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Cad Saude Publica ; 40(1): e00180022, 2024.
Artículo en Portugués | MEDLINE | ID: mdl-38359276


This study aimed to analyze the temporal trend of malnutrition in children aged under five years assisted by the Brazilian Income Transfer Program from 2008 to 2019, by exploring regional inequalities and seeking to determine the impact of the economic and political crises aggravated in 2014, and the government's adherence to fiscal austerity policies on the trend. The analyses were performed using aggregated data from infants (0-23 months) and preschoolers (24-59 months), extracted from the Brazilian Food and Nutritional Surveillance System (SISVAN) assisted by the Brazilian Income Transfer Program (n = 34,272,024). Trends were analyzed using generalized linear models with age-specific mixed effects (negative binomial distribution and log linkage function). The regional inequalities were analyzed based on the grouping of Federative Units according to the Social Vulnerability Index (SVI) and the influence of crises and austerity policies on the prevalence of malnutrition by the interaction between "year" and "crisis" (2008-2013 vs. 2014-2019). There was a reduction in the prevalence of child malnutrition until mid-2013, when the trends became stationary for preschoolers and upward for infants. There was also a higher risk of malnutrition in Federative Units with medium- and high-social vulnerability, when compared to those with low-social vulnerability. The inflection points in the trends corroborate the hypothesis that the political and economic crises, and the governmental responses to these crises, negatively impacted the nutritional status of children in poverty and extreme poverty in Brazil.

O objetivo deste estudo foi analisar a tendência temporal da desnutrição em crianças menores de 5 anos de idade assistidas pelo Programa Bolsa Família entre 2008 e 2019, explorando desigualdades regionais e buscando determinar o impacto das crises econômica e política agravadas em 2014 e da adesão governamental às políticas de austeridade fiscal na tendência. As análises foram realizadas utilizando dados agregados de lactentes (0-23 meses) e pré-escolares (24-59 meses), extraídos do Sistema de Vigilância Alimentar e Nutricional (SISVAN) assistidas pelo Programa Bolsa Família (n = 34.272.024). As tendências foram analisadas por meio de modelos lineares generalizados, com efeitos mistos específicos para as faixas etárias (distribuição binomial negativa e função de ligação log). As desigualdades regionais foram analisadas a partir do agrupamento das Unidades Federativas segundo o Índice de Vulnerabilidade Social (IVS) e a influência das crises e das políticas de austeridade na prevalência de desnutrição por meio da interação entre "ano" e "crise" (2008-2013 vs. 2014-2019). Houve redução na prevalência de desnutrição infantil até meados de 2013, quando as tendências passaram a ser estacionárias para pré-escolares e ascendentes para lactentes. Observou-se, também, maior risco de desnutrição nos estados com média e alta vulnerabilidade social, quando comparadas àqueles com baixa vulnerabilidade social. Os pontos de inflexão nas tendências corroboram a hipótese de que as crises política e econômica, e as respostas governamentais a essas crises, provocaram impacto negativo sobre o estado nutricional de crianças em situação de pobreza e extrema pobreza no Brasil.

El objetivo de este estudio fue analizar la tendencia temporal de la desnutrición en niños menores de cinco años atendidos por el Programa Bolsa Familia entre los años 2008 y 2019, explorando desigualdades regionales y buscando determinar el impacto de las crisis económica y política que se intensificaron en 2014, así como la adhesión del gobierno a políticas de austeridad fiscal en esta tendencia. Los análisis se realizaron utilizando datos agregados de lactantes (0-23 meses) y preescolares (24-59 meses), extraídos del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) atendidos por el Programa Bolsa Familia (n = 34.272.024). Se analizaron las tendencias a través de modelos lineales generalizados con efectos mixtos específicos para los grupos de edad (distribución binomial negativa y función de enlace de logaritmo). Se analizaron las desigualdades regionales a partir del agrupamiento de las unidades federativas conforme el Índice de Vulnerabilidad Social (IVS) y la influencia de las crisis y de las políticas de austeridad en la prevalencia de desnutrición a través de la interacción entre "año" y "crisis" (2008-2013 vs. 2014-2019). Hubo una disminución en la prevalencia de desnutrición infantil hasta mediados de 2013, cuando las tendencias se volvieron estacionarias para preescolares y ascendentes para lactantes. También se observó un riesgo más alto de desnutrición en estados con vulnerabilidad social media y alta, en comparación con aquellos con vulnerabilidad social baja. Los puntos de inflexión en las tendencias corroboran la hipótesis de que las crisis política y económica, y las respuestas del gobierno para estas crisis, tuvieron un impacto negativo en el estado nutricional de niños en situación de pobreza y extrema pobreza en Brasil.

