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1.
BMJ Open ; 12(11): e055853, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328394

RESUMO

OBJECTIVES: To identify and investigate complex pathways to stunting among children aged 6-24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting. DESIGN, SETTING AND PARTICIPANTS: We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children's height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients. OUTCOME MEASURE: The primary outcome measure was height-for-age Z-scores as a continuous measure. RESULTS: Findings suggest that children's dietary diversity and continued breast feeding mediate the association between socioeconomic status and children's height. While there was no significant direct effect of maternal education on children's height, results suggested significant indirect pathways through which maternal education effects children's height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children's height was mediated by either dietary diversity or continued breast feeding. CONCLUSION: We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status.


Assuntos
Transtornos do Crescimento , Fenômenos Fisiológicos da Nutrição do Lactente , Lactente , Criança , Feminino , Humanos , Estudos Transversais , Camboja/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Aleitamento Materno , Fatores Socioeconômicos , Classe Social , Estado Nutricional
2.
BMJ Open ; 12(11): e060692, 2022 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-36356996

RESUMO

BACKGROUND AND OBJECTIVES: Over centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate seasonal variations in child stunting and wasting, and identify factors associated with both forms of child malnutrition in drought-prone areas. METHODS: This cohort study was conducted among a random sample of 909 children in rural southern Ethiopia. The same children were followed for 1 year (2017-2018) with quarterly repeated measurements of their outcomes: height-for-age and weight-for-height indices (Z-scores). Linear regression models were used to analyse the association between both outcomes and baseline factors (eg, household participation in a social safety net programme and water access) and some time-varying factors (eg, household food insecurity). RESULTS: Child wasting rates varied with seasonal household food insecurity (ᵪ2 trend = 15.9, p=0.001), but stunting rates did not. Household participation in a social safety net programme was associated with decreased stunting (p=0.001) and wasting (p=0.002). In addition to its association with decreased wasting (p=0.001), protected drinking water access enhanced the association between household participation in a social safety net programme and decreased stunting (p=0.009). Absence of a household latrine (p=0.011), lower maternal education level (p=0.001), larger family size (p=0.004) and lack of non-farming income (p=0.002) were associated with increased child stunting. CONCLUSIONS: Seasonal household food insecurity was associated with child undernutrition in rural Ethiopia. Strengthening community-based food security programmes, such as the Ethiopian social safety net programme, could help to reduce child undernutrition in drought-prone areas. Improving clean water access and sanitation could also decrease child undernutrition.Key terms: Z-scores; Social safety net program; Water access.


Assuntos
Transtornos da Nutrição Infantil , Desnutrição , Criança , Humanos , Lactente , Etiópia/epidemiologia , Abastecimento de Alimentos , Estudos de Coortes , Secas , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Caquexia , Prevalência
3.
Rev Saude Publica ; 56: 93, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36383806

RESUMO

OBJECTIVE: To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS: Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006-2007, 2009-2010, 2013-2014, and 2016-2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS: Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35-1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10-1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02-1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68-3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75-3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39-3.28). CONCLUSIONS: DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.


Assuntos
Desnutrição , Obesidade Pediátrica , Adolescente , Criança , Feminino , Humanos , Masculino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Prevalência , Estudos Transversais , Brasil , Sobrepeso/complicações , Sobrepeso/epidemiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Fatores de Risco , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etiologia , Fatores Socioeconômicos
4.
Sci Rep ; 12(1): 19293, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36369357

RESUMO

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24-59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24-59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.


