Early Childhood Undernutrition Research Articles

Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys.

Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.

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 >.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.

Nutritional status of young children born with low birthweight in a low resource setting: an observational study

ObjectiveEvery year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda.MethodsWe conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14.ResultsOf the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively.ConclusionSix of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.

LABOUR PRODUCTIVITY IN ADO-EKITI COMMUNITY: IMPLICATIONS FOR CHILDHOOD MALNUTRITION-MICRO VIEW PERSPECTIVES

Recent studies affirmed that inability for children in low-and-middle-income countries (rural area mostly concerned) to develop to their full cognitive potential and perhaps having adverse effects on physical and mental development, thus led to poor labour productivity in rural communities, had been traced to malnourished syndrome. Given this scenario, this paper is out to investigate the effect of childhood malnutrition on labour productivity as evidence in Ado-Ekiti community, Ekiti State, Nigeria using micro data analysis. The data was sourced from respondents across population samples (Ado Ekiti) State Capital of Ekiti State from Ekiti Central Senatorial District. The study was descriptive in nature. Simple random and purposive sampling techniques are used to select fifty (50) respondents out of 152 selected sampled. The research instrument adopted a wellstructured questionnaire for the study. The data gathered was analyzed using of simple percentage. Results from the study showed that under-nutrition (wasting, stunting and underweight), inadequate vitamins or minerals, overweight, obesity and mental health conditions are the prevalence of childhood malnutrition affecting labour productivity output of rural area in Ado Ekiti. Findings from the study indicates that under-nutrition in early childhood makes an individual more prone to non-communicable diseases later in life, including but not limited to diabetes and heart diseases that exhibits negative influence on labour productivity output in the communityAdo Ekiti; education gap and consequent lower skill-level of workforce substantially derail the development of countries affected by malnutrition; mortality and morbidity rates associated with malnutrition represented a direct loss in human capital and productivity of the economy as well as poor cognitive function and reduced school attainment that originate in early childhood undernutrition. Based on the findings of the study, it is therefore recommended that breast feeding mothers should be well educated on the significance of proper child breast feeding. This will go a long way to boost the immune system of the children and reduce illness, thus lead to labour productivity improvement of Ado Ekiti community’s growth and development and by extension to the country’s economy.

Associations between dental caries and ponderal growth in children: A Cambodian study

BackgroundThe evidence around the relationship between Early Childhood Caries (ECC) and undernutrition is sparse and mostly reported from cross-sectional data sets. This paper aimed to test the relationship between ECC and linear and ponderal growth trajectories.MethodsThis project involves secondary data analysis from the Cambodia Longitudinal Health and Nutrition Study. The analytical sample included a 2y-cohort of 894 children who were younger than 2 years of age at the time of first height and weight measurement. Statistical analysis used both logistic regression modelling and Latent Class Analysis to examine the effect of exposure to dental caries in the first 1000 days on weight for height Z-score (WHZ) and height for age Z-score (HAZ) trajectory class groups. The presence of any cavity and pulp involvement were examined using multinomial regression adjusting for gender, socioeconomic status, maternal age and education.FindingsWithin each class groupings (HAZ and WHZ groupings), there was a trend whereby those with one or more cavities had lower Z-scores across the three follow-up time points of observation. There was an association between exposure to caries and WHZ class membership whereby children with caries exposure were more likely belong to WHZ class groups with lower Z-scores over time.ConclusionsThe study offers evidence that ECC is correlated with less favourable ponderal growth categorized by WHZ trajectory class groups.

Early childhood undernutrition, preadolescent physical growth, and cognitive achievement in India: A population-based cohort study.

