Child Undernutrition Research Articles

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.

Prevalence of Stunting Among Under 5 Children in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen

Background: Yemen is one of the low-income countries, with 80% of the population living below the poverty line and almost half the population lacks adequate access to nutritious food. The low-birth-weight rate is 24.6%, and the overall infant mortality rate is 47 per 1,000 births. The risk of death of newborns varies depending on social, demographic, and economic factors. Objectives: This study aims to evaluate the effect of the ongoing war on stunting prevalence among children under five years in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen. Methods: This study is an observational analytic with a cross-sectional design. It was conducted from January to June 2022, following purposive sampling gathered 254 participants. Results: The data revealed that the prevalence of severe stunting in 6- to 23-month-old children was higher in urban areas than in rural areas (45% vs. 43.7%); it was also higher in girls than in boys (58.4% vs. 30.3%). Furthermore, in 24- to 59-month-old children, it was higher in urban areas than in rural areas (50% vs. 12.5%) and higher in girls than in boys (42.9% vs. 19.6%) with p-value (0.040, 0.018, 0.001 and &gt;.001) respectively. Conclusions: Findings demonstrated that the ongoing war has a significant effect on the stunting prevalence among children under five years. Early childhood undernutrition is linked to several adverse outcomes in adulthood, and it is plausible that undernutrition in early childhood may be a significant factor in explaining the health disparities faced by Yemeni children under five.

Gut microbiota in regulation of childhood bone growth.

Childhood stunting and wasting, or decreased linear and ponderal growth associated with undernutrition, continue to be a major global public health challenge. Although many of the current therapeutic and dietary interventions have significantly reduced childhood mortality caused by undernutrition, there remain great inefficacies in improving childhood stunting. Longitudinal bone growth in children is governed by different genetic, nutritional and other environmental factors acting systemically on the endocrine system and locally at the growth plate. Recent studies have shown that this intricate interplay between nutritional and hormonal regulation of the growth plate could involve the gut microbiota, highlighting the importance of a holistic approach in tackling childhood undernutrition. In this review, I focus on the mechanistic insights provided by these recent advances in gut microbiota research and discuss ongoing development of microbiota-based therapeutics in humans, which could be the missing link in solving undernutrition and childhood stunting.

Early Life Nutrition during the First 1000 Days from a Malaysian Perspective

The first 1000 days of life, encompassing the period from conception to a child’s second birthday, represents a pivotal phase in human development. This review paper highlighted the importance of this critical window with a comprehensive analysis exploring the multifaceted impact of nutrition during the three distinct phases: the pregnancy-intrauterine period, early infancy-breastfeeding period, and early childhood-complementary feeding period. Within the pregnancy-intrauterine period, the maternal body mass index emerges as a crucial factor, directly affecting the well-being of both mother and child. Optimal nutrition, including essential micronutrients such as folic acid, iron, iodine, and vitamin D, are imperative to mitigate the risk of neural tube defects and related disorders, which remain a concern in Malaysia. Exclusive breastfeeding during the initial six months of life is identified as a cornerstone of infant development, nurturing both the child’s cognitive abilities and immune system. Timely introduction of complementary foods is equally vital, acting as a safeguard against childhood obesity and undernutrition. This review paper provided an in-depth examination of the importance and critical role of nutrition in the first 1000 days of life. It further outlined the current status, recommended strategies and interventions to improve child nutrition during this crucial phase in the Malaysian context.

The intergenerational effect of tuition-free lower-secondary education on children’s nutritional outcomes in Africa

ABSTRACT One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children’s nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.

Junk Food Consumption Causing Obesity Pandemic in India

In terms of epidemiology, demographics, and dietary habits, India is undergoing several changes. The startlingly high rates of childhood undernutrition in India, together with the rapidly rising prevalence of chronic illnesses and their risk factors, like obesity and overweight, across all social classes, are making the country's health issues worse. Obesity has emerged as a major public health concern affecting individuals of all ages. India is reportedly ranked third (just behind US and China) among nations with the highest rates of obesity. In this paper we study and analyse the trends in obesity in India and examine the leading cause for such concerning rise in obesity in the nation. This will help government formulate the policy responses appropriately to tame the rising trend in obesity and to confer to Sustainable Development Goals (SDGs) by 2030.

