Agricultural Development and Nutritional Status in Malawi*

BackgroundThe analysis of acute malnutrition in 2018 for the Integrated Phase Classification of Food Security in Yemen shows that high malnutrition rates are present in Abyan governorate (23%) and Lahj governorate (21%). This analysis was community based addressed all children and mostly due to problems related to food intake. The role of diseases was not yet addressed in Yemen. The aim of this study is to assess acute and chronic malnutrition among hospitalized children at 12–59 months of age in Lahj and Abyan governorates in Yemen.MethodologyA cross-sectional, multi-center study is designed. The assessment of the nutritional status was measured by standardized anthropometry of 951 sick children at 12–59 months of age.ResultsThe prevalence of Global acute malnutrition (GAM) among the sick children seeking care in health facilities in Lahj and Abyan is 21%. More specifically; the prevalence of moderate acute malnutrition (MAM) is 15.1% while the prevalence of severe acute malnutrition (SAM) is 6.2%. The prevalence of acute malnutrition (wasting) among the studied sick children in lahj is 23.4% while in Abyan is 19.3%. The prevalence of MAM in Lahj is 17.7% and the prevalence of SAM is 5.7%. The prevalence of acute malnutrition (wasting) in Abyan is 12.6% while the prevalence of SAM in Abyan is 6.7%. The prevalence of acute malnutrition among male children (25.2%) is significantly higher than among female children (17.5%). The prevalence of the chronic malnutrition (Stunting) in the studied sick children is 41.3%; the prevalence of stunting in Lahj is 41% while in Abyan is 41.7%.ConclusionsHigh acute and chronic malnutrition rates were identified among sick children seeking care in health facilities in lahj and Abyan, and higher than the SPHERE indicators of malnutrition. Boys are more exposed than girls to acute and chronic malnutrition.

Background: The influence of household food insecurity on poor child growth has been widely studied. However, there is a lack of clarity in such relationships therefore, more studies are required. Hence, the present study evaluated household food insecurity and sciodemographic determinants of undernutrition in young children (6-59 months old) in Ghana. Materials and methods: This cross-sectional study was conducted in Tamale South using 240 mother-child pairs. Mothers and their children (6-59 months old) were recruited from child welfare clinics within the Constituency. Data were collected from face-to-face interviews using a structured questionnaire. Child anthropometric data were measured (weight and height/length) based on World Health Organization’s prescribed procedures. Child anthropometric Z-scores for the determination of acute and chronic malnutrition were generated using WHO Anthroplus 1.0.4. Household food insecurity access scale (HFIAS) was used to estimate household food insecurity. Binary logistics regression models were run using Statistical Product and Service Solutions version 24.0 to estimate the odds of acute and chronic malnutrition following the independent variables (HFIAS and sciodemographic factors). Results: The prevalence of acute malnutrition (wasting) was 7.5%. Also, the prevalence of chronic malnutrition (stunting) was 29.2%. In multiple binary logistics regressions model, there was a significant relationship between higher scores of HFIAS and the odds of acute malnutrition [1.34(1.07-1.68); P=0.010]. In the study, children aged 6-23 months had lower odds for chronic malnutrition [0.36 (1.20-0.66); P=0.001] compared with their colleagues (24-59 months old). Conclusions: In the study, we found a medium and a high prevalence of acute and chronic malnutrition, respectively. Also, HFIAS was a significant predictor of acute malnutrition but not chronic malnutrition. Further, children less than 24 months old compared with those aged 24-59 months old had lower odds for chronic malnutrition. To reduce the odds for acute malnutrition, nutrition and health authorities in the Tamale South Constituency ought to intensify education on strategies to increase household food security status.

