing infant and young child feeding practices was used to collect data on parents' socioeconomic status, household characteristics, hygiene and sanitation practices, mothers' knowledge on feeding practices such as child's meal frequency and dietary diversity and child morbidity within the past two weeks. Predictors of child nutritional status were determined using multinomial logistic regression analysis. Findings – Underweight in the children was significantly predicted by maternal knowledge on protein foods (AOR = 0.045, p = 0.008), time of initiation of complementary feeding (AOR = 0.222, p = 0.032) and maternal age (AOR = 9.455, p = 0.017). Feeding child from separate bowls (AOR = 0.239, p = 0.005), minimum meal frequency per child's age (AOR = 0.189, p = 0.007) and time of initiation of complementary feeding (AOR = 0.144, p = 0.009) were significant determinants of stunting among the children. Exclusive breast feeding (AOR = 7.975, p = 0.012) and child's past morbidity (AOR = 0.014, p = 0.001) significantly contributed to anemia among the children. Research limitations/implications – This is a cross-sectional study and cannot establish causality. The small sample size also limits the generalizability of study findings. However, findings of the study highlight factors which could potentially influence the high rate of child undernutrition in the study setting. Practical implications – This study identifies determinants of undernutrition in the East Mamprusi district, an underresourced area in Ghana. This information could inform the development/reformulation of locally sensitive key messages and targeted intervention strategies to curb the high levels of child undernutrition in the East Mamprusi district of Ghana. Originality/value – This study identifies maternal care practices as key potential drivers of undernutrition in a low-resource setting known for high prevalence of child undernutrition. It suggests insight for large-scale studies on the predictors of child undernutrition in Northern Ghana and other resource-poor settings.

The purpose of this research was to determine whether or not routine home visiting (by the Philani Maternal Child Health and Nutrition Project) influences the prevalence of stunted, wasted and underweight children in Cape Town peri-urban settlements. The study was a cross-sectional cohort in which weight and height measurements were collected for all children from 24 matched neighbourhoods; three years earlier 12 of these neighbourhoods were randomized to receive the home visiting intervention and 12 did not. The research took place at all households located within the 24 neighbourhoods in Khayelitsha and Mfuleni peri-urban settlements. Participants included 8715 children aged 0-6 years old (4694 intervention; 4021 control). A total of 41.3% of children were stunted, 3.1% were underweight and 1.4% were wasted. Children in the intervention group were significantly less likely to be underweight or severely underweight for age than children in the control group. While the rates of stunting were also significantly lower in intervention areas, the effect was not clinically significant, and no significant differences were found between the study arms on the prevalence of wasting. The Philani model is effective in the prevention and rehabilitation of underweight children. Philani could strengthen their intervention by focussing specifically on screening for child stunting in addition to underweight children. The results also suggests that efforts to address the long-term adverse effects of undernutrition require structural and economic transformation, in addition to socio-medical intervention.

Objective: Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms.Design: This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia.Setting: Households in Ethiopia.Participants: A total of 9471 children below 5 years of age participated in this study.Results: The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others.Conclusions: The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia. [ABSTRACT FROM AUTHOR]

This qualitative study explored facilitators, barriers and perceived changes related to programme participation and utilisation among 69 parents of young children who attended a Positive Deviance/Hearth (PDH) programme alone or a PDH programme alongside an Economic Development (PDH/ED) programme to improve child nutrition in rural Bangladesh. Family support stimulated participation in the programmes, while a lack of understanding of the programme's objectives could hinder the effective assets utilisation provided by the ED programme to improve child nutrition. Improvement in child nutritional status was frequently observed in both groups. Proactive engagement and elevated self‐esteem were distinctively reported in the PDH/ED group. [ABSTRACT FROM AUTHOR]

Rising micronutrient deficiencies threaten the well-being of preschool-aged children, as is the case for disadvantaged farmers in Madagascar. However, effective interventions to improve their nutritional status are still unknown. This study investigates the disjointed link between agriculture - food/nutrition security and food/nutrition security - nutritional status through a dual approach. Using a panel dataset, our result supports the link between production diversity - dietary diversity, and dietary diversity - improvement in children's wasting. Importantly, the finding highlights an association of own production of pulse with energy/micronutrient intake and that of energy/zinc intake with the reduction of undernourished and stunted child, respectively. [ABSTRACT FROM AUTHOR]