Trastornos de la Nutrición del Niño , Desnutrición , Niño , Lactante , Humanos , Brasil/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Prevalencia , Desnutrición/epidemiología , Renta , Factores Socioeconómicos
Sci Rep ; 14(1): 3326, 2024 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-38336795


Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: - 0.26, 95% CI - 0.31 to - 0.20], and Cameroon [C: - 0.19, 95% CI - 0.22 to - 0.17], and relatively it was less concentrated among the poor in Liberia [C: - 0.07, 95% CI - 0.11 to - 0.04], and Gambia [C: - 0.07, 95% CI - 0.11 to - 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.

Trastornos de la Nutrición del Niño , Desnutrición , Niño , Humanos , Lactante , Países en Desarrollo , Estudios Transversales , Desnutrición/epidemiología , Renta , Delgadez/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Factores Socioeconómicos
PLoS One ; 19(2): e0296774, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38300944


In low-to-middle-income countries (LMICs), enteric pathogens contribute to child malnutrition, affecting nutrient absorption, inducing inflammation, and causing diarrhoea. This is a substantial problem in LMICs due to high disease burden, poor sanitation and nutritional status, and the cyclical nature of pathogen infection and malnutrition. This relationship remains understudied in Timor-Leste. In our pilot study of enteric pathogens and malnutrition in Dili, Timor-Leste (July 2019-October 2020), we recruited 60 infants in a birth cohort from Hospital Nacional Guido Valadares (HNGV) with up to four home visits. We collected faecal samples and details of demographics, anthropometrics, diet and food practices, and animal husbandry. Additionally, we collected faecal samples, diagnostics, and anthropometrics from 160 children admitted to HNGV with a clinical diagnosis of severe diarrhoea or severe acute malnutrition (SAM). We tested faeces using the BioFire® FilmArray® Gastrointestinal Panel. We detected high prevalence of enteric pathogens in 68.8% (95%CI 60.4-76.2%) of infants at home, 88.6% of SAM cases (95%CI 81.7-93.3%) and 93.8% of severe diarrhoea cases (95%CI 67.7-99.7%). Diarrhoeagenic Escherichia coli and Campylobacter spp. were most frequently detected. Pathogen presence did not significantly differ in birth cohort diarrhoeal stool, but hospital data indicated associations between Salmonella and Shigella and diarrhoea. We observed wasting in 18.4% (95%CI 9.2-32.5%) to 30.8% (95%CI 17.5-47.7%) of infants across home visits, 57.9% (95%CI 34.0-78.9%) of severe diarrhoea cases, and 92.5% (95%CI 86.4-96.2%) of SAM cases. We associated bottle feeding with increased odds of pathogen detection when compared with exclusive breastfeeding at home (OR 8.3, 95%CI 1.1-62.7). We detected high prevalence of enteric pathogens and signs of malnutrition in children in Dili. Our pilot is proof of concept for a study to fully explore the risk factors and associations between enteric pathogens and malnutrition in Timor-Leste.

Trastornos de la Nutrición del Niño , Desnutrición , Desnutrición Aguda Severa , Lactante , Niño , Animales , Femenino , Humanos , Proyectos Piloto , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/complicaciones , Cohorte de Nacimiento , Timor Oriental/epidemiología , Desnutrición/epidemiología , Desnutrición/complicaciones , Diarrea/epidemiología , Diarrea/etiología , Desnutrición Aguda Severa/complicaciones , Hospitales
Public Health Nutr ; 27(1): e29, 2024 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-38253537


OBJECTIVE: This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. DESIGN: A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. SETTING: Ghana. PARTICIPANTS: Children under 5 years. RESULTS: The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. CONCLUSION: In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.

