Chronic Undernutrition Research Articles

Causal relationship between Environmental Enteric Dysfunction (EED), poor WaSH practices and growth failure in children from Rukwa-Tanzania

Stunting is the most prevalent form of chronic undernutrition. The Rukwa region in Tanzania has one of the highest prevalence of stunting, despite being one of the most food secure region in the country. It is therefore important to understand other possible environmental and biological factors for stunting/growth failure, apart from food insecurity. This was a hospital based prospective cohort study aimed at assessing other causal relationship between Environmental Enteric Dysfunction (EED), WaSH practices and growth failure in children aged between 1–2 years from Rukwa, Tanzania, using univariate and multivariate logistic regression models. We found very significant causal relationship between growth failure and combined water availability (p = 0.0055), toilet sharing by parents/caregivers (OR = 2.632, CI: 1.156–6.233, p = 0.023 from univariate analysis, and OR = 4.067, CI: 1.484–12.206, p = 0.008 from multivariate analysis), and handwashing by parents/caregivers before food (OR = 3.363, CI: 0.928 -11.454, p = 0.05 from univariate analysis and OR = 15.038, CI:2.422–115.8, p = 0.005 from multivariate analysis). This significant causal relationship may be linked to increased diarrheal incidence and other waterborne infections among the studied children, which may then lead to inadequate absorption of nutrients and subsequent growth failure. The findings herein should therefore improve policy and programs designed to deliver targeted intervention strategies in Tanzania, to also identify and include other entry points for managing child growth failure and improving WaSH services.

Chronic undernutrition and adolescent school performance in central Ethiopia

Chronic undernutrition among adolescents in developing countries has been identified as a major public health issue. Previous research has found associations between chronic undernutrition and academic performance outcomes in adolescents. There is need for localized research focusing on nutritional status and its association with educational outcomes among adolescents in different areas of Ethiopia. The purpose of this study was to examine whether chronic undernutrition (stunting) in adolescents in Ethiopia was correlated with various school performance outcomes. This study was a school-based cross-sectional study conducted in North Shewa zone, Ethiopia. Data were collected through a structured questionnaire. The researchers conducted multivariable linear regression analyses to investigate the relationship between stunting and four school performance outcomes, which included grade 8 Ministry exam score, all-subjects average score, English score, and Math score. The prevalence of stunting in this sample was 11%. After adjusting for all other variables in the model, stunting was positively associated with the grade eight Ministry exam score (β = -4.96; 95% [CI -7.68, -2.25]; p < 0.001). In the multivariate analyses, sex (being female) was significantly associated with the grade eight Ministry exam score (β = -2.08; 95% CI [-3.81, -0.35]; p = 0.019 ), the all-subjects average score (β = -3.97; 95% CI [-5.51, -2.43]; p < 0.001), English score (β = -3.72; 95% CI [-5.60, -1.84]; p < 0 .001), and Math score (β = -4.87; 95% CI [-7.02, -2.72]; p < 0.001). Residence (living in a rural area) was significantly associated with all-subjects average score (β = -3.93; 95% CI [-5.81, -2.06]; p < 0.001), English score (β = -2.65; 95% CI [-4.94, -0.35]; p = 0.024), and Math score (β = -3.86; 95% CI [-6.50, -1.22]; p = 0.004). Maternal education (grade 1-8) was significantly associated with English score (β = 5.46; 95% CI [1.31, 9.62]; p = 0.010) and Math score (β = 4.78; 95% CI [0.03, 9.53]; p = 0.049). These findings indicate that further research focusing on adolescent chronic undernutrition and educational outcomes as well as why chronic undernutrition is associated with certain performance outcomes and not others is needed before definitive conclusions can be made. Positive changes in child growth later in a child’s life may have important implications for cognition. Key words: Adolescent health, Central Ethiopia, undernutrition, stunting, academic performance

Every drop matters: combining population-based and satellite data to investigate the link between lifetime rainfall exposure and chronic undernutrition in children under five years in rural Burkina Faso

