Child Anthropometry Research Articles

The effect of maternal and child factors on stunting, wasting and underweight among preschool children in Northern Ghana

BackgroundUndernutrition among preschool children in Northern region is the highest in Ghana. However, there is scarcity of data on the factors that determine undernutrition in these children. This study investigated the effect of maternal and child factors on undernutrition among preschool children in Northern Ghana.MethodsThis study was a community based analytical cross-sectional survey on a sample of 425 mother- child pairs drawn from 25 clusters. A semi- structured questionnaire was used to collect data on maternal and child socio-demographic characteristics, feeding practices and anthropometry. Anthropometric indices of Height-for-age Z-scores (HAZ), Weight-for-height Z-scores (WHZ) and Weight-for – age Z-scores (WAZ) were used to classify child stunting, wasting and underweight respectively. Bivariate and multivariate analyses were performed to determine associations between explanatory variables and undernutrition.ResultsThe prevalence of stunting, wasting and underweight were 28.2, 9.9 and 19.3% respectively. Multiple logistic regression analysis showed that, the odds of stunting was higher among male children [AOR = 1.99; 95% CI (1.26–3.13); p = 0.003], children of mothers less than 150 cm in height [AOR = 3.87; 95% CI (1.34–11.20); p = 0.01], mothers 155–159 cm tall [AOR = 2.21; 95% CI (1.34–3.66); p = 0.002], and older children aged 12–23 months [AOR 9.81; 95% CI (2.85–33.76); p < 0.001]. Wasting was significantly higher among male children [AOR = 2.40; 95% CI (1.189–4.844); p = 0.015], consumption of less than four food groups [AOR = 3.733; 95% CI (1.889–7.376); p < 0.001] and among children of underweight mothers [AOR = 3.897; 95% CI (1.404–10.820); p = 0.009]. Male children [AOR = 2.685; 95% CI (1.205–5.98); p = 0.016] and having low birth weight [AOR = 3.778; 95% CI (1.440–9.911); p < 0.001] were associated with higher odds of underweight in children.ConclusionMaternal height associated negatively with stunting but not wasting. Factors that affect low height –for-age z-score (HAZ) may not necessarily be the same as stunting. Infant and child feeding practices as measured by dietary diversity score associated positively with weight-for-height Z-scores than length-for-age Z-scores of young children. Surprisingly, consumption of some specific food groups including, animal source foods, legumes, staples and eggs were associated with lower HAZ but with increased likelihood of higher WHZ among children 6–59 months.

Association of Novel Complementary Feeding Indicators with Length‐for‐Age Z‐Scores in Rural Malawi

BackgroundInadequate complementary feeding (CF) from 6–24 months contributes to growth failure in many low income settings. However, recommended indicators of CF are inconsistently associated with length‐for‐age z‐scores (LAZ).ObjectiveTo assess the relationship between novel indicators of CF, including consistency and meal volume, with LAZ in rural Malawi.Methods1,331 households with a child aged 6 to 17 months were sampled from 53 communities in Mchinji district, Malawi using a single stage cluster sampling approach based on caregivers' participation in community women's groups. Data were collected on household sociodemographics, CF practices, and child anthropometry using WHO recommended methods. To assess food consistency, caregivers selected from a series of photographs that which most closely resembled their child's food. Caregivers estimated meal volume using uncooked rice which was then measured; meal volume was then classified as either below or above the age‐specific median for the following age categories: 6–8 months, 9–11 months, and 12–17 months. A summary feeding index (range 0–8 points) was created based on partially or fully meeting WHO recommended CF practices in addition to meal volume and consistency. Length‐for‐age z‐scores, derived from WHO Child Growth Standards, were regressed onto individual CF indicators and the summary feeding index, controlling for covariates. Logistic regression was used to assess the relationship between stunting and scoring in the second or third range of index scores (3–5 and 6–8 points, respectively).ResultsMean child age was 10.8 ± 3.2 months and 51% were female. There was no association between LAZ and minimum dietary diversity (P=0.4), minimum meal frequency (P=0.6), or minimum acceptable diet (P =0.8). There was evidence of interaction between child's age and both food consistency and meal volume. Among 6–8 month old infants, thicker food consistency was positively associated with LAZ (β = 0.14, 95% CI 0.02, 0.27); there was no relationship in older age categories. Meal volume was positively associated with LAZ in children 9–11 months (β = 0.29, 95% CI = 0.04, 0.54) and 12–17 months (β = 0.33, 95% CI = 0.10, 0.56), but not those aged 6–8 months. Each one point increase in the summary feeding index (median=5, IQR=3), was positively associated with LAZ (β = 0.05, 95% CI 0.00, 0.10) and reduced odds of stunting (OR = 0.93, 95% CI 0.87, 1.00). Compared to scoring in the lowest index category, scoring in the middle (3–5 points; OR=0.69, 95% CI 0.46, 1.05) or highest range (6–8 points; OR=0.58, 95% CI 0.38, 0.88) was associated with reduced odds of stunting.ConclusionNovel indicators of CF, such as consistency and meal volume, may be useful to understand the totality of CF and its relation to child growth in low income settings.Support or Funding InformationFunding and support for this research was provided by Concern Worldwide; Malawi Department of Nutrition, HIV and AIDS; World Bank; Emory Global Health Institute; Laney Graduate School, Emory University; and the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award number T32DK007734.