Anemia , Trastornos de la Nutrición del Niño , Niño , Humanos , Preescolar , Ghana/epidemiología , Encuestas Epidemiológicas , Factores de Riesgo , Anemia/epidemiología , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Demografía
PLoS One ; 19(1): e0295810, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38215079


BACKGROUND: While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016. METHOD: We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI). RESULT: A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P<0.01), 9.5 percentage points for underweight (33.2% to23.7%, P<0.01), and 2.1 percentage points for wasting (12.2% to10.1%, P<0.01). There was persistent and statistically evidence of wealth inequality in stunting, underweight, and wasting (concentration indeces of -0.2 to -0.04, all P values <0.05). Stunting, underweight, and wasting variables were associated with male sex of the child (RR 0.94, 0.95, 0.85, all P-values <0.01) recent diarrhea (RR 1.18, 1.27, 1.37, all P-values <0.01), secondary education status of the mother (RR 0.66, 0.57, 0.61, all P-values < 0.057), increasing wealth index (richest) (RR 0.73, 0.70, 0.50, all P-values < 0.05), and having no toilet facility (RR 1.16, 1.22, 1.18, all P-values < 0.05). CONCLUSION: Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.

Trastornos de la Nutrición del Niño , Desnutrición , Síndrome Debilitante , Femenino , Humanos , Masculino , Lactante , Delgadez/epidemiología , Determinantes Sociales de la Salud , Síndrome Debilitante/epidemiología , Desnutrición/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Caquexia , Trastornos del Crecimiento/epidemiología , Prevalencia , Encuestas Epidemiológicas
Nutrition ; 119: 112300, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38141569


OBJECTIVES: Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. METHODS: This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. RESULTS: In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53-2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure-child undernutrition association. CONCLUSIONS: Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

Trastornos de la Nutrición del Niño , Desnutrición , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Inundaciones , Bangladesh/epidemiología , Estudios Transversales , Desnutrición/epidemiología , Diarrea/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/etiología
Cult. cuid ; 27(67): 455-468, Dic 11, 2023. tab, ilus
Artículo en Portugués | IBECS | ID: ibc-228596


Objective: To identify in the literature the scientific evidence about the dermatological manifestations presented by children with nutritional disorders. Methods: This is an integrative literature review carried out in March 2022 with a bibliographic survey through the following databases: Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed and Scopus. Results: Twelve (12) studies were selected and organized into four thematic axes: skin manifestations related to macronutrient deficiency - protein-energy malnutrition; micronutrient deficiency, subgroup of fat-soluble vitamins: vitamin D; mineral deficiency: zinc and obesity. Final considerations: Cutaneous dermatoses caused by nutritional deficiencies in children are clinical findings still little explored in the literature; however, the analyzed studies demonstrate the importance of knowledge on the subject so that health professionals can identify and provide timely treatment, thus offering quality care and ensuring healthy children growth and development.(AU)

Objetivo: identificar en la literatura las evidencias científicassobre las manifestaciones dermatológicas que presentan los niños con trastornos nutricionales. Métodos: Se trata de una revisión integrativa de la literatura realizada en marzo de 2022, con levantamiento bibliográfico a través de las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), PubMed y Scopus. Resultados: fueron seleccionados 12 estudios organizados en cuatro ejes temáticos: manifestaciones cutáneas relacionadas con la deficiencia de macronutrientes desnutrición proteiconergética; deficiencia de micronutrientes, subgrupo de vitaminas liposolubles: vitamina D; carencia de minerales: zinc y obesidad. Consideraciones finales: Las dermatosis cutáneas causadas por deficiencias nutricionales en niños son hallazgos clínicos aún poco explorados en la literatura, sin embargo, los estudios encontrados demuestran la importancia del conocimiento sobre el tema para que los profesionales de la salud puedan identificar y tratar tempranamente las alteraciones, ofreciendo así una atención de calidad y asegurar el crecimiento y desarrollo saludable del niño.(AU)

