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1.
PLoS Negl Trop Dis ; 14(8): e0008435, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32817617

RESUMO

Noma is an orofacial gangrene affecting primarily children living in extreme poverty in remote parts of subtropical and tropical countries. Mortality and disability are high, and survivors often have physical and functional deformities resulting in stigma and isolation. Many healthcare professionals and primary healthcare workers where noma risk factors exist have no knowledge about noma and its implications. Public health measures to improve nutrition, immunizations, sanitation, and access to healthcare and measures to eliminate extreme poverty can lead to the eradication of noma. Research allocation has been insufficient to study the epidemiology, treatment, and prevention of noma. In a recent editorial by Hotez and colleagues in PLOS Neglected Tropical Diseases (NTDs), "What constitutes an NTD?" Noma is not included. The exclusion of noma from NTDs constitutes this preventable childhood disease as a neglected neglected disease. The purpose of this article is the inclusion of noma with the PLOS NTDs. Increased awareness and attention to noma can lead to the eradication of this disease affecting the world's most vulnerable.


Assuntos
Transtornos da Nutrição Infantil/complicações , Doenças Negligenciadas , Noma , Criança , Humanos , Pobreza , Fatores de Risco
5.
Am J Clin Nutr ; 112(2): 251-256, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32559276

RESUMO

Coronavirus disease 2019 (COVID-19) continues to ravage health and economic metrics globally, including progress in maternal and child nutrition. Although there has been focus on rising rates of childhood wasting in the short term, maternal and child undernutrition rates are also likely to increase as a consequence of COVID-19 and its impacts on poverty, coverage of essential interventions, and access to appropriate nutritious foods. Key sectors at particular risk of collapse or reduced efficiency in the wake of COVID-19 include food systems, incomes, and social protection, health care services for women and children, and services and access to clean water and sanitation. This review highlights key areas of concern for maternal and child nutrition during and in the aftermath of COVID-19 while providing strategic guidance for countries in their efforts to reduce maternal and child undernutrition. Rooted in learnings from the exemplars in Global Health's Stunting Reduction Exemplars project, we provide a set of recommendations that span investments in sectors that have sustained direct and indirect impact on nutrition. These include interventions to strengthen the food-supply chain and reducing food insecurity to assist those at immediate risk of food shortages. Other strategies could include targeted social safety net programs, payment deferrals, or tax breaks as well as suitable cash-support programs for the most vulnerable. Targeting the most marginalized households in rural populations and urban slums could be achieved through deploying community health workers and supporting women and community members. Community-led sanitation programs could be key to ensuring healthy household environments and reducing undernutrition. Additionally, several COVID-19 response measures such as contact tracing and self-isolation could also be exploited for nutrition protection. Global health and improvements in undernutrition will require governments, donors, and development partners to restrategize and reprioritize investments for the COVID-19 era, and will necessitate data-driven decision making, political will and commitment, and international unity.


Assuntos
Saúde da Criança , Infecções por Coronavirus , Saúde do Lactente , Recém-Nascido , Desnutrição , Saúde Materna , Estado Nutricional , Pandemias , Pneumonia Viral , Criança , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Coronavirus , Infecções por Coronavirus/complicações , Características da Família , Abastecimento de Alimentos , Saúde Global , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Desnutrição/complicações , Desnutrição/prevenção & controle , Pneumonia Viral/complicações , Pobreza
7.
PLoS One ; 15(6): e0234343, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589637

RESUMO

BACKGROUND: Severe acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM. METHODS: This was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0. RESULTS: We enrolled 122 children, median age of 15 months [IQR:11-24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14-24.08, p = 0.001). CONCLUSION: The in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines.