Climate change is projected to induce extreme and irregular rainfall patterns in the West African Sahel region, affecting household food security and income. Children are among the worst affected population groups. Previous studies focusing on rainfall irregularities in specified periods have revealed how child health and nutritional status are impacted, especially in rural settings. However, the aggregated effect of rainfall over a lifetime on chronic child undernutrition remains poorly understood. We conducted a multilevel regression using a 2017 household survey from rural Burkina Faso containing 12 919 under-five-year-old children and their corresponding household rainfall data. The rainfall data originated from the Climate Hazards Infrared Precipitation with Stations monthly dataset with a native resolution of 4.8 km (0.05°). We show that an increase in rainfall below 75 mm monthly average tends to produce poor nutritional outcomes (regression coefficient = −0.11***; 95% CI = −0.13, −0.10; p < 0.001) in rural Burkina Faso children. We found a consistent negative relationship between different sex and household wealth groups, but not age groups. Vulnerable younger children were more affected by the adverse effects of increased rainfall, while older children seemed to handle it better. Our methodological approach tracing the impact of rainfall over children’s lifetimes makes a meaningful contribution to the portfolio of tools for studying the complex relationship between climate change and health outcomes. Our work confirms that rainfall is a risk factor for chronic child undernutrition, highlighting the need for adaptation strategies that boost household and community resilience to counteract the harmful impacts of climate change on child nutritional status.

Pemberdayaan Kelompok Ibu PKK Desa Bresela dalam Peningkatan Pengetahuan Gizi Seimbang untuk Pencegahan Stunting

Stunting is a linear growth disorder caused by chronic nutrient intake malnutrition and or chronic or recurrent infectious diseases as indicated by a z-score for height for age (TB/U) less than -2 standard deviations (SD) based on World Health Organization standards (WHO). Stunting describes chronic undernutrition status during growth and development since early life. The prevalence of stunting in Gianyar Regency, Bali Province in 2013 was 40.99%. One of the 10 villages at the locus of stunting in Gianyar Regency is Bresela Village. The main factor causing stunting in Gianyar district based on data verification from the District Health Office. Gianyar, among others: smoking habits, personal hygiene in food preparation, level of adequacy of vitamin A, and availability of clean water. The problems that are often found are the lack of knowledge, attitudes, and behavior of the community regarding balanced nutrition and stunting in toddlers, therefore, together with partners, community empowerment is carried out through counseling about balanced nutrition as an effort to prevent stunting. Based on the pre and posttest evaluations, it was found that the knowledge of the PKM partners had increased from before and after the education had increased significantly (p value = 0.000).&#x0D;

Indexing Estimates of GFR to Body Surface Area in Low-Resource Settings With a High Burden of Malnutrition: Evidence From Guatemala

Indexing Estimates of GFR to Body Surface Area in Low-Resource Settings With a High Burden of Malnutrition: Evidence From Guatemala

Association of trends in child undernutrition and implementation of the National Rural Health Mission in India: A nationally representative serial cross-sectional study on data from 1992 to 2015.

BackgroundIndia launched the National Rural Health Mission (NRHM) in 2005 to strengthen its primary healthcare system in high-focus and northeast-focus states. One of the NRHM objectives was to reduce child undernutrition in India.Methods and findingsWe used data from 1992, 1998, 2005, and 2015 National Family Health Survey (NFHS) of India to evaluate trends in child undernutrition prevalence before and after NRHM and across different categories of focus states. Stunting, Wasting, and Comprehensive Index of Anthropometric Failure (CIAF) were assessed using the World Health Organization (WHO) growth curves to assess chronic, acute, and overall undernutrition. The study included 187,452 children aged 3 years or under. Survey-weighted and confounder-adjusted average annualized reduction rates (AARRs) and predicted probability ratios were used to assess trends and socioeconomic disparities for child undernutrition, respectively. Nationwide, the prevalence of all types of undernutrition decreased from 1992 to 2015. However, the trends varied before and after NRHM implementation and differentially by focus states. After NRHM, acute undernutrition declined more rapidly among high-focus states (AARR 1.0%) but increased in normal-focus states (AARR −1.9% per year; p-value for the difference <0.001). In contrast, the prevalence of chronic undernutrition declined more rapidly (AARR 1.6%) in the normal-focus states in comparison to high-focus states (0.3%; p-value for the difference = 0.01). Income and caste-based disparities in acute undernutrition decreased but did not disappear after the implementation of the NRHM. However, similar disparities in prevalence of chronic undernutrition appear to be exacerbated after the implementation of the NRHM. Major limitations of this study include the observational and cross-sectional design, which preclude our ability to draw causal inferences.ConclusionsOur results suggests that NRHM implementation might be associated with improvement in wasting (acute) rather than stunting (chronic) forms of undernutrition. Strategies to combat undernutrition equitably, especially in high-focus states, are needed.

