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1.
BMC Public Health ; 20(1): 1559, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066763

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Áreas de Pobreza , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco , Fatores Socioeconômicos
2.
BMC Public Health ; 20(1): 1027, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600372

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Dieta/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Síndrome de Emaciação/epidemiologia , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Estudos Transversais , Dieta/efeitos adversos , Comportamento Alimentar , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Mães/estatística & dados numéricos , Nepal/epidemiologia , Estado Nutricional , Razão de Chances , Prevalência , Fatores Socioeconômicos , Síndrome de Emaciação/etiologia
4.
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
6.
Ann Hum Biol ; 47(2): 125-131, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32429759

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Inquéritos Nutricionais , Estado Nutricional , População Rural/estatística & dados numéricos , Criança , Pré-Escolar , Gâmbia , Humanos , Estudos Longitudinais , Parto , Estações do Ano
7.
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)
8.
BMC Public Health ; 20(1): 555, 2020 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334558

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Escolaridade , Disparidades nos Níveis de Saúde , Desnutrição Aguda Grave/epidemiologia , Adolescente , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
9.
Int J Public Health ; 65(3): 281-290, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32240317

RESUMO

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.


Assuntos
Agricultura , Transtornos da Nutrição Infantil/epidemiologia , Secas , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Magreza/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Prevalência , Análise Espacial
10.
BMC Public Health ; 20(1): 532, 2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32306937

RESUMO

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.


Assuntos
Conflitos Armados/psicologia , Transtornos da Nutrição Infantil/epidemiologia , Exposição à Violência/psicologia , Desnutrição/epidemiologia , Magreza/epidemiologia , Criança , Saúde da Criança , Transtornos da Nutrição Infantil/psicologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Desnutrição/psicologia , Prevalência , Sudão/epidemiologia , Inquéritos e Questionários , Magreza/psicologia
11.
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
13.
Rev. esp. nutr. comunitaria ; 26(1): 0-0, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193824

RESUMO

FUNDAMENTOS: El aporte alimentario desequilibrado provoca malnutrición, siendo un grave problema de salud pública. El objetivo fue valorar el consumo alimentario de los escolares de una región Andina de Perú, comparando dos poblaciones con características socioeconómicas distintas: una rural en pobreza extrema con Programa Nacional de Alimentación Escolar (PNAE) y otra urbana en transición nutricional sin PNAE. MÉTODOS: Estudio transversal que incluyeron 432 escolares. Se valoraron medidas antropométricas y consumo alimentario mediante recuerdo de 24 horas y cuestionario de frecuencia alimentaria. Se calculó el Índice Ponderal (IP) (Z-score IMC/Edad-OMS) y la adecuación al consumo aconsejado. RESULTADOS: La zona en pobreza extrema, con 4,7% de delgadez y 8,8% de exceso de peso, consume más pescado (18,3 g/día vs 7,78 g/día), lácteos (593,5 g/día vs 176,8 g/día), cereales (150,8 g/día vs 134,8 g/día), tubérculos (147,4 g/día vs 57,9 g/día) y legumbres (50,3 g/día vs 14,9 g/día) y menos carne (14,4 g/día vs 64,9 g/día), huevos (9,5 g/día vs 26,3 g/día), frutas (9,6 g/día vs 95,9 g/día) grasas (20,2 g/día vs 34,2 g/día) y alimentos superfluos (18,7 g/día vs 124,7 g/día) (p˂0,001) que la zona en transición nutricional, que presenta 21,8% de delgadez y 20,7% de exceso de peso. CONCLUSIONES: Mayoritariamente los escolares de la zona en pobreza extrema presentan normopeso y un patrón alimentario cercano al modelo saludable, relacionado con el PNAE, mientras la otra zona presenta características de la transición nutricional


BACKGROUND: The unbalanced food intake causes malnutrition remains a serious public health problem. The objective was to assess the food consumption of schoolchildren in an Andean region of Peru, comparing two areas with very different socioeconomic status: a rural one in extreme poverty with a National Program for School Feeding (NPSF) and another urban in nutritional transition without NPSF. METHODS: Cross-sectional study. 432 schoolchildren. Anthropometric measures and food consumption were evaluated by 24-hour recall and food frequency questionnaire. The Ponderal Index (PI) (Z-score BMI/Age-WHO) and the advised consumption adequacy were calculated. RESULTS: The extreme poverty area, with 4.7% of thinness and 8.8% of excess weight, consumes more fish (18.3 g/day vs 7.8 g/day), dairy products (593.5 g/day vs 176.8 g/day), cereals (150.8 g/day vs 134.8 g/day), tubers (147.4 g/day vs 57.9 g/day) and legumes (50.3 g/day vs 14.9 g/day); and less meat (14.4 g/day vs 64,9 g/day), eggs (9.5 g/day vs 26.3 g/day), fruits (9.6 g/day vs 95.9 g/day), visible fats (20.2 g/day vs 34.2 g/day) and superfluous foods (18.7 g/day vs 124.7 g/day) (p˂0.001) than the nutritional transition area, which presents 21.8% thinness and 20.7% of excess-weight. CONCLUSIONS: Mostly of the schoolchildren in the extreme poverty area present normal weight and a food pattern close to the healthy model, related to the NSFP, while the nutritional transition area presents characteristics of the nutritional transition