BackgroundThere is a lack of nationally representative estimates for the consequences of early childhood undernutrition on preadolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences.Methods and findingsIn this cohort study, we analyzed prospectively gathered data from 2 waves of the India Human Development Survey (IHDS) to investigate the association of undernutrition during early childhood (0 to 5 years) in 2004 to 2005 with physical and cognitive outcomes during preadolescent (8 to 11 years) years in 2011 to 2012. These surveys interviewed 41,554 households across all 33 states and union territories in India in 2004 to 2005 and reinterviewed 83% of the households in 2011 to 2012. Primary exposure was assessed using the Composite Index of Anthropometric Failure (CIAF) based on 2004 to 2005 survey. Primary outcomes were short stature (height-for-age z-score [HAZ] <−2), thinness (body mass index [BMI] <18.5 kg/m2), reading, and arithmetic skills during preadolescence based on the 2011 to 2012 survey. Survey-weighted generalized linear models were used, and effect modification based on child sex and sociodemographic variables were evaluated using 3-way interaction terms. Of the 7,868 children included in this analysis, 4,334 (57.3%) were undernourished. Being undernourished was associated with increased odds of short stature (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.45 to 2.06) and thinness (OR 1.52, 95% CI 1.33 to 1.73) during the preadolescent period, while it was associated with decreased odds of achieving a higher reading (cumulative odds ratio [cumOR]: 0.76, 0.66 to 0.87) and arithmetic (cumOR: 0.72, 0.63 to 0.82) outcomes. The disparity in outcomes based on CIAF increased with age, especially for female children. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Study limitations include observational and missing data, which limit our ability to draw strong causal inferences.ConclusionsIn this study, we found that early child undernutrition was associated with several adverse preadolescent physical and cognitive outcomes, especially among female children. Improved female education mitigates this association. Female education promotion should assume a central role in Indian public health policy making.

Association of Undernutrition and Neonatal, Infant and Under-5 Mortality: Evidence from 62 Low-Income and Middle-Income Countries

Abstract Objectives During the Millennium Development Goals (MDG) era, many low- and middle-income countries (LMICs) failed to achieve the MDG 4 of reducing neonatal, infant, and under-5 mortality. In this study, we aimed to assess whether reductions in early childhood undernutrition is associated with a reduction in neonatal, infant and under-5 mortality rate in LMICs. Methods We analyzed demographic and health household survey data from 62 LMICs collected between 2006 and 2018. The sample consisted of nationally representative cross-sectional surveys of children aged 0–59 months (n = 600,390). We examined country-level prevalence of stunting, wasting and underweight (based on z scores &amp;lt; −2 per the WHO Growth Standard) each as predictors of neonatal, infant and under-5 mortality incidence using multivariate Poisson regression models adjusted for country-level mean duration of breastfeeding and gross domestic product per capita. We also examined the association between breastfeeding and mortality. Results Overall, 28.4% (95% CI: 26.3%, 30.7%) of young children were stunted, 5.4% (95% CI: 4.5%, 6.6%) were wasted, 12.3% (95% CI: 10.4%, 14.6%) were underweight. Per 1000 live births, neonatal mortality was 23.6 (95% CI: 19.3–27.1), infant mortality was 43.4 (95% CI: 30.2–50.1) and under-5 mortality was 61.6 (95% CI: 55.3- 68.3). At the country level, a 10-fold decrease in stunting was associated with a relative risk (RR) of 0.81 (95% CI 0.66–0.98; P &amp;lt; 0.001) for neonatal mortality, 0.66 (95% CI 0.55–0.80; P &amp;lt; 0.001) for infant mortality, and 0.63 (95% CI 0.52–0.76; P &amp;lt; 0.001) for under-5 mortality. No association was seen between wasting or underweight and child mortality. Breastfeeding was associated with lower rates of child mortality. A one standard deviation (16 months) increase in breastfeeding was associated with a RR of 0.86 (95% CI 0.76–0.97; P = 0.015) for neonatal mortality, 0.79 (95% CI 0.70–0.89; P &amp;lt; 0.001) for infant mortality, and 0.75 (95% CI 0.67–0.85; P &amp;lt; 0.001) for under-5 mortality. Conclusions In a very large, multi-country sample of nationally-representative surveys in LMICs, stunting was strongly associated with child mortality from birth to 5 years. Stunting should be a focus in the effort to achieve the Sustainable Development Goal 3.2 target to reduce neonatal and under-5 mortality in all countries by 2030. Funding Sources National Institute of Health.