To document the current prevalence of protein-energy malnutrition compared with that reported from the same institution in 1976. All inpatients of this tertiary-care facility were assessed by anthropometric, laboratory, and clinical nutrition assessment methods in a 1-day cross-sectional survey. The comparison study from 1976 was also a 1-day cross-sectional survey. A tertiary-care facility in Boston, Mass. The entire inpatient population was assessed on a single weekday in September 1992. Prevalence of acute and chronic malnutrition as judged by anthropometric and laboratory data. Data on demographics, admission classification, underlying disease, route of nutrition, and global nutritional status were also assessed. The prevalence of acute protein-energy malnutrition (weight for height) based on the Waterlow criteria was as follows: severe, 1.3%; moderate, 5.8%; mild, 17.4%; and none, 75.5%. The prevalence of chronic protein-energy malnutrition (height for age) was as follows: severe, 5.1%; moderate, 7.7%; mild, 14.5%; and none, 72.8%. Although the prevalence of acute and chronic protein-energy malnutrition was significantly less in 1992 than in 1976 (P = .03 and P < .001, respectively), the numbers are still alarmingly high. Children younger than 2 years and older than 18 years and those with chronic medical conditions had a higher prevalence of protein-energy malnutrition. Twenty-four percent of patients had a serum albumin level less than 30 g/L, 34.8% had a total lymphocyte count less than 1.5 x 10(9)/L, and 24.9% had a hemoglobin concentration less than 105 g/L. One fourth of all patients were obese (> 120% weight for height), with the greatest prevalence in children aged 2 to 18 years. Acute and chronic protein-energy malnutrition remains common in hospitalized pediatric patients in the United States. Important risk factors may be underlying chronic disease, periods of normally rapid growth, and recognized need for nutrition intervention.

To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea. Children <18years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-for-age Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis. A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <-2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <-2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (height-for-age <-2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5years than in children >5years (36.4% vs. 19.1%, P=0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P=0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P=0.010). We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.

A cross sectional descriptive study was conducted using a structured questionnaire and anthropometric measurements to assess chronic malnutrition (stunting) and acute malnutrition (wasting) for 570 children at 60 to 180 months age, including 294 girls and 276 boys at Dar EL Salam, Khartoum State, Sudan. The prevalence of malnutrition was calculated using World Health Organization (WHO) Anthro Plus; it was shown that severe and moderate chronic malnutrition in both male and female was 4.6 and 15.25%, respectively. The prevalence of chronic malnutrition (stunting) in male was 6.2 and 17.43% for severe and moderate stunting and in females was 3.03 and 12.85% for severe and moderate stunting, respectively. The prevalence of acute malnutrition in both males and females according to the BMI-for-age body mass index (BMI) was 6.99 and 19.19% for severe and moderate acute malnutrition. The prevalence of acute malnutrition (wasting) in males was 6.66 and 19.66% for severe and moderate acute malnutrition and in female was 6.95 and 18.93% for severe and moderate acute malnutrition. Key words: Cross-sectional study, chronic malnutrition, acute malnutrition, World Health Organization (WHO) Anthro Plus.

Background of the Study: Stunting, wasting, and underweight are the important nutritional status indicators for children. “While stunting is caused by long-term insufficient nutrient intake and repeated infections, wasting is a result of acute food shortage and illness. Wasting, on the other hand, is a strong predictor of mortality and requires urgent response. Underweight combines information about linear growth obstruction and weight for length/height” [7]. Understanding differences in the determinants of childhood malnutrition between urban and rural areas is important to design appropriate, relevant program and policy implementation. Aims &amp; Objectives: The aim of the study is to assess and compare the prevalence of underweight, stunting and wasting among pre-school children in rural and urban area. Methodology: Convenient random sampling technique was used to gather data in 100 samples, 50 each from rural and urban population. Data was collected by using structured interview and anthropometric assessment. The questionnaire consisted of two parts, i.e., demographic data and questions regarding anthropometric assessment, age, height, weight etc. The three nutritional status indicators, HAZ - z-score for height-for-age, (Stunting), WAZ - z-score for weight for age (Underweight), WHZ- z – score weight for height (Wasting) were calculated using WHO Anthro survey application. Results: This study revealed that Prevalence of acute malnutrition (stunting) among rural pre-school children is 28% which was higher than the prevalence of acute malnutrition in urban pre-school children which was only 18 %. Prevalence of Underweight among rural pre-school children is 36% which was higher than the prevalence of underweight in urban pre-school children which was only 34 %. Prevalence of chronic malnutrition (wasting) among rural pre-school children is 32% which was lower than the prevalence of chronic malnutrition in urban pre-school children in which it was 46%. There is no significant association between the nutritional status of the rural and urban pre-school children with the selected demographic variables. This indicates even though there was a significant difference between the rural and urban pre-school children, both group of children are at the risk of one or other malnutrition related problems. Conclusion: This study suggests that even though there was a significant difference between the rural and urban pre-school children, both group of children are at the risk of one or other malnutrition problem.