Assuntos
Humanos , Masculino , Feminino , Criança , Avaliação Nutricional , Estado Nutricional , Nutrição da Criança , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Transição Nutricional , Transtornos da Nutrição Infantil/epidemiologia , Inquéritos Nutricionais/estatística & dados numéricos , Comportamento Alimentar , Estudos Transversais , Consumo de Alimentos , Pesos e Medidas Corporais/estatística & dados numéricos , Áreas de Pobreza
14.
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
15.
Nutrients ; 12(2)2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32023929

RESUMO

Children of migrant families are known to be at a higher risk of diet-related morbidities due to complex variables including food insecurity, cultural and religious beliefs, and sociodemographic factors like ethnicity, socioeconomic status, and education. Several studies have assessed the presence of specific diseases related to dietary issues in migrant children. This systematic review aims to highlight the existing body of work on nutritional deficiencies in the specific vulnerable pediatric population of immigrants. Refugees were intentionally excluded because of fundamental differences between the two groups including the reasons for migration and health status at the time of arrival. A total of 29 papers were included and assessed for quality. Most of them described a strong correlation between obesity and migration. A high prevalence of stunting, early childhood caries, iron and vitamin D deficiency was also reported, but the studies were few and heterogeneous. Food insecurity and acculturation were found important social factors (nevertheless with inconclusive results) influencing dietary habits and contributing to the development of morbidities such as obesity and other metabolic disorders, which can cause progressive unsustainability of health systems. Public health screening for diet-related diseases in migrant children may be implemented. Educational programs to improve children's diet and promote healthy-living behaviors as a form of socioeconomic investment for the health of the new generations may also be considered.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Dieta/efeitos adversos , Abastecimento de Alimentos/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Aculturação , Adolescente , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/etnologia , Criança , Transtornos da Nutrição Infantil/etnologia , Pré-Escolar , Cárie Dentária/epidemiologia , Cárie Dentária/etnologia , Dieta/etnologia , Comportamento Alimentar/etnologia , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etnologia , Humanos , Masculino , Morbidade , Obesidade/epidemiologia , Obesidade/etnologia , Prevalência , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/etnologia
16.
Nutrients ; 12(2)2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32024025

RESUMO

Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potential points for intervention in three dissimilar countries. Stakeholders from across the food system in Jamaica (n = 16), St. Kitts and Nevis (n = 19), and St. Vincent and the Grenadines (n = 6) engaged with researchers in two group model building (GMB) workshops in 2018. Participants described and mapped the system driving unhealthy eating, identified points of intervention, and created a prioritized list of intervention strategies. Stakeholders were also interviewed before and after the workshops to provide their perspectives on the utility of this approach. Stakeholders described similar underlying systems driving unhealthy eating across the three countries, with a series of dominant feedback loops identified at multiple levels. Participants emphasized the importance of the relative availability and price of unhealthy foods, shifting cultural norms on eating, and aggressive advertising from the food industry as dominant drivers. They saw opportunities for governments to better regulate advertising, disincentivize unhealthy food options, and bolster the local agricultural sector to promote food sovereignty. They also identified the need for better coordinated policy making across multiple sectors at national and regional levels to deliver more integrated approaches to improving nutrition. GMB proved to be an effective tool for engaging a highly diverse group of stakeholders in better collective understanding of a complex problem and potential interventions.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Política Nutricional , Formulação de Políticas , Análise de Sistemas , Adolescente , Região do Caribe/epidemiologia , Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Dieta/efeitos adversos , Comportamento Alimentar , Feminino , Humanos , Jamaica/epidemiologia , Masculino , São Cristóvão e Névis/epidemiologia , São Vicente e Granadinas/epidemiologia , Participação dos Interessados , Adulto Jovem
17.
Am J Trop Med Hyg ; 102(5): 1124-1130, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32100681

