Paternal Alcohol Consumption and Childhood Malnutrition: A Community-based Participatory Case-control Study among Adivasis in Rural South India.

BACKGROUND: Childhood malnutrition in India remains among the highest in the world. Adult alcohol consumption and severe malnutrition have increased among indigenous people in South India. However, the association between them is poorly understood. OBJECTIVES: We aimed to evaluate this association, which could help design better intervention strategies. METHODS: This case-control observational study was conducted in the Nilgiri district in South India. Cases included children aged 1-5 years with moderate malnutrition. Controls were defined as children in the same age group with normal weight-for-age. A questionnaire was used to collect data on demographics, socioeconomic status (SES), and parental education. The WHO Alcohol Use Disorders Identification Test (AUDIT) questionnaire was used to estimate parental alcohol use. Health-care workers collected data from within the community. RESULTS: The baseline demographics of the children in the control (n = 250) and case groups (n = 177) were similar. Paternal age and AUDIT scores were not different in the two groups. SES was lower in the malnourished group, while maternal education among cases was significantly lower. Maternal and paternal education were associated with childhood malnutrition (odds ratio [OR]: 0.728 [95% confidence interval (CI): 0.583-0.903] and OR: 0.753 [95% CI: 0.589-0.957], respectively). After adjustment for covariates, paternal alcohol use was associated with a higher risk of malnutrition (OR: 1.56 [95% CI: 1.00-2.47]), which SES partly mediated. CONCLUSION: Paternal alcohol consumption is associated with childhood malnutrition, partially mediated by lower SES. Furthermore, lower SES appeared to be strongly associated with paternal alcohol consumption.

Assessment of malnutrition using Z-scores and Composite Index of Anthropometric Failure among street children in Delhi.

BACKGROUND: Street children are poverty-stricken and have insufficient money to meet their daily nutritional requirements. They do not have a proper place to sleep and defecate. They sleep at traffic signals, in religious places, and on footpaths. This exposes them to pollution, dirt, and other pathogens. OBJECTIVES: This study aimed to measure the nutritional status of street children in Delhi using Z-scores and Composite Index of Anthropometric Failure (CIAF). METHODS: Anthropometric measurements are direct methods of measuring the nutritional status of humans. Anthropometric indicators such as underweight (weight-for-age), stunting (height-for-age) and BMI/wasting (weight-for-height) are used to measure the nutritional status of street children. Z-scores and CIAF are calculated for street children based on the WHO 2009 reference. RESULTS: According to Z-scores, stunting (56%) is the most common anthropometric failure among street children followed by underweight (31%) and wasting (19%). According to the CIAF, 63% of street children are malnourished, where stunting (37%) is the highest single burden of anthropometric failure, followed by wasting (3%) and underweight (1%); children suffering from the double burden of anthropometric failure are 9%, and children suffering from the triple burden of anthropometric failure (i.e., wasting, stunting, and underweight) are 13%. CONCLUSION: A high incidence of stunting points to poor quality of food and suggests prolonged nutrition deficiency among street children. The Z-score or conventional measures of anthropometry underestimate the total burden of malnutrition among street children, while CIAF provides an estimation of children with single-burden, double-burden, and triple-burden malnutrition or total burden of malnutrition.

The Global Burden of Disease Attributable to Child and Maternal Malnutrition: 1990-2019.