The Effect of Early Childhood Undernutrition on Pre-Adolescent Physical Growth and Cognitive Achievement: Results from India's First Nationally Representative Panel Dataset

Background: There is a lack of nationally representative estimates for the consequences of early child undernutrition on pre-adolescent outcomes in India. Understanding this relationship is helpful to develop interventions that not only prevent child undernutrition but also mitigate its consequences. Methods: Data from two waves of India Human Development, a nationally representative panel survey dataset was used to identify 7,868 children who were assessed for undernutrition during early childhood (0-5 years) in 2004-05 and later re-interviewed during their pre-adolescent (8-11 years) years in 2011-12. Early childhood undernutrition was assessed using the Composite Index of Anthropometric Failure (CIAF). Short stature (height-for-age z <-2), thinness (BMI <18·5 kg/m2), reading, and arithmetic skills during pre-adolescence were considered as outcomes. We used survey-weighted generalized linear models to determine the association between child undernutrition and pre-adolescent outcomes. We assessed differences in this association based on child sex and sociodemographic variables using three-way interaction terms. Results: CIAF increased the odds of short stature and thinness in the pre-adolescent period by 73% and 52%, respectively, while it decreased the odds of achieving a higher reading and arithmetic score by 20%. The disparity in outcomes based on CIAF increased with age, especially for girls. Increased level of female education within the household reduced the disadvantages of undernutrition among female children. Discussion: Early child undernutrition is associated with several adverse pre-adolescent physical and cognitive outcomes, especially among female children. Improved female education can mitigate these consequences. Female education promotion should assume a central role in Indian public health policy-making. Funding Statement: AS received support from the National Institute of General Medical Science (T32GM107000), National Center for Advancing Translational Sciences (TL1-TR001454) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1F30HD091975-03). TMS received support from the National Center for Chronic Disease Prevention and Health Promotion (5U01DP006093-04). JA received support from the National Institute on Minority Health and Health Disparities (P60-MD006912-05). JAF received support from the National Institute of Health (R01 HD092374-03), and the National Institute of Child Health and Human Development (UH3OD023348-03). Declaration of Interests: The authors have indicated they have no potential conflicts of interest to disclose. Dr. Frazier has had research support from F. Hoffmann-La Roche Ltd., Fulcrum Therapeutics, Janssen Research & Development, LLC, and has served as a consultant for Takeda Pharmaceuticals. However, these activities were not related to the research contained in this manuscript. Ethics Approval Statement: The IRB at the University of Massachusetts Medical School reviewed the protocol and exempted it from full committee review because the publicly available data contained no personal identifiable information on survey participants.

Prevalence of underweight, wasting and stunting among young children with a significant cognitive delay in 47 low-income and middle-income countries.

Undernutrition in early childhood is associated with a range of negative outcomes across the lifespan. Little is known about the prevalence of exposure to undernutrition among young children with significant cognitive delay. Secondary analysis of data collected on 161188 three- and four-year-old children in 47 low-income and middle-income countries in Rounds 4-6 of UNICEF's Multiple Indicator Cluster Surveys. Of these, 12.3% (95% confidence interval 11.8-12.8%) showed evidence of significant cognitive delay. In both middle-income and low-income countries, significant cognitive delay was associated with an increased prevalence of exposure to three indicators of undernutrition (underweight, wasting and stunting). Overall, children with significant cognitive delay were more than twice as likely than their peers to be exposed to severe underweight, severe wasting and severe stunting. Among children with significant cognitive delay (and after controlling for country economic classification group), relative household wealth was the strongest and most consistent predictor of exposure to undernutrition. Given that undernutrition in early childhood is associated with a range of negative outcomes in later life, it is possible that undernutrition in early childhood may play an important role in accounting for health inequalities and inequities experienced by people with significant cognitive delay in low-income and middle-income countries.