Geostatistical modelling of child undernutrition in developing countries using remote-sensed data: evidence from Bangladesh and Ghana demographic and health surveys

Childhood chronic undernutrition, known as stunting, remains a critical public health problem globally. Unfortunately while the global stunting prevalence has been declining over time, as a result of concerted public health efforts, there are areas (notably in sub-Saharan Africa and South Asia) where progress has stagnated. These regions are also resource-poor, and monitoring progress in the fight against chronic undernutrition can be problematic. We propose geostatistical modelling using data from existing demographic surveys supplemented by remote-sensed information to provide improved estimates of childhood stunting, accounting for spatial and non-spatial differences across regions. We use two study areas–Bangladesh and Ghana–and our results, in the form of prevalence maps, identify communities for targeted intervention. For Bangladesh, the maps show that all districts in the south-eastern region are identified to have greater risk of stunting, while in Ghana the greater northern region had the highest prevalence of stunting. In countries like Bangladesh and Ghana with limited resources, these maps can be useful diagnostic tools for health planning, decision making and implementation.

Determinants of undernutrition in children under five years in the Southern Africa sub-region: a scoping review

Determinants of undernutrition in children under five years in the Southern Africa sub-region: a scoping review

The Outcome of the Treatment of Malnourished Children Treated by Ready To Use Therapeutic Food and Ready to Use Supplementary Food in Wad ElBashir Heath Cente 2021

introduction: Malnutrition includes both undernutrition and overnutrition. Child undernutrition is a major global health problem that is more common in low-income countries like Sudan, it can cause childhood morbidity, mortality, and impaired intellectual development. Objective: This study was conducted to assess the outcome of malnourished children treated with ready to-Use Therapeutic Food (RUTF), and ready to-Use Supplementary Food (RUSF) in Wad Elbasheir Health Centre in Ombada Locality Methods: This is an analytical Cross-Sectional facility-based Study conducted at Wad Elbasheir Health Centre. A convenient nonprobability sampling technique was used in this study. Data were collected using a datasheet after being pretested. Data were collected from secondary data from the records of malnourished children treated by the RTUF and RUSF. Results: The majority of the participants of this study were aged between 6 to 23 months (84%) and most of the participants were females (56%). This study showed that 70 (24%) of the participants were classified as severe Acute Malnutrition (SAM), while 218 (76%) were classified as moderate Acute malnutrition (MAM). This study showed that having a smaller number of children in the family and middle Upper Arm Circumference (MUAC) between 11.5-12.5 cm were more associated with recovery. Moreover, this study showed that children who use amoxicillin or anti-worms were more likely to be recovered from malnutrition. Conclusion: RUTF was designed for the nutritional management of children with uncomplicated acute malnutrition treated as outpatients. In this study, most of the children recovered. In addition, this study found that several factors were associated with better outcomes including fewer children in the family, MUAC between 11.5-12.5 cm, having MAM (compared to having SAM), and using amoxicillin or anti-worms.

Understanding the Relationship between Child Malnutrition and Cognitive Development: An Analysis of the Ecuadorian Case

The analysis of the relationship between childhood malnutrition and cognitive development in children contributes significantly to the literature, given that nutritional status is recognized as a determinant factor for health and cognitive and psychosocial development during early childhood. Malnutrition at these stages can lead to imbalances in nutritional needs, which, in turn, can influence cognitive development. Our research was based on a representative sample of 4,568 children under 5 years of age from the 2018 National Health and Nutrition Survey (ENSANUT). We used a linear regression model and quantile regressions to estimate heterogeneous relationships in the studied relationship. Our results show that child undernutrition decreases by 0.25 BMI points with respect to those children who did not report child undernutrition. In addition, we have evidence that an increase in BMI at the extremes of the cognitive development distribution (Q0.10 and Q0.90) has a greater effect on children with lower and higher cognitive development. Another important finding is that males are more likely to have high cognitive development. Likewise, a greater number of siblings at home reduces cognitive development by -0.1032 points. Our data also reveal that more hours in front of the TV could reduce the risk of high cognitive development, while the number of hours of play causes the opposite effect, as the coefficient reveals that children with more hours of play have 0.1034 points less cognitive development. From our findings, the importance of exploring the neurodevelopmental processes involved in malnutrition is highlighted. In this article, we examine the basic psychomotor process, which is characterized by the child's ability to carry out bodily movements and mental representations, as well as symbolic expressions that allow him or her to relate constructively to people and objects.

Undernutrition among children and its determinants across the parliamentary constituencies of India: a geospatial analysis.

