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1.
Medicine (Baltimore) ; 100(5): e24419, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592890

RESUMEN

ABSTRACT: Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos del Crecimiento/epidemiología , Delgadez/epidemiología , Síndrome Debilitante/epidemiología , Antropometría , Preescolar , Estudios Transversales , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estado Nutricional , Prevalencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Yemen/epidemiología
2.
BMC Infect Dis ; 21(1): 18, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407207

RESUMEN

BACKGROUND: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Diarrea/epidemiología , Desnutrición/epidemiología , Infecciones por Rotavirus/epidemiología , Rotavirus/inmunología , Animales , Lactancia Materna , Preescolar , Comorbilidad , Estudios Transversales , Diarrea/virología , Composición Familiar , Heces/virología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Mozambique/epidemiología , Prevalencia , Factores de Riesgo , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/virología , Vacunas contra Rotavirus/uso terapéutico
5.
Afr J Prim Health Care Fam Med ; 12(1): e1-e7, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33354983

RESUMEN

BACKGROUND: Malnutrition is a significant risk factor for ill health among children under 5 years of age and the consequences are significant. AIM: The aim of this study was to determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalised children. SETTING: This study was set at Sebokeng, Kopanong and Heidelberg hospitals, Sedibeng district, South Africa. METHODS: This was a cross-sectional study comprising 306 hospitalised under-5-year-old children. Information on socio-demography, feeding practices, immunisation and clinical problems was obtained from caregivers and medical records. Anthropometric measurements were also performed. RESULTS: Most participants were male (59.8%), had normal birth weights (80.0%), come from a household with a monthly income R2000 (about 150 US dollars) (50.3%), up-to-date immunisation (97.4%), breastfed for 6 months (57.4%) and were fed 3-4 meals/day (66.7%) and, at most, one snack/day (63.4%). Acute malnutrition accounted for 9.5% (n = 29) of admissions. Among these, 82.8% (n = 24) had severe acute malnutrition. On test of association, monthly household income (p = 0.01), mother's and father's employment status (p = 0.01; p = 0.01), breastfeeding history (p = 0.01) and having diarrhoea in index admission (p = 0.01) were significantly associated with malnutrition admission. In multivariate regression analyses, not being breastfed (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.23-12.29; p = 0.02) and diarrhoea at index admission were independently associated with malnutrition (OR = 23.3; 95% CI: 6.85-79.43; p = 0.01). CONCLUSION: A significant proportion of participants had malnutrition and were subjected to suboptimal feeding practices. Healthcare providers in primary care need to entrench dietary education and anthropometric screening in all clinic visits for children 5 years old, particularly when they present with diarrhoea or are not being breastfed.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Diarrea , Conducta Alimentaria , Hospitalización , Desnutrición/epidemiología , Antropometría , Lactancia Materna , Salud del Niño , Trastornos de la Nutrición del Niño/etiología , Preescolar , Estudios Transversales , Escolaridad , Femenino , Hospitales Públicos , Humanos , Renta , Lactante , Masculino , Desnutrición/etiología , Comidas , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Desnutrición Aguda Severa/epidemiología , Desnutrición Aguda Severa/etiología , Sudáfrica/epidemiología
6.
Rev Saude Publica ; 54: 111, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33175027

RESUMEN

OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Estado Nutricional , Brasil/epidemiología , Trastornos de la Nutrición del Niño/diagnóstico , Preescolar , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Recién Nacido , Masculino , Desnutrición/epidemiología , Prevalencia , Factores Socioeconómicos
7.
BMC Public Health ; 20(1): 1559, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066763

RESUMEN

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Áreas de Pobreza , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Preescolar , Estudios Transversales , Femenino , Humanos , India/epidemiología , Lactante , Masculino , Madres/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Factores Socioeconómicos
9.
BMC Public Health ; 20(1): 1027, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-32600372