2012 Ritual Fluids in Relation to Early Child Nutrition in Quetzaltenango, Guatemala

Guatemala has the highest prevalence of one of the main forms of childhood malnutrition in Latin America, with 49% of children chronically undernourished, i.e., stunted. Bhutta et al2 show that education about complementary feeding can increase height-for-age Z score by 0.25. Nutrition-related interventions can also reduce stunting at 36 months by 36%, and mortality between birth and 36 months by about 25%. Adherence to the World Health Organization (WHO) Complementary Feeding Guidelines has also been shown to prevent weanling diarrhea. (The guidelines are related to better micronutrient status and growth.) In addition to having the highest chronic undernutrition in the Americas, Guatemala also scores most poorly on adherence to complementary feeding guidelines. Ruel and Menon attributed the low score for complementary feeding practices to the relative poverty of Guatemala. Together, lack of complementary feeding practices and poverty may explain Guatemala’s high rate of stunting as shown in the surveys included (42% and 39% in 1995 and 1999, respectively). On the other hand, recent research (completed and published), supported in part by a Sight and Life grant to the Center for Studies of Sensory Impairment, Aging and Metabolism (CESSIAM), shows that in Guatemala, the intakes of most micronutrients were near recommended levels.

Low height-for-age among Limbu and Mech children and adolescents from two districts of West Bengal, India

&#x0D; Background: Low height-for-age (stunting) is a state of chronic undernutrition in children and adolescents. Studies reported that India has very high prevalence of stunting in children, particularly from rural and tribal communities. Objective of the present study was to record prevalence of stunting in 6 to 18 year-old boys and girls from two tribal communities (Limbu and Mech) in Darjeeling and Alipurduar districts of West Bengal, India. The study also aimed to compare height-for-age of the participants with standard growth reference curves.&#x0D; Methods: In this cross-sectional study, the sample comprises 1523 individuals of both sexes from Limbu (377 boys, 379 girls) and Mech (365 boys, 402 girls) communities. Height data was normalized using LMS.&#x0D; Results: Overall frequency of stunting among 6 to 18 year-old boys (33%) and girls (34.7%) was remarkably high. Prevalence of stunting was higher in Limbu boys (43.5%) and girls (44.6%) than their age-peers from Mech community (boys 22.2%, girls 25.4%). Height data after normalization, shows that all centile curves of height of Limbu and Mech boys and girls are consistently below the standard height-for-age reference curves of the WHO. Limbu and Mech children appear to be taller with respect to their median (50th percentile) height when compared with the median height of children in the dataset of Indian Council of Medical Research.&#x0D; Conclusion: High frequency stunting in Mech and limbu children was recorded and situation of girls was worse. There was a tendency of decline in prevalence of stunting with advancement of age among children.&#x0D;

Hepatic PPARα Is Destabilized by SIRT1 Deacetylase in Undernourished Male Mice.

The nutrient sensing nuclear receptor peroxisome proliferator-activated receptor-α (PPARα) regulates the host response to short-term fasting by inducing hepatic transcriptional programming of ketogenesis, fatty acid oxidation and transport, and autophagy. This adaptation is ineffective in chronically undernourished individuals, among whom dyslipidemia and hepatic steatosis are common. We recently reported that hepatic PPARα protein is profoundly depleted in male mice undernourished by a low-protein, low-fat diet. Here, we identify PPARα as a deacetylation target of the NAD-dependent deacetylase sirtuin-1 (SIRT1) and link this to the decrease in PPARα protein levels in undernourished liver. Livers from undernourished male mice expressed high levels of SIRT1, with decreased PPARα acetylation and strongly decreased hepatic PPARα protein. In cultured hepatocytes, PPARα protein levels were decreased by transiently transfecting constitutively active SIRT1 or by treating cells with the potent SIRT1 activator resveratrol, while silencing SIRT1 increased PPARα protein levels. SIRT1 expression is correlated with increased PPARα ubiquitination, suggesting that protein loss is due to proteasomal degradation. In accord with these findings, the dramatic loss of hepatic PPARα in undernourished male mice was completely restored by treating mice with the proteasome inhibitor bortezomib. Similarly, treating undernourished mice with the SIRT1 inhibitor selisistat/EX-527 completely restored hepatic PPARα protein. These data suggest that induction of SIRT1 in undernutrition results in hepatic PPARα deacetylation, ubiquitination, and degradation, highlighting a new mechanism that mediates the liver's failed adaptive metabolic responses in chronic undernutrition.