Assuntos
Enteropatias Parasitárias , Saneamento , Animais , Estudos Transversais , Etiópia/epidemiologia , Escherichia coli , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Enteropatias Parasitárias/complicações , Prevalência , Diarreia/etiologia , Diarreia/complicações
5.
Front Public Health ; 10: 985786, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36388319

RESUMO

Background: Exposure to air pollution, especially indoor air pollution, was associated with an increased risk of childhood stunting. However, few longitudinal studies have explored the long-term impacts of indoor air pollution from household solid fuel use on child growth. We aimed to investigate the association between household air pollution (HAP) from solid fuel use and childhood stunting in Chinese children. Method: The longitudinal data from the Chinese Family Panel Study over 2010-2018 were included in this study with a total of 6,013 children aged 0-15 years enrolled at baseline. Exposure to HAP was measured as solid fuel use for cooking, while solid fuel was defined as coal and firewood/straw according to the questionnaire survey. Stunting was defined as-2SD below the height-for-age z-score (HAZ) of the reference children. Logistic regression and Cox proportional hazards models with time-varying exposures were employed to estimate the association between childhood stunting and HAP exposure. Results: At baseline, children with exposure to HAP from combusting solid fuels had a relatively higher risk of stunting [OR (95%CI): 1.42 (1.24-1.63)]. Among children without stunning at baseline, those living in households with solid fuel use had a higher stunting risk over an 8-year follow-up [HR (95%CI): 2.05 (1.64-2.57)]. The risk of childhood stunting was increased for those with HAP exposure from firewood/straw combustion or with longer exposure duration [HR (95%CI): 2.21 (1.74-2.79) and 3.01 (2.23-4.08), respectively]. Meanwhile, this risk was significantly decreased among children from households switching from solid fuels to clean fuels [HR (95%CI): 0.53 (0.39-0.70)]. Solid fuel use was suggested to be a mediator of the relationship between poor socioeconomic factors (i.e., household income and parental education level) and childhood stunning, with a mediation effect ranging from 11.25 to 14.26%. Conclusions: HAP exposure from solid fuel use was associated with childhood stunting. Poor parental education and low household income might be socioeconomic factors contributing to solid fuel use. Therefore, household energy policies to facilitate access to clean fuels are urgently needed, especially for low-income and low-educated households.


Assuntos
Poluição do Ar em Ambientes Fechados , Poluição do Ar , Criança , Humanos , Estudos Prospectivos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/análise , China/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia
6.
Nutrients ; 14(19)2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36235598

RESUMO

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.


Assuntos
Desnutrição , Saúde Pública , Estatura , Caquexia , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Guatemala/epidemiologia , Humanos , Lactente , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia
7.
Pan Afr Med J ; 42: 157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36187028

RESUMO

Introduction: stunting in under five children is a great concern in low and middle-income countries including Rwanda. While over the past decades different developing countries have made remarkable efforts improving their economic growth, there is mixed evidence and lack of consensus on the impact of economic development on nutrition improvement. The objective of this study was to assess the relationship between economic attributes and childhood stunting in the City of Kigali. Methods: this was a retrospective cross-sectional and comparative study documenting the period 2010-2017. Stunting in under five children was analyzed in relation to the economic attributes which include the household consumption per capita, annual household income and level of poverty. The analysis was done at the level of district. Official reports from the National Institute of Statistics of Rwanda provided data on both economic attributes and stunting. Results: in some situations, the improvements in economic attributes such as increase in average household consumption per capita and increase in annual household income are followed by the reduction of stunting in under five children. However, in some other situations, the reduction of the level of poverty and the increase of annual household income was not translated into the reduction of stunting. Conclusion: improvements in some economic attributes do not necessarily translate into reduction of stunting in under five children. Further studies are needed to understand possible lead forces underlying this situation including establishing the proportion of household income spent on children´s nutrition as well as possible inequity and inequality in wealth distribution.


Assuntos
Transtornos do Crescimento , Renda , Criança , Estudos Transversais , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Estudos Retrospectivos , Ruanda/epidemiologia
8.
Proc Natl Acad Sci U S A ; 119(41): e2209589119, 2022 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-36197997