Young Mom, Short Kid: Examining Social, Biological and Health and Nutrition Service Factors Linking Adolescent Pregnancy to Early Childhood Undernutrition in India (P10-011-19)

ObjectivesAdolescent pregnancy is a global public health concern and one in five adolescents live in India, where early marriage is widely practiced. We sought to examine linkages between adolescent pregnancy and child undernutrition using a holistic approach. MethodsData were from India’s 2015–2016 National Family Health Surveys. Primiparous women aged 15–49 years who gave birth between 2010 and 2015 (n = 60,096) were classified based on age at first birth: ≤19 years (adolescence), 20–24 years (young adulthood), and ≥25 years (adulthood). Multivariable regression and structural equation models were used to understand how adolescent pregnancy is linked to child undernutrition through women’s education and bargaining power, nutritional status, health service use, child feeding and living conditions. ResultsOverall, 24% of first births among Indian women aged 15–49 years in 2016 occurred during adolescence, with large state and district variability (from 4% to 45% for states and 1% to 62% for districts). Compared to children born to adult mothers, those born to adolescent mothers had lower z-scores for height-for-age (mean difference: -0.53 SD), weight-for-age (-0.40 SD), and weight-for-height (-0.16 SD). Compared to adult mothers, adolescent mothers were shorter (-1.2 cm), more likely to be underweight (+ 18%) and anemic (+ 8%), had lower education (-3.0 years), less bargaining power (-7% to -15%), and lived in poorer households (-0.66 SD) with poorer sanitation (-28%). Adolescent mothers were less likely to access health services (-4% to -15%) and had poorer complementary feeding practices (-3% to -9%). These intermediate factors were predictive of child anthropometry, with the strongest links being women’s education, socioeconomic status, and weight. ConclusionsAdolescent pregnancy is related to maternal nutritional status, education, access to nutrition and health services, complementary feeding practices, and living conditions; together, these are associated with child undernutrition. Policies and programs to delay marriage are likely to help break the intergenerational cycle of poverty and undernutrition in India. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

Predictors of early childhood undernutrition in Nigeria: the role of maternal autonomy.

To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged &lt;2 years in Nigeria, considering the cultural context and sociodemographic factors. Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling. 2013 Nigerian Demographic Health Survey. Children aged between 3 and 24 months (n 7532). Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity. Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

Social, biological, and programmatic factors linking adolescent pregnancy and early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey

SummaryBackgroundAdolescent pregnancy and child undernutrition are major social and public health concerns. We aimed to examine associations between adolescent pregnancy and child undernutrition in India, where one in five adolescents live, and one in three of the world's stunted children.MethodsData were from India's fourth National Family Health Survey, 2015–16. Primiparous women aged 15–49 years who gave birth between 2010 and 2016 were classified on the basis of age at first birth: 10–19 years (adolescence), 20–24 years (young adulthood), and 25 years or older (adulthood). Primary outcomes were anthropometric measures of offspring undernutrition. Multivariable regression and structural equation models were used to understand the extent to which these measures were linked to adolescent pregnancy and the potential social, biological, and programmatic pathways.FindingsOf the 60 096 women in the sample, 14 107 (25%) first gave birth during adolescence. Children born to adolescent mothers had lower Z scores for length or height-for-age (mean difference −0·53 SD), weight-for-age (–0·40 SD), and weight-for-length or height (–0·16 SD) than children born to adult mothers. Compared with adult mothers, adolescent mothers were shorter (–1·21 cm, 95% CI −1·78 to −0·65), more likely to be underweight (18 percentage points, 15–21) and anaemic (8 percentage points, 6–11), less likely to access health services (–4 to −15 percentage points), and had poorer complementary feeding practices (–3 to −9 percentage points). Adolescent mothers also had less education (–3·30 years, 95% CI −3·68 to −2·91), less bargaining power (–7 to −15 percentage points), and lived in poorer households (–0·66 SD, 96% CI −0·82 to −0·50) with poorer sanitation (–28 percentage points, −32 to −24). In the path analysis, these intermediate factors predicted child anthropometry, with the strongest links being mother's education (18%), socioeconomic status (13%), and weight (15%).InterpretationChildren born to adolescent mothers are at risk of being undernourished. Adolescent pregnancy is related to child undernutrition through poor maternal nutritional status, lower education, less health service access, poor complementary feeding practices, and poor living conditions. Policies and programmes to delay pregnancy and promote women's rights could help break the intergenerational cycle of undernutrition through many routes.FundingBill & Melinda Gates Foundation through Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India, led by the International Food Policy Research Institute.

