Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996-2017.

Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996-2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10-19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10-15 years old) were more likely to be underweight (+11 pp), have lower education (-24 pp), have less decision-making power (-10 pp), live in poorer households (-0.9 SD) with poorer sanitation (-15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (-3 to -24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height-for-age Z-scores (-0.29 SD for young and -0.10 SD for old adolescents (16-19 years old)), weight-for-age Z-score (-0.18 and -0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.

Measles, Malnutrition and Mortality: Puerto Rico, 1917-1918.

OBJECTIVE: Recent measles outbreaks in the United States and Europe have highlighted the threat of the disease. We studied the 1917-1918 epidemic in Puerto Rico to better understand the social and place-specific risk factors and severity of such crises. METHODS: We reviewed medical and government reports, newspapers and private contemporary documents. RESULTS: The epidemic developed over two years, encompassed the Island, and caused nearly 2,000 deaths among more than 9,000 registered cases (with much underreporting). During the first six months, 59% of fatalities were children under 2 years of age. Officials recognized poor nutrition and living conditions as an important determinant of epidemic severity. Responses came from different social sectors before the central government mobilized to help. In San Juan, Catholic and Protestant churches and philanthropic women from both Spanish and Englishlanguage communities joined to provide free milk to needy children and create a temporary Infants' Hospital. Despite food scarcity and wartime conditions, central and municipal governments established hospitals and milk stations. CONCLUSION: Studies that examine the impact of reemerging diseases in a time and place-specific context look at disease severity together with the socioeconomic conditions of patients and health care systems. This type of investigation also suggests avenues into the history of pediatrics, the use of epidemiologic methods, the utility of historical statistics, nutritional history, and the history of disaster response. Historical and recent outbreaks show the need for health care professionals and public health systems to be prepared to confront measles epidemics.

Alexandre Frias i Roig: puericultor, médico y divulgador. Luchador incansable en favor de la lactancia materna y de la infancia / Alexandre Frias i Roig: childcare pediatrician, medical doctor and scientific disseminator. Tireless fighter in favor of breastfeeding and childhood

Alexandre Frias nació en Reus, ciudad donde desarrolló la mayor parte de su actividad profesional. Médico y puericultor, trabajó incansablemente con el fin de mejorar la salud infantil. Creó el primer Instituto de Puericultura integral de España en 1919, que se mantuvo en funcionamiento hasta su muerte. Las actividades del instituto se iniciaron con un consultorio para niños lactantes, servicio de lactario y un laboratorio de análisis, y se ampliaron posteriormente con servicios de puericultura prenatal, refectorio para embarazadas y mujeres, un consultorio de pediatría con servicio de vacunación y, como complemento, un servicio de asistencia domiciliaria de comadrona y un médico tocólogo. Convencido de que la lactancia materna y la higiene eran fundamentales para la prevención de enfermedades, realizó una ingente labor educativa entre madres, médicos, gobernantes y sociedad en general. Precursor de numerosas iniciativas con fines curativos y preventivos, instauró la educación sanitaria para madres y profesionales, las colonias escolares, la inspección médica-escolar, el servicio a domicilio de básculas para control de peso e incubadoras para niños prematuros e incluso un modelo de vestido higiénico para recién nacidos. Realizó numerosas publicaciones en forma de libros, como el titulado "Lo que deben saber las madres", opúsculos y artículos de prensa. Fundó y dirigió la revista Puericultura, editada en Reus y distribuida a todo el país, que se publicó hasta 1936. Su incesante actividad en pro de la lucha contra la mortalidad infantil redujo drásticamente las muertes en Reus e influyó en la mejora sanitaria y demográfica de toda España