RESUMO

Environmental enteric dysfunction (EED) is an inflammatory syndrome postulated to contribute to stunted child growth and to be associated with intestinal dysbiosis and nutrient malabsorption. However, the small intestinal contributions to EED remain poorly understood. This study aimed to assess changes in the proximal and distal intestinal microbiota in the context of stunting and EED and to test for a causal role of these bacterial isolates in the underlying pathophysiology. We performed a cross-sectional study in two African countries recruiting roughly 1,000 children aged 2 to 5 years and assessed the microbiota in the stomach, duodenum, and feces. Upper gastrointestinal samples were obtained from stunted children and stratified according to stunting severity. Fecal samples were collected. We then investigated the role of clinical isolates in EED pathophysiology using tissue culture and animal models. We find that small intestinal bacterial overgrowth (SIBO) is extremely common (>80%) in stunted children. SIBO is frequently characterized by an overgrowth of oral bacteria, leading to increased permeability and inflammation and to replacement of classical small intestinal strains. These duodenal bacterial isolates decrease lipid absorption in both cultured enterocytes and mice, providing a mechanism by which they may exacerbate EED and stunting. Further, we find a specific fecal signature associated with the EED markers fecal calprotectin and alpha-antitrypsin. Our study shows a causal implication of ectopic colonization of oral bacterial isolated from the small intestine in nutrient malabsorption and gut leakiness in vitro. These findings have important therapeutic implications for modulating the microbiota through microbiota-targeted interventions.


Assuntos
Microbioma Gastrointestinal , Transtornos do Crescimento , Intestino Delgado , Lipídeos , Boca , Animais , Bactérias , Pré-Escolar , Estudos Transversais , Transtornos do Crescimento/etiologia , Humanos , Complexo Antígeno L1 Leucocitário , Metabolismo dos Lipídeos , Síndromes de Malabsorção , Camundongos , Modelos Teóricos , Boca/microbiologia
9.
BMC Pediatr ; 22(1): 581, 2022 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-36207712

RESUMO

BACKGROUND: Optimal nutrition during the first two years of a child's life is critical for the reduction of morbidity and mortality. In Ghana, majority of children miss out on optimal nutrition and only few (13%) of children receive a Minimum Acceptable Diet (MAD). Several studies have investigated the influence of community-level factors on infants and young children feeding (IYCF) practices. However, little is known about the influence of maternal factors on IYCF practices in rural settings. Therefore, this study assessed the influence of maternal factors on the feeding indicators and nutritional status of children aged 6-23 months in two administrative districts in Ghana. METHODS: Data were collected among 935 mothers who had children aged 6-23 months and accessed 21 Child Welfare Clinics within the study area. The study involved a face- to-face interview using structured questionnaires to capture maternal characteristics, dietary intake and anthropometric measurements of children. Multivariate logistic regression was used to study the association between maternal factors and child nutrition outcomes (MAD, dietary diversity score (DDS) and anthropometric indicators) using Stata 16.0 software. RESULTS: Being employed (AOR = 3.07, 95% CI: 1.71-5.49, p < 0.001) and attaining secondary or higher education (AOR = 2.86, 95% CI: 1.42-5.78, p = 0.003) were significant predictors of children receiving MAD. Similarly, having an average decision-making autonomy increased the child's odds of receiving MAD (AOR = 1.68, 95% CI: 1.02-2.76, p = 0.040). Children of mothers who attained secondary or a higher level of education (AOR = 0.59, 95% CI: 0.36 -0.97, p = 0.040) and those whose mothers were employed (AOR = 0.71, 95% CI: 0.47-1.07, p = 0.043) were associated with a reduced risk of underweight and stunting respectively. Children of mothers with average financial independence status were more likely to receive diversified meals (AOR = 1.55, 95% CI: 1.01-2.38, p = 0.045). CONCLUSIONS: High educational level and being employed have positive influence on MAD, stunting and underweight of children. High decision-making power and average financial independence of mothers are good predictors of children receiving MAD. Family planning, women empowerment in decision-making, providing employment opportunities for mothers and promoting girl-child education are recommended.