Heterogeneity in the effect of mid-childhood height and weight gain on human capital at age 14-15 years: Evidence from Ethiopia, India, Peru, and Vietnam.

BackgroundUnder-nutrition in early childhood has harmful impacts on human capital formation in children, with implications for educational, adult health, and labor market outcomes. We investigate the association of linear growth and weight gain in mid-childhood with years of schooling, the Peabody Picture Vocabulary Test score, and math test score during the adolescent age of 14–15 years.MethodsData were derived from the Young Lives study conducted in four low- and middle-income countries (Ethiopia, India, Peru, and Vietnam). The data had detailed information on the children anthropometry and characteristics of the child, household, and community. Multivariate regression analysis, adjusted for the confounding variables, was used to investigate the association between mid-childhood health, measured by conditional linear growth and relative weight gain, and human capital outcomes in adolescent age.ResultsAfter controlling for several confounders, one cm increase in conditional linear growth increased years of schooling by 0.034 years and the Peabody Picture Vocabulary Test score and math test score by 0.474 and 0.083 points respectively. Relative weight gain was negatively associated with years of schooling and math test score. There is no evidence of heterogeneous effects by rural, gender, and household wealth. In the quantile regression analyses, the association between conditional linear growth and outcomes is stronger at the lower level of years of schooling and the Peabody Picture Vocabulary Test score.ConclusionOur study highlights that mid-childhood nutritional intervention targeted for students at the lower level of education distribution can accelerate the rate of human capital accumulation in low- and middle-income countries.

The effect of childhood stunting and wasting on adolescent cardiovascular diseases risk and educational achievement in rural Uganda: a retrospective cohort study

ABSTRACTBackground: Little is known about the long-term effects of early childhood undernutrition on adolescent cardiovascular disease risk and educational performance in low-income countries. We examined this in a rural Ugandan population.Objective: To investigate if stunting or wasting among children aged 2–5 years is associated with cardiovascular disease risk or educational achievement during adolescence.Methods: We conducted analyses using data from a cohort of children followed from early childhood to adolescence. Weight and height were measured in 1999–2000 when the children were 2–5 years of age and repeated in 2004/2005 and 2011. We compared cardiovascular disease risk parameters (mean blood pressure, lipids, HbA1c) and schooling years achieved in 2011 among 1054 adolescents categorised into four groups: those who experienced stunting or wasting throughout follow-up; those who recovered from stunting or wasting; those who were normal but later became stunted or wasted; and those who never experienced stunting or wasting from childhood up to adolescence. We controlled for possible confounding using multiple generalised linear regression models along with Generalised Estimating Equations to account for clustering of children within households.Results: Wasting was negatively associated with systolic blood pressure (−7.90 95%CI [−14.52,-1.28], p = 0.02) and diastolic blood pressure (−3.92, 95%CI [−7.42, −0.38], p = 0.03). Stunting had borderline negative association with systolic blood pressure (−2.90, 95%CI [−6.41, 0.61] p = 0.10). Recovery from wasting was positively associated with diastolic blood pressure (1.93, 95%CI [0.11, 3.74] p = 0.04). Stunting or wasting was associated with fewer schooling years.Conclusion: Recovery from wasting rather than just an episode in early childhood is associated with a rise in blood pressure while educational achievement is compromised regardless of whether recovery from undernutrition happens. These findings are relevant to children exposed to undernutrition in low-income settings.