The unfinished health agenda: Neonatal mortality in Cambodia.

BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends.ConclusionAnalysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia’s pressing unfinished agenda in health.

Evaluation of the Indonesian National Standard for elementary school furniture based on children's anthropometry

In Indonesia, National Standardization Agency of Indonesia issued the Indonesian National Standard SNI 12-1015-1989 and SNI 12-1016-1989 to define the type of furniture dimensions that should be used by children in the elementary school level. This study aims to examine whether the current national standards for elementary school furniture dimensions issued by National Standardization Agency of Indonesia match the up-to-date Indonesian children's anthropometry. Two types of school furniture, small type (Type I, for grade 1–3) and large type (Type II, for grade 4–6), were evaluated in terms of seat height, seat depth, seat width and backrest height of a chair as well as the height and underneath height of a desk. 1146 students aged between 6 and 12 years old participated in the study. Seven anthropometric measurements were taken including stature, sitting shoulder height, sitting elbow height, popliteal height, buttock-popliteal length, knee height and hip breadth. Based on the standard school furniture dimensions and students' body dimensions, numbers of matches and mismatches between them were computed. Results indicated a substantial degree of mismatch between children's anthropometry and the standard dimensions of school furniture. The standard seat height was not appropriate for students among different grades with the mismatch percentage ranging from 63.4% to 96.7% for Type I and 72.7% to 99.0% for Type II. For desk height, the standard dimensions were not appropriate for students among different grades with the mismatch percentage ranging from 32.3% to 88.9% for Type I and 67.7% to 99.0% for Type II. Apparently, the current standards are out of date and need to be updated. Four different sizes of school furniture were hence proposed to accommodate the variation in students' anthropometry from Grade 1 to Grade 6. The proposed standard dimensions (PrS) of school furniture cover a slightly broader range of age and present a higher cumulative fit than the current standard dimensions (CrS). In addition, a better strategy for sizing can be also developed to fit chairs and desks to a larger number of students.

Simulated effects of home fortification of complementary foods with micronutrient powders on risk of inadequate and excessive intakes in West Gojjam, Ethiopia

Home fortification of complementary foods (CFs) with multiple micronutrient powders (MNPs) is being scaled up in various countries, but little is known about the prevailing complementary feeding practices and the type and nutrient gaps to be filled with MNPs. The present study evaluated the complementary feeding practices of young children and simulated the risk of inadequate and excessive intakes associated with home fortification with MNPs. We have assessed the sociodemographic status, anthropometry, and complementary feeding practices of young children (N=122) in Mecha district, rural Ethiopia. Using a 2-day, quantitative 24-hr recall, usual intakes of energy, protein, iron, zinc, and calcium were estimated. The risks of inadequate and excessive iron and zinc intakes with or without home fortification scenarios were assessed. The simulations considered intakes from CFs assuming average breast milk contributions and additional nutrients provided by the MNPs. Stunting was highly prevalent (50%) and was associated with a lower dietary diversity (P=.009) and nutrient intakes from the CFs. Median energy, zinc, and calcium intakes were below the estimated needs from CFs; protein needs were met. Median dietary iron intake appeared adequate, but 76%, 95% CI [68%, 84%], of children had inadequate intake (assuming low bioavailability), whereas another 8%, 95% CI: [3%, 13%], had excessive intakes. Simulation of daily and alternative day's fortification with MNP decreased the prevalence of inadequate iron and zinc intake but significantly increased the risk of excessive intakes that remained unacceptably high for iron (>2.5%). Untargeted MNP interventions may lead to excessive intakes, even in settings where poor complementary feeding practices are prevalent.

Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam

Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth. ObjectivesWe investigated the relationship between household food expenditures and child growth using factor analysis. MethodsWe used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the “household food group expenditure index” (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households’ allocations of their finances across food groups in the context of local food pricing, availability and pReferences ResultsThe HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries. ConclusionHousehold food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth.

Assessment of Child Anthropometry in a Large Epidemiologic Study

Assessment of Child Anthropometry in a Large Epidemiologic Study

Assessment of Child Anthropometry in a Large Epidemiologic Study.

A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to understand health effects of child growth and adiposity. Gold standard methods of measuring adiposity, such as dual X-ray absorptiometry (DXA), may not be feasible in large field studies. Research staff can, however, complete anthropometric measurements, such as body circumferences and skinfold measurements, using inexpensive portable equipment. In this protocol we detail how to obtain manual anthropometric measurements from children, including standing and sitting height, weight, waist circumference, hip circumference, mid-upper arm circumference, triceps skinfold thickness, and subscapular skinfold thickness, and procedures to assess the quality of these measurements. To demonstrate accuracy of these measurements, among 1,110 school-aged children in the pre-birth cohort Project Viva we calculated Spearman correlation coefficients comparing manual anthropometric measurements with a gold standard measure of body fat, DXA fat mass1. To address reliability, we evaluate intra-rater technical error of measurement at a quality control session conducted on adult female volunteers.

Blood pressure and anthropometry in children treated with stimulants: a longitudinal cohort study with an individual approach.

BackgroundKnowledge about the long-term effects on blood pressure (BP) and body mass index (BMI) when treating young patients for attention-deficit/hyperactivity disorder (AD/HD) with stimulants is limited. Most of the studies have reported mean and not individual values for anthropometrics and BP in treatment with stimulants. This seems to be the first study of changes based on the analyses of individual data measured over time.Patients and methodsSeventy young patients (aged 8–18 years) diagnosed with AD/HD and responding well to treatment with stimulants were followed for a mean period of 3 years and 3 months. BP, heart rate, height, weight, and BMI were transformed to standard deviations or z-scores from before treatment to the last registered visit.ResultsThe mean dose of methylphenidate was 0.95 mg/kg. The mean increase of systolic and diastolic BP was 0.4 z-score and 0.1 z-score, respectively. The systolic BP was associated with BMI; a higher BMI at baseline increased the risk for an increase in systolic BP. Ten percent of the total group had a weight at follow-up of <−1.5 standard deviation (SD) and 12% had a height of <−1.5 SD. Mean height at follow-up was −0.2 SD, but 40% had a reduced height of at least 0.5 SD during the treatment period. BMI on a group level was reduced from +0.8 SD to +0.3 SD. Of the 19 patients with a BMI >+1.5 SD at baseline, 50% had a significantly reduced BMI.ConclusionConsequences of stimulant treatment must be evaluated individually. Besides significant effects on core AD/HD symptoms, some patients have lower BMI and BP and some increase/maintain their BMI and/or increase their systolic BP. The risk of reduced height trajectory needs further research.

Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9-12 years in Indonesia: follow-up of the SUMMIT randomised trial.

Brain and cognitive development during the first 1000 days from conception are affected by multiple biomedical and socioenvironmental determinants including nutrition, health, nurturing, and stimulation. An improved understanding of the long-term influence of these factors is needed to prioritise public health investments to optimise human development. We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live infants from birth to 3 months of age in 2001-04, we re-enrolled 19 274 (70%) children at age 9-12 years, and randomly selected 2879 from the 18 230 who were attending school at a known location. Of these, 574 children were oversampled from mothers who were anaemic or malnourished at SUMMIT enrolment. We assessed the effects of MMN and associations of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and socioenvironmental determinants (ie, parental education, socioeconomic status, home environment, and maternal depression) on general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fine motor dexterity, and socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616. Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01-0·20, p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in scores with half a year of schooling. Children of anaemic mothers in the MMN group scored 0·18 SD (0·06-0·31, p=0·0047) higher in general intellectual ability, similar to the increase with 1 year of schooling. Overall, 18 of 21 tests showed a positive coefficient of MMN versus IFA (p=0·0431) with effect sizes from 0·00-0·18 SD. In multiple regression models, socioenvironmental determinants had coefficients of 0·00-0·43 SD and 22 of 35 tests were significant at the 95% CI level, whereas biomedical coefficients were 0·00-0·10 SD and eight of 56 tests were significant, indicating larger and more consistent impact of socioenvironmental factors (p<0·0001). Maternal MMN had long-term benefits for child cognitive development at 9-12 years of age, thereby supporting its role in early childhood development, and policy change toward MMN. The stronger association of socioenvironmental determinants with improved cognition suggests present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not sufficiently enhance child cognition, and that programmes addressing socioenvironmental determinants are essential to achieve thriving populations. Grand Challenges Canada Saving Brains Program.