Assuntos
Estado Nutricional , Magreza , Pré-Escolar , Dieta , Feminino , Gana/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Lactente , Mães , Magreza/epidemiologia
10.
Sci Rep ; 12(1): 17859, 2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36284133

RESUMO

Worldwide, over 250 million children under 5 years do not reach their developmental potential due to several causes, including malnutrition. In Cambodia, the prevalence of stunting and wasting among children remains high. This prospective cohort study aimed to assess acquisition of motor and cognitive developmental milestones in early childhood and their associations with stunting and wasting. Children aged from 0 to 24 months were recruited from three provinces in Cambodia and followed up to seven times from March 2016 to June 2019, until their 5 years. Data collection included anthropometry and developmental milestones. Seven motor and seven cognitive milestones were evaluated using the Cambodian Development Milestone Assessment Tool. Associations were assessed with parametric survival models. Hazard ratios (HR) below 1 stood for lower probabilities for achieving developmental milestones. Data were available for 7394 children. At 12 months, the prevalence of stunting and wasting were 23.7% and 9.6% respectively. Both were consistently associated with delays in most motor and cognitive milestones. Stunting was strongly associated with delays in gross motor milestones (HR < 0.85; p < 0.001). Wasting was more strongly associated with delays in fine motor development and most cognitive milestones (HR < 0.75; p < 0.001). Promoting nutritional programs in the first 1000 days to prevent malnutrition is essential to further the optimal growth and motor and cognitive development of Cambodian children.


Assuntos
Transtornos do Crescimento , Desnutrição , Criança , Humanos , Pré-Escolar , Lactente , Estudos Prospectivos , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Desnutrição/epidemiologia , Desnutrição/complicações , Estudos de Coortes , Caquexia , Prevalência , Asiáticos
11.
Nutrients ; 14(20)2022 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-36297057

RESUMO

Stunting prevalence in South Kalimantan has been higher than the national figure and is the sixth highest in Indonesia. Not many studies in South Kalimantan have analysed the risk factors for stunting comprehensively that combine sociodemographic factors, utilization of maternal health services, and characteristics of children. Therefore, the purpose of this study was to analyse sociodemographic factors, utilization of maternal health services, and characteristics of children under 5 as determinants of stunting in South Kalimantan Province. This study used an analytic observational method with a cross-sectional design. Data collection used secondary data from the results of South Kalimantan Baseline Health Research 2018. The total population of toddlers obtained from South Kalimantan Baseline Health Research 2018 data was 1218 toddlers, and all of them were taken as samples. Data analysis used a chi square test for bivariate test and Logistic Regression for multivariate test. There is a relationship between mother's education level (p = 0.001), father's education (p = 0.002), toddler age (p < 0.001), low birth weight (p = 0.05), exclusive breastfeeding (p = 0.008), and underweight (p = 0.000) with stunting. The data were continued with the Logistics Regression test and the dominant variables related to stunting were underweight (p < 0.001 with OR 18,241), under-five age (p < 0.001, with OR value for ages 24-35 months 9511), and premature birth (p = 0.027 with an OR of 2187). The conclusion of this study is that the most important factor in the incidence of stunting in South Kalimantan is underweight nutritional status.


Assuntos
Serviços de Saúde Materna , Magreza , Feminino , Gravidez , Humanos , Pré-Escolar , Lactente , Magreza/epidemiologia , Magreza/complicações , Estudos Transversais , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Fatores de Risco , Escolaridade , Prevalência , Fatores Socioeconômicos
12.
BMC Public Health ; 22(1): 1943, 2022 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261797

RESUMO

BACKGROUND: Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. METHODS: A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. RESULTS: The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child's stool, or improved household flooring and child wasting. CONCLUSION: The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting.