This paper looks at how changing cereal prices affect child undernutrition in Ethiopia. It derives height for age (stunting) and weight for height (wasting) as indicators of child undernutrition from the two most recent years of the Living Standards Measurement Survey and utilises market prices for key cereals, teff, wheat, and maize in enumeration areas across all regions of the country. Using a panel data fixed effects model, the analysis finds that, contrary to previous studies, rising cereal prices are positively associated with improved child stunting rates for children between ages 6 months and 5 years. There is no evidence to suggest that cereal prices have a significantly greater impact on height for age for children that come from households who are net sellers of these crops. Cereal prices do not appear to be associated with wasting, which is a short-term negative health outcome. [ABSTRACT FROM AUTHOR]

Background and Objectives: Child undernutrition remains an area of public health concern across the globe, particularly in developing countries like India. Previous studies have focused on the association of maternal nutrition with premature pregnancy and birthweight of child, with few establishing the intergenerational effect but limited to select populations and geography. Methods and Study Design: This study used data from 35,452 children aged under 5 years and their biological mother from nationally representative Comprehensive National Nutrition Survey (CNNS) in India. The outcome variables were anthropometric indices: height-for-age, weight-for-height, and weight-for-age. The exposure variables were maternal height and body mass index (BMI). Multivariate regression analysis was used to examine the association between maternal height and BMI with child undernutrition. Results: Out of total number of mothers, 11.1% were short in stature and 28% were underweight. Of total number of children, 33.9%, 17.3% and 32.7% were stunted, wasted, and underweight respectively. Children born to mother with short stature were more likely to be stunted (OR=1.73, 95% CI 1.59-1.89), wasted (OR=1.26, 95% CI 1.12-1.41) and underweight (OR=1.64, 95% CI 1.50-1.79). Similarly, children with underweight mother were more likely to be stunted (OR=1.63, 95% CI 1.53-1.73), wasted (OR=1.64, 95% CI 1.52-1.77) and underweight (OR=2.14, 95% CI 2.01-2.27). Conclusions: The study shows a strong association between maternal and child undernutrition demonstrating intergenerational linkage between the two. The national programme needs to focus on holistic and comprehensive nutrition strategy with targeted interventions to improve both maternal and child health. [ABSTRACT FROM AUTHOR]

Background: The complex etiology of child growth failure and anemia—commonly used indicators of child undernutrition—involving proximate and distal risk factors at multiple levels is generally recognized. However, their independent and joint effects are often assessed with no clear conceptualization of inferential targets. Methods: We utilized hierarchical linear modeling and a nationally representative sample of 139,116 children aged 6–59 months from India (2015–2016) to estimate the extent to which a comprehensive set of 27 covariates explained the within- and between-population variation in height-for-age, weight-for-age, weight-for-height, and hemoglobin level. Results: Most of the variation in child anthropometry and hemoglobin measures was attributable to within-population differences (80–85%), whereas between-population differences (including communities, districts, and states) accounted for only 15–20%. The proximate and distal covariates explained 0.2–7.5% of within-population variation and 2.1–34.0% of between-population variation, depending on the indicator of interest. Substantial heterogeneity was observed in the magnitude of within-population variation, and the fraction explained, in child anthropometry and hemoglobin measures across the 36 states/union territories of India. Conclusions: Policies and interventions aimed at reducing between-population inequalities in child undernutrition may require a different set of components than those concerned with within-population inequalities. Both are needed to promote the health of the general population, as well as that of high-risk children.

Context: There is a paucity of research investigating the association between antenatal care (ANC) attendance and child undernutrition in Madhya Pradesh, India. Aim: To determine whether body weight status in children under the age of 5 years is associated with ANC attendance in Madhya Pradesh. Methods: A cross-sectional study was carried out using data from India's National Family Health Survey (2005–2006). Bodyweight status (an indicator of undernutrition) was determined using weight-for-age. Descriptive statistics and logistic regression were used to estimate prevalence and obtain adjusted odds ratios (AOR) to investigate associations between ANC indicators and weight-for-age. Results: Majority of children were underweight (55.1%). ANC attendance was inadequate, with only 36.8% of women having four or more visits. None of the ANC indicators were associated with body weight status. Increased child age especially an age of 2 years (AOR 2.29; 1.66–3.15), belonging to a scheduled tribe [ST] (AOR 2.36; CI 1.64–3.39), scheduled caste [SC] (AOR 1.75; CI 1.25–2.45) or other backward caste [OBC] (AOR 1.43; CI 1.08–1.89) were associated with being underweight; a birth weight of ≥2.5 kg was associated with lower relative odds of being underweight (AOR 0.43; CI 0.29–0.64). Mothers who had a normal BMI (AOR 0.66; CI 0.53–0.82) or were overweight (AOR 0.42; CI 0.25–0.69) were less likely to have underweight children. Conclusions: ANC attendance was not associated with body weight status. Increased child age, low birth weight, poor maternal nutrition status and belonging to SCs, STs or OBCs increased the odds of child undernutrition.