Assuntos
Transtornos da Nutrição Infantil/mortalidade , Previsões/métodos , Desnutrição Aguda Grave/mortalidade , Pré-Escolar , Estudos de Coortes , Feminino , Hidratação/métodos , Mortalidade Hospitalar , Hospitalização , Humanos , Lactente , Infusões Intravenosas , Masculino , Prognóstico , Estudos Prospectivos , Uganda/epidemiologia
9.
Medicine (Baltimore) ; 99(18): e19595, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358344

RESUMO

To evaluate the effect of chronic malnutrition on the oral health of children aged 1 to 5 years.An observational, analytical, cross-sectional study was conducted and involved 82 children (12-71 months of age). Nutritional status was evaluated using anthropometric indicators and oral health status/caries prevalence was measured. Non-stimulated saliva was collected and flow rate and buffering capacity was measured.The mean dmft index was 1.38 for the adequately nourished children, 3.04 for those with mild malnutrition, 2.5 for those with moderate malnutrition and 2.4 for those with severe malnutrition. 69 of the 82 children had low to very low buffering capacity. No significant differences among the groups were found between malnutrition and age, buffering capacity or the dmft index (P > .05). However, significant differences in salivary flow were found among the different malnutrition categories (P < .05). Spearman correlation coefficient revealed a weak negative correlation between nutrition and salivary flow (r = -0.267).Malnutrition exerts a negative impact on the oral cavity of children and a reduction in salivary flow rate was observed with the increase in malnutrition. Diagnosing the effects of malnutrition in oral environment of children is important because it could improve the quality of life and give them an adequate treatment.


Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Cárie Dentária/epidemiologia , Saúde Bucal , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Doença Crônica , Estudos Transversais , Cárie Dentária/etiologia , Feminino , Humanos , Lactente , Masculino , Estado Nutricional , Prevalência , Saliva/metabolismo
10.
PLoS One ; 15(5): e0232838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384106

RESUMO

BACKGROUND: In South Africa, 30.9% of children under five years with Severe Acute Malnutrition (SAM) died in 2018. We aimed to identify factors associated with mortality among children under five years hospitalized with SAM in Limpopo province, South Africa. METHODS: We conducted a cross-sectional study including children under five years admitted with SAM from 2014 to 2018 in public hospitals of Limpopo province. We extracted socio-demographic and clinical data from hospital records. We used logistic regression to identify factors associated with mortality. FINDINGS: We included 956 children, 50.2% (480/956) male and 49.8% (476/956) female. The median age was 13 months (inter quartile range: 9-19 months). The overall SAM mortality over the study period was 25.9% (248/956). The most common complications were diarrhea, 63.8% (610/956), and lower respiratory tract infections (LRTIs), 42.4% (405/956). Factors associated with mortality included herbal medication use (adjusted Odds Ratio (aOR): 2.2, 95% Confidence Interval (CI): 1.4-3.5, p = 0.001), poor appetite (aOR: 2.7, 95% CI: 1.4-5.2, p = 0.003), Mid-upper circumference (MUAC) <11.5 cm (aOR: 3.0, 95% CI: 1.9-4.7, p<0.001), lower respiratory tract infections (LRTIs) (aOR: 1.6, 95% CI: 1.2-2.0, p<0.001), anemia (aOR: 2.5, 95% CI: 1.1-5.3, p = 0.021), hypoglycemia (aOR: 12.4, 95% CI: 7.1-21.8, p<0.001) and human immunodeficiency virus (HIV) infection (aOR: 2.3, 95% CI: 1.6-3.3, p<0.001). INTERPRETATION: Herbal medication use, poor appetite, LRTIs, anemia, hypoglycemia, and HIV infection were associated with mortality among children with SAM. These factors should guide management of children with SAM.