Assuntos
Transtornos da Nutrição Infantil , Água Potável , Desnutrição , Criança , Humanos , Lactente , Saneamento , Etiópia/epidemiologia , Higiene , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/complicações , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Desnutrição/epidemiologia , Desnutrição/complicações , Prevalência
13.
BMC Public Health ; 22(1): 1977, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-36307789

RESUMO

BACKGROUND: Despite the multiple initiatives implemented to reduce stunting in Ecuador, it continues to be a public health problem with a significant prevalence. One of the most affected groups is the rural indigenous population. This study aimed to analyze the prevalence of chronic malnutrition in indigenous children under 5 years of age and its association with health determinants, focusing on one of the territories with the highest prevalence of stunting. METHODS: A cross-sectional study in 1,204 Kichwa indigenous children under the age of five, residing in rural areas of the counties with the highest presence of indigenous in the province of Chimborazo-Ecuador. A questionnaire on health determinants was applied and anthropometric measurements were taken on the child and the mother. Stunting was determined by the height-for-age z-score of less than 2 standard deviations, according to the World Health Organization´s parameters. Data were analyzed using bivariate and multivariate Poisson regression. RESULTS: 51.6% (n = 646) of the children are stunted. Height-for-age z-scores were significantly better for girls, children under 12 months, families without overcrowding, and families with higher family income. The variables that were significantly and independently associated with stunting were: overcrowding (PR 1.20, 95% CI 1-1.44), the mother required that the father give her money to buy medicine (PR 1.33, 95% CI 1.04-1.71), the father did not give her money to support herself in the last 12 months (1.58, 95% CI 1.15-2.17), mother's height less than 150 cm (PR 1.42, 95% CI 1.19-1.69) and the child was very small at birth (PR 1.75, 95% CI 1.22-2.5). CONCLUSION: One out of every two rural indigenous children included in this study is stunted. The high prevalence of stunting in the indigenous and rural population is multicausal, and requires an intersectoral and multidisciplinary approach. This study identified three fundamental elements on which public policy could focus: (a) reduce overcrowding conditions, improving economic income in the rural sector (for example, through the strengthening of agriculture), (b) provide prenatal care and comprehensive postnatal care, and (c) promote strategies aimed at strengthening the empowerment of women.


Assuntos
Desnutrição , Criança , Recém-Nascido , Gravidez , Feminino , Humanos , Lactente , Pré-Escolar , Prevalência , Desnutrição/epidemiologia , Desnutrição/etiologia , Estudos Transversais , Equador/epidemiologia , Transtornos do Crescimento/etiologia
14.
PLoS One ; 17(10): e0275889, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36228030

RESUMO

BACKGROUND: Over 155 million children under five suffer from stunting, and it is responsible for over one million deaths and 54.9 million Disability Adjusted Life Years (DALYS) of under-five children worldwide. These predominantly occurred in low-and middle-income countries like sub-Saharan Africa. Stunted children begin their lives at a marked disadvantage. Some of these are; poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life and the devastating effects of stunting can last a lifetime and even affect the next generation. Despite this, its magnitude rises in the past 25 years in sub-Saharan Africa. Studies that capture the pooled prevalence and associated factors of stunting among children aged 6-59 months in sub-Saharan Africa are limited. Therefore, this study was carried out on the basis of the Bayesian approach to determine the pooled prevalence and predictors of stunting among children aged 6-59 months in Sub-Saharan Africa. OBJECTIVE: To assess the pooled prevalence of stunting and associated factors among children aged 6-59 months in Sub-Saharan Africa. METHODS: For this study a total of 173,483 weighted samples from the demography and health survey data set of 35 sub-Saharan African countries from 2008 to 2020 were used. After checking Variation between cluster by computing Intraclass Correlation Coefficient, binary logistic regression model was conducted based on hierarchical Bayesian statistical approach to account the hierarchical nature of demography and health survey data and to get reliable estimates by using additional information from the prior distribution. Adjusted odds ratio with 95% credible interval of the best fitted model was used to ascertain the predictors. RESULTS: The pooled prevalence of stunting in Sub-Saharan Africa was about 35% (95%CI: 34.87, 35.31). Of the sub-regions, the highest prevalence of stunting was in East Africa, 37% (95%, CI: 36.96, 37.63) followed by Central Africa, 35% (95%CI: (34.93, 35.94). Being male (AOR = 1.27, 95% CrI 1.25, 1.30), small birth size (AOR = 1.29, CrI 1.25, 1.32), home delivery (AOR = 1.17, CrI 1.14, 1.20), and no education of mothers (AOR = 3.07, CrI 2.79, 3.39) were some of the significant predictors of stunting of children. CONCLUSION AND RECOMMENDATION: The prevalence of stunting of children in sub-Saharan Africa is among the highest in the world. Predictors such as being male, being small at birth, a child delivered at home, and, low level of maternal education were some of the predictors of childhood stunting. Stakeholders and non-governmental organizations should consider those contributing factors of stunting when they plan and design nutritional improvement programs.