Objetivo: identificar na literatura as evidências científicas acerca das manifestações dermatológicas apresentadas por crianças com desordens nutricionais. Métodos: Tratae de uma revisão integrativa da literatura realizada no mês de março de 2022, com levantamento bibliográfico por meio das bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed e Scopus. Resultados: Dos 12 estudos selecionados e organizados em quatro eixos temáticos: manifestações cutâneas relacionadas a deficiência de macronutrientes - desnutrição proteico-energética; deficiência de micronutrientes, subgrupo das vitaminas lipossolúveis: vitamina D; deficiência de minerais: zinco e obesidade. Considerações finais: As dermatoses cutâneas causadas por deficiências nutricionais em crianças são achados clínicos ainda pouco explorados na literatura, porém, os estudos encontrados demonstram a importância do conhecimento acerca do tema para que os profissionais de saúde possam identificar e tratar precocemente as alterações, ofertando assim uma assistência de qualidade e garantindo um crescimento e desenvolvimento infantil saudável.(AU)

Humanos , Masculino , Femenino , Niño , Trastornos de la Nutrición del Niño , Salud Infantil , Ciencias de la Nutrición , Enfermedades de la Piel
BMJ Open ; 13(12): e075723, 2023 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-38110390


OBJECTIVE: In developing countries, malnutrition is a noteworthy concern related to the well-being of people, and this study aimed to determine the factors that affect malnutrition among children below 5 years in Ghana. DESIGN: The study used a secondary data source, specifically the Ghanaian Multiple Indicator Cluster Survey Six (MICS 6), which was conducted by the Ghana Statistical Service in 2017-2018. The MICS data are hierarchical, as children are categorised within households, and households are further grouped within a higher cluster, violating the independence assumption that must be addressed in the analyses. This study used a Bayesian multilevel ordinal logistic regression to model, identify and analyse the factors linked to child malnutrition in Ghana. SETTING: The setting of the study was the household level across the previous 10 administrative regions in Ghana. PARTICIPANTS: Data for 8875 children under 5 years were used for the study. The data were gathered from households in all 10 administrative regions of Ghana using a sampling procedure consisting of stratification and random selection to ensure national representation. RESULTS: The results showed that the Northern Region of Ghana had the highest occurrence rate of severe and moderate malnutrition, and factors such as the count of children's books or picture books, whether the child experienced fever in the last 2 weeks, age and sex of the child, and the child's household wealth index quintile were strongly linked to malnutrition among Ghanaian children. CONCLUSION: These findings underscore the intricate interplay of factors contributing to child nutrition in Ghana and suggest that addressing malnutrition necessitates a comprehensive approach that considers factors such as access to healthcare and reading materials, household wealth, and other social and environmental factors.

Trastornos de la Nutrición del Niño , Desnutrición , Preescolar , Humanos , Teorema de Bayes , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/complicaciones , Estudios Transversales , Ghana/epidemiología , Encuestas Epidemiológicas , Modelos Logísticos , Desnutrición/epidemiología , Desnutrición/complicaciones , Lactante
BMJ Open ; 13(12): e073349, 2023 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-38110392


INTRODUCTION: Chronic malnutrition is a serious problem in southern Angola with a prevalence of 49.9% and 37.2% in the provinces of Huila and Cunene, respectively. The MuCCUA (Mother and Child Chronic Undernutrition in Angola) trial is a community-based randomised controlled trial (c-RCT) which aims to evaluate the effectiveness of a nutrition supplementation plus standard of care intervention and a cash transfer plus standard of care intervention in preventing stunting, and to compare them with a standard of care alone intervention in southern Angola. This protocol describes the planned economic evaluation associated with the c-RCT. METHODS AND ANALYSIS: We will conduct a cost-efficiency and cost-effectiveness analysis nested within the MuCCUA trial with a societal perspective, measuring programme, provider, participant and household costs. We will collect programme costs prospectively using a combined calculation method including quantitative and qualitative data. Financial costs will be estimated by applying activity-based costing methods to accounting records using time allocation sheets. We will estimate costs not included in accounting records by the ingredients approach, and indirect costs incurred by beneficiaries through interviews, household surveys and focus group discussions. Cost-efficiency will be estimated as cost per output achieved by combining activity-specific cost data with routine data on programme outputs. Cost-effectiveness will be assessed as cost per stunting case prevented. We will calculate incremental cost-effectiveness ratios comparing the additional cost per improved outcome of the different intervention arms and the standard of care. We will perform sensitivity analyses to assess robustness of results. ETHICS AND DISSEMINATION: This economic evaluation will provide useful information to the Angolan Government and other policymakers on the most cost-effective intervention to prevent stunting in this and other comparable contexts. The protocol was approved by the República de Angola Ministério da Saúde Comité de Ética (27C.E/MINSA.INIS/2022). The findings of this study will be disseminated within academia and the wider policy sphere. TRIAL REGISTRATION NUMBER: Registry (NCT05571280).