Assuntos
Transtornos da Nutrição Infantil/mortalidade , Criança Hospitalizada/estatística & dados numéricos , Mortalidade Hospitalar , Transtornos da Nutrição do Lactente/mortalidade , Desnutrição Aguda Grave/mortalidade , Adulto , Anemia/epidemiologia , Cuidadores/estatística & dados numéricos , Criança , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Comorbidade , Estudos Transversais , Diarreia Infantil/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Lactente , Transtornos da Nutrição do Lactente/terapia , Modelos Logísticos , Malária/epidemiologia , Masculino , Preparações de Plantas , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia
11.
PLoS One ; 15(5): e0232663, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396554

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Estudos Transversais , Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Lactente , Transtornos da Nutrição do Lactente/terapia , Estado Nutricional , Cobertura Universal do Seguro de Saúde , Zâmbia/epidemiologia
12.
BMC Public Health ; 20(1): 511, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299403

RESUMO

BACKGROUND: Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. However, there exists disparity between the groups identified as malnourished by them. Thus, here we aim to investigate the clinical features and linkage with chronicity of the acute malnutrition cases identified by either WHZ or MUAC. Besides, there exists evidence indicating that fat restoration is disproportionately rapid compared to that of muscle gain in hospitalized malnourished children but related research at community level is lacking. In this study we suggest proxy measure to inspect body composition restoration responding to malnutrition management among the malnourished children. METHODS: The data of this study is from World Vision South Sudan's emergency nutrition program from 2006 to 2012 (4443 children) and the nutrition survey conducted in 2014 (3367 children). The study investigated clinical presentations of each type of severe acute malnutrition (SAM) by WHZ (SAM-WHZ) or MUAC (SAM-MUAC), and analysed correlation between each malnutrition and chronic malnutrition. Furthermore, we explored the pattern of body composition restoration during the recovery phase by comparing the relative velocity of MUAC3 with that of weight gain. RESULTS: As acutely malnourished children identified by MUAC more often share clinical features related to chronic malnutrition and minimal overlapping with malnourished children by WHZ, Therefore, MUAC only screening in the nutrition program would result in delayed identification of the malnourished children. CONCLUSIONS: The relative velocity of MUAC3 gain was suggested as a proxy measure for volume increase, and it was more prominent than that of weight gain among the children with SAM by WHZ and MUAC over all the restoring period. Based on this we made a conjecture about dominant fat mass gain over the period of CMAM program. Also, considering initial weight gain could be ascribed to fat mass increase, the current discharge criteria would leave the malnourished children at risk of mortality even after treatment due to limited restoration of muscle mass. Given this, further research should be followed including assessment of body composition for evidence to recapitulate and reconsider the current admission and discharge criteria for CMAM program.


Assuntos
Peso Corporal , Transtornos da Nutrição Infantil/diagnóstico , Hospitalização/estatística & dados numéricos , Estado Nutricional , Desnutrição Aguda Grave/diagnóstico , Antropometria/métodos , Composição Corporal , Tamanho Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Inquéritos Nutricionais , Sudão do Sul , Síndrome de Emaciação/diagnóstico , Ganho de Peso
13.
J Food Sci ; 85(4): 1265-1273, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32249412

RESUMO

Ready-to-use therapeutic foods (RUTFs) are special foods used to encourage rapid weight gain in 5-year-old malnourished children, avoiding hospitalization. The factors affecting sensory characteristics and acceptability of RUTFs have been not adequately described. The aim of this work was to evaluate both the sensory properties and volatile compounds of four alternative RUTFs, varying in soy and sorghum, icing sugar, and oil content. Nine nonoral sensory attributes were evaluated by nine selected and trained assessors. The perceived intensity of five oral sensory attributes and the overall liking were assessed by 100 adult consumers. The volatile compounds were extracted and concentrated by solid phase microextraction and analyzed by gas chromatography/mass spectrometry. RUTF formulations significantly differed for graininess between fingers (size of granules) (P = 0.007), viscosity (P = 0.013), adhesiveness to the spoon (P < 0.044), and meltability (P = 0.005), but in consumers' opinion, they differed only for difficulty in swallowing, intensity of global odor, flavor, and sweetness. A positive correlation between overall liking and sweetness was found. Volatile compounds arising from lipid oxidation (hexanal and octanoic acid) were positively correlated with global odor and flavor. These attributes negatively affected the overall liking and were mainly contained in one out of the four formulations. Sensory and instrumental characterization identified key attributes for this kind of food, such as difficulty in swallowing, global odor, and sweetness, suggesting how to formulate an alternative RUTF to be used for a future clinical trial on malnourished children. PRACTICAL APPLICATION: Starting from the world's need to fight child malnutrition, the present study tried to characterize alternative ready-to-use therapeutic foods (RUTFs), special foods used to encourage rapid weight gain in 5-year-old malnourished children, from several points of view, such as acceptability, stability, technological, and overall quality. Results obtained will be an aid to setup the technological conditions and scale-up parameters for local productions of RUTFs to be tested in real trials on malnourished children. Indeed, key sensory attributes that drive consumer acceptance for this special food, such as sweetness and difficulty in swallowing, came out from the present study.