Assuntos
Transtornos do Crescimento , Distúrbios Nutricionais , Adulto , Teorema de Bayes , Criança , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Recém-Nascido , Masculino , Estado Nutricional , Prevalência
15.
PLoS One ; 17(9): e0272618, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36103509

RESUMO

BACKGROUND: Child undernutrition is a challenge in Ethiopia, where morbidity and mortality among children are attributed to it. This study aimed to describe the dietary practices, household food insecurity, and nutritional status of young children in Dale district, Sidama region, southern Ethiopia. We discuss our findings in light of research from the same area 3 to 5 decades ago, and we analyze factors associated with linear growth of young children. METHOD: A community-based cross-sectional study design was employed. Children less than two years old and their primary caretakers (n = 903) were included in this study. Among whom 791 children were aged above six months and 742 children out of 791 provided a 24-hour dietary recall. Interviews capturing other dietary practices, food insecurity, socio-demographic characteristics, anthropometric measurements, and haemoglobin assessments were performed for all. The WHO Child Growth Standards were used to calculate anthropometric indices and to describe stunting (length-for-age z-score <-2). Haemoglobin measures below 11g/dl were defined as low haemoglobin levels (anaemia). Multilevel linear regression was used to identify factors associated with length-for-age z-scores. RESULT: The prevalence of stunting, wasting, and anaemia was 39.5%, 3.9%, and 61.7%, respectively. The majority of children (97%) ate cereals (maize) during the past 24 hours, and 79.6% of households use maize as the main food. Three fourth (75%) of the total households were food insecure ranging from mild to severe food insecurity. Boys were at higher risk of having lower length-for-age z-score than girls (ß -0.53; 95% Confidence Interval (CI): -0.78, -0.27). For each month the children grew older, length-for-age z-score decreased slightly (ß -0.06; -0.07, -0.04). Household food insecurity scores (ß -0.05; -0.08, -0.01) and children haemoglobin levels, (ß 0.21; 0.06, 0.35) were also associated with length-for-age z-score among young children. CONCLUSION: Linear growth failure (stunting) was prevalent among young children in the rural Sidama region and the majority of them were also anaemic. Older age, male sex, a lower haemoglobin level in children, and household food insecurity were risk factors of linear growth failure in young children. Maize seems to be the dominant food in this previously ensete dominated area; however, there have been minimal improvements in length-for-age z-score over decades. Strategies to ensure household's food access and improve the quality of child diets need to be implemented.


Assuntos
Anemia , Musaceae , Idoso , Anemia/complicações , Anemia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Etiópia/epidemiologia , Feminino , Abastecimento de Alimentos , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Masculino , Estado Nutricional
16.
Artigo em Inglês | MEDLINE | ID: mdl-36078367

RESUMO

Previous studies have suggested that a toddler stunting is closely related to maternal characteristics. Working mothers, as a group, are vulnerable to having a stunted toddler. The present research aimed to analyze factors related to stunting incidence in toddlers with working mothers in Indonesia. The study sampled 44,071 toddlers with working mothers. The final stage used a multinomial logistic regression test. The study found that working mothers living in rural areas have a higher probability of having stunted or severely stunted toddlers. Maternal age partially affects the incidence of stunted toddlers in Indonesia. Mothers in the ≤19 age group are 1.461 (95% CI 1.140-1.872) times more likely than those in the ≥45 group to have a severely stunted toddler. Those who were never married were 1.433 (95% CI 1.006-2.043) times more likely than those who were divorced/widowed to have a severely stunted toddler. A married mother was 0.734 (95% CI 0.617-0.872) times less likely to have a severely stunted toddler than a divorced/widowed mother. Better education is protective against working mothers having stunted toddlers. Moreover, the present study found that the toddler's age determined the incidence of stunted toddlers. This study concluded that there are five variables related to stunting incidence in toddlers with working mothers in Indonesia: residence, age, marital status, education, and toddler age.