OBJECTIVE: With this study, we aimed to estimate the disease burden attributable to child and maternal malnutrition (CMM) throughout the world between 1990 and 2019. METHODS: The number, age-standardized rate, population attributable fraction of deaths, disability-adjusted life-years, years of life lost, and years lived with disability associated with CMM were estimated using the Global Burden of Disease Study 2019 by age, sex, year, location, and sociodemographic index at the global level. The slope index of inequality and concentration index were employed to measure socioeconomic-related health inequalities across countries. RESULTS: The number (million) of global deaths, disability-adjusted life-years, and years of life lost related to CMM were 2.9, 294.8, and 250.5 in 2019, showing decreases of 60.8, 57.4, and 60.7% since 1990. However, the number of years lived with CMM-related disability increased from 36.0 in 1990 to 44.3 in 2019. Additionally, the age-standardized rates of these 4 indicators showed varying degrees of decline. The global burden of CMM-related conditions differed with age and sex. The burden was the heaviest in western sub-Saharan Africa, especially in Chad. In terms of diseases, neonatal disorders represented the most significant burden attributed to CMM. Additionally, the CMM burden was more concentrated in regions with low sociodemographic indices, shown by the slope index of inequality and concentration index. CONCLUSIONS: The findings of this study highlight the ongoing global burden of CMM, particularly in terms of years lived with disability. Population-wide actions targeting the effective treatment and relief of CMM may reduce the CMM-related disease burden.

Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study.

BACKGROUND: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

Epidemiological study of pediatric nutritional deficiencies: an analysis from the global burden of disease study 2019.

BACKGROUND: Nutritional deficiencies (ND) continue to threaten the lives of millions of people around the world, with children being the worst hit. Nevertheless, no systematic study of the epidemiological features of child ND has been conducted so far. Therefore, we aimed to comprehensively assess the burden of pediatric ND. METHODS: We analyzed data on pediatric ND between 1990 and 2019 from the Global Burden of Disease study (GBD) 2019 at the global, regional, and national levels. In addition, joinpoint regression models were used to assess temporal trends. RESULTS: In 2019, the number of prevalent cases of childhood malnutrition increased to 435,071,628 globally. The global age-standardized incidence, prevalence, and DALY rates showed an increasing trend between 1990 and 2019. Meanwhile, the burden of child malnutrition was negatively correlated with sociodemographic index (SDI). Asia and Africa still carried the heaviest burden. The burden and trends of child malnutrition varied considerably across countries and regions. At the age level, we found that malnutrition was significantly more prevalent among children < 5 years of age. CONCLUSION: Pediatric ND remains a major public health challenge, especially in areas with low SDI. Therefore, primary healthcare services in developing countries should be improved, and effective measures, such as enhanced pre-school education, strengthened nutritional support, and early and aggressive treatment, need to be developed.

Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys.

BACKGROUND: Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. METHODS: Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. RESULTS: Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. CONCLUSIONS: The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.

Child undernutrition in Brazil: the wound that never healed.

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.

Enfermedades emergentes, pobreza y hambre / Emerging diseases, poverty and hunger

La pobreza y el hambre son elementos significativos para la prevalencia de las enfermedades emergentes, además de la ignorancia, la indigencia, las falencias sanitarias y los cambios ambientales debidos al calentamiento global. La desnutrición es consecuencia de la pobreza y ésta es causa de desnutrición. Los niños que viven en condiciones de mayor vulnerabilidad tienen un riesgo alto de morir por diarrea, neumonía y enfermedades emergentes. La mayoría son desnutridos. Su futuro en la adultez guarda relación con la desnutrición en la infancia. En el mundo 820 millones de niños padecen hambre y mueren anualmente 3 millones de menores de 5 años, según datos del Fondo de las Naciones Unidas para la Infancia. En Argentina, según datos del segundo semestre de 2022, un 39,2% de la población es pobre (Instituto Nacional de Estadísticas y Censos). El 15,5% de niños y adolescentes padecen inseguridad alimentaria y 2 millones de niños padecen hambre (Médicos sin Fronteras). La tasa de mortalidad infantil en menores de 5 años tiene una prevalencia del 0,4%. Los cambios climáticos ejercen influencia sobre la salud, produciendo cambios en la epidemiologia de las enfermedades emergentes, mientras que la insuficiente alimentación ocasiona efectos negativos sobre la salud. El calentamiento global aumenta las inundaciones y las sequías, incidiendo en la escasez de alimentos e incrementando las enfermedades emergentes. La situación debe ser revertida mediante el desarrollo sostenido de la educación, el bienestar social y los proyectos sanitarios. (AU)