Assessment of dietary pattern of school going adolescents in a metro city: a cross sectional study

Background: Childhood is considered as one of the most vulnerable age group, since, in developing country like India due to poverty and a particular socio-cultural pattern. Epidemiological evidences suggest a strong link between maternal and early childhood undernutrition and increased adult risk of various chronic diseases. The present study aims at assessment of assessment of dietary pattern of school going adolescent.Methods: The present cross-sectional study was conducted among 440 school going children of class 9th,10th,11th,12th in a Government School at Kolkata, over a period of 6 months. The study participants were interviewed and their responses regarding their dietary patterns, habits, and knowledge about healthy dietary practices were noted down using pre-validated case record proforma. Their anthropometric records were also noted. Statistical analysis used: All the data was entered using Microsoft Excel software and analyzed using appropriate statistical tests with the help of SPSS statistical software.Results: Majority of children (50%) belonged to age group of 15-16yrs. The present study finds 48% prevalence of overnutrition and 12% undernutrition in school children.Conclusions: Developing countries like India shows the double burden of nutritional disorders, undernutrition as well as overnutrition due to limited availability of resources on one hand and western food habits, junk/fast food habits on the other hand respectively.

Effect of maternal height on caesarean section and neonatal mortality rates in sub-Saharan Africa: An analysis of 34 national datasets.

RationaleThe lifecycle perspective reminds us that the roots of adult ill-health may start in-utero or in early childhood. Nutritional and infectious disease insults in early life, the critical first 1000 days, are associated with stunting in childhood, and subsequent short adult stature. There is limited or no opportunity for stunted children above 2 years of age to experience catch-up growth. Some previous research has shown short maternal height to lead to adverse birth outcomes. In this paper, we document the association between maternal height and caesarean section, and between maternal height and neonatal mortality in 34 sub-Saharan African countries. We also explore the appropriate height cut-offs to use. Our paper contributes arguments to support a focus on preventing non-communicable risk factors, namely early childhood under-nutrition, as part of the fight to reduce caesarean section rates and other adverse maternal and newborn health outcomes, particularly neonatal mortality. We focus on the Sub-Saharan Africa region because it carries the highest burden of maternal and neonatal ill-health.MethodsWe used the most recent Demographic and Health Survey for 34 sub-Saharan African countries. The distribution of heights of women who had given birth in the 5 years before the survey was explored. We adopted the following cut-offs: Very Short (<145.0cm), Short (145.0–149.9cm), Short-average (150.0–154.9cm), Average (155.0–159.9cm), Average-tall (160.0–169.9cm) and Tall (≥170.0cm). Multivariate logistic regression was used to assess the contribution of maternal stature to the odds ratio of caesarean section delivery, adjusting for other exposures, such as age at index birth, residence, maternal BMI, maternal education, wealth index quintile, previous caesarean section, multiple birth, birth order and country of survey. We also look at its contribution to neonatal mortality adjusting for age at index birth, residence, maternal BMI, maternal education, wealth index quintile, multiple birth, birth order and country of survey.ResultsThere was a gradual increase in the rate of caesarean section with decreasing maternal height. Compared to women of Average height (155.0–159.9cm), taller women were protected. The adjusted odds ratio (aOR) for Tall women was 0.67 (95% CI:0.52–0.87) and for Average-tall women was 0.78 (95% CI:0.69–0.89). Compared to women of Average height, shorter women were at increased risk. The aOR for Short-average women was 1.19 (95% CI:1.03–1.37), for Short women was 2.06 (95% CI:1.71–2.48), and for Very Short women was 2.50 (95% CI:1.85–3.38). There was evidence that compared to Average height women, Very Short and Short women had increased odds of experiencing a neonatal death aOR = 1.95 (95% CI 1.17–3.25) and aOR = 1.66 (95% CI 1.20–2.28) respectively. When we focused on the period of highest risk, the day of delivery and first postnatal day, these aORs increased to 2.36 (95% CI 1.57–3.55) and 2.34 (95% CI 1.19–4.60) respectively. The aORs for the first week of life (early neonatal mortality) were 1.90 (95% CI 1.07–3.36) and 1.83 (95% CI 1.30–2.59) respectively.ConclusionsShort stature is associated with an increased prevalence of caesarean section and neonatal mortality, particularly on the newborn’s first days. These results are even more striking because we know that caesarean section rates tend to be higher among wealthier and more educated women, who are often taller and that the same patterns may hold for neonatal survival; in such cases, adjusting for wealth, education and urban residence would attenuate these associations. Caesarean sections can be lifesaving operations; however, they cost the health system and families more, and are associated with worse health outcomes. We suggest that our findings be used to argue for policies targeting stunting in infant girls and potential catch-up growth in adolescence and early adulthood, aiming to increase their adult height and thus decrease their subsequent risk of experiencing caesarean section and adverse birth outcomes.