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Background: In India, 54% of under five children death mainly due to under nutrition. First two years of age is most critical. Nutritional status was assessed by using WHO standard growth chart. Wasting represents acute malnutrition, stunting with chronic, underweight represents both acute and chronic. Based on NFHS-3 data the prevalence of under nutrition rise up to 2 years of age, thereafter more or less stabilizes. Faulty feeding practices plays major role in under nutrition. Hence, this study carried out to assess nutritional status of 6 months to 2 years children in terms of acute and chronic malnutrition and to estimate the association of nutritional status with feeding practices.Methods: Cross sectional study done during March to August 2016. Sample size estimated was 180. Stratified random sampling method used to collect data among children in Peerkankaranai.Results: Mean age of children was 15.82 months. About 61.2% belonged to 12 to 24 months age group. Sex distributions were equal. About 55% belongs to middle socioeconomic status. The prevalence of underweight was 31.65, wasting 15%, stunting 45.6%. Male children affected by chronic malnutrition more than female children. Not initiating breast feeding within 4 hours of birth plays significant role in acute malnutrition. Prevalence of malnutrition was high among those not practising colostrum feeding and exclusive breast feeding. Only 15 mothers not influenced by formula feeding. Feeding frequency and traditional feeding practices had main role in chronic malnutrition.Conclusions: The prevalence of under nutrition among study population was high among this area. Feeding practices should be improved among the mothers.

Background: Acute malnutrition refers to someone who has lost a significant amount of weight over a short period of time, resulting in being underweight or wasting. In refugee situations where the population is often extremely dependent on the humanitarian assistance and food aid, the value of the food will greatly determine their nutritional status. Objective: The main objective of this study was to assess the prevalence of acute malnutrition and its associated factors, among children aged 6-59 months in Mai-Aini Eritrean refugees’ camp, Northern Ethiopian in 2014. Methods: Community based cross-sectional study was conducted on 593 mother-child pairs between January 1 and 30, 2014. Anthropometric measurements of height and weight of children were taken and questionnaire prepared in local language (Tigrigna) were used to collect the data. Data were entered using EPI-data software (version 3.2) and exported to SPSS (version 16.0) for analysis. ENA for SMART 2007 software was used to convert nutritional data into Z-scores of the indices; weight-for-height and weight-for age. Bivariate and multivariate analyses were used to identify factors associated with child malnutrition. Results: The finding of this study revealed that 33.4% and 24.6% of children were underweight and wasted, respectively. Prevalence of acute malnutrition was higher in males compared to females. Underweight was associated with child age, consuming extra food during pregnancy and maternal BMI less than 18.5 Kg/m2. Children age and receiving pre-lactate food was independently associated with wasting. Conclusion: The prevalence of malnutrition among children aged 6-59 months was high, indicating that the nutrition situation in study area is very critical issue. Therefore, especial attention should be given on intervention of malnutrition.

Prevalence of acute malnutrition is classically estimated by the proportion of children meeting a case definition in a representative population sample. In 1995 the WHO proposed the PROBIT method, based on converting parameters of a normally distributed variable to cumulative probability, as an alternative method requiring a smaller sample size. The present study compares classical and PROBIT methods for estimating the prevalence of global, moderate and severe acute malnutrition (GAM, MAM and SAM) defined by weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC). Bias and precision of classical and PROBIT methods were compared by simulating a total of 1·26 million surveys generated from 560 nutrition surveys. Data used for simulation were derived from nutritional surveys of children aged 6-59 months carried out in thirty-one countries around the world. Data of 459 036 children aged 6-59 months from representative samples were used to generate simulated populations. The PROBIT method provided an estimate of GAM, MAM and SAM using WHZ or MUAC proportional to the true prevalence with a small systematic overestimation. The PROBIT method was more precise than the classical method for estimating the prevalence for GAM, MAM and SAM by WHZ or MUAC for small sample sizes (i.e. n<150 for SAM and GAM; n<300 for MAM), but lost this advantage when sample sizes increased. The classical method is preferred for estimating acute malnutrition prevalence from large sample surveys. The PROBIT method may be useful in sentinel-site surveillance systems with small sample sizes.