Poverty and hunger are significant elements for the prevalence of emerging diseases, in addition to ignorance, indigence, sanitary deficiencies and environmental changes due to global warming. Malnutrition is a consequence of poverty and poverty is a cause of malnutrition. Children living in more vulnerable conditions are at greater risk of dying from diarrhea, pneumonia and emerging diseases. Most are malnourished. Their future in adulthood is related to malnutrition in childhood. Worldwide, 820 million children suffer from hunger and 3 million children under 5 die annually (United Nations Children's Fund). In Argentina, according to data from the second half of 2022, 39.2% of the population is poor (Instituto Nacional de Estadísticas y Censos). 15.5% of children and adolescents are food insecure and 2 million children are hungry (Médecins Sans Frontières). The infant mortality rate in children under 5 years of age has a prevalence of 0.4%. Climate change influences health, producing changes in the epidemiology of emerging diseases, while insufficient food has negative effects on health. Global warming increases floods and droughts, leading to food shortages and increasing emerging diseases. The situation must be reversed through sustained development of education, social welfare and health projects. (AU)

Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries.

Importance: Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children's health. Objective: To assess the associations between economic growth and malnutrition, contributing factors and malnutrition, and economic growth and contributing factors of malnutrition in low- and middle-income countries (LMICs). Design, Setting, and Participants: This cross-sectional study used data from 239 Demographic and Health Surveys from January 1, 1990, to December 31, 2021. Observations included 1 138 568 children aged 0 to 35 months with valid anthropometric measures and information on contributing factors of malnutrition from 58 LMICs. Data were analyzed from May 20, 2022, to February 16, 2023. Exposure: National per-capita gross domestic product (GDP) was used as a proxy for economic growth. Main Outcomes and Measures: Six measures of childhood malnutrition were constructed: stunting (height-for-age z score <-2), underweight (weight-for-age z score <-2), wasting (weight-for-height z score <-2), overweight (weight-for-height z score >2), obesity (weight-for-height z score >3), and dietary diversity failure (consumption of less than 5 of 8 different food groups in the past 24 hours). Eighteen contributing factors of malnutrition were constructed, of which 10 were underlying determinants (eg, access to improved sanitation) and 8 were immediate determinants (eg, breastfeeding initiation). Results: A total of 1 138 568 children (mean [SD] age, 17.14 [10.26] months; 579 589 [50.9%] boys and 558 979 [49.1%] girls) were included in the analysis. Of these, 27.3% (95% CI, 27.2%-27.4%) had stunting; 25.7% (95% CI, 25.6%-25.8%), underweight; 11.2% (95% CI, 11.1%-11.2%), wasting; 3.8% (95% CI, 3.7%-3.8%), overweight; 1.1% (95% CI, 1.1%-1.1%), obesity; and 79.8% (95% CI, 79.7%-79.9%), dietary diversity failure. Per-capita GDP was weakly associated with childhood malnutrition. The odds ratios associated with a 5% increase in per-capita GDP were 0.99 (95% CI, 0.99-1.00) for stunting, 1.01 (95% CI, 1.00-1.01) for wasting, 1.00 (95% CI, 1.00-1.00) for underweight, 0.98 (95% CI, 0.98-0.98) for overweight, 0.98 (95% CI, 0.97-0.98) for obesity, and 1.03 (95% CI, 1.01-1.04) for dietary diversity failure. Although strong associations were found between many contributing factors and most outcomes for malnutrition, associations identified between per-capita GDP and these contributing factors themselves were ambiguous. Conclusions and Relevance: In this multicountry cross-sectional study, economic growth was weakly associated with childhood malnutrition and several contributing factors. To reduce child malnutrition, economic growth may need to be accompanied by more targeted investments to improve contributing factors that are strongly associated with child malnutrition, such as maternal health and education.