Ingestion, Immunity, and Infection: Nutrition and Viral Respiratory Tract Infections.

Respiratory infections place a heavy burden on the health care system, particularly in the winter months. Individuals with a vulnerable immune system, such as very young children and the elderly, and those with an immune deficiency, are at increased risk of contracting a respiratory infection. Most respiratory infections are relatively mild and affect the upper respiratory tract only, but other infections can be more serious. These can lead to pneumonia and be life-threatening in vulnerable groups. Rather than focus entirely on treating the symptoms of infectious disease, optimizing immune responsiveness to the pathogens causing these infections may help steer towards a more favorable outcome. Nutrition may have a role in such prevention through different immune supporting mechanisms. Nutrition contributes to the normal functioning of the immune system, with various nutrients acting as energy sources and building blocks during the immune response. Many micronutrients (vitamins and minerals) act as regulators of molecular responses of immune cells to infection. It is well described that chronic undernutrition as well as specific micronutrient deficiencies impair many aspects of the immune response and make individuals more susceptible to infectious diseases, especially in the respiratory and gastrointestinal tracts. In addition, other dietary components such as proteins, pre-, pro- and synbiotics, and also animal- and plant-derived bioactive components can further support the immune system. Both the innate and adaptive defense systems contribute to active antiviral respiratory tract immunity. The initial response to viral airway infections is through recognition by the innate immune system of viral components leading to activation of adaptive immune cells in the form of cytotoxic T cells, the production of neutralizing antibodies and the induction of memory T and B cell responses. The aim of this review is to describe the effects of a range different dietary components on anti-infective innate as well as adaptive immune responses and to propose mechanisms by which they may interact with the immune system in the respiratory tract.

Early life migration and undernutrition among circular migrant children: An observational study in the brick kilns of Bihar, India.

BackgroundIndia holds the world's largest burden of chronic and acute child undernutrition. Poverty and systemic inequities are basic causes of undernutrition that also drive households to engage in circular migration for livelihood. Short-term, temporary movement of the whole family, including young children, is common; yet, the nutritional implications of recurrent movements beginning in early life has not been studied. We sought to estimate the association of repeat and early life migration with stunting and wasting outcomes among circular migrant children under three.MethodsUsing a stratified cluster design, we conducted two waves of primary data collection among 2564 randomly selected circular migrant children under three years of age temporarily residing across 1156 brick kilns in Bihar, India. We conducted multilevel modeling to estimate the association of the number of migration episodes and age at first migration with stunting (<-2 standard deviations (SD) height-for-age z scores (HAZ)) and wasting (<-2 SD weight-for-height z-scores (WHZ)) and examined the determinants of nutrition status among migrant children, including diet, illness, food security and the health environment.ResultsThe overall prevalence of stunting was 51.6%. Among children who were either born during migration or first migrated before six months of age, those who experienced multiple episodes of migration were more likely to be stunted compared to those who migrated once (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI) = 1.30-3.41). Children were over three times as likely to be wasted in the summer compared to the winter (aOR = 3.28; 95% CI = 2.68-4.01); in the summer, the overall prevalence of wasting was 38.8%. Public health access indicators such as interaction with frontline health workers at the destination was low (5.3%), whereas feeding indicators such as exclusive breastfeeding among 0-5 months was high (81.1%).ConclusionsPolicy efforts should ensure continuity of social protection and welfare entitlements between home and destinations for circular migrant families, with an explicit focus on rural-to-rural movement.