Assuntos
Transtornos da Nutrição Infantil/dietoterapia , Fast Foods , Alimentos Formulados , Paladar , Adulto , Criança , Pré-Escolar , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Microextração em Fase Sólida
14.
PLoS One ; 15(4): e0231479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275697

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/etiologia , Peso Corporal/fisiologia , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Estações do Ano , Magreza/epidemiologia , Magreza/etiologia , Tempo (Meteorologia)
16.
Demetra (Rio J.) ; 15(1): e42004, jan.- mar.2020. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1117021

RESUMO

Introdução: A triagem nutricional em crianças é de extrema importância no ambiente hospitalar, pois é uma ferramenta simples e eficiente. Objetivo: Detectar o risco nutricional, a partir do método de triagem nutricional pediátrica Strong Kids, em crianças e adolescentes com cardiopatias congênitas. Método: Foram avaliados 81 crianças e adolescentes com cardiopatia congênita, até 48 horas de internação, no período de agosto de 2016 a maio de 2017. Dados foram coletados através de triagem nutricional pediátrica. A análise estatística se deu através do teste qui-quadrado, a fim de verificar o nível de significância, p < 0,05. Resultados: Dentre os resultados obtidos, houve maior prevalência de crianças com cardiopatia congênita internadas do gênero feminino 60,49% (n=49). De acordo com a classificação das fases de vida, a predominância ocorreu na fase pré-escolar 46,91%, seguida de lactentes 27,16%, adolescentes 13,58% e escolar 12,35%. Não houve déficit nutricional para 74,07%. Segundo o teste qui-quadrado, observou-se relevância do médio risco nutricional. Conclusão: A triagem nutricional pediátrica é fundamental na prática clínica, e sua melhor forma de avaliação é a intervenção nutricional precoce. Isto implicará um tratamento nutricional adequado, em especial para crianças com cardiopatia congênita. (AU)


Introduction: The nutritional screening in children is extremely important in the hospital environment because it is a simple and efficient tool. Objective: Detecting the nutritional risk, from pediatric nutritional screening Strong Kids method in children and adolescents with congenital heart desease. Method: 81 children and adolescents were evaluated with congenital heart desease until 48 hours of hospitalization, in the period from August 2016 to May 2017. The data collection was through a pediatric nutritional screening. The statistical analysis was through chi-square test for the purpose of verify the level of significance, p < 0,05. Results: Among the results obtained, there was a higher prevalence of children with hospitalized congenital heart desease of the female gender 60,49% (n=49). According to the classification of the life phases, the highest predominance was in the pre school phase (46,91%), then infants (27,16%), adolescents (13,58%) and scholar (12,35%). There was no nutritional deficit for 74,07%. According chi-square test, it was observed a relevance to the medium nutritional risk. Conclusion: The pediactric nutritional screening is extremely important in clinical practice, in view of the best form of evaluation through the reach of early nutritional intervention, this will entail adequate nutritional treatment, specially children with congenital heart desease. (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Pediatria , Cardiopatias Congênitas , Nutrição de Grupos de Risco , Transtornos da Nutrição Infantil
17.
Medwave ; 20(2): e7839, 2020 Mar 10.
Artigo em Espanhol | MEDLINE | ID: mdl-32191682