Assuntos
Transtornos do Crescimento , Mães , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Incidência , Indonésia/epidemiologia , Lactente , Modelos Logísticos
17.
Trop Med Int Health ; 27(9): 823-830, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36075687

RESUMO

OBJECTIVE: The role of HIV exposure in determining growth among HIV-uninfected children is debated. We determined whether intrauterine HIV exposure influences linear growth in a cohort of Ethiopian children followed up to 18 months of age in public health facilities in Adama city, Ethiopia. METHODS: Participants were offspring of pregnant women enrolled in a prospective cohort study that included screening for HIV infection during antenatal care. Growth patterns of HIV-exposed and uninfected (HEU) and HIV-unexposed (HU) children were compared up to 18 months of age, with length-for-age z-score (LAZ) and proportion with stunting as primary outcomes. Multivariable linear and logistic regression models were constructed to investigate the associations between HIV exposure and linear growth, controlling for socio-demographic factors and breastfeeding status. RESULTS: Of 1705 included infants (164 HEU), 1276 remained in follow-up at 18 months. Among HIV-positive mothers, 132 (80.5%) were receiving antiretroviral therapy at enrolment. At the 18-month visit, mean LAZ was -1.08 among HEU children and -0.74 among HU children (p = 0.052). Proportions of HEU and HU children with stunting at the 18-month visit were 27.8% and 18.7%, respectively (p = 0.010). In multivariable models, HIV exposure was associated with lower LAZ at all follow-up visits, and with stunting at the 18-month visit (adjusted odds ratio 2.29, 95% confidence interval 1.40-3.71). HIV exposure was not associated with weight-related growth outcomes. CONCLUSIONS: HEU children in Ethiopia had inferior linear growth compared with HU children, implying that intrauterine HIV exposure impacts early childhood growth in this setting.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/complicações , Transtornos do Crescimento/etiologia , Infecções por HIV/complicações , Humanos , Lactente , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos
18.
PLoS One ; 17(8): e0272634, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930584

RESUMO

BACKGROUND: Child undernutrition is a burden and the leading cause of child mortality in low-and middle-income countries like Bangladesh and India. Currently, this issue is a matter of great concern, inasmuch as achieving the Sustainable Development Goals (SDGs). The study intends to determine the factors of child undernutrition using a single composite index of anthropometric failure (CIAF) among the Bengali population. METHODS: Unit level data on 14055 under 5 children were extracted from the Bangladesh Demographic and Health Survey 2017-18 (BDHS) and the 4th National Family Health Survey of India (NFHS-4). To understand child undernutrition and generate CIAF, data on height-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight) were used by WHO guidelines. These three undernutrition indicators were combined into a single undernutrition indicator called anthropometric failure (anth-failure) using the CIAF concept. Explanatory factors of anth-failure included data on maternal health, socio-demographic and birth-related variables. Differences of frequency were determined by Z-proportional and Chi-square tests; predictors of anth-failure were determined by binary logistic regression. Cut off point of p-value was taken as 0.05 to test the significance. RESULTS: Inter-country disparities were revealed, about half of Bengali children in India and two-fifths in Bangladesh being prone to anth-failure. Stunting and underweight were more prevalent in both countries than wasting. Maternal undernutrition, lack of maternal education, and poor wealth index were common factors of anth-failure for both countries. Children in Bangladesh developed anth-failure after the end of breastfeeding period, indicating a lack of nutritious food. Lack of antenatal care was another significant factor in Bangladesh. In India, the first child suffered from anth-failure due to lack of maternal education. CONCLUSIONS: This study provides a better understanding of multifactorial impact on child undernutrition. It is proposed that the emphasis should be on initiatives that improve maternal education and nutrition, child food security, boost household wealth index, and enhance mothers' access to health care. The study strongly recommends that the governments of Bangladesh and India invest financially in preventing child malnutrition, which will contribute to achieving the first four SDGs.