Effect of correcting for gestational age at birth on population prevalence of early childhood undernutrition

BackgroundPostmenstrual and/or gestational age-corrected age (CA) is required to apply child growth standards to children born preterm (< 37 weeks gestational age). Yet, CA is rarely used in epidemiologic studies in low- and middle-income countries (LMICs), which may bias population estimates of childhood undernutrition. To evaluate the effect of accounting for GA in the application of growth standards, we used GA-specific standards at birth (INTERGROWTH-21st newborn size standards) in conjunction with CA for preterm-born children in the application of World Health Organization Child Growth Standards postnatally (referred to as ‘CA’ strategy) versus postnatal age for all children, to estimate mean length-for-age (LAZ) and weight-for-age (WAZ) z scores at 0, 3, 12, 24, and 48-months of age in the 2004 Pelotas (Brazil) Birth Cohort.ResultsAt birth (n = 4066), mean LAZ was higher and the prevalence of stunting (LAZ < −2) was lower using CA versus postnatal age (mean ± SD): − 0.36 ± 1.19 versus − 0.67 ± 1.32; and 8.3 versus 11.6%, respectively. Odds ratio (OR) and population attributable risk (PAR) of stunting due to preterm birth were attenuated and changed inferences using CA versus postnatal age at birth [OR, 95% confidence interval (CI): 1.32 (95% CI 0.95, 1.82) vs 14.7 (95% CI 11.7, 18.4); PAR 3.1 vs 42.9%]; differences in inferences persisted at 3-months. At 12, 24, and 48-months, preterm birth was associated with stunting, but ORs/PARs remained attenuated using CA compared to postnatal age. Findings were similar for weight-for-age z scores.ConclusionsPopulation-based epidemiologic studies in LMICs in which GA is unused or unavailable may overestimate the prevalence of early childhood undernutrition and inflate the fraction of undernutrition attributable to preterm birth.

Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal

ABSTRACTBackgroundPrevalence of young adult hearing loss is high in low-resource societies; the reasons for this are likely complex but could involve early childhood undernutrition.ObjectiveWe evaluated preschool childhood stunting, wasting, and underweight as risk factors for hearing loss in young adulthood in Sarlahi District, southern Nepal.DesignEar health was assessed in 2006–2008 in a cohort of 2193 subjects aged 16–23 y, who as children <60 mo of age participated in a 16-mo placebo-controlled, randomized vitamin A supplementation trial from 1989 to 1991. At each of five 4-mo assessments, field staff measured children's weight, height, and mid-upper arm circumference (MUAC) and recorded validated parental history of ear discharge in the previous 7 d. Children were classified as stunted [<–2 z score height-for-age (HAZ)], underweight [<–2 z score weight-for-age (WAZ)], or wasted [<–2 z score MUAC-for-age (MUACAZ) or body mass index-for-age (BMIAZ)]. At follow-up, hearing was tested by audiometry and tympanometry, with hearing loss defined as pure-tone average >30dB in the worse ear (0.5, 1, 2, 4 kHz) and middle-ear dysfunction as abnormal tympanometric peak height (<0.3 or >1.4 mmho) or width (<50 or >110 daPa).ResultsHearing loss, present in 5.9% (95% CI: 5.01%, 7.00%) of subjects, was associated with early childhood stunting (OR: 1.64; 95% CI: 1.10, 1.45), underweight (OR: 1.70; 95% CI: 1.18, 2.44) and wasting by BMIAZ (OR: 1.88; 95% CI: 1.19, 2.97) and MUACAZ (OR: 2.14; 95% CI: 1.47, 3.12). Abnormal tympanometry, affecting 16.6% (95% CI: 15.06%, 18.18%), was associated with underweight (OR: 1.46; 95% CI: 1.16, 1.84) and wasting by BMIAZ (OR: 1.80; 95% CI: 1.32, 2.46) and MUACAZ (OR: 1.42; 95% CI: 1.10, 1.84), but not stunting (OR: 1.18; 95% CI: 0.93, 1.49) in early childhood. Highest ORs were observed for subjects with both hearing loss and abnormal tympanometry, ranging from 1.87 to 2.24 (all lower 95% CI >1.00).ConclusionsEarly childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.

Heterogeneity in predictive power of early childhood nutritional indicators for mid-childhood outcomes: Evidence from Vietnam

We utilize longitudinal data on nearly 1800 children in Vietnam to study the predictive power of alternative measures of early childhood undernutrition for outcomes at age eight years: weight-for-age (WAZ8), height-for-age (HAZ8), and education (reading, math and receptive vocabulary). We apply two-stage procedures to derive unpredicted weight gain and height growth in the first year of life. Our estimates show that a standard deviation (SD) increase in birth weight is associated with an increase of 0.14 (standard error [SE]: 0.03) in WAZ8 and 0.12 (SE: 0.02) in HAZ8. These are significantly lower than the corresponding figures for a SD increase in unpredicted weight gain: 0.51 (SE: 0.02) and 0.33 (SE: 0.02).The heterogeneity of the predictive power of early childhood nutrition indicators for mid-childhood outcomes reflects both life-cycle considerations (prenatal versus postnatal) and the choice of anthropometric measure (height versus weight). Even though all the nutritional indicators that involve postnatal nutritional status are important predictors for all the mid-childhood outcomes, there are some important differences between the indicators on weight and height. The magnitude of associations with the outcomes is one aspect of the heterogeneity. More importantly there is a component of height-for-age z-score (at age 12 months) that adds predictive power for all the mid-childhood outcomes beyond that of birth weight and weight gain in the first year of life.

Risk Factors of Underweight in Children Aged 6-59 Months in Ethiopia.

Background Undernutrition in early childhood has irreversible and long-lasting implications. Hence, this study was aimed at assessing risk factors of child undernutrition. Methods A community-based cross-sectional study was conducted on 642 households with mothers to children pairs aged 6–59 months selected by a multistage systematic random sampling method. Child anthropometric measurements on weight were recorded using standardized and calibrated weighing scales. Weight-for-age was compared to the 2007 WHO growth reference by WHO Anthro software. Data were entered using Epi-Info and analyzed using SPSS. Bivariate and multivariate logistic regression analyses were used to evaluate the association between underweight children and their predictors; both crude and adjusted odds ratios with 95% confidence interval were reported. Results One-fourth (25%) of the children were underweight. Child age (AOR: 2.36), gender (AOR: 1.82), illness (AOR: 0.09), maternal decision making power (AOR: 0.07), maternal education (AOR: 0.19), employment/occupation (AOR: 5.29), and household income (AOR: 4.16) were found to be independent and significant predictors of underweight children. Conclusion Significant proportion of the children were underweight. Maternal decision-making power persists as a strong predictor of children's weight. Therefore, intervention programs focusing on improving mothers' decision-making power on child nutrition would contribute to the efforts towards alleviating the problem.