Underweight and associated factors among children under five years in North Shewa Zone, Oromia, Ethiopia: An observational community-based study

Background: Acute and chronic child undernutrition is a continuous problem in Ethiopia. Therefore, this study was initiated to compare the prevalence of underweight and its associated factors among children aged 6-23 months in the Kuyu district, North Shewa zone, Oromia, Ethiopia. Methods: An observational community-based study was conducted on 612 children (304 from household security and 308 from household food insecurity). A structured and standardize questionnaire was used in this study. Anthropometric measurements were generated using WHO standardize. Data was analyzed using SPSS version 20.0. Bivariate and multivariate logistic regression analysis was used to identify the independent variables associated with underweight (weight-for-age) among children in household food security and insecurity, a p value less than 0.05 with 95%CI was considered as statistically significant. Results: The results indicated that 30.9% [95%CI; 25.7, 36.2] and 36.7% [95% CI; 31.8, 42.5] of children were underweight for their age in household food security and insecurity. Low wealth status (AOR=3.2; 95%CI: 1.099, 9.275), poor dietary diets (AOR=5.2; 95%CI: 2.046, 13.27), and lack of breastfeeding for two years (AOR= 2.1; 95%CI= 1.78, 5, 42) were associated with underweight children in household food security. Whereas lack of antenatal care visits (AOR=0.52; 95%CI: 0.12, 0.68) and poor dietary diets (AOR=3.01; 95%CI= 2.1, 17.4) were other independent variables associated with underweight children in household food insecurity. Conclusions: This study established that there was a high prevalence of underweight in children from Oromia. Therefore, introducing household income generating activities are vital interventions in order to overcome the problem of undernutrition in this region.

Évolution du statut nutritionnel d’une cohorte d’enfants tunisiens au cours de l’hospitalisation : facteurs de risque de la dénutrition hospitalière

ObjectivesStudy the evolution of the nutritional status of a cohort of hospitalized children and identify the risk factors of hospital malnutrition. MethodsProspective, cross-sectional study carried out in a pediatric department over a period of six months, including all children aged≥30days, hospitalized for a period≥six days. Anthropometric data were assessed on admission and discharge. Food consumption was assessed using the flower tool. We identified the risk factors for hospital undernutrition (HUN) by multivariate analysis. ResultsWe included 120 patients with a mean age 46.3months. The prevalence of acute undernutrition at admission was 21.7% and that of chronic undernutrition was 10%. The prevalence of acute undernutrition at discharge rose to 34%. Weight loss during hospitalization was noted in 68.3% of cases. The prevalence of HUN was 55% considering a decrease in BMI or P/PAT z-score≥25%. The risk factors for HUN were: age≤24months (P=0.039; OR 95% CI=2.67 [1.05–6.82]), the presence of undernutrition on admission (P=0.002; OR 95% CI=2.32 [0.93–6.51]) and average food consumption<50% during hospitalization (P<10−3; OR 95% CI=6.69 [2.57–17.40]). ConclusionScreening for undernutrition on admission to hospital as well as assessment of the nutritional risk in hospitalized children is essential so that preventive or curative nutritional care can be taken.

Stunting Prevention Program of West Sumbawa Regency Health Office: A Qualitative Study in West Nusa Tenggara, Indonesia

BACKGROUND: Indonesia has included stunting in one of the Sustainable Development Goals targets. Stunting is a chronic undernutrition status during growth and development since early life which is caused by multidimensional factors. Prevalence of stunting rate in West Nusa Tenggara (NTB) remains high. AIM: This study aimed to determine the implementing process to stunting prevention program in West Sumbawa’s Public Health Office, NTB Province, Indonesia. METHODS: This was qualitative research design using case studies where the researcher carefully investigated a program, event, activity, process, or group of individuals. The population in this study were all staff of the West Sumbawa’s public health office, health facilities, and pregnant women in West Sumbawa Regency (KSB), NTB with purposive sampling. The data analysis was thematic analysis with the Colaizzi method. RESULTS: Stunting Prevention Programs in 2019, there were 11 priority programs that were approved by the Government and Regional Apparatus Organization outpatient department of KSB, five priority programs for the locus stunting in Maluk district and 10 recommendation programs through the APBDes in KSB, and the flagship program in KSB was the Hearth. Based on local food (Kelor), the implementation of two programs from five priority programs in Mantun Village did not successful like optimizing parenting classes and alert village forums had less success as the inhibiting factors being the lack of participation of community human resources. The achievement of stunting prevalence reduction in KSB in 2018–2020 decreasing from 32.6% to 12.3% in NTB Province. CONCLUSION: Program launched by West Sumbawa’s Public Health Office in 2019 has been running and implemented with several important notes related to community participation and monitoring from agencies related to the program that has been launched by the government KSB.