Assuntos
Transtornos da Nutrição Infantil , Desnutrição , Bangladesh/epidemiologia , Criança , Transtornos da Nutrição Infantil/epidemiologia , Feminino , Transtornos do Crescimento/etiologia , Humanos , Índia/epidemiologia , Lactente , Desnutrição/complicações , Desnutrição/epidemiologia , Gravidez , Prevalência , Magreza/complicações , Magreza/epidemiologia
19.
Ecol Food Nutr ; 61(5): 608-623, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35934984

RESUMO

Low height/length-for-age (stunting) is a public health problem in Ethiopia. Efforts that have been made to evaluate factors affecting national and international strategies related to the problem are very limited and poorly achieved. The present study aimed to evaluate low length/height-for-age (stunting) and its associated factors among children 6 to 23 months of age in Ethiopia. We used cross-sectional data collected for 2019 EMDHS. We cleaned, processed, and analyzed in Stata v.15. Socio-demographic, socio-economic parameters, and nutritional (wasting, diet frequency, breast milk, and animal milk) factors were used in the analysis. We fitted Generalized Linear Latent and Mixed Model (GLLAMM) to examine the associations. We analyzed the data of 2,037 children aged 6-23 months and found stunting of 933.07(45.80%). Some factors such as home delivery [coef. = -4.58, 95% CI:-7.81,-1.34] and household size of ≥6 [coef. = -5.53, 95% CI:-10.36,-7.10] were positively associated. No current breastfeeding [coef. = 10.70, 95% CI: 2.16, 19.23] and still breastfeed [coef. = 10.68, 95% CI: 2.62, 18.74] were negatively associated with stunting. Stunting among 6-23 months aged children in Ethiopia is very high above all the national, regional, and international targets. Feeding practice, socio-economic, and psychosocial-support for mothers need revised commitment for pragmatic solution.


Assuntos
Transtornos do Crescimento , Mães , Animais , Estudos Transversais , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Prevalência
20.
BMC Public Health ; 22(1): 1550, 2022 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-35971115

RESUMO

BACKGROUND: A single anthropometric index such as stunting, wasting, or underweight does not show the holistic picture of under-five children's undernutrition status. To alleviate this problem, we adopted a multifaceted single index known as the composite index for anthropometric failure (CIAF). Using this undernutrition index, we investigated the disparities of Ethiopian under-five children's undernutrition status in space and time. METHODS: Data for analysis were extracted from the Ethiopian Demographic and Health Surveys (EDHSs). The space-time dynamics models were formulated to explore the effects of different covariates on undernutrition among children under five in 72 administrative zones in Ethiopia. RESULTS: The general nested spatial-temporal dynamic model with spatial and temporal lags autoregressive components was found to be the most adequate (AIC = -409.33, R2 = 96.01) model. According to the model results, the increase in the percentage of breastfeeding mothers in the zone decreases the CIAF rates of children in the zone. Similarly, the increase in the percentages of parental education, and mothers' nutritional status in the zones decreases the CIAF rate in the zone. On the hand, increased percentages of households with unimproved water access, unimproved sanitation facilities, deprivation of women's autonomy, unemployment of women, and lower wealth index contributed to the increased CIAF rate in the zone. CONCLUSION: The CIAF risk factors are spatially and temporally correlated across 72 administrative zones in Ethiopia. There exist geographical differences in CIAF among the zones, which are influenced by spatial neighborhoods of the zone and temporal lags within the zone. Hence these findings emphasize the need to take the spatial neighborhood and historical/temporal contexts into account when planning CIAF prevention.


Assuntos
Desnutrição , Antropometria/métodos , Criança , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/etiologia , Humanos , Lactente , Desnutrição/complicações , Desnutrição/epidemiologia , Prevalência , Magreza/complicações
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