This study investigated the prevalence of malnutrition at childhood cancer diagnosis in South Africa and the association with 1-year post-diagnosis overall survival (OS). Nutritional status was prospectively assessed for newly diagnosed children with cancer. Chronic undernutrition was defined as two standard deviations (SDs) or more below zero for height/length-for-age (HAZ), and acute as underweight (weight-for-age [WAZ], and wasted as body mass index for age [BAZ] and mid-upper arm circumference for age [MUAC/A]). The association between the nutritional status at diagnosis and age, sex, disease group and 1-year post-diagnosis OS was analysed with Cox regression and hazard ratios (HRs). Less than 15% were chronically malnourished (stunted: 14.3%) and up to 24.3% acutely undernourished (wasted: 24.3% MUAC-Z and BAZ 8.1%), 11.6% underweight, of 320 patients at cancer diagnosis). More females than males were underweight (12.2% vs. 4.5%; p = 0.027). Children of 5 years of age and older had a higher prevalence of wasting (18.7%) than children under 5 years of age (3.9%) (p < 0.001) at diagnosis, with significant improvement 6 months after diagnosis. Stunting was significantly associated with poorer OS at 3 years after a cancer diagnosis (HR 1.8; 95% CI 1.1, 2.8; p = 0.011). MUAC/A identified more children with undernutrition than other nutritional parameters. Stunting was significantly associated with poorer OS 3 years and EFS 2 years after a cancer diagnosis. Optimal nutritional support should be provided for South African children, especially those with acute and chronic malnutrition, to improve OS.

Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined social determinants of health, including race, socioeconomic status, and geography, as these factors influence household food insecurity. This study aimed to analyze the interrelationships of nutritional status, social determinants of health, and health outcomes in critically ill children. Retrospective cohort study of 6418 critically ill children admitted to PICU from January 2014 to December 2017. Demographic and anthropometric measurements were collected upon admission and outcomes. Based on the patient's zip code, and median household income, we estimated the percentage of the population living in poverty, and the percentage of the population experiencing food insecurity for 5912 children. The prevalence of underweight, chronic, and acute malnutrition was 13.2%, 17.9%, and 5.6%, respectively. Malnourished children had longer duration of mechanical ventilation and longer PICU and hospital lengths of stay (LOS) compared to nourished children. Underweight and chronic malnutrition were associated with higher mortality. Hispanic children had the highest prevalence of poverty level, while non-Hispanic Black children had the highest food insecurity level and lowest median income. Ethnicity was not associated with mortality. Malnourished critically ill children who were disproportionately non-Hispanic Black, Hispanic, and Asian had worse hospital outcomes, including prolonged hospital and PICU length of stay, increased time on mechanical ventilation, and a higher risk of mortality.

Malnutrition leads to disruption of cognitive development and poor academic performance among children. However, few studies have been conducted in primary school to measure its burden and risk factors in Guinea. The objective of this study was to measure the prevalence of malnutrition and determine its associated factors among primary school children in Conakry, Guinea. A cross-sectional study was conducted from December 1^st, 2015 to March 31^st, 2016 among fifth grade primary school children in three communes of Conakry, Guinea. Children aged between 8 to 19 years were randomly selected using a two-stage sampling technic. Data on socio-demographic characteristics, of both children and their parents, and food habits were collected. The Z-scores of height-for-age and body mass index (BMI) were generated using SPSS macro 2007 developed by WHO for the analysis of anthropometric data for children aged between 5-19 years. Acute malnutrition was defined as a weight-for-height z-score ≤-2.0 standard deviation (SD) and a chronic malnutrition was considered as a height-for-age z-score ≤-2.0 standard deviation (SD). A multivariable logistic regression analysis was conducted to assess factors associated with acute or chronic malnutrition among children. A total of 2,408 children were included in the analysis. The mean age was 12.5±1.8 years, and 53.4% were female. The prevalence of acute malnutrition was 11.8% (95% CI: 10.6-13.2) and that of chronic malnutrition was 13.7% (95% CI: 12.1-14.9). Being a male (AOR = 1.88, 95% CI: 1.45-2.45, p <.001), living in the communes of Dixinn (AOR = 3.78, 95% CI: 2.53-5.65, p <.001) and Matoto (AOR = 3.45, 95% CI: 2.29-5.20, p <.001), as well as having a father who was a trader (AOR = 1.66, 95% CI: 1.15-2.41, p =.007) were statistically significantly associated with acute malnutrition. Children attending Matoto schools (AOR = 3.72, 95% CI: 2.68-5.16, p<.001) were independently associated with chronic malnutrition. Acute and chronic malnutrition were common in primary school children in Conakry. Targeted awareness raising actions must be undertaken with the parents of those who have an important risk.