RESUMO

Acute respiratory infections cause mortality in young children. We assessed the effects of water, sanitation, hygiene (WASH) and nutritional interventions on childhood ARI. Geographic clusters of pregnant women from rural Bangladesh were randomly assigned to receive 1) chlorinated drinking water and safe storage (W); 2) upgraded sanitation (S); 3) handwashing promotion (H); 4) combined water, sanitation, and handwashing (WSH); 5) nutrition intervention including lipid-based nutrient supplements; 6) combined WSH plus nutrition (WSHN); or 7) no intervention (control). Masking of participants was not possible. Acute respiratory illness was defined as caregiver-reported persistent cough, panting, wheezing, or difficulty breathing in the past 7 days among index children, those born to enrolled women. We assessed outcomes at 12 and 24 months of intervention using intention to treat. Compared with children in the control group (ARI prevalence, P: 8.9%), caregivers of index children reported significantly lower ARI in the water (P: 6.3%, prevalence ratio (PR): 0.71; 95% CI: 0.53, 0.96), sanitation (P: 6.4%, PR: 0.75, 95% CI: 0.58, 0.96), handwashing (P: 6.4%, PR: 0.68, 95% CI: 0.50, 0.93), and the combined WSH+N arms (P: 5.9%, PR: 0.67, 95% CI: 0.50, 0.90). Those in the nutrition (P: 7.4%, PR: 0.84, 95% CI: 0.63, 1.10) or the WSH arm (P: 8.9%, PR: 0.99, 95% CI: 0.76, 1.28) reported similar ARI prevalence compared with control children. Single targeted water, sanitation, and hygiene interventions reduced reported respiratory illness in young children. There was no apparent respiratory health benefit from combining WASH interventions.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Higiene , Doenças Respiratórias/prevenção & controle , Saneamento , Qualidade da Água , Adolescente , Bangladesh/epidemiologia , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças Respiratórias/epidemiologia , População Rural/estatística & dados numéricos , Saneamento/métodos , Toaletes , Adulto Jovem
18.
Nutrients ; 12(2)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31973225

RESUMO

Micronutrient deficiencies continue to be widespread among children under-five in low- and middle-income countries (LMICs), despite the fact that several effective strategies now exist to prevent them. This kind of malnutrition can have several immediate and long-term consequences, including stunted growth, a higher risk of acquiring infections, and poor development outcomes, all of which may lead to a child not achieving his or her full potential. This review systematically synthesizes the available evidence on the strategies used to prevent micronutrient malnutrition among children under-five in LMICs, including single and multiple micronutrient (MMN) supplementation, lipid-based nutrient supplementation (LNS), targeted and large-scale fortification, and point-of-use-fortification with micronutrient powders (MNPs). We searched relevant databases and grey literature, retrieving 35,924 papers. After application of eligibility criteria, we included 197 unique studies. Of note, we examined the efficacy and effectiveness of interventions. We found that certain outcomes, such as anemia, responded to several intervention types. The risk of anemia was reduced with iron alone, iron-folic acid, MMN supplementation, MNPs, targeted fortification, and large-scale fortification. Stunting and underweight, however, were improved only among children who were provided with LNS, though MMN supplementation also slightly increased length-for-age z-scores. Vitamin A supplementation likely reduced all-cause mortality, while zinc supplementation decreased the incidence of diarrhea. Importantly, many effects of LNS and MNPs held when pooling data from effectiveness studies. Taken together, this evidence further supports the importance of these strategies for reducing the burden of micronutrient malnutrition in children. Population and context should be considered when selecting one or more appropriate interventions for programming.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Suplementos Nutricionais , Alimentos Fortificados , Micronutrientes/administração & dosagem , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Feminino , Ácido Fólico/administração & dosagem , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Renda , Ferro/administração & dosagem , Ferro/deficiência , Masculino , Micronutrientes/deficiência , Magreza/epidemiologia , Magreza/prevenção & controle , Oligoelementos/administração & dosagem , Oligoelementos/deficiência
19.
PLoS One ; 15(1): e0228258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999737

RESUMO

Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6-59 months) and non-pregnant women (15-49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana's food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.


Assuntos
Anemia/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Hemoglobinopatias/epidemiologia , Malária/epidemiologia , Micronutrientes/deficiência , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Gana/epidemiologia , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Adulto Jovem
20.
BMC Public Health ; 20(1): 83, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959142

RESUMO

BACKGROUND: Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda. METHODS: Data for this study come from the 2000 to 2015 Rwanda's Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting. RESULTS: The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight. CONCLUSIONS: Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.


Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Demografia , Feminino , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Masculino , Políticas , Prevalência , Fatores de Risco , Ruanda/epidemiologia , Fatores Socioeconômicos
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