RESUMEN

BACKGROUND: Wasting is a consequence of food insecurity, inappropriate dietary practices, and inadequate caring and feeding practices. The present study assessed association between wasting and household food insecurity among under 5 years old children, along with other socio-demographic characteristics. METHODS: This study is a secondary analysis of the Nepal Demographic and Health Survey 2016. The survey is cross-sectional in design with use of standardized tools. The sampling frame used is an updated version of the frame from the 2011 National Population and Housing Census. The participants were children under 5 years of age (n = 2414). Logistic regression was carried out to identify the odds of being wasted for children belonging to different levels of food insecure households using odds ratio and 95% confidence intervals. RESULTS: The prevalence of wasting increased with the level of food insecurity, from mild (9.4%) to moderate (10.8%) and to severe (11.3%). The highest proportions of wasted children were in Province 2 (14.3%), from rural areas (10.1%), born to mothers with no education (12.4%) and from a richer quintile (11.3%). Children belonging to severe food insecure households had 1.36 (95%CI 0.72-2.57) adjusted odds of being wasted and those belonging to mild food insecure and moderately food insecure households had 0.98 (95%CI 0.64-1.49) and 1.13 (95%CI 0.65-1.97) odds of being wasted respectively. Province 1 (AOR 2.06, 95%CI 1.01-4.19) and Province 2 (AOR 2.45, 95%CI 1.22-4.95) were significantly associated with wasting. CONCLUSION: Considering the increment in childhood wasting as per level of food insecurity, an integrated intervention should be developed in Nepal that, 1. addresses improving knowledge and behavior of community people with respect to diet and nutrition; 2. reduce the problem of food insecurity through agricultural interventions.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Dieta/estadística & datos numéricos , Abastecimiento de Alimentos/estadística & datos numéricos , Síndrome Debilitante/epidemiología , Trastornos de la Nutrición del Niño/etiología , Preescolar , Estudios Transversales , Dieta/efectos adversos , Conducta Alimentaria , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Madres/estadística & datos numéricos , Nepal/epidemiología , Estado Nutricional , Oportunidad Relativa , Prevalencia , Factores Socioeconómicos , Síndrome Debilitante/etiología
10.
Ann Hum Biol ; 47(2): 125-131, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32429759

RESUMEN

Context: Population-based cohort studies have been pivotal in establishing a number of nutrition-health interactions, especially in high-income settings. Less research is available from low- and middle-income countries due to the lack of detailed longitudinal data.Objective: To describe the use of prospectively collected longitudinal data from the rural West Kiang region of The Gambia to explore nutrition-health interactions in a rural sub-Saharan African context.Methods: Demographic records initiated in 1947, coupled with data on maternal and child health, have been used to explore nutrition-health relationships.Results: An analysis of the longitudinal demographic data demonstrated a highly significant association between season of birth and infection-related adult mortality in this context. Additionally, using routine data on childhood anthropometry, it has been shown that, despite a significant decline in child undernutrition, rates remain unacceptably high, likely reflecting the very high socio-economic threshold required to eliminate undernutrition.Conclusion: The foresight to establish demographic data collection over seventy years ago has supported a wealth of novel research within a traditional African context. The availability of detailed clinical records on maternal and child health is helping to unravel the factors driving child undernutrition in rural Africa, and to identify targets for interventions to improve health in this context.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Encuestas Nutricionales , Estado Nutricional , Población Rural/estadística & datos numéricos , Niño , Preescolar , Gambia , Humanos , Estudios Longitudinales , Parto , Estaciones del Año
12.
PLoS One ; 15(5): e0232663, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32396554

RESUMEN

BACKGROUND: Malnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services. METHODS: This analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes. RESULTS: We found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and 58% respectively. We also found inadequate numbers of human resource across all cadres with an exception of nutritionists as recommended by the Ministry of Health. CONCLUSIONS: This study has revealed a number of gaps in the health system and health service delivery that requires to be addressed; most notably, a lack of tools, policies and guidelines, drugs and health specialists to help care for malnourished infants and children. Our findings also reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition. Achieving universal coverage for nutrition services in Zambia will require a lot more attention to the health systems issues found in this study.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Niño/terapia , Preescolar , Estudios Transversales , Servicios de Salud , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Trastornos de la Nutrición del Lactante/terapia , Estado Nutricional , Cobertura Universal del Seguro de Salud , Zambia/epidemiología
13.
BMC Public Health ; 20(1): 532, 2020 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-32306937

RESUMEN

BACKGROUND: Children's nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health. METHODS: We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors. RESULTS: Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03-2.49 for the low intensity group). CONCLUSION: Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.


Asunto(s)
Conflictos Armados/psicología , Trastornos de la Nutrición del Niño/epidemiología , Exposición a la Violencia/psicología , Desnutrición/epidemiología , Delgadez/epidemiología , Niño , Salud del Niño , Trastornos de la Nutrición del Niño/psicología , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Estudios Transversales , Composición Familiar , Femenino , Humanos , Masculino , Desnutrición/psicología , Prevalencia , Sudán/epidemiología , Encuestas y Cuestionarios , Delgadez/psicología
14.
BMC Public Health ; 20(1): 555, 2020 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-32334558

