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The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score Z-score Z-score Z-scores

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6–59 months by age and sex. We categorised children into younger (6–23 months) and older (24–59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < −2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.

In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low‐ and middle‐income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near‐term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid‐upper‐arm circumference combined with weight‐for‐age Z score might effectively identify children at most risk of near‐term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.

BackgroundExcess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at-risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed.MethodsWe searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0-59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random effects model.Results76 studies were identified: 46/76 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13-1.40). 39 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.31 95% CI 1.24-1.39). 25 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.19, 95% CI 1.07-1.32). There was some limited evidence that the female advantage indicating lower risk of stunting and underweight was weaker in South Asia than other parts of the world.44/76 (58%) studies discussed possible reasons for boy/girl differences; 11/76 (14%) cited studies with similar findings with no further discussion; 21/76 (28%) had no sex difference discussion. 6/44 studies (14%) postulated biological causes, 21/44 (48%) social causes and 17/44 (38%) to a combination.ConclusionOur review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice.Key QuestionsWhat is already known?Undernutrition (wasting, stunting, and underweight) is a public health problem affecting millions of children aged under 5 years globally.Although higher neonatal and infant morbidity/mortality for boys is well described, little attention has been given to sex differences in the field of undernutrition due to an assumption that girls are very often disadvantaged over boys.What are the new findings?In most settings studied, undernutrition is more common among boys than girls, though the extent of these differences varies and is reversed in a few contexts.Both biological and social mechanisms have been proposed to be responsible for the observed differences as well as a combination of the two.What do the new findings imply?Greater awareness of actual sex differences is needed within the field of nutrition. While sex-specific data is routinely analysed and reported in nutrition surveys it should be used in nutrition programming to better identify and understand what differences exist. Analysis should assess if the sex balance in programme admissions is reflective of the population undernutrition burden.Further research is needed to understand the mechanisms that lead to sex and gender differences in undernutrition and their implications. Better epidemiological understanding is a priority, as is work to explore their consequent effects on morbidity and mortality.

Background Nutritional requirements have been previously calculated for emergency-affected populations and are widely used for planning and assessing the nutritional adequacy of humanitarian food assistance. The Sphere Project is an interagency collaboration that defines minimum standards and indicators for humanitarian responses, including food and nutrition. It last published population nutritional requirements in 2004, but a revision was required due to the release of new Reference Nutrient Intakes (RNIs) by the World Health Organization and Food and Agriculture Organization (WHO/FAO). Objective To review and revise the list of specified nutrients and recalculate population requirements using RNIs published by WHO/FAO. Methods Review of published normative documents, consultation with experts and participants in the Sphere revision process, construction of a reference demographic profile, and calculation of population nutrient requirements for use in designing emergency general rations. Results Twenty-one nutrients and energy were selected for inclusion, and a demographic profile was constructed to represent a typical beneficiary population. Compared with the previous version of the Sphere Handbook, population requirements for nine vitamins and minerals were found to have increased as a result of the new WHO/FAO RNIs. Conclusions The calculated requirements were adopted and published as part of the Sphere 2011 Handbook. The incorporation of these requirements into planning, monitoring, and evaluation practices for food assistance will help to ensure that populations receive appropriate nutritional support during crises.

A blanket supplementary feeding programme for young children was implemented for four months in five northern districts of Kenya from January 2010 because of fears of food insecurity exacerbated by drought. An attempt to evaluate the impact of the food on children's anthropometric status was put in place in three districts. The main aim of the analysis was to assess the quality of the data on the cohort of children studied in the evaluation and to propose methods by which it could be improved to evaluate future blanket feeding programmes. Data on the name, age, sex, weight and height of a systematic sample of children recruited at 61 food distribution sites were collected at the first, second and third rounds and again at an extra, fifth food distribution, offered only to the evaluation subjects. Of the 3,544 children enrolled, 483 (13.63%) did not collect a fifth ration. Of the 2,640 children who were considered by their name to be the same at the first and fifth food distribution (13% were different), data on only 902 children (34.17%) were considered acceptable based on their age (an arbitrary ±3 months different) and their length or height (between >−1 or ≤4 cm different) at the two instances they were seen. Data on nearly two thirds of children were of questionable quality. The main reasons for the poor quality data were inconsistencies in estimating age or because caretakers may have brought different children. Recommendations are made about how to improve data quality including ensuring that entry to a blanket feeding programme is clearly based on height, not age, to avoid misreporting age; careful identification of subjects at all contacts; and using well-trained, specialist evaluation staff.

Background Severe malnutrition in childhood associated with HIV infection presents a serious humanitarian and public health challenge in Southern Africa. The aim of this study was to collect country wide data on HIV infection patterns in severely malnourished children to guide the development of integrated care in a resource limited setting. Methods A cross sectional survey was conducted in 12 representative rural and urban Nutrition Rehabilitation Units (NRUs), from each of Malawi's 3 regions. All children and their caretakers admitted to each NRU over a two week period were offered HIV counselling and testing. Testing was carried out using two different rapid antibody tests, with PCR testing for discordant results. Children under 15 months were excluded, to avoid difficulties with interpretation of false positive rapid test results. The survey was conducted once in the dry/post-harvest season, and repeated in the rainy/hungry season. Results 570 children were eligible for study inclusion. Acceptability and uptake of HIV testing was high: 523(91.7%) of carers consented for their children to take part; 368(70.6%) themselves accepted testing. Overall HIV prevalence amongst children tested was 21.6%(95% confidence intervals, 18.2–25.5%). There was wide variation between individual NRUs: 2.0–50.0%. Geographical prevalence variations were significant between the three regions (p < 0.01) with the highest prevalence being in the south: Northern Region 23.1%(95%CI 14.3–34.0%), Central Region 10.9%(95%CI 7.5–15.3%), and Southern Region 36.9%(95%CI 14.3–34.0%). HIV prevalence was significantly higher in urban areas, 32.9%(95%CI 26.8–39.4%) than in rural 13.2%(95%CI 9.5–17.6%)(p < 0.01). NRU HIV prevalence rates were lower in the rainy/hungry season 18.4%(95%CI 14.7–22.7%) than in the dry/post-harvest season 30.9%(95%CI 23.2–39.4%) (p < 0.001%). Conclusion There is a high prevalence of HIV infection in severely malnourished Malawian children attending NRUs with children in urban areas most likely to be infected. Testing for HIV is accepted by their carers in both urban and rural areas. NRUs could act as entry points to HIV treatment and support programmes for affected children and families. Recognition of wide geographical variations in childhood HIV prevalence will ensure that limited resources are initially targeted to areas of highest need. These findings may have implications for the other countries with similar patterns of childhood illness and food insecurity.