Trastornos de la Nutrición del Niño , Desnutrición , Femenino , Humanos , Lactante , Angola , Trastornos de la Nutrición del Niño/prevención & control , Análisis Costo-Beneficio , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/prevención & control , Desnutrición/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto
JAMA Netw Open ; 6(11): e2342654, 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-37943556


Importance: Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children's health. Objective: To assess the associations between economic growth and malnutrition, contributing factors and malnutrition, and economic growth and contributing factors of malnutrition in low- and middle-income countries (LMICs). Design, Setting, and Participants: This cross-sectional study used data from 239 Demographic and Health Surveys from January 1, 1990, to December 31, 2021. Observations included 1 138 568 children aged 0 to 35 months with valid anthropometric measures and information on contributing factors of malnutrition from 58 LMICs. Data were analyzed from May 20, 2022, to February 16, 2023. Exposure: National per-capita gross domestic product (GDP) was used as a proxy for economic growth. Main Outcomes and Measures: Six measures of childhood malnutrition were constructed: stunting (height-for-age z score <-2), underweight (weight-for-age z score <-2), wasting (weight-for-height z score <-2), overweight (weight-for-height z score >2), obesity (weight-for-height z score >3), and dietary diversity failure (consumption of less than 5 of 8 different food groups in the past 24 hours). Eighteen contributing factors of malnutrition were constructed, of which 10 were underlying determinants (eg, access to improved sanitation) and 8 were immediate determinants (eg, breastfeeding initiation). Results: A total of 1 138 568 children (mean [SD] age, 17.14 [10.26] months; 579 589 [50.9%] boys and 558 979 [49.1%] girls) were included in the analysis. Of these, 27.3% (95% CI, 27.2%-27.4%) had stunting; 25.7% (95% CI, 25.6%-25.8%), underweight; 11.2% (95% CI, 11.1%-11.2%), wasting; 3.8% (95% CI, 3.7%-3.8%), overweight; 1.1% (95% CI, 1.1%-1.1%), obesity; and 79.8% (95% CI, 79.7%-79.9%), dietary diversity failure. Per-capita GDP was weakly associated with childhood malnutrition. The odds ratios associated with a 5% increase in per-capita GDP were 0.99 (95% CI, 0.99-1.00) for stunting, 1.01 (95% CI, 1.00-1.01) for wasting, 1.00 (95% CI, 1.00-1.00) for underweight, 0.98 (95% CI, 0.98-0.98) for overweight, 0.98 (95% CI, 0.97-0.98) for obesity, and 1.03 (95% CI, 1.01-1.04) for dietary diversity failure. Although strong associations were found between many contributing factors and most outcomes for malnutrition, associations identified between per-capita GDP and these contributing factors themselves were ambiguous. Conclusions and Relevance: In this multicountry cross-sectional study, economic growth was weakly associated with childhood malnutrition and several contributing factors. To reduce child malnutrition, economic growth may need to be accompanied by more targeted investments to improve contributing factors that are strongly associated with child malnutrition, such as maternal health and education.