Estrogen for the Treatment of Low Bone Mineral Density in Anorexia Nervosa.

Anorexia nervosa is a disorder of chronic, self-induced negative energy balance which typically results in a low body weight. Functional hypothalamic amenorrhea is an adaptive response to states of negative energy balance and chronic undernutrition. A majority of women with anorexia nervosa are amenorrheic with resultant hypoestrogenemia, and longer durations of amenorrhea are associated with lower bone mineral density in this population. In this review, we highlight studies that have investigated the effects of estrogen replacement on bone mineral density in anorexia nervosa, including prospective and randomized studies that show no benefit to treatment with oral estrogen with respect to bone mineral density in either adolescent girls or women with anorexia nervosa. We also review data from a randomized, placebo-controlled study in adolescent girls and a prospective, open-label pilot study in women with anorexia nervosa suggesting that transdermal estrogen may have beneficial effects with respect to bone mineral density in this population.

The effect of short-term high-caloric feeding and fasting on bone microarchitecture.

States of chronic overnutrition and undernutrition are both associated with impaired bone health and increased fracture risk but there are no data on bone microarchitecture following short-term controlled nutritional challenges. The purpose of our study was to evaluate the impact of short-term high-caloric feeding and fasting on bone microarchitecture. We hypothesized that both high-caloric feeding and fasting would have negative effects on microarchitecture. We recruited 23 adult healthy subjects (13 males, 10 females, mean age 33.2±1.4years, mean BMI 26.0±1.5kg/m2). Subjects underwent an in-patient 10-day high-caloric visit (caloric intake with goal to achieve 7% weight gain), after which they went home to resume a normal diet for 13-18days (stabilization period), and were then readmitted for a 10-day in-patient fasting stay (no caloric intake). All subjects underwent HRpQCT (XtremeCT, Scanco Medical AG, Brüttisellen, Switzerland) of the distal tibia and distal radius after each visit to assess volumetric bone mineral density (vBMD), trabecular and cortical microarchitecture, and strength estimates. The Wilcoxon signed rank test was used to perform within group comparisons. During the high-caloric period, there was a mean increase in weight by 6.3+1.7% (p<0.0001). There were no significant changes in bone parameters in the distal tibia or distal radius (p>0.05). During the stabilization period there was a significant reduction in weight by -2.7+1.9% (p<0.0001) but no change in bone parameters (p>0.05). During the fasting period there was a further reduction in weight by -8.8+1.2% (p<0.0001). In the distal tibia, there was a significant increase in total and cortical vBMD, trabecular and cortical parameters as well as strength estimates (p<0.05). In the distal radius there was an increase in total and trabecular vBMD (p<0.05), while there were no changes in other microarchitecture parameters or strengths estimates. Short-term fasting after high-caloric feeding improves vBMD, bone microarchitecture and strength estimates of the distal tibia, while short-term high-caloric feeding does not change vBMD or microarchitecture. These results suggest that short-term fasting after high-caloric feeding in healthy individuals improves bone health and that these changes can be detected using HRpQCT in-vivo.

Association Between Household Food Insecurity and Nutritional Status Among Children of age

Household food insecurity (HFI) is considered one of the main risk factors of undernutrition. However, the evidence is not conclusive in our study settings. This study aimed to examine the association between HFI and nutritional status. It was a community-based cross-sectional observational study among children of age <5 years and their mothers (n = 257) conducted in a slum of Kolkata, West Bengal, carried out from March to May 2019. Data were analyzed using the Statistical Package for the Social Sciences software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the association. The current study found that 72.4% of participants living in food-insecure households and the proportion of underweight, wasting, and stunting among the under-five children found to be 29.9%, 17.8%, and 27.2%, respectively. Bivariate analysis showed wasting and stunting associated with HFI, whereas in multivariable regression, only stunting remained significant. Food insecurity (FI) remains a predictor of chronic undernutrition (wasting and stunting) highlighting the need for multisectoral strategies and policies to combat FI and multiple forms of malnutrition which will lay the foundation for sustainable and inclusive growth.