RESUMEN

BACKGROUND: Low- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, household and neighbourhood characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities. METHODS: We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p = 0.05. RESULTS: The proportion of children whose mothers were not educated ranged from 0.1% in Armenia and Kyrgyz Republic to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p < 0.001), Chad(p < 0.001), Comoro(p = 0.047), Burkina Faso(p < 0.001), Ethiopia(p < 0.001), India(p < 0.001), Kenya(p < 0.001), Mozambique(p = 0.012), Namibia(p = 0.001), Nigeria(p < 0.001), Pakistan(p < 0.001), Senegal(p = 0.003), Togo(p = 0.013), and Timor Leste(p < 0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child's age (p < 0.001), child's sex(p < 0.001), maternal age(p = 0.001), household wealth quintile(p = 0.001), mother's access to media(p = 0.001), birth weight(p < 0.001) and neighbourhood socioeconomic status disadvantage(p < 0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type. CONCLUSIONS: SAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Países en Desarrollo/estadística & datos numéricos , Escolaridad , Disparidades en el Estado de Salud , Desnutrición Aguda Severa/epidemiología , Adolescente , Adulto , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
15.
PLoS One ; 15(4): e0231479, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32275697

RESUMEN

BACKGROUND: India is expected to experience an increase in the frequency and intensity of extreme weather events in the coming decades, which poses serious risks to human health and wellbeing in the country. OBJECTIVE: This paper aims to shed light on the possible detrimental effects of monsoon weather shocks on childhood undernutrition in India using the Demographic and Health Survey 2015-16, in combination with geo-referenced climate data. METHODS: Undernutrition is captured through measures of height-for-age, weight-for-height, stunting and wasting among children aged 0-59 months. The standardised precipitation and evapotranspiration index (SPEI) is used to measure climatic conditions during critical periods of child development. RESULTS: The results of a multivariate logistic regression model show that climate anomalies experienced in utero and during infancy are associated with an increased risk of child undernutrition; exposure to excessive monsoon precipitation during these early periods of life elevates the risk of stunting, particularly for children in the tropical wet and humid sub-tropical regions. In contrast, the risk of stunting is reduced for children residing in the mountainous areas who have experienced excessive monsoon precipitation during infancy. The evidence on the short-term effects of climate shocks on wasting is inconclusive. We additionally show that excessive precipitation, particularly during the monsoon season, is associated with an increased risk of contracting diarrhoea among children under five. Diseases transmitted through water, such as diarrhoea, could be one important channel through which excessive rainfall increases the risk of stunting. CONCLUSIONS: We find a positive association between childhood undernutrition and exposure to excessive monsoon precipitation in India. Pronounced differences across climate zones are found. The findings of the present analysis warn of the urgent need to provide health assistance to children in flood-prone areas.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/etiología , Peso Corporal/fisiología , Preescolar , Femenino , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Humanos , India/epidemiología , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estaciones del Año , Delgadez/epidemiología , Delgadez/etiología , Tiempo (Meteorología)
16.
Int J Public Health ; 65(3): 281-290, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32240317

RESUMEN

OBJECTIVES: Indian agriculture is mostly dependent on monsoon. Poor and irregular rainfall may result in crop failure and food shortage among the vulnerable population. This study examined the variations in drought condition and its association with under age 5 child malnutrition across the districts of India. METHODS: Using remote sensing and National Family Health Survey (NFHS-4) data, univariate Moran's I and bivariate local indicator of spatial autocorrelation (LISA) maps were generated to assess the spatial autocorrelation and clustering. To empirically check the association, we applied multivariate ordinary least square and spatial autoregressive models. RESULTS: The study identified highly significant spatial dependence of drought followed by underweight, stunting, and wasting. Bivariate LISA maps showed negative spatial autocorrelation between drought and child malnutrition. Regression results suggest agricultural drought is substantially associated with stunting. An increasing value of drought showed statistical association with the decreasing (ß = - 8.251; p value < 0.05) prevalence rate of child stunting across India. CONCLUSIONS: This study provides evidence of child undernutrition attributable to drought condition, which will further improve the knowledge of human vulnerability and adaptability in the climatic context.


Asunto(s)
Agricultura , Trastornos de la Nutrición del Niño/epidemiología , Sequías , Trastornos del Crecimiento/epidemiología , Desnutrición/epidemiología , Delgadez/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Prevalencia , Análisis Espacial
17.
BMC Public Health ; 20(1): 399, 2020 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-32220224