Alexandre Frias was born in Reus, the city where he developed most of his professional activity. Medical doctor and childcare pediatrician, he worked tirelessly in order to improve children's health. He created the first Instituto de Puericultura Integral (Integral Institute of Childcare) in Spain in 1919, which remained in operation until his death. The Institute's activities began with a clinic for breastfeeding children, breastfeeding service and a biochemical analysis laboratory, later expanding with prenatal childcare services, a refectory for pregnant women and general women, a pediatric office with a vaccination service and, as a complement, a home health care service and medical obstetrics. Convinced that breastfeeding and hygiene were fundamental for the prevention of diseases, he carried out an enormous educational work among mothers, doctors, governors and society in general. Forerunner of numerous initiatives for curative and preventive purposes, he established health education for mothers and professionals, school colonies, medical-school inspection, home delivery of scales for weight control and incubators for premature children and even a hygienic dress model for newborns. He made numerous publications as books form, such as the one entitled "Lo que deben saber las madres", booklets and newspapers articles. He founded and directed the scientific journal Puericultura (child care), published in Reus and distributed throughout the country until 1936. Its incessant activity in favor of the fight against infant mortality drastically reduced infant/children mortality in Reus and influenced the health and demographic improvement of all of Spain

Milk products in the dietary management of childhood undernutrition - a historical review.

The present narrative review outlines the use of milk products in infant and young child feeding from early history until today and illustrates how research findings and technical innovations contributed to the evolution of milk-based strategies to combat undernutrition in children below the age of 5 years. From the onset of social welfare initiatives, dairy products were provided by maternal and child health services to improve nutrition. During the last century, a number of aetiological theories on oedematous forms of undernutrition were developed and until the 1970s the dogma of protein deficiency was dominant. Thereafter, a multifactorial concept gained acceptance and protein quality was emphasised. During the last decades, research findings demonstrated that the inclusion of dairy products in the management of severe acute malnutrition is most effective. For children suffering from moderate acute malnutrition the evidence for the superiority of milk-based diets is less clear. There is an unmet need for evaluating locally produced milk-free alternatives at lower cost, especially in countries that rely on imported dairy products. New strategies for the dietary management of childhood undernutrition need to be developed on the basis of research findings, current child feeding practices, socio-cultural conditions and local resources. Exclusive and continued breast-feeding supported by community-based nutrition programmes using optimal combinations of locally available complementary foods should be compared with milk product-based interventions.

Grande Covián y la malnutrición infantil en la Guerra Civil Española; comentario a dos artículos clásicos publicados en Revista Clínica Española hace setenta años / No disponible

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A brief history of fatal child maltreatment and neglect.

Child abuse encompasses four major forms of abuse: physical abuse, sexual abuse, psychological abuse, and neglect. The United States retains one of the worst records of child abuse in the industrialized world. It has also been determined that a large portion of these cases are missed and go undocumented in state and federal reporting agencies. In addition, disparate risk factors have been identified for physical abuse and neglect cases, but substance abuse has been found to be a significant factor in all forms of abuse. Fatal child maltreatment and neglect investigations require a multi-pronged and multidisciplinary approach requiring the coordination and information gathering from various agencies. A major difficulty in determining the accidental or non-accidental nature of these cases is that the account surrounding the events of the death of child is acquired from the caretaker. In this review, we outline common diagnostic characteristics and patterns of non-accidental injuries and neglect as a result of nutritional deprivation.

RICKETS AT THE MEDICI COURT OF FLORENCE: THE CASE OF DON FILIPPINO (1577-1582).