Assessment of nutritional status among adult Hos of Paschim Medinipur District, West Bengal, India

The tribal population in India, as per 2011 census is 104.3 million, constituting 8.6% of the total population. Overall, 89.97% of them live in rural areas. Nutrition has been a major health issue in India for centuries. Chronic hunger and under-nutrition are the worst tribulation of the poverty that still plagues millions of tribal households in India. The objective of this study was to assess the anthropometric characteristics and nutritional status of the population. The present cross-sectional study was carried out at 2 blocks (Debra and Dantan II) of Paschim Medinipur District, West Bengal, India. A total 392 adults (Female= 207; Male= 185) Ho tribal people were included in this study. The mean (SD) value of height (cm), weight (kg), mid-upper arm circumference [MUAC (cm)], body mass index [BMI (kg/m2)] was higher among males 159.68 (5.64), 54.53 (8.00), 24.79 (2.56) and 21.37 (2.85) respectively, than females 149.16 (5.42), 46.01 (7.98), 22.00 (2.76) and 20.65 (3.19). These values were statistically significant (p&lt;0.0001). Based on MUAC, the prevalence of undernutrition was higher among females (55.6%) than males (26.5%) and this was statistically significant (p&lt;0.001). However, based on BMI, the prevalence of undernutrition was higher among females (27.5%) than males (16.8%), which was statistically significant (p&lt;0.05) also. According to WHO classification of chronic energy deficiency (CED), the rate of under nutrition indicated a serious situation. Thus, to reduce the nutritional stress among this ethnic group, appropriate nutritional intervention programmes are needed to be initiated.

Nutritional Supplementation Would Be Cost-Effective for Reducing Tuberculosis Incidence and Mortality in India: The Ration Optimization to Impede Tuberculosis (ROTI-TB) Model.

Undernutrition is the leading cause of tuberculosis (TB) in India and is associated with increased TB mortality. Undernutrition also decreases quality of life and economic productivity. We assessed the cost-effectiveness of providing augmented rations to undernourished Indians through the government's Targeted Public Distribution System (TPDS). We used Markov state transition models to simulate disease progression and mortality among undernourished individuals in 3 groups: general population, household contacts (HHCs) of people living with TB, and persons living with human immunodeficiency virus (HIV). The models calculate costs and outcomes (TB cases, TB deaths, and disability-adjusted life years [DALYs]) associated with a 2600 kcal/day diet for adults with body mass index (BMI) of 16-18.4kg/m2 until they attain a BMI of 20kg/m2 compared to a status quo scenario wherein TPDS rations are unchanged. We employed deterministic and probabilistic sensitivity analyses to test result robustness. Over 5 years, augmented rations could avert 81% of TB cases and 88% of TB deaths among currently undernourished Indians. Correspondingly, this intervention could forestall 78% and 48% of TB cases and prevent 88% and 70% of deaths among undernourished HHCs and persons with HIV, respectively. Augmented rations resulted in 10-fold higher resolution of undernutrition and were highly cost-effective with (incremental cost-effectiveness ratio [ICER] of $470/DALY averted). ICER was lower for HHCs ($360/DALY averted) and the HIV population ($250/DALY averted). A robust nutritional intervention would be highly cost-effective in reducing TB incidence and mortality while reducing chronic undernutrition in India.

Influence of Household Remittance on Childhood Stunting in Nepal.

Migration is a livelihood strategy for many poor households in Nepal. About 56% of the households receive remittances, the country also has high rates of undernutrition as 36% of children under five years of age are stunted. Remittance are known to increase household income, potentially contributing to improvements in health and nutrition of children, but few studies have examined it in the Nepalese context. We used data of 2,498 children under 5 years of age from the Nepal Living Standard Survey 2010/11 to investigate associations between childhood stunting and household remittances. Multiple logistic regression was used to evaluate the odds of child stunting by remittances received by the families in the 12 months preceding the survey. Guided by a conceptual framework, the model was adjusted for variables representing child, maternal and household level characteristics. Our investigation showed that the odds of a child being stunted decreased with increased levels of remittance received by households, 67% (OR: 0.33, 95% CI: 0.16, 0.67) lower for households receiving more than Nrs.60,000 remittance per year. However, there was no difference in the risk of stunting by gender of the household head and income categories. An increased household income could potentially reduce the burden of chronic undernutrition in poor families in Nepal, which in turn paves a path for the expansion of cash transfer programs. Further research is indicated to understand the threshold of remittance or cash transfer needed to estimate nutritional outcomes.