RESUMEN

BACKGROUND: Ethiopia is one of the developing countries where child under-nutrition is prevalent. Prior studies employed three anthropometric indicators for identifying factors of children's under-nutrition. This study aimed at identifying the factors of child under-nutrition using a single composite index of anthropometric indicators. METHODS: Data from Ethiopia's Demographic and Health Survey 2016 was the base for studying under-nutrition in a sample of 9494 children below 59 months. A single composite index of under-nutrition was created from three anthropometric indices through principal component analysis recoded into an ordinal outcome. In line with World Health Organization 2006 Child Growth Standards, the three anthropometric indices involve z-score of height-for-age (stunting), weight-for-height (wasting) and weight-for-age (underweight). Partial proportional odds model was fitted and its relative performance compared with some other ordinal regression models to identify significant determinants of under-nutrition. RESULTS: The single composite index of anthropometric indicators showed that 49.0% (19.8% moderately and 29.2% severely) of sampled children were undernourished. In the Brant-test of proportional odds model, the null hypothesis that the model parameters equal across categories was rejected. Compared to ordinal regression models, partial proportional odds model showed an improved fit. A child with mother's body mass index less than 18.5 kg, from poorest family and a husband without education, and male to be in a severe under-nutrition status was 1.4, 1.8 1.2 and 1.2 times more likely to be in worse under-nutrition status compared to its reference group respectively. CONCLUSION: Authors conclude that the fitted partial proportional odds model indicated that age and sex of the child, maternal education, region, source of drinking water, number of under five children, mother's body mass index and wealth index, anemic status of child, multiple births, fever of child before 2 months of the survey, mother's age at first birth, and husband's education were significantly associated with child under-nutrition. Thus, it is argued that interventions focus on improving household wealth index, food security, educating mothers and their spouses, improving maternal nutritional status, and increasing mothers' health care access.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Antropometría , Preescolar , Etiopía/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios
18.
Trop Med Int Health ; 25(6): 740-750, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32166877

RESUMEN

OBJECTIVES: Mass administration of azithromycin has reduced mortality in children in sub-Saharan Africa but its mode of action is not well characterised. A recent trial found that azithromycin given alongside seasonal malaria chemoprevention was not associated with a reduction in mortality or hospital admissions in young children. We investigated the effect of azithromycin on the nutritional status of children enrolled in this study. METHODS: A total of 19 578 children in Burkina Faso and Mali were randomised to receive either azithromycin or placebo alongside seasonal malaria chemoprevention with sulfadoxine-pyrimethamine plus amodiaquine monthly for three malaria transmission seasons (2014-2016). After each transmission season, anthropometric measurements were collected from approximately 4000 randomly selected children (2000 per country) at a cross-sectional survey and used to derive nutritional status indicators. Binary and continuous outcomes between treatment arms were compared by Poisson and linear regression. RESULTS: Nutritional status among children was poor in both countries with evidence of acute and chronic malnutrition (24.9-33.3% stunted, 15.8-32.0% underweight, 7.2-26.4% wasted). There was a suggestion of improvement in nutritional status in Burkina Faso and deterioration in Mali over the study period. At the end of each malaria transmission season, nutritional status of children did not differ between treatment arms (seasonal malaria chemoprevention plus azithromycin or placebo) in either the intention-to-treat or per-protocol analyses (only children with at least three cycles of SMC in the current intervention year). CONCLUSIONS: The addition of azithromycin to seasonal malaria chemoprevention did not result in an improvement of nutritional outcomes in children in Burkina Faso and Mali.


Asunto(s)
Antimaláricos/uso terapéutico , Azitromicina/uso terapéutico , Trastornos de la Nutrición del Niño/epidemiología , Malaria/prevención & control , Antimaláricos/administración & dosificación , Azitromicina/administración & dosificación , Burkina Faso , Quimioprevención , Preescolar , Estudios Transversales , Quimioterapia Combinada , Femenino , Humanos , Lactante , Masculino , Malí , Administración Masiva de Medicamentos , Estado Nutricional , Estaciones del Año
20.
PLoS Med ; 17(3): e1003055, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32203504

RESUMEN

BACKGROUND: Housing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA. METHODS AND FINDINGS: Cross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0-5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%-18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80-0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77-0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88-0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87-1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77-0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83-0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80-0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82-0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84-0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%-17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78-0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79-0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education. CONCLUSIONS: In this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children's health and survival across SSA.


Asunto(s)
Anemia/epidemiología , Salud del Niño , Trastornos de la Nutrición del Niño/epidemiología , Diarrea/epidemiología , Vivienda , Malaria/epidemiología , Determinantes Sociales de la Salud , África del Sur del Sahara/epidemiología , Factores de Edad , Anemia/diagnóstico , Anemia/mortalidad , Anemia/prevención & control , Trastornos de la Nutrición del Niño/diagnóstico , Trastornos de la Nutrición del Niño/mortalidad , Trastornos de la Nutrición del Niño/prevención & control , Preescolar , Estudios Transversales , Diarrea/diagnóstico , Diarrea/mortalidad , Diarrea/prevención & control , Agua Potable , Femenino , Estado de Salud , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Mosquiteros Tratados con Insecticida , Malaria/diagnóstico , Malaria/mortalidad , Malaria/prevención & control , Masculino , Estudios Prospectivos , Factores Protectores , Medición de Riesgo , Factores de Riesgo , Saneamiento
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