In India, undernutrition among children has been extremely critical for the last few decades. Most analyses of undernutrition among Indian children have used the administrative boundaries of a state or a district level as a unit of analysis. This paper departs from such a practice and focuses instead on the political boundaries of a parliamentary constituency (PC) as the unit of analysis. The PC is a critical geopolitical unit where political parties and party candidates make election promises and implement programmes to improve the socio-economic condition of their electorate. A focus on child undernutrition at this level has the potential for greater policy and political traction and could lead to a paradigm shift in the strategy to tackle the problem by creating a demand for political accountability. Different dimensions and new approaches are also required to evaluate the socio-economic status and generate concrete evidence to find solutions to the problem. Given the significance of advanced analytical methods and models embedded into geographic information system (GIS), the current study, for the first time, uses GIS tools and techniques at the PC level, conducting in-depth analysis of undernutrition and its predictors. Hence, this paper examines the spatial heterogeneity in undernutrition across PCs by using geospatial techniques such as univariate and bivariate local indicator of spatial association and spatial regression models. The analysis highlights the high-low burden areas in terms of local hotspots and identifies the potential spatial risk factors of undernutrition across the constituencies. Striking variations in the prevalence of undernutrition across the constituencies were observed. Most of these constituencies that performed poorly both in terms of child nutrition and socio-economic indicators were located in the northern, western, and eastern parts of India. A statistically significant association of biological, socio-economic, and environmental factors such as women's body mass index, anaemia in children, poverty, household sanitation facilities, and institutional births was established. The results highlight the need to bring in a mechanism of political accountability that directly connects elected representatives to maternal and child health outcomes. The spatial variability and pattern of undernutrition indicators and their correlates indicate that priority setting in research may also be greatly influenced by the neighbourhood association.

Anthropometric failure and associated factors among children aged 6-23 months in Ethiopia.

Undernutrition in childhood is a crucial public health issue in Ethiopia. Yet, more than an assessment of undernutrition using conventional index is needed to conclude the overall prevalence of undernutrition among children aged 6-23 months. Therefore, this study aimed to assess the prevalence of undernutrition using composite index of anthropometric failure and its associated factors among children aged 6-23 months in Southwest Ethiopia. A community-based cross-sectional study was employed among 440 mother-child pairs selected using a two-stage cluster sampling method in the rural Kersa district, Jimma Zone, Southwest Ethiopia. A pretested structured questionnaire was used to collect data. Multivariable logistic regression analysis was employed to identify factors associated with undernutrition. Variables with a p-value of <.05 were considered statistically significant. The proportion of undernutrition using composite indexes of anthropometric failure was 57.3% among children aged 6-23 months. Children being male [AOR = 1.55; 95% CI (1.013, 2.373)], not met minimum acceptable diet (MAD) [AOR = 2.104; 95% CI (1.05, 4.214)], larger family size [AOR = 1.699; 95% CI (1.0791, 2.675)], having comorbidity [AOR = 3.31; 95% CI (2.068, 5.327)], and being in food insecurity household [AOR = 3.12; 95% CI (2.0, 4.868)] were more likely to be in anthropometric failure, whereas children from the mother who attended higher and above schooling [AOR = 0.244; 95% CI (0.093, 0.641)] were less likely to be in anthropometric failure. More than half of children aged 6-23 months were experienced anthropometric failure. Male children, those who have not received the MAD, come from larger families, have comorbidities, live in food-insecure households, and have mothers with higher education levels were found to be at higher risk of anthropometric failure.

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh

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

RELATIONSHIP BETWEEN MOTHER'S ATTITUDE AND SOCIO-CULTURE WITH THE INCIDENCE OF LACK NUTRITION IN UNDER-FREE (12-59 MONTHS)

Nutrition is crucial for supporting the growth and development of toddlers. The government program aimed at preventing undernutrition is the Supplementary Feeding Program (SFP). The nutritional status can be determined through laboratory tests and anthropometric measurements. The rapid developmental stage of children aged 1-5 years makes them vulnerable to undernutrition if not supported by balanced nutrition. The objective of this study was to examine the relationship between maternal attitudes, socio-cultural factors, and the occurrence of undernutrition in toddlers (12-59 months) in the village of Karangan Seberang. This research employed a descriptive correlational survey design with a cross-sectional approach. The total population of toddlers aged 12-59 months was 100 individuals, with a sample size of 86. The sampling technique used was accidental sampling. The univariate analysis revealed that 31 (36%) respondents experienced undernutrition, while 55 (64.0%) respondents did not. The bivariate analysis using the chi-square test showed a p-value of 0.000 &lt; α value of 0.05, indicating a significant relationship between maternal attitudes, parental education, economic factors, and parental knowledge with undernutrition in toddlers (12-59 months) in the village of Karangan Seberang. There is a significant relationship between maternal attitudes, parental education, economic factors, and parental knowledge with undernutrition in toddlers (12-59 months) in the village of Karangan Seberang. Close collaboration among the government, healthcare institutions, education sector, and the community is needed to address the issue of undernutrition in children. Effective coordination and synergy between these sectors can help enhance awareness, knowledge, and effective actions in combating undernutrition.

Urban-rural difference in factors associated with childhood functional difficulty in Bangladesh: a cross-sectional study.