Association Between Household Food Insecurity (Access) Scores, Poverty Indicators and Child Malnutrition in Botswana.

In Botswana the Household Food Insecurity Access Scale (HFIAS) has been used in studying the urban-poor, but less in rural settings high in poverty, child malnutrition (CM), and social protection beneficiaries. This cross-sectional study compared HFIAS scores, household poverty (HP) and CM in two rural districts: Bobirwa with moderate and Mabutsane with high poverty. Households (n = 872) with children under-five years participated. Most children (87.6%) experienced food insecurity. Mean HFIAS for all households was 11.0 ± 8. HFIAS scores were higher in Mabutsane (p < .001). HFIAS scores were consistently associated with HP and CM in both districts. HFIAS can assist in targeting the rural-poor.

Child malnutrition in Brazil: Public health issue that needs awareness.

In developing countries, child malnutrition is a serious public health problem. Brazil is a country that has several projects to combat hunger and malnutrition in early childhood, but 2021 was a year with the highest number of hospitalizations of children up to 60 months of life in the last 13 years. Factors such as social disparities and the Covid-19 pandemic contributed to this scenario.

Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa?

OBJECTIVE: We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship. DESIGN: Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis. SETTING: West Africa. PARTICIPANTS: 132 448 under-five children born within 5 years preceding the survey were included. RESULTS: Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend P-values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship. CONCLUSIONS: The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.

Social network of malnourished children and its association with family's food and nutritional security / Rede social de crianças desnutridas e sua relação com a segurança alimentar e nutricional da família

Abstract Objectives: evaluate the relationship between family's food and nutrition insecurity (FNI) and the social network of malnourished children. Methods: cross-sectional study with 92 children, included in the economic class D-E. For the analysis of the children's social network, the mothers answered four simple questions. To investigate the FNI, the Brazilian Scale of Food Insecurity was used. The association between variables was analyzed by Poisson regression with robust analysis of variances. Results: 56.5% of the children had a weak social network (<10 individuals), and the prevalence of FNI was 72.8%. An inverse association was observed between children of the daily social network and FNI family (OR=0.94; CI95%=0.89-0.99], p=0.03). The number of individuals in the children's daily social network was negatively associated with the likelihood of FNI. The mother's educational level was also related to FNI (OR=2.20 [CI95%=1.11-4.34]; p=0.02), being the child up to 2.2 times more likely to be in FNI when the mother has less than four years of study. Conclusion: these results suggest that social network is associated with the FNI of malnourished children. Interventions designed to strengthen instrumental and other forms of support among small social networks can improve the health/nutrition of malnourished children with FNI.

Resumo Objetivos: avaliar a relação entre a insegurança alimentar e nutricional (IAN) da família e a rede social de crianças desnutridas. Métodos: estudo transversal com 92 crianças, inseridas na classe econômica D-E. Para a análise da rede social das crianças, as mães responderam quatro perguntas simples. Para investigar a IAN foi utilizada a Escala Brasileira de Insegurança Alimentar. A associação entre as variáveis foi analisada por regressão de Poisson com análise robusta das variâncias. Resultados: 56,5% das crianças apresentaram rede social fraca (<10 indivíduos), e a prevalência de IAN foi de 72,8%. Foi observada uma associação inversa entre rede social diária das crianças e IAN da família (RP=0,94, [IC95%=0,89-0,99]; p=0,03). O número de indivíduos na rede social diária das crianças se associou negativamente com a probabilidade de IAN. O nível de escolaridade materno também estava relacionado com a IAN (RP=2,20 [IC95%=1,11-4,34]; p=0,02), tendo a criança até 2,2 vezes mais probabilidade de estar em IAN quando a mãe apresenta menos de quatro anos de estudo. Conclusão: esses resultados sugerem que a rede social está associada à IAN de crianças desnutridas. Intervenções destinadas a fortalecer maneiras instrumentais e outras formas de apoio entre pequenas redes sociais podem melhorar a saúde/nutrição de crianças desnutridas com IAN.