Trastornos de la Nutrición del Niño , Desnutrición , Masculino , Niño , Femenino , Humanos , Adolescente , Desarrollo Económico , Países en Desarrollo , Sobrepeso , Delgadez/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Estudios Transversales , Desnutrición/epidemiología , Obesidad , Trastornos del Crecimiento/epidemiología
Asia Pac J Public Health ; 35(8): 494-501, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37837291


Childhood undernutrition and diarrhea remain a global health burden in the 21st century. We assessed the effect of access to basic drinking water and sanitation at home on reducing children's likelihood of being undernourished and experiencing diarrhea in Laos. We pooled two rounds of nationally representative cross-sectional household surveys: the Lao Social Indicator Surveys 2011/2012 and 2017, encompassing 23 070 children aged <5 years. We employed multivariate multilevel logistic regression for the analysis. The results showed that access to basic drinking water was associated with a reduced likelihood of undernutrition and was effective in improving child undernutrition. Moreover, access to basic sanitation reduced diarrhea in addition to undernutrition. Notably, sanitation facilities only mitigated childhood stunting and diarrhea when basic drinking water facilities were present in the household. We also confirmed that socio-economic disparities existed among children accessing basic drinking water and sanitation. Consequently, further efforts are needed toward equitable access to these facilities in Laos.

Trastornos de la Nutrición del Niño , Agua Potable , Desnutrición , Niño , Humanos , Laos/epidemiología , Saneamiento , Estudios Transversales , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Niño/prevención & control , Diarrea/epidemiología
Food Nutr Bull ; 44(2_suppl): S9-S22, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37850921


BACKGROUND: This article presents a new analytical approach to acute malnutrition causal analysis that is different from the orthodox approach in 2 respects. First, it engages with basic causes, that is, beyond the usual focus on individuals and households. Second, it uses a relational view in the causal analysis. The orthodox approach identifies the malnourished and their individual and household characteristics. In contrast, a relational approach explores the ways in which the relationships between people, their livelihoods, and the environment, mediated by systems and institutions, create the underlying drivers associated with acute malnutrition for some, while simultaneously creating better conditions for others. METHODS: The article draws on 2 case study communities in West Darfur, Sudan, first considering the Darfur context and the inequitable policies and weakened institutions that have led to ethnic polarization, multilayered conflict, and humanitarian crises. The article explores how this context has played out differently in each community, contrasting their livelihood specializations, conflict-related losses, and livelihood diversification over time. FINDINGS: This analysis shows how the relative vulnerability of some people versus others is strongly influenced by their social, economic, and political relationships, as reflected in their shifting power relations and uneven control over livelihood resources. CONCLUSIONS: Shifting the focus to the basic drivers, especially the institutional structures, processes, and relationships, will deepen the causal analysis of child acute malnutrition, make it more meaningful, and provide a new direction for engagement, learning, and action to address the deepening problem of child acute malnutrition.

Plain language titleA Relational Approach to the Drivers of Acute MalnutritionPlain language summaryThis article introduces a new approach to understanding the causes of child acute malnutrition that differs from the traditional methods in 2 key ways. First, it goes beyond focusing solely on individuals and households by examining the underlying and basic causes. Secondly, it adopts a relational perspective in analyzing the causes. The traditional approach to studying the causes of acute malnutrition identifies malnourished individuals and examines their personal and household characteristics. In contrast, the relational approach looks at how the connections between people, their livelihoods, and the environment, influenced by systems and institutions, contribute to the development of acute malnutrition while also creating better conditions for some others. To illustrate this approach, the article presents findings from 2 communities in West Darfur, Sudan. It examines the Darfur context, including the policy and institutional context that has contributed to ethnic polarization and multiple conflicts and led to humanitarian crises. The article compares these 2 communities, focusing on their livelihood specializations, losses related to conflict, and changes in livelihood strategies over time. The article argues that by concentrating on the basic drivers of acute malnutrition, particularly the institutional structures, processes, and relationships, we can gain a deeper understanding of the issue. This approach can make the analysis of child acute malnutrition more meaningful and provide new insights for addressing this pressing problem.

Trastornos de la Nutrición del Niño , Desnutrición , Humanos , Niño , Desnutrición/diagnóstico , Sudán
Food Nutr Bull ; 44(2_suppl): S83-S93, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37850923