Early childhood functional difficulty poses a substantial worldwide public health challenge, leading to adverse effects on children's quality of life and overall productivity. Moreover, it represents a significant social and economic problem in Bangladesh. Therefore, the current study aimed to identify factors contributing to childhood functional difficulty in Bangladesh within the context of urban-rural areas. A nationally representative cross-sectional survey data from Multiple Indicator Cluster Survey (MICS), 2019 in Bangladesh was used in this study. Chi-square test and multivariable logistic regression analyses were carried out to identify factors associated with childhood functional difficulty. Functional difficulties were found in approximately 3.3% of children 2-4 years of age in urban areas and 2.5% in rural areas. Having a mother with functional difficulties and undernutrition were identified as significant factors common in both urban and rural areas. Further, mothers who had no formal education (AOR = 2.76, 95%CI = 1.18-6.45) and experienced infant death (AOR = 1.94, 95%CI = 1.01-3.70) were identified as significant factors of functional difficulty in urban areas. On the other hand, in rural areas, no access to mass media, children with acute respiratory infection (ARI) (AOR = 2.13, 95%CI = 1.39-3.28), female sex (AOR = 0.69, 95%CI = 0.53-0.91), child undernutrition (AOR = 1.73, 95%CI = 1.32-2.27) and poorer socio-economic status (AOR = 1.95, 95%CI = 1.08-3.55) were found significant factors. Functional difficulty was found to be present in one out of every 35 children age 2 to 4 years in Bangladesh. Childhood functional difficulties were reported slightly higher in urban areas as compared to rural areas. Reducing childhood difficulties in urban areas demands comprehensive strategies: quality healthcare, inclusive education, community support, better information systems, and collaboration. To achieve urban-rural parity in child health, address disparities in economic development, healthcare, and education, especially for girls.

Association between infant and young child feeding indicators and the nutritional status of children aged 6-23 months in rural areas of Hunan Province in 2019

To estimate the status of complementary feeding among infants and young children aged 6-23 months in rural areas of Hunan Province. The association between infant and young child feeding indicators and child undernutrition were assessed. A total of 1220 infants and young children aged 6-23 months from 24 investigated places of 6 cities in Hunan Province were selected by multi-stage stratified sampling for physical measurement, hemoglobin(Hb) test and caregiver interview. Complementary diet was analyzed according to the World Health Organization&apos;s definition of infant and young child feeding indicators. Z-scores were used to elevate nutrition status. Logistic regression models were used to explore the influencing factors of the nutritional status. The prevalence rates of underweight, stunting, wasting, overweight, obesity and anemia were 3.6%, 4.8%, 2.7%, 10.5%, 2.0% and 16.3%. The percentage of infants and young children aged 6-23 months in rural areas of Hunan Province who get minimum dietary diversity, minimum meal frequency, and minimum acceptable diet was 43.3%, 68.5% and 28.1%. None of the individual infant and young child feeding indicators showed significant association with undernutrition, except minimum meal frequency for obesity and anemia. The nutritional status of infants and young children in rural areas of Hunan Province has improved, but the anemia problem is still serious. Complementary feeding frequency is closely associated with anemia for infants and young children.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis.

Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia. This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI. The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting. This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

Maternal empowerment and gender equality for child undernutrition: a multilevel study in Africa

Abstract Backgrounds Women's empowerment is a complex construct that requires a multi-level conceptualization, yet its association with child undernutrition has been restricted to single-level analysis and the existing evidence are mixed. Methods We pooled recent Demographic and Health Surveys from 28 sub-Saharan African countries (N = 137,699 children &amp;lt;5 years old). Undernutrition was defined as stunting, underweight, and wasting. Maternal empowerment at individual-level was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making with each domain divided into terciles. As for country-level gender inequality, Gender Inequality Index (GII) was used. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII with child anthropometric failures as well as their interactions, adjusting for sociodemographic covariates. Results Compared to children of mothers with high-level of empowerment, children of mothers with low-level of empowerment had higher odds of stunting for all domains of SWPER (Ranging ORs=1·15 to 1·21). A similar pattern was observed for underweight and wasting. GII also increased the probability of underweight and wasting. Our interaction analyses indicates that for social independence and decision-making domain, the gap in probabilities of stunting between high versus low-level of empowerment was widest in countries with highest GII. Conclusions In countries with stricter gender norms, achieving mother's social independence and decision-making power are found to be the strategies that should be prioritized in the first place to reduce their children's anthropometric failures. Policies and interventions aimed at promoting maternal empowerment should be carefully tailored to the specific national context to effectively address child undernutrition in sub-Saharan Africa. Key messages • Advanced our understandings of the role of maternal empowerment on child undernutrition by discovering that each domain of empowerment differently functions across larger social contexts. • In countries with stricter gender norms, achieving mother's social independence and decision-making power should be prioritized in the first place to improve their children's nutrition.