Understanding malnutrition management through a socioecological lens: Evaluation of a community-based child malnutrition program in rural Uganda.

In Uganda, almost half of children under 5 years old suffer from undernutrition. Undernutrition, a common form of malnutrition in children, encompasses stunting, wasting and underweight. The causes of child undernutrition are complex, suggesting that interventions to tackle malnutrition must be multifaceted. Furthermore, limited access to healthcare for vulnerable populations restricts the potential of hospital-based strategies. Community-based management of acute malnutrition (CMAM), which includes nutritional counselling, ready-to-use therapeutic foods and the outpatient management of malnutrition by caregivers, is recognised as an effective approach for children's recovery. However, evaluations of CMAM programs are largely based on biomedical and behavioural health models, failing to incorporate structural factors that influence malnutrition management. The objective of this evaluation was to understand the factors influencing malnutrition management in a CMAM program in rural Uganda, using the socioecological model to assess the multilevel determinants of outpatient malnutrition management. This evaluation used qualitative methods to identify factors related to caregivers, healthcare providers and societal structures that influence children's outpatient care. Data were collected at a community health clinic in 2019 through observations and interviews with caregivers of malnourished children. We observed 14 caregiver-provider encounters and interviewed 15 caregivers to examine factors hindering outpatient malnutrition management. Data were thematically analysed informed by the socioecological model. Findings showed that caregivers had a limited understanding of malnutrition. Counselling offered to caregivers was inconsistent and insufficient. Poverty and gender inequality limited caregivers' access to healthcare and their ability to care for their children. Factors at the caregiver and healthcare levels interacted with societal factors to shape malnutrition management. Results suggest that CMAM programs would benefit from providing holistic interventions to tackle the structural barriers to children's care. Using a socioecological approach to program evaluation could help move beyond individual determinants to address the social dynamics shaping malnutrition management in low- and middle-income countries.

Nutritional inequalities among under-five children: a geospatial analysis of hotspots and cold spots in 73 low- and middle-income countries.

BACKGROUND: Child undernutrition is a severe health problem in the developing world, which affects children's development in the long term. This study analyses the extent and patterns of under-five child undernutrition using Demographic and Health Surveys (DHS) for 73 low- and middle-income countries (LMICs). METHODS: First, we mapped the prevalence of undernutrition in the developing world. Second, using the LISA (a local indicator of spatial association) technique, we analyzed the geographical patterns in undernutrition to highlight the localized hotspots (regions with high undernutrition prevalence surrounded by similar other regions), cold spots (regions with low undernutrition prevalence surrounded by similar other regions), and outliers (regions with high undernutrition surrounded by low undernutrition and vice versa). Third, we used Moran's I to find global patterns in child undernutrition. RESULTS: We find that South Asia has the highest under-five child undernutrition rates. The intra-country nutritional inequalities are highest in Burundi (stunting), Kenya (wasting), and Madagascar (underweight). The local indicator of spatial association (LISA) analysis suggests that South Asia, Middle East and North Africa (MENA) region, and Sub-Saharan Africa are undernutrition hotspots and Europe and Central Asia and Latin America, and the Caribbean are undernutrition cold spots (regions with low undernutrition surrounded by similar other regions). Getis Ord-Gi* estimates generally support LISA analysis. Moran's I and Geary's C gave similar results about the global patterns of undernutrition. Geographically weighted regressions suggest that several socioeconomic indicators significantly explain child undernutrition. CONCLUSIONS: We found a significant within and across country variation in stunting, wasting and underweight rates among the under-five children's population. The geospatial analysis also suggested that stunting, wasting, and underweight patterns exhibit clear regional patterns, underscoring the need for coordinated interventions at the regional level.