Among the children found in the crypt of the Grand Duke Giangastone in S. Lorenzo Basilica (Florence), the skeletal remains of a 5-year-old child still wearing his fine high social status clothing were recovered. This child of the Medici family was identified as Don Filippino (1577-1582), son of the Grand Duke Francesco I (1541-1587) and Giovanna from Austria (1547 - 1578). The prince showed several pathological deformities of the cranial and post-cranial skeleton, including enlargement of the cranium, thinning of the cranial vault bones (craniotabes), platybasia and marked bending of femora, tibiae and fibulae. Differential diagnosis suggests that Don Filippino was affected by rickets. The occurrence of this metabolic disease related to vitamin D deficiency in a Renaissance high social class individual can be explained by the practice of very prolonged breast-feeding, up until two years of age. Maternal milk contains insufficient vitamin D ratios and retarded weaning severely exposes children to a higher risk of developing rickets, especially if dietary habits are combined with inadequate exposure to sunlight. Historical sources describe Don Filippino as frail and sickly, with frequent illnesses and persistent slight fevers, and it can be supposed that the child was frequently confined indoors, especially in the cold season. Integration of osteoarchaeological evidence with historical documentation suggests that bone lesions observed in the skeletal remains of Don Filippino are compatible with a diagnosis of rickets, caused by the custom of prolonged breast-feeding associated with inadequate sunlight exposure to sunlight. Historical sources describe Don Filippino as frail and sickly, with frequent illnesses and persistent slight fevers, and it can be supposed that the child was frequently confined indoors, especially in the cold season. Integration of osteoarchaeological evidence with historical documentation suggests that bone lesions observed in the skeletal remains of Don Filippino are compatible with a diagnosis of rickets, caused by the custom of prolonged breast-feeding associated with inadequate sunlight exposure.

Malnutrición y desigualdades en la España del franquismo; el impactodel complemento alimenticio lácteo en el crecimiento de los escolares españoles (1954-1978) / Malnutrition and inequalities in francoist Spain; the impact of a milk supplement on the growth of spanish school children (1954-1978)

A lo largo del siglo XX, la población española fue consolidando su proceso de transición nutricional y alimentaria. En la etapa pre-transicional, se produjo un renovado interés por las deficiencias que mostraba la alimentación de los niños y se apostó por la educación alimentaria-nutricional para superarlas. El objetivo del trabajo es analizar el estado nutricional, a través de la talla como parámetro antropométrico, que mostraba la población escolar del ámbito rural español, entre las décadas de 1950 y 1970, su evolución y las diferencias que existían entre regiones. Los resultados ponen de manifiesto que al inicio de la década de 1960 se apreciaban dos patrones: un primer grupo donde la estatura de los niños de la costa cantábrica, zona de Levante, Cataluña y Baleares, mostraba niveles similares a los de niños bien alimentados; y un segundo grupo donde las tallas eran inferiores, en el que se encontraban las regiones de Andalucía, Extremadura y Galicia. Entre 1954 y 1977, las tallas de los niños bien alimentados mostraron un incremento que fue especialmente intenso entre 1954 y la primera mitad de la década de 1960. En el caso de los niños y niñas que acudían a las escuelas nacionales del ámbito rural, también se produjo un significativo incremento en la talla, además de corregirse las diferencias regionales que existían al principio de los años sesenta. En todos aquellos avances habrían influido tanto el complemento alimenticio, como las actividades de educación alimentación y nutrición que se llevaron a cabo en el marco del Programa EDALNU (AU)

The Spanish nutritional and food transition was consolidated over the course of the twentieth century. In the pre-transition stage, a renewed interest emerged in the deficiencies presented by children''s diets, and food and nutritional education was considered the best course of action to correct them. The aim of this study was to analyse the changes over time and regional differences in the nutritional status of Spanish schoolchildren in rural areas in the 1950s and 1970s, using their height as an anthropometric parameter. The results revealed the existence of two categories at the beginning of the 1960s: a first group in which the height of children from the Cantabrian coast, the Levante, Catalonia and the Balearic Islands was similar to that of well-nourished children, and a second group from the regions of Andalusia, Extremadura and Galicia, who were not as tall. Between 1954and 1977, the height of well-nourished children rose, particularly between 1954 and the first half of the 1960s.There was also a significant increase in the height of children attending national schools in rural areas, and the regional differences that had existed at the beginning of the 1960s disappeared. These advances were undoubtedly influenced both by the milk supplement and the food and nutritional education activities carried out within the framework of the Spanish Diet and Nutrition Education programme (EDALNU) (AU)

Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.

Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.

INCAP studies of malnutrition and cognitive behavior.