Malnutrition is a huge problem in Burundi. In order to improve the health system response, the Ministry of Health piloted the introduction of malnutrition prevention and care indicators within its performance-based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services. The objective of this study is to assess the impacts of this intervention, on both child acute malnutrition recovery rates at health centre level and prevalence of chronic and acute malnutrition among children at community level. This study follows a cluster-randomized controlled evaluation design: 90 health centres (HC) were randomly selected for the study, 45 of them were randomly assigned to the intervention and received payment related to their performance in malnutrition activities, while the other 45 constituted the control group and got a simple budget allocation. Data were collected from baseline and follow-up surveys of the 90 health centres and 6,480 households with children aged 6 to 23 months. From the respectively 1,067 and 1,402 moderate and severe acute malnutrition transcribed files and registers, findings suggest that the intervention had a positive impact on moderate acute malnutrition recovery rates (OR: 5.59, p = 0.039 –at the endline, 78% in the control group and 97% in the intervention group) but not on uncomplicated severe acute malnutrition recovery rate (OR: 1.16, p = 0.751 –at the endline, 93% in the control group and 92% in the intervention group). The intervention also had a significant increasing impact on the number of children treated for acute malnutrition. Analyses from the anthropometric data collected among 12,679 children aged 6–23 months suggest improvements at health centre level did not translate into better results at community level: prevalence of both acute and chronic malnutrition remained high, precisely at the endline, acute and chronic malnutrition prevalence were resp. 8.80% and 49.90% in the control group and 8.70% and 52.0% in the intervention group, the differences being non-significant. PBF can contribute to a better management of malnutrition at HC level; yet, to address the huge problem of child malnutrition in Burundi, additional strategies are urgently required.

Malnutrition is a huge problem in Burundi. In order to improve the health system response, the Ministry of Health piloted the introduction of malnutrition prevention and care indicators within its performance-based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services. The objective of this study is to assess the impacts of this intervention, on both child acute malnutrition recovery rates at health centre level and prevalence of chronic and acute malnutrition among children at community level. This study follows a cluster-randomized controlled evaluation design: 90 health centres (HC) were randomly selected for the study, 45 of them were randomly assigned to the intervention and received payment related to their performance in malnutrition activities, while the other 45 constituted the control group and got a simple budget allocation. Data were collected from baseline and follow-up surveys of the 90 health centres and 6,480 households with children aged 6 to 23 months. From the respectively 1,067 and 1,402 moderate and severe acute malnutrition transcribed files and registers, findings suggest that the intervention had a positive impact on moderate acute malnutrition recovery rates (OR: 5.59, p = 0.039 -at the endline, 78% in the control group and 97% in the intervention group) but not on uncomplicated severe acute malnutrition recovery rate (OR: 1.16, p = 0.751 -at the endline, 93% in the control group and 92% in the intervention group). The intervention also had a significant increasing impact on the number of children treated for acute malnutrition. Analyses from the anthropometric data collected among 12,679 children aged 6-23 months suggest improvements at health centre level did not translate into better results at community level: prevalence of both acute and chronic malnutrition remained high, precisely at the endline, acute and chronic malnutrition prevalence were resp. 8.80% and 49.90% in the control group and 8.70% and 52.0% in the intervention group, the differences being non-significant. PBF can contribute to a better management of malnutrition at HC level; yet, to address the huge problem of child malnutrition in Burundi, additional strategies are urgently required.