BACKGROUND: Malnutrition is an umbrella term that refers to an impairment in nutrition indicative of subsequently compromised human well-being. The term covers the full spectrum of nutritional impairments from a small yet detectable departure from a "norm" to a terminal stage when severe malnutrition could result in death. This broad spectrum of nutritional departures from "the optimum" dictates the need for an ensemble of metrics to capture the complexity of involved mechanisms, risk factors, precipitating events, short-term, and long-term consequences. Ideally, these metrics should be universally applicable to vulnerable populations, settings, ages, and times when people are most susceptible to malnutrition. We should be able to characterize and intervene to minimize the risk of malnutrition, especially child acute malnutrition that could be assessed by anthropometric measurements. OBJECTIVES: The main challenge in reaching such an ambitious goal is the complexity of measuring, characterizing, explaining, predicting, and preventing malnutrition at any dimension: temporal or spatial and at any scale: a person or a group. The expansive body of literature has been accumulated on many temporal aspects of malnutrition and seasonal changes in nutritional (anthropometric) status. The research community is now shifting their attention to predictive modeling of child malnutrition and its importance for clinical and public health interventions. This communication aims to provide an overview of challenges for understanding child malnutrition from a perspective of predictive modeling focusing on well-documented seasonal variations in nutritional outcomes and exploring "the systems approach" to tackle underlining conceptual and practical complexities to forecast seasonal malnutrition in an accurate and timely manner. This generalized approach to forecasting seasonal malnutrition is then applied specifically to child acute malnutrition.

Trastornos de la Nutrición del Niño , Desnutrición , Desnutrición Proteico-Calórica , Niño , Humanos , Trastornos de la Nutrición del Niño/epidemiología , Estaciones del Año , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/prevención & control , Estado Nutricional
Food Nutr Bull ; 44(2_suppl): S32-S44, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37850929


Persistent child wasting is evident across the Sahel and Horn of Africa, much of which is typically dryland and dependent on agropastoralism. Two events in 2021, the United Nations (UN) Food Systems Summit and the Tokyo Nutrition for Growth Summit, represented a watershed moment for the alignment of food systems and nutrition. Against this backdrop, the costed country operational roadmaps, developed in 22 countries as part of the joint UN Global Action Plan on Child Wasting (UNICEF 2021), recognized the importance of preventing child wasting using a multisectoral approach. We use a food systems lens to assess how current governance mechanisms, policies, and programming priorities in 8 sub-Saharan countries are responsive to the food security and nutritional needs of the most vulnerable people. For governance mechanisms, we draw from a narrative review of joint annual assessments conducted by the Scaling Up Nutrition Movement's national multistakeholder platforms since 2016. For policy frameworks, we analyze recommendations included in operational roadmaps and findings from the review of national multisectoral nutrition plans. For programming priorities, we analyze the typologies of costed interventions in the food and social protection systems. We present how nutrition and healthy diets were factored into national food systems pathways and how Government commitments to Nutrition for Growth integrate food systems and resilience. Results of this exploratory review suggest opportunities offered by the implementation of the country roadmaps should rely on a fundamental understanding of context-specific risks and vulnerabilities embedded in the systems and their dynamics.

Plain language titleUsing a Food Systems Lens to Prevent Child Wasting in 8 Sub-Saharan Countries Characterized by Dryland LivelihoodsPlain language summaryChild wasting persists across the Sahel and Horn of Africa, much of which is typically dryland and dependent on agropastoralism. We use a food systems lens to assess how governance mechanisms, policies, and programming priorities in 8 sub-Saharan countries are responsive to the food security and nutritional needs of the people in greatest vulnerability. For governance mechanisms, we draw from a narrative review of joint annual assessments conducted by the Scaling Up Nutrition (SUN) Movement's national multistakeholder platforms between 2016 and 2021. For policy frameworks, we analyze policy recommendations and national multisectoral nutrition plans. For programming priorities, we examine costed interventions within the food and social protection systems that have been included in the country's operational roadmaps for the prevention of child wasting. As indications of high-level political dedication, we present how nutrition and healthy diets were factored into national food systems pathways developed for the 2021 UN Food Systems Summit and how food systems and resilience were integrated into Government commitments made for the 2021 Tokyo Nutrition for Growth Summit. Findings of this exploratory review point to an enabling governance, policy, and political environment for the implementation of interventions to prevent child wasting. However, results will rely on a fundamental understanding of context-specific risks and vulnerabilities embedded in the food systems and their dynamics.