Prevalence of child undernutrition measures and their spatio-demographic inequalities in Bangladesh: an application of multilevel Bayesian modelling.

Micro-level statistics on child undernutrition are highly prioritized by stakeholders for measuring and monitoring progress on the sustainable development goals. In this regard district-representative data were collected in the Bangladesh Multiple Indicator Cluster Survey 2019 for identifying localised disparities. However, district-level estimates of undernutrition indicators - stunting, wasting and underweight - remain largely unexplored. This study aims to estimate district-level prevalence of these indicators as well as to explore their disparities at sub-national (division) and district level spatio-demographic domains cross-classified by children sex, age-groups, and place of residence. Bayesian multilevel models are developed at the sex-age-residence-district level, accounting for cross-sectional, spatial and spatio-demographic variations. The detailed domain-level predictions are aggregated to higher aggregation levels, which results in numerically consistent and reasonable estimates when compared to the design-based direct estimates. Spatio-demographic distributions of undernutrition indicators indicate south-western districts have lower vulnerability to undernutrition than north-eastern districts, and indicate significant inequalities within and between administrative hierarchies, attributable to child age and place of residence. These disparities in undernutrition at both aggregated and disaggregated spatio-demographic domains can aid policymakers in the social inclusion of the most vulnerable to meet the sustainable development goals by 2030.

Multilevel multivariate analysis on the anthropometric indicators of under-five children in Ethiopia: EMDHS 2019.

BACKGROUND: Undernutrition is the main cause of morbidity and mortality of children aged under five and it is an important indicator of countries' economic and health status. Limited attention is given to research papers conducted in Ethiopia that identified and estimates the determinants of under-five anthropometric indicators by considering their association and clustering effect. Therefore, this study aimed to identify and estimate the effects of important determinants of anthropometric indicators by taking into account their association and cluster effects. METHODS: In this study, a cross-sectional study design was implemented based on the data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) consists a total of 5027 under-five children. A multilevel multivariate logistic regression model was employed to estimate the effect of the determinants given their association of anthropometric indicators and clustering effect. RESULTS: Among 5027 children considered in the study 36.0, 23.3, and 9.1% of them were stunted, underweight, and wasted, respectively. Whereas the total number of undernourished (stunting, underweight and/or wasting) children was 42.9%. More than half of the children (51.2%) were males and 77.0% lived in rural area. The estimated odds of children from households with secondary and above education levels being stunted was 0.496 (OR = 0.496) times the estimated odds of children from households with no education. Whereas children from the richest households were less likely to be stunted as compared to children from the poorest households (OR = 0.485). The estimated odds of children from urban areas being underweight and wasting were lower by 24.9 and 33.7% of estimated odds of children from rural areas respectively. CONCLUSION: The prevalence of anthropometric indicators of stunting, underweight, and wasting in Ethiopia was increased. The children underweight has significant dependency with both stunting and wasting. The sex of the child, wealth index, and education level of a household are the common important determinants of stunting, underweight and wasting. The undernourished status of children was more alike within the region and differences between regions.

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania.

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents-and even less regarding younger adolescents-a vulnerable group at a critical stage of the life course. Africa's rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10-14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p<0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p<0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p<0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p<0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings.

La desnutrición infantil en Ecuador. Una revisión de literatura / Child malnutrition in Ecuador. A literature review