The Institute of Nutrition of Central America and Panama (INCAP) has made major contributions to the study of the effects of malnutrition on learning. This report summarizes work on the relationship of nutrition to children's learning and development from the 1960's through 1998. The Oriente Longitudinal Study examined the effects of two types of supplementation for mothers and young children on their growth and development (an energy-only drink compared with a protein-energy drink) using a quasi-experimental design. Both drinks were supplemented with micronutrients, and were offered daily. As a result of the research on malnutrition and mental development, researchers could conclude by 1993 that supplementary feeding of infants and young children resulted in significant increases cognitive development and school performance through adolescence. The research also suggested that the pathways that link malnutrition with later development are not only through the neurological system but also operate through changes in child behavior which affect the kinds of care children receive. Other research on learning and development showed that families understood the concept of intelligence, demonstrated the link between micronutrients and cognitive development, and documented the amount of wastage or repetition and drop-out that occurs in Guatemalan schools.

Regional variations in living conditions during the North Korean food crisis of the 1990s.

In the 1990s, North Korea experienced one of the severest famines in modern history. Considering the level of food deprivation during famines in totalitarian states, substantial debate exists over how differently the crisis affected households and regions. Here, the authors investigate regional differences in socioeconomic living conditions by comparing height-for-age z scores (HAZs) of 9934 preschool children living in 11 administrative provinces. Data are based on 2 UN/DPRK anthropometric surveys performed in North Korea representing cohorts born from 1991 to 2002. Through regression of pooled HAZs on a set of province dummies, the authors find that children born in Pyongyang are more healthy, providing evidence that elites residing in the capital seemingly possess comparative advantages in food supply. When controlling for further variables, they find that boys and older children suffered more during the crisis, although cohorts born before the onset of the famine were significantly better-off.

A transiçäo nutricional no Brasil: tendências regionais e temporais / Nutritional transition in Brazil: geographic and temporal trends

Tendo como principal fonte de informações três estudos transversais realizados nas décadas de 70, 80 e 90, faz-se uma análise da transiçäo nutricional do Brasil, referenciada no rápido declínio da prevalência de desnutriçäo em crianças e elevaçäo, num ritmo mais acelerado, da prevalência de sobrepeso/obesidade em adultos. (AU)

Porotic hyperostosis as a marker of health and nutritional conditions during childhood: studies at the transition between Imperial Rome and the Early Middle Ages.

Porotic hyperostosis, characterized by small and localized perforations on the surface of cranial bones, is considered a good indicator for assessing the health and nutritional status of past human populations. The most widely accepted theory at present indicates that anemias, either acquired or of genetic origin, are responsible for the bony lesions described as porotic hyperostosis. In this paper, the prevalence of these lesions in two skeletal samples from Latium (central Italy) was used to evaluate health and life conditions in Italy after the collapse of the Roman Empire. One sample belongs to the Roman Imperial Age (1st-3rd centuries A.D.) rural town of Lucus Feroniae; the other comes from the 7th century A.D. Lombard necropolis of Selvicciola. The prevalence of cribra orbitalia and cribra cranii was quite similar in the two samples but slightly more frequent in the Medieval community. Differential diagnosis suggested iron deficiency anemia in early childhood as the causative agent of the hyperostotic lesions in both samples. These results may be interpreted in light of previous examinations of same samples and according to their respective historical and socio-economical characteristics.

Weight charts and well-child care: how the pediatrician became the expert in child health.

Weighing children became popular in the 1910s, when public health workers hoped to identify malnourished children based on weight. They measured tens of thousands of children in school halls and church basements, compared their results with standard weight charts, and reported evidence of widespread malnutrition. In the 1920s, physicians argued that a complete medical history and a physical examination, not just weight, were necessary to diagnose malnutrition. By the 1930s, the weight chart had become merely one of the many diagnostic tools used to monitor the health of well children in the physician's office. Weight charts remain an essential part of pediatric practice, but their history is more than a simple tale of scientific progress. This article explores how pediatrics emerged as a primary care specialty in the midst of conflict over the meaning of weight, the professional role of women in medicine, and the pediatrician's preeminence as a child health expert.