Trastornos de la Nutrición del Niño , Estado Nutricional , Humanos , Niño , Alimentos , Trastornos de la Nutrición del Niño/prevención & control , Gobierno , África del Sur del Sahara
Pediatr Neurol ; 149: 151-158, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37890309


BACKGROUND: This review was conducted to summarize the current evidence on the structural findings seen in brain magnetic resonance imaging (MRI) in malnourished children and the effect of optimized nutritional supplementation on brain development as studied through MRI. METHODS: A systematic search was carried out in PubMed, Embase, The Cochrane Library, Web of Science (Clarivate Analytics), WHO ICTRP Clinical Trials in Children, and using a predefined search criterion for relevant literature from inception to January 2022. The primary outcome of the study was structural changes observed in the brain on MRI. RESULTS: The most common abnormal findings on MRI in malnourished infants were cerebral atrophy and dilated ventricles. Furthermore, a higher proportion of breast milk, calorie, and lipid intake in the diet was significantly associated with increased brain volumes; this also increased the likelihood of normal MRI scores at term. When followed till adolescence, it was observed that these infants had increased neonatal weight gain and a higher intelligence quotient when compared with the group. CONCLUSIONS: In conclusion, most children with moderate/severe malnutrition had abnormal MRI findings, mostly cerebral atrophy with or without ventricular dilatation. Since none of the studies measured the degree of atrophy or ventricular dilatation, it was not possible to assess the effect of the severity of malnutrition on brain atrophy. A universal measurement or scoring system for assessing the degree of brain atrophy is needed to help correlate the severity of malnutrition with the degree of brain atrophy and monitor the effects of nutritional rehabilitation over time.

Trastornos de la Nutrición del Niño , Desnutrición , Adolescente , Femenino , Lactante , Recién Nacido , Niño , Humanos , Encéfalo/diagnóstico por imagen , Atrofia , Imagen por Resonancia Magnética
BMC Pediatr ; 23(1): 520, 2023 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-37858130


OBJECTIVE: Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda. METHODS: We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14. RESULTS: Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. CONCLUSION: Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.

Trastornos de la Nutrición del Niño , Desnutrición , Lactante , Recién Nacido , Femenino , Humanos , Masculino , Niño , Preescolar , Adulto , Estado Nutricional , Delgadez/epidemiología , Peso al Nacer , Estudios Transversales , Desnutrición/epidemiología , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Recién Nacido de muy Bajo Peso , Prevalencia , Trastornos de la Nutrición del Niño/epidemiología
PLoS One ; 18(10): e0292322, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37862310


BACKGROUND: To examine the socio-demographic factors associated with the decline in undernutrition among preschool children in India from National Family Health Survey (NFHS)-3, 2005-06 to NFHS- 5, 2019-21. METHODS: For this study data were obtained from India's nationally representative datasets such as NFHS-3 and NFHS-5. The outcome variables for this study were Binary undernutrition which were defined as the coexistence of anemia and either stunting or wasting and Undernutrition triad which were defined as the presence of Iron deficiency anemia, stunting and wasting, respectively. Decomposition analysis was used to study the factors responsible for a decline in undernutrition. This method was employed to understand how these factors contributed to the decline in undernutrition whether due to change in the composition (change in the composition of the population) or propensity (change in the health-related behaviour of the population) of the population over a period of 16 years. RESULTS: Results showed that rate, which contributes 85.26% and 65.64%, respectively, to total change, was primarily responsible for a decline in both binary undernutrition and undernutrition triad. Reduction in Binary undernutrition was mainly explained by the change in the rate of education level of the mothers and media exposer during the inter-survey period. On the other hand, the decline in the Undernutrition triad can be explained by household wealth index, mother's education, birth order and a change in people's knowledge or practice about the preceding birth interval. CONCLUSION: Identifying important factors and understanding their relationship with the decline of undernutrition can be beneficial for reorienting nutrition-specific policies to achieve the targets of the Sustainable Development Goals by 2030.

Trastornos de la Nutrición del Niño , Desnutrición , Femenino , Humanos , Preescolar , Lactante , Trastornos de la Nutrición del Niño/epidemiología , Estudios Transversales , Factores de Riesgo , Desnutrición/epidemiología , India/epidemiología , Trastornos del Crecimiento/epidemiología , Prevalencia , Delgadez/epidemiología