RESUMO

Context: Child malnutrition is a public health problem not only in Colombia but throughout the world, as it increases mortality associated with preventable causes. In Colombia, poverty is one of those causes present mainly in rural areas where one in 10 children suffers from malnutrition. Methodology: We searched ScienceDirect, PubMed, ClinicalKey, and SciELO for references on child malnutrition, its social determinants, and elements for its intervention in Colombia. Results: The review allowed us to identify that many factors influence this problem determined not only by the lack of food but also by other factors such as poverty, lack of resources, restricted access to health care, rising prices of essential foods, political conflicts leading forced displacement, drought, the absence of an equity-based policy approach, poor environmental sanitation, among others. Conclusions: Child malnutrition should not be conceived as mainly a food-related problem. Other factors that influence this problem should also be taken into account in order to prevent it. Trained personnel should be deployed to intervene in the social determinants that underpin child malnutrition. Thus, in Colombia, the family physician is a fundamental link in the health system, responsible for providing comprehensive medical care and for the leadership of the newly introduced health model based on primary health care.


Assuntos
Transtornos da Nutrição Infantil , Atenção Primária à Saúde , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Criança , Pré-Escolar , Colômbia , Assistência à Saúde , Medicina de Família e Comunidade , Recursos em Saúde , Humanos , Pobreza , Saúde Pública
18.
PLoS Med ; 17(3): e1003055, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32203504

RESUMO

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.


Assuntos
Anemia/epidemiologia , Saúde da Criança , Transtornos da Nutrição Infantil/epidemiologia , Diarreia/epidemiologia , Habitação , Malária/epidemiologia , Determinantes Sociais da Saúde , África ao Sul do Saara/epidemiologia , Fatores Etários , Anemia/diagnóstico , Anemia/mortalidade , Anemia/prevenção & controle , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Estudos Transversais , Diarreia/diagnóstico , Diarreia/mortalidade , Diarreia/prevenção & controle , Água Potável , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Mosquiteiros Tratados com Inseticida , Malária/diagnóstico , Malária/mortalidade , Malária/prevenção & controle , Masculino , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Saneamento
19.
BMC Public Health ; 20(1): 399, 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32220224

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Antropometria , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
20.
Pediatr Blood Cancer ; 67 Suppl 3: e28117, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32134218

RESUMO

Adequate and appropriate nutrition is essential for growth and development in children; all put at risk in those with cancer. Overnutrition and undernutrition at diagnosis raise the risk of increased morbidity and mortality during therapy and beyond. All treatment modalities can jeopardize nutritional status with potentially adverse effects on clinical outcomes. Accurate assessment of nutritional status and nutrient balance is essential, with remedial interventions delivered promptly when required. Children with cancer in low- and middle-income countries (LMICs) are especially disadvantaged with concomitant challenges in the provision of nutritional support. Cost-effective advances in the form of ready-to-use therapeutic foods (RUTF) may offer solutions. Studies in LMICs have defined a critical role for the gut microbiome in the causation of undernutrition in children and have demonstrated a beneficial effect of selected RUTF in redressing the imbalanced microbiota and improving nutritional status. Challenges in high-income countries relate both to concerns about the potential disadvantage of preexisting obesity in those newly diagnosed and to undernutrition identified at diagnosis and during treatment. Much remains to be understood but the prospects are bright for offsetting malnutrition in children with cancer, resulting in enhanced opportunity for healthy survival.


Assuntos
Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição Infantil/metabolismo , Neoplasias/dietoterapia , Neoplasias/metabolismo , Estado Nutricional , Fatores Etários , Criança , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/patologia , Humanos , Neoplasias/mortalidade , Neoplasias/patologia , Apoio Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto
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