La desnutrición infantil constituye un grave problema de salud, afectando los sectores sociales más desfavorecidos. La desnutrición causa disminución del crecimiento y del desempeño escolar, altera el estado bioquímico e incrementa la morbimortalidad infantil. Entre las principales causas de desnutrición están la dieta inadecuada, la presencia de infecciones que interfieren con la utilización adecuada de nutrientes, inequidad e insuficiente disponibilidad de alimentos. En América Latina, aproximadamente 2,3 millones de niños de 0 a 4 años se ven afectados por desnutrición moderada o grave y 8,8 millones presentan baja talla para su edad, con alta prevalencia de desnutrición crónica, lo que es atribuible a determinantes sociales, económicos y políticas de salud deficientes en la mayoría de países de la región. En Ecuador existe una prevalencia de desnutrición de 23,2%, situación que se agrava en el contexto rural, presentando más frecuencia en la Sierra (32%), la Costa (15,7%), la Amazonía (22,7%) y la zona Insular (5,8%), y aun cuando se han implementado programas de nutrición, los logros positivos de indicadores nutricionales, no han alcanzado impactar lo suficiente en algunas comunidades indígenas en las que se estima una tasa de desnutrición crónica infantil por encima de 50%. La presente investigación muestra los principales rasgos de la desnutrición infantil en Ecuador, partiendo de un diseño cualitativo, interpretativo y análisis documental con el objetivo de sistematizar el conocimiento y fortalecer las bases teórico-metodológicas de planes y estrategias necesarios para disminuir los efectos negativos de la desnutrición en el desarrollo infantil(AU)

Infant malnutrition constitutes a serious health problem, affecting the most disadvantaged social sectors. Malnutrition causes a decrease in growth and school performance, an alteration in the biochemical state and an increase in infant morbidity and mortality. Among the main causes of malnutrition are an inadequate diet, the presence of infections that interfere with the adequate use of nutrients, inequity, and insufficient food availability. In Latin America, approximately 2.3 million children aged 0 to 4 are affected by moderate or severe malnutrition and 8.8 million are short for their age, with a high prevalence of chronic malnutrition, which is attributable to social determinants economic, economic and health policies in most countries of the region. In Ecuador there is a prevalence of malnutrition of 23.2%, a situation that worsens in the rural context, presenting more frequency in the Sierra (32%), the Coast (15.7%), the Amazon (22.7%) and the Insular zone (5.8%), and even when nutrition programs have been implemented, the positive achievements of nutritional indicators have not had a sufficient impact on some indigenous communities in which a rate of chronic child malnutrition is estimated by above 50%. This research shows the main features of child malnutrition in Ecuador, starting from a qualitative, interpretive design and documentary analysis with the aim of systematizing knowledge and strengthening the theoretical-methodological bases of plans and strategies necessary to reduce the negative effects of the malnutrition in child development(AU)

Effect of wealth, social inequality, Mother's BMI, and education level on child malnutrition in India.

BACKGROUND AND AIMS: The differences in prevalence of malnutrition are mostly on account of social factors. However, we did not find any published study that provided an estimate of proportion of stunting and underweight among under-5 children due to household economic conditions, social inequalities, mother's BMI and education level. Hence, study has taken to study the effect of household economic status, social inequality, mother's BMI and education on stunting and underweight among children under-5 years and its determinants. METHODS: The study used Kids file of NFHS-4 (2015-16), which comprised 259,627 children aged less than five years. This data was analysed by bivariate and Forward Logistic Regression techniques using M.S. Excel and IBM SPSS-22 version. RESULTS: The prevalence of stunting and underweight children was significantly higher among those born to underweight mothers, poor households, working women, and women had a home delivery. It was also high among children of 4th or higher birth order, those from scheduled castes and tribes, born to illiterate women and those residing in rural. The odds of stunting (OR = 2.67, 95% CI: 2.54-2.81) and underweight (OR = 2.74, 95% CI: 2.60-2.88) were more than two times higher among children living in poor households than among those from rich households. Poor households account for about 40% of stunted and underweight children. Fifteen percent of stunted children and 26.9% of underweight were born to underweight mothers. Overall, 60% of stunted and 56.6% of underweight children had illiterate mothers. CONCLUSIONS: children of illiterate and underweight mothers, socially deprived and economically poor groups are at a higher risk of being stunted and underweight. Hence, necessary health programmes are needed for improving nutritional status by giving special attention to illiterate, underweight mothers, socially deprived and economically poor groups.