Anthropometry of children with cerebral palsy at the Lagos University Teaching Hospital

Anthropometry of children with cerebral palsy at the Lagos University Teaching Hospital

DELAY ON GAIT PATTERNS ON DOWN SYNDROME CHILDREN

ABSTRACT The main purpose was to compare the spatiotemporal variables of the gait cycle in children with Down Syndrome as a function of age. A longitudinal study was conducted with 20 children, of both genders, aged between 24 and 83 months. Conventional techniques were used in the methodological procedures to record the children's anthropometry and two-dimensional cinematographic techniques for quantification of the spatiotemporal variables of their gait in relation to the global and partial variables. The results showed differences in the behavior of the anthropometric and kinematic variables, stride time, stride frequency, and time of first simple support in children with Down Syndrome between the age of 24-59 months and 60-83 months. The children's gait pattern over the years was established by the changes in frequency instead of the changes in the stride length for the development of gait speed. In conclusion the Behavior modifications in the anthropometric and spatiotemporal variables of the gait in children with Down Syndrome appear to be barely evident between 24 and 59 months of age.

Child anthropometry data quality from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and National Nutrition Surveys in the West Central Africa region: are we comparing apples and oranges?

ABSTRACT Background: There has been limited work comparing survey characteristics and assessing the quality of child anthropometric data from population-based surveys. Objective: To investigate survey characteristics and indicators of quality of anthropometric data in children aged 0–59 months from 23 countries in the West Central Africa region. Methods: Using established methodologies and criteria to examine child age, sex, height, and weight, we conducted a comprehensive assessment and scoring of the quality of anthropometric data collected in 100 national surveys. Results: The Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) collected data from a greater number of younger children than older children while the opposite was found for the National Nutrition Surveys (NNS). Missing or implausible height/weight data proportions were 12% and 8% in MICS and DHS compared to 3% in NNS. Average data quality scores were 14 in NNS, 33 in DHS, and 41 in MICS. Conclusions: Although our metric of data quality suggests that data from the NNS appear more consistent and robust, it is equally important to consider its disadvantages related to access and lack of broader socioeconomic information. In comparison, the DHS and MICS are publicly-accessable for research and provide socioeconomic context essential for assessing and addressing the burden of undernutrition within and between countries. The strengths and weaknesses of data from these three sources should be carefully considered when seeking to determine the burden of child undernutrition and its variation within countries.

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis.

It has recently been hypothesized that exposure to livestock constitutes a significant risk factor for diarrhea and environmental enteric disorder in young children, which may significantly contribute to undernutrition. To date, though, very little research has documented the extent of exposure to animal feces and whether this exposure is associated with child anthropometry in large samples and diverse settings. This study investigates these issues using data from the Alive and Thrive study conducted in rural areas of Ethiopia, Bangladesh, and Vietnam. These surveys used spot-checks to collect data on proxies of hygiene behaviors such as the cleanliness of mothers, young children, and the homestead environment, including the presence of animal feces. Animal feces were visible in 38–42% of household compounds across the three countries and were positively associated with household livestock ownership and negatively associated with maternal and child cleanliness. One-sided tests from multivariate least squares models for children 6–24 months of age indicate that the presence of animal feces is significantly and negatively associated with child height-for-age z scores in Ethiopia (β = −0.22), Bangladesh (β = −0.13), and in a pooled sample (β = −0.11), but not in Vietnam. There is also suggestive evidence that animal feces may be positively associated with diarrhea symptoms in Bangladesh. The results in this article, therefore, contribute to a growing body of evidence suggesting that animal ownership may pose a significant risk to child nutrition and health outcomes in developing countries.

Short Sleep Duration Is Associated With Eating More Carbohydrates and Less Dietary Fat in Mexican American Children.

Short sleep duration is a risk factor for childhood obesity. Mechanisms are unclear, but may involve selection of high carbohydrate foods. This study examined the association between estimated sleep duration and macronutrient intake as percentages of total energy among Mexican American (MA) 9-11 year olds. This cross-sectional study measured diet using two 24-hour recalls and estimated sleep duration using hip-worn accelerometry in MA children (n = 247) who were part of a cohort study. Child and maternal anthropometry were obtained; mothers reported on demographic information. Using linear regression, we examined the relationship of sleep duration with energy intake, sugar intake, and the percentage of energy intake from carbohydrates, fat, and protein. Children were 47% male; mean age was 10 (SD = 0.9) years. Mean sleep duration was 9.6 (SD = 0.8) hours; 53% were overweight/obese, with a mean energy intake of 1759 (SD = 514) calories. Longer sleep duration was independently associated with a lower percentage of energy intake from carbohydrates (β = -0.22, p < .01) and a higher percentage of energy from fat (β = 0.19, p < .01), driven by the percentage of energy from polyunsaturated fatty acids (PUFA; β = 0.17, p < .05). No association was found with the intake of energy or total sugars, or the percent of calories from protein. MA children who slept longer consumed diets with a lower percentage of calories from carbohydrates and a higher percentage from fat, especially from PUFA. Short sleep duration may be a risk factor for food cravings that are high in carbohydrate content and may displace heart-healthy dietary fat, and thereby increase obesity risk among children.

Parameters associated with design effect of child anthropometry indicators in small-scale field surveys.

BackgroundCluster surveys provide rapid but representative estimates of key nutrition indicators in humanitarian crises. For these surveys, an accurate estimate of the design effect is critical to calculate a sample size that achieves adequate precision with the minimum number of sampling units. This paper describes the variability in design effect for three key nutrition indicators measured in small-scale surveys and models the association of design effect with parameters hypothesized to explain this variability.Methods380 small-scale surveys from 28 countries conducted between 2006 and 2013 were analyzed. We calculated prevalence and design effect of wasting, underweight, and stunting for each survey as well as standard deviations of the underlying continuous Z-score distribution. Mean cluster size, survey location and year were recorded. To describe design effects, median and interquartile ranges were examined. Generalized linear regression models were run to identify potential predictors of design effect.ResultsMedian design effect was under 2.00 for all three indicators; for wasting, the median was 1.35, the lowest among the indicators. Multivariable linear regression models suggest significant, positive associations of design effect and mean cluster size for all three indicators, and with prevalence of wasting and underweight, but not stunting. Standard deviation was positively associated with design effect for wasting but negatively associated for stunting. Survey region was significant in all three models.ConclusionsThis study supports the current field survey guidance recommending the use of 1.5 as a benchmark for design effect of wasting, but suggests this value may not be large enough for surveys with a primary objective of measuring stunting or underweight. The strong relationship between design effect and region in the models underscores the continued need to consider country- and locality-specific estimates when designing surveys. These models also provide empirical evidence of a positive relationship between design effect and both mean cluster size and prevalence, and introduces standard deviation of the underlying continuous variable (Z-scores) as a previously unexplored factor significantly associated with design effect. The magnitude and directionality of this association differed by indicator, underscoring the need for further investigation into the relationship between standard deviation and design effect.

Combining Home Garden, Poultry, and Nutrition Education Program Targeted to Families With Young Children Improved Anemia Among Children and Anemia and Underweight Among Nonpregnant Women in Nepal.

The impact of food-based interventions on child and maternal anthropometry and anemia has not been adequately studied. This study tested the effect of an enhanced homestead food production (EHFP) program consisting of home garden, poultry raising, and nutrition education implemented over 2.5 years versus control (no intervention) on anthropometry and anemia among children (12-48 months) and their mothers. An unblinded cluster-randomized controlled trial involving pre- and post-surveys with independent samples was conducted in rural areas of Baitadi District, Nepal. Data (including weight, height/length, and hemoglobin) were obtained from 2106 and 2614 mother-child pairs at baseline and follow-up, respectively. Changes in outcome variables (stunting, underweight, wasting, and anemia among children and underweight and anemia among mothers) were compared between the study groups using mixed-effects logistic regression models. At follow-up, anemia was significantly lower among children (odds ratio, OR [95% confidence interval, CI]: 0.76 [0.59-0.98]) and mothers (OR [95% CI]: 0.62 [0.48-0.82]) in the treatment group compared to the control. Underweight was lower among mothers in the treatment group compared to the control (OR [95% CI]: 0.61 [0.46-0.82]). There was no impact on child anthropometry. The EHFP intervention improved anemia among children aged 12 to 48 months and their mothers in Baitadi District of Nepal. The intervention also reduced underweight among these women, but had no impact on child growth, in this district.

Anthropometry, physical ability and dispensary observation of school-age children - contribution to health prevention and public health

INTRODUCTION : Morphological /anthropometric/ indicators are the basis for assessing the physical growth of children of school age, the relevant organs and the whole body. External factors affect growth and development, especially during puberty. We set ourselves the task to analyze anthropometric studies of stu­dents in organized groups in Varna - on height, body weight, activity, and their dispensary observation by ICD for a period of two years - 2012 - 2014. MATERIALS AND METHODS : We have used reports, analyses, tests, data from prophylactic examinations and dispensary, anthropometric measurements, laboratory tests of RHI Varna, examination of physical abil­ities and more. Our methods included documentary, statistical, laboratory tests, physical abilities and more. RESULTS : We explored the physical development of 80 771 students in organized groups in Varna - 33 669 for the 2012-2013 school year and 42 918 for 2013-2014, divided into three groups: first group - norm, second group - extended norm and third group - outside the norm. We analyzed the physical abilities to pass and not pass the tests for norm and out of norm and the ones free from physical education and remedial gymnastics. CONCLUSIONS : The share of anthropometric measurement of height and weight within the norm is high­est in schoolchildren in group I (norm) - 87.0% for a height and 84.0% for a bodyweight. However, it is signifi­cantly lower in group II (extended norm) - 8.57% for height and 9.85% for body mass. The detected and regis­tered main diseases and abnormalities in prophylactic examinations were: obesity, visual disturbances, spine curvature disorders, and asthma.

The association of lead exposure during pregnancy and childhood anthropometry in the Mexican PROGRESS cohort

Lead exposure during pregnancy remains a public health problem with potential lifelong impacts on children's growth and development. Mexico is unique in that stunting and obesity are both major public health concerns in children. This situation might be exacerbated by lead exposure which remains more common in Mexico than in the United States due in part to the use of lead glazed pottery in food preparation and storage. Our objective is to determine how lead exposure during pregnancy is associated with children's growth parameters, including height, weight, body mass index and percentage body fat measured between ages 4–6 years old in a Mexico City pregnancy cohort. Blood lead was collected in the 2nd and 3rd trimester of pregnancy as well as at delivery. Bone lead was assessed in mothers as a long term exposure biomarker. We performed multivariable linear regression analyses to assess the association between each of these lead exposure biomarkers and child anthropometry.We found a significant negative association between maternal 3rd trimester blood lead concentration and offspring height for age (β−0.10; 95% CI −0.19, −0.01), and a negative association between maternal 3rd trimester blood lead concentration and weight for age (β−0.11; 95% CI −0.22,−0.003). Our results in this Mexican population add to previous findings of an association of lead and decreased stature and weight in early childhood. Ongoing follow-up and longitudinal analyses may help elucidate how this impacts growth trajectory and other children's health outcomes.

Family structure and childhood anthropometry in Saint Paul, Minnesota in 1918

Concern with childhood nutrition prompted numerous surveys of children’s growth in the United States after 1870. The Children’s Bureau’s 1918 ‘Weighing and Measuring Test’ measured two million children to produce the first official American growth norms. Individual data for 14,000 children survives from the Saint Paul, Minnesota survey whose stature closely approximated national norms. As well as anthropometric details the survey recorded exact age, street address and full name. These variables allow linkage to the 1920 census to obtain demographic and socio-economic information. We matched 72% of children to census families creating a sample of nearly 10,000 children. Children in the entire survey (linked set) averaged 0.74 (0.72) standard deviations below modern World Health Organization height-for-age standards, and 0.48 (0.46) standard deviations below modern weight-for-age norms. Sibship size strongly influenced height-for-age, and had weaker influence on weight-for-age. Each additional child aged six or under reduced height-for-age scores by 0.07 standard deviations (95% confidence interval: –0.03, 0.11). Teenage siblings had little effect on height-for-age. Social class effects were substantial. Children of laborers averaged half a standard deviation shorter than children of professionals. Family structure and socio-economic status had compounding impacts on children’s stature.