Malnutrition Research Articles

Distribution and redistribution of salt ions in saline soils with shallow groundwater table

Saline water resources are more abundant than freshwater. Bringing these resources into sustainable, productive use will offer opportunities to reduce competition for freshwater resources, especially in arid and semi-arid areas where freshwater is scarce. Hence, the primary objective of this study was to elucidate the dynamics of salt ions in saline profiles of various soil types (sandy Clovelly and sandy loam Bainsvlei) under malt barley cultivation across 2 seasons where no leaching between the seasons took place. Results of this lysimeter study investigating increasing irrigation salinity (ECi) set at 1.5, 4.5, 6, 9, and 12 dSꞏm−1 over 2 seasons were used to explore ion dynamics of a saline environment. The lysimeter set-up included a saline constant (1.2 m) groundwater table with its salinity corresponding to ECi. Findings showed that ion concentrations are higher closer to the water source only in the Bainsvlei soil and remain variable in the Clovelly soil. Salt dynamics were more predictable in sandy loam soil than in sandy soil, making management of saline sandy soils far more challenging when leaching is not possible. Therefore, our hypothesis that the absence of leaching between seasons will lead to a differentiated progressive accumulation of salt ions in the soil profile, with variable effects on the soil depending on soil texture, was true. We conclude that the desalinized zone, which we determined to be at a depth of 600 mm, should be used to guide crop selection. Furthermore, in addition to the apparent provision for leaching of saline profiles, fertilization should target restoring ion balances, especially provisioning for calcium deficiencies. Both soils were prone to nutritional disorders, most especially calcium deficiency. Therefore, in addition to provision for leaching saline profiles, fertilization should target calcium provisioning for crop production in arid saline environments.

Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties: Study protocol.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &Revised (GMFCS-E&R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Malnutrition in infants aged 6-23 months in China’s poorest rural counties from 2016 to 2021: cross sectional study

ObjectivesTo assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China’s poorest rural counties.DesignSix consecutive cross sectional surveys were conducted annually.SettingThe study was...

Exploring Meditron-7b performance on a small-scale purpose made dataset in human nutrition queries

Abstract The interest in Large Languages Models (LLMs) has been rapidly evolving over the last years, boosting concerns about their potential to improve the efficiency and effectiveness of clinical, educational and research work in medicine. In this study, we aimed to test the performance of MEDITRON, a recently released suite of open-source LLMs with 7B parameters adapted to the medical domain, on a small sample of human nutrition queries. To facilitate our assessment, we curated a specialized dataset comprising a diverse range of human nutrition-related queries, which have been manually collected from various medical databases and nutrition exams. The dataset was adapted for the scope of our analysis to encompass variations in language complexity, query types, and semantic nuances commonly encountered in real-world settings. Additionally, to ensure a standardized and clinically relevant context for our evaluations, we engineered a specialized prompt designed to mimic interactions with a highly esteemed physician specializing in nutrition, food science, and diet-related disorders. The prompt guided the generation of nutrition-related queries in a structured format, enabling MEDITRON to provide responses consistent with the latest advancements in medical research. Our preliminary findings revealed promising capabilities of MEDITRON in understanding medical language, providing contextually appropriate responses to several human nutrition related questions. Through this study, we add valuable insights to the ongoing discussion around the deployment of LLMs in public health, highlighting their potential to improve access to essential human nutrition literacy. Key messages • Design of LLMs tools holds the potential to improve healthcare in clinical, research and education applications. • Further evidence is needed to foster their actual integration in real world settings.

Consumers’ attitudes towards healthy eating: a qualitative comparison between older and younger Chinese consumers

PurposeUnhealthy diets are associated with an increased risk of non-communicable diseases and present a significant public health challenge. When developing effective interventions and policies, consideration must be given to the unique social culture in which food choice is embedded. Health vulnerabilities to poor nutrition exist throughout life but may be influenced by socio-cultural factors such as age. This study aimed to assess the attitudes of older or younger Chinese consumers towards healthy eating and explore the factors influencing their food choices.Design/methodology/approachSemi-structured interviews were conducted in Wuhan, China, with 20 consumers aged 18–25 (Group A) and 20 consumers aged 65 and over (Group B).FindingsThematic analysis revealed that the two groups had positive attitudes towards healthy eating, although Group A participants were more knowledgeable. Time pressure, food prices and social networks differentially influence healthