Child Undernutrition Research Articles

Risk of exposure to aflatoxin M1 through consumption of cow's milk among children in Magadu, Morogoro.

Aflatoxin M1 (AFM1) contamination of milk affects the general population with particular attention to children who frequently consume milk as part of complementary food. This study determined AFM1 contamination of cow's milk and estimated the health risk of dietary AFM1 through consumption of cow's milk among children (6 to 36months) in the Magadu ward of Morogoro region in Tanzania. A total of 165 mother-baby pairs were recruited and interviewed on child feeding practices with a focus on feeding of cow's milk in the past 24h. Alongside the interview, 100 raw cows' milk samples were collected from subsampled respondent households and were analyzed for AFM1 using enzyme-linked immunosorbent assay (ELISA). The results showed that about 35% of the surveyed children consumed cow's milk in the form of plain milk, incorporated in porridge and/or tea. The amount consumed varied from 62.5 to 500 mls with a median of 125 (125, 250) mls at a frequency of 1 to 2 times a day. All raw cows' milk (100%) samples (n = 100) were found contaminated with AFM1 at concentrations ranging from 0.052 to 9.310µg/L and median of 2.076µg/L (1.27, 2.48). All samples were contaminated by AFM1 at levels above the limits of 0.05µg/L of raw milk set by the Tanzania Bureau of Standard and the European Union, while 97% exceeded 0.5µg/L set by the US Food and Drug Administration. Exposure to AFM1 due to consumption of cow's milk ranged from 0.0024 to 0.077 µg/kg bw per day with a median of 0.019 (0.0016, 0.026) µg/kg bw per day, while the margin of exposure (MOE) ranged from 5.19 to 166.76 and median 20.68 (15.33, 25.40) implying high risk of public health concern. This study recommends that advocacy on consumption of cows' milk to combat undernutrition in children should consider a holistic approach that considers the milk's safety aspect.

Perspective on alternative therapeutic feeds to treat severe acute malnutrition in children aged between 6 and 59 months in sub-Saharan Africa: a narrative review.

Worldwide, nearly 200 million children younger than 5 years old suffer from stunting and wasting, 2 different types of undernutrition. Moreover, 45% of deaths among children in that age group are associated with these conditions. Severe acute malnutrition (SAM) refers to children with a weight-for-height z score < -3, a midupper arm circumference < 115 mm, or the presence of bilateral edema, and is especially prevalent in low- and middle-income countries. Undernutrition in children can have a major impact on both their physical and cognitive development. It can lead to infections and death if it remains undetected or untreated. The use of therapeutic feeds is an important component in the management of SAM, which remains a challenge in poorly resourced countries. The aim of this review was to assess the alternatives to the standard therapeutic foods used to treat SAM and to summarize their advantages and disadvantages, providing an overview of current research. A literature search was performed from September to November 2022 using PubMed, the Trip medical database, and the German Institute for Medical Documentation and Information (DIMDI). This review includes 13 randomized controlled trials testing alternatives to the standard therapeutic foods used to treat SAM by using alternative ingredients or a reduced dosage. The results show that, while a few alternative ready-to-use therapeutic food formulas lead to recovery rates similar to those seen with the standard protocol, many alternatives were less effective in the affected children. Thus, the evidence is not yet strong enough to change the World Health Organization's guidelines. The review identifies promising results of treatment alternatives related to treatment outcomes and costs. Additional research should focus on the interventions that positively impact the recovery process of severely malnourished children to facilitate the treatment and enable greater treatment coverage worldwide.

Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022

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.

Sugar-Sweetened Beverages, Foods of Low Nutritional Value, and Child Undernutrition in Cambodia.

Child undernutrition persists in Cambodia despite recent progress. As Cambodia undergoes a shift in dietary consumption that coincides with economic, demographic, and epidemiologic changes, there is risk of ultra-processed foods and sugar-sweetened beverages displacing nutrient-dense foods during the critical period of infant growth in the first 24 months. The aim of this study was to assess the introduction and intake of foods of low nutritional value and sugar-sweetened beverages and their association with undernutrition among children 24 months of age in rural and semi-urban Cambodia. Cross-sectional analyses of a 24-h dietary recall from a sample (n = 377) of 24-month-olds found that the majority of infants had been introduced to packaged salty snacks and sweets by 12 months of age and to sugar-sweetened beverages by 15 months. By 24 months of age, 78% of children had consumed foods of low nutritional value and 57% consumed a sugar-sweetened beverage on the previous day. Multivariate logistic regression analyses demonstrated that infant intake of a flavored sugary drink on the previous day was associated with over two times the odds of both stunting and wasting, and consumption of packaged sweets on the previous day was associated with over two times the odds of wasting, but no association was found with stunting. These findings underscore the need to improve educational and policy interventions to support healthy feeding practices for infants and young children.

FACTORS RELATED TO INCIDENCE OF MALNUTRITION IN UNDER FIVE CHILDREN

Background: Malnutrition is one of the main nutritional problems in Indonesia and East Java. Malnutrition is the cause of more than 1/3 of 9.2 million deaths in children under the age of 5 in the world. Toddlers are a very vulnerable group related to nutrition in society. If the nutrition of children under five is not fulfilled continuously it will cause stunting. Method: This study uses descriptive analysis to overview of the problem of factors related to the incidence of undernutrition in children under five at Posyandu Randugading, Tajinan District, Malang Regency. The sample consisted of 36 children under five using a total sampling technique. This data was obtained from the nutritional status report of the Tajinan Community Health Center which met the nutritional criteria of less than -3 SD to &lt;-2 SD based on the z-score formula. This research instrument used a questionnaire, data collection was carried out by interviews to obtain data on variables Frequency of giving MP-ASI, Infectious diseases, Exclusive breastfeeding, Mother's weight gain during pregnancy, and Number of siblings. The data collection period was carried out on 18 April 2023–25 April 2023. Result: from 36 children showed that 30.55% giving MP-ASI at most was according to the child’s request, children who have had history of an infectious disease 58.33%, exclusive breastfeeding was 50 %, weight gain during pregnancy less as it shouls was 50%, children who have siblirng is more than 2 was 63.89%. Conclusion: Malnutrition children under five year old in Posyandu Randugading, Tajinan District, Malang Regency have characteristic related to feeding meals was most of them according to the child’s request, majority children have history of an infectious disease, Mother wight gain during pregnancy lower as it should, majority children have more than 2 sibling.

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

BackgroundMalnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery.MethodsChildren 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively.ResultsForty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score − 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score − 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable.ConclusionMalnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.

Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005-2016.

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. 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). 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). 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.

Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan

BackgroundMalnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan.MethodsA multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children’s anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio.ResultsThis study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five.ConclusionThis study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.

Determinants of Child Undernutrition in Tanzania: Agriculture and Season Perspective: A Review

Determinants of Child Undernutrition in Tanzania: Agriculture and Season Perspective: A Review

Associated factors of undernutrition in children with congenital heart disease: a cross-sectional study.

To evaluate the prevalence and associated factors of undernutrition among children with congenital heart disease (CHD) who have not undergone surgeries in China. This cross-sectional study included 734 CHD children along with their parents. The outcome of interest was undernutrition, including underweight, wasting, and stunting, defined as Z-scores (i.e., weight-for-age, weight-for-height, and height-for-age) ≤-2, according to the World Health Organization (WHO) growth standard. Exposures of interest, containing demographics, obstetric factors, maternal dietary factors, parents' life behaviors and habits, birth-related factors, cardiac-related factors, and preoperative factors, were analyzed using a multivariate logistic regression model to test their associations with undernutrition in CHD children. Overall, 36.1%, 29.7%, and 21.3% of cases were underweight, wasted, and stunted, respectively. Multivariate logistic regression indicated that underweight was associated with demographic factors (including parents' occupational status, family income, and maternal body mass index pre-pregnancy), low birth weight (OR = 4.60, 2.76-7.70), pulmonary hypertension (OR = 4.46, 3.09-6.43), and pneumonia (OR = 1.88, 1.28-2.76). Artificially-fed children were 2.34 (1.36-4.01) times more likely to be underweight. Occupied mothers (OR = 0.62, 0.44-0.88) and fathers (OR = 0.49, 0.26-0.92) served as protective factors, while mothers having gestational complications (OR = 1.56, 1.11-2.18) and exposed to noisy environment (OR = 1.64, 1.11-2.42) during this pregnancy, and pulmonary hypertension (OR = 3.21, 2.30-4.49) increased the chance of wasting in offspring. The odds of being stunted were greater in families with >2 children (OR = 1.88, 1.13-3.14), placental abruption during this pregnancy (OR = 25.15, 2.55-247.89), preterm births (OR = 1.84, 1.02-3.31), low birth weight (OR = 3.78, 2.16-6.62), pulmonary hypertension (OR = 2.35, 1.56-3.53) and pneumonia (OR = 1.93, 1.28-2.90). In subgroup analyses, the associations differed between patients with different feeding patterns (breastfeeding vs. non-breastfeeding), CHD classifications (cyanotic vs. acyanotic), and prematurity (preterm vs. non-preterm). Undernutrition is common in preoperative CHD children. Familial demographics, maternal factors (including having gestational complications and exposure to noisy environment during pregnancy), and patient-related factors (encompassing preterm births, low birth weight, pulmonary hypertension, pneumonia, and feeding pattern) were found to contribute to undernutrition in CHD cases. However, associated factors among the three subgroups of distinct feeding patterns, CHD categorization, and prematurity exhibited varied outcomes, suggesting the necessity for targeted interventions.

A Comparative Study to Evaluate the Body Mass Index in Urban and Rural School Children of Belagavi

Introduction Body mass index BMI is a simple tool used to screen body weight and assess whether the body weight is healthy for your body size. In the post COVID-19 era a new normal has been established. A high BMI augments the risk of various health hazards. In developing countries both obesity and undernutrition in children is a burning issue.Objective The current cross-sectional study was conducted to assess the BMI of urban and rural school children and to compare their BMI.Methodology Five schools were selected 3 urban and 2 rural and a total of 1191 students from these schools were screened and assessed for their BMI.Results On comparison urban school boys were more underweight 85 than rural school boys 79 while among rural and urban school girls urban school girls were more underweight 77 than rural school girls 63. Among urban school girls 3294 1.02 were obese while among rural school girls 1195 0.5 was obese. About 68454 14.9 urban boys 50248 20 rural boys 65294 22 urban girls and 70195 36 rural girls showed healthy weight BMI.Conclusion Unlike the common concern about obesity in Indian school children this study indicates that underweight is more prevalent especially among urban school children boys and girls compared to rural school children.

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018.

The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali. Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018. Urban and rural areas of Mali. A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months). In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group. This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.

An analysis of the dual burden of childhood stunting and wasting in Myanmar: a copula geoadditive modelling approach.

To analyze the spatial variation and risk factors of the dual burden of childhood stunting and wasting in Myanmar. Analysis was carried out on nationally representative data obtained from the Myan-mar Demographic and Health Survey conducted during 2015-2016. Childhood stunting and wasting are used as proxies of chronic and acute childhood undernutrition. A child with standardized height-for-age Z score (HAZ) below -2 is categorized as stunted while that with a weight-for-height Z score (WHZ) below -2 as wasted. A nationally representative sample of households from the 15 states and regions of Myanmar. Children under the age of five (n 4162). Overall marginal prevalence of childhood stunting and wasting were 28.9% (95% CI 27.5, 30.2) and 7.3% (95% CI 6.5, 8.0) while their concurrent prevalence was 1.6% (95% CI 1.2, 2.0). The study revealed mild positive association between stunting and wasting across Myanmar. Both stunting and wasting had significant spatial variation across the country with eastern regions having higher burden of stunting while southern regions having higher prevalence of wasting. Child age and maternal weight-for-height Z score had significant non- linear association with both stunting and wasting while child gender, ethnicity and household wealth quintile had significant association with stunting. The study provides data-driven evidence about the association between stunting and wasting and their spatial variation across Myanmar. The resulting insights can aid in the formulation and implementation of targeted, region-specific interventions towards improving the state of childhood under-nutrition in Myanmar.

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya.

Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

Spatiotemporal variations in child undernutrition in Bihar: A district level analysis

Spatiotemporal variations in child undernutrition in Bihar: A district level analysis

Socioeconomic and regional patterns of child nutritional inequality between tribal and non-tribal communities in India: An analysis based on National Family Health Survey 5 (2019–21)

Background: Despite India’s impressive economic growth and the implementation of a large-scale antimalnutrition program, the country continues to face the highest levels of child malnutrition globally. Among the affected children, half of those under the age of 3 years, in both tribal and nontribal populations, are underweight, while a third of the wealthiest children experience overnutrition. Economic inequality plays a significant role in contributing to malnutrition in both tribal and nontribal communities. Therefore, utilizing data from the fifth round of the National Family Health Survey (2019–21), the present study aims to examine the socioeconomic disparities in childhood malnutrition across all 640 districts of India, with a specific focus on tribal and nontribal populations. Methods: The analysis includes a sample of children aged 0 to 59 months from tribal and nontribal communities. Sociodemographic, personal, clinical, and environmental factors are considered as independent variables. The outcomes of interest include stunting, wasting, and underweight, which are assessed using binary variables. Linear modeling are used to determine the associations between the independent variables and child undernutrition. Results: The study reported a negative Z value (−4.763), indicating greater overall inequality in the tribal population compared to the nontribal population. In terms of odds ratios, females had lower odds of being underweight in both tribal and nontribal populations. Children aged 1 to 2 years had higher odds of being underweight compared to those aged 1 year. The duration of breastfeeding showed varying associations, with breastfeeding for 7 to 12 months increased the risk of underweight in nontribal areas, while longer durations (13–24 and &gt;24 months) were associated with higher chances of wasting in nontribal areas. Higher maternal age at first birth, higher education levels, and sufficient antenatal care visits were protective factors against underweight in both populations. A higher wealth index consistently correlated with reduced odds of underweight in both tribal and nontribal populations. Institutional delivery was associated with higher odds of underweight in tribal areas but lower odds in nontribal areas. Conclusion: The study concludes that in order to address the socioeconomic disparities contributing to stunting, wasting, and undernutrition among tribal populations, targeted interventions are required. These interventions should focus on improving access to education, healthcare, and economic opportunities, particularly among tribal communities. Additionally, policies should aim to reduce income inequality and promote inclusive economic development, ensuring that the benefits of progress are equitably distributed across all population groups. By addressing these socioeconomic factors, it is possible to improve the nutritional status and overall well-being of tribal populations.

Undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia: A community-based study.

An exclusive breastfeeding period is a time when the infant's feeding depends on only breast milk. Inadequate maternal nutrition during this period could lead to insufficient infant feeding, which can further lead to childhood undernutrition and developmental restrictions. Evidently, the burden of maternal undernutrition was higher in resource-limited countries, including Ethiopia. This study aimed to assess the proportion of undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia. The study used a community-based cross-sectional design. The study was conducted among 442 nursing mothers from 10 to 30 June 2022. The participants were selected using multistage sampling techniques. An interviewer-administered structured questionnaire was used to collect information. Statistical software EpiData version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. The factors associated with undernutrition were identified using a binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used to include the variable in the multivariable analysis, whereas p-value less than 0.05 was an odds ratio used to declare an independent association at a 95% confidence interval. The proportion of undernutrition among the participants was found to be 24.8% in the study area. Poor intake of extra meals (adjusted odds ratio = 2.104; 95% confidence interval: 1.208, 3.664), poor dietary diversity habits (adjusted odds ratio = 3.605; 95% confidence interval: 2.112, 6.153), a lack of nutrition information (adjusted odds ratio = 1.853; 95% confidence interval: 1.070, 3.212), and household food insecurity (adjusted odds ratio = 4.424; 95% confidence interval: 2.639, 7.417) were identified as factors enhancing undernutrition among exclusive breastfeeding mothers in the area. A quarter of exclusive breastfeeding mothers were undernourished in the area. Poor dietary diversity habits, poor intake of extra meals, a lack of nutrition information, and household food insecurity were found to be the factors determining undernutrition. Hence, it is important to reinforce nutrition intervention programs, including maternal nutrition education and counseling.

Childhood stunting is highly clustered in Northern Province of Rwanda: A spatial analysis of a population-based study

BackgroundIn Northern Province, Rwanda, stunting is common among children aged under 5 years. However, previous studies on spatial analysis of childhood stunting in Rwanda did not assess its randomness and clustering, and none were conducted in Northern Province. We conducted a spatial-pattern analysis of childhood undernutrition to identify stunting clusters and hotspots for targeted interventions in Northern Province. MethodsUsing a household population-based questionnaire survey of the characteristics and causes of undernutrition in households with biological mothers of children aged 1–36 months, we collected anthropometric measurements of the children and their mothers and captured the coordinates of the households. Descriptive statistics were computed for the sociodemographic characteristics and anthropometric measurements. Spatial patterns of childhood stunting were determined using global and local Moran's I and Getis-Ord Gi* statistics, and the corresponding maps were produced. ResultsThe z-scores of the three anthropometric measurements were normally distributed, but the z-scores of height-for-age were generally lower than those of weight-for-age and weight-for-height, prompting us to focus on height-for-age for the spatial analysis. The estimated incidence of stunting among 601 children aged 1–36 months was 27.1 %. The sample points were interpolated to the administrative level of the sector. The global Moran's I was positive and significant (Moran's I = 0.403, p < 0.001, z-score = 7.813), indicating clustering of childhood stunting across different sectors of Northern Province. The local Moran's I and hotspot analysis based on the Getis-Ord Gi* statistic showed statistically significant hotspots, which were strongest within Musanze district, followed by Gakenke and Gicumbi districts. ConclusionChildhood stunting in Northern Province showed statistically significant hotspots in Musanze, Gakenke, and Gicumbi districts. Factors associated with such clusters and hotspots should be assessed to identify possible geographically targeted interventions.

The role of parental education and occupation on undernutrition among children under five in Bangladesh: A rural-urban comparison.

Bangladesh continues to face the persistent issue of child malnutrition. This study aims to investigate the influence of parental characteristics on undernutrition among children under the age of five in both urban and rural areas of Bangladesh. This study utilizes data from the Bangladesh Demographic and Health Survey (BDHS) 2017-18, which includes 7806 children under the age of five and their parents. The effects of parental education and occupation on undernutrition (e.g., stunting, underweight, and wasting) are examined using the binary probit regression technique. Among rural children, 32.6% are stunted, 22.5% are underweight, and 8.1% are wasted. The corresponding figures for urban children are 25.3%, 18.9%, and 8.9%, respectively. In all forms of undernutrition, children living in rural areas face greater challenges than those living in urban areas. The prevalence of stunting and underweight is low among children, irrespective of their rural or urban background, when both parents have the same level of education. The prevalence is also low when fathers are employers or traders and mothers are homemakers, or when highly educated fathers are employers or traders and highly educated mothers are homemakers. In both rural and urban areas, the risk of stunting, underweight and all forms of malnutrition among children decreases as parents' education levels increase. Children whose fathers work in service or business activities are less likely to experience stunting, being underweight, or wasting compared to children whose fathers work in agriculture or other professions in both areas. In urban areas, children born to mothers with lower levels of education are more vulnerable to wasting than children whose mothers have at least secondary education. To reduce child undernutrition nationwide, it is recommended that both parents have at least a secondary school education and that the father has a stable and sufficient income.

WHO Growth Charts for Diagnosis of Malnutrition

Child malnutrition is a major public health issue worldwide. An estimated 144 million children under age 5 are stunted, 47 million are wasted and 38.3 million have overweight or obesity. Around 45% of deaths among children under 5 years of age are linked to undernutrition.1 Measuring the growth of infants and children is an important part of child health surveillance and gives an idea about the nutritional status of the baby. Inadequate infant growth leads to under-nutrition in children in many low- and middle-income countries, which, if followed later in life by an increased intake of calories, can result in overweight or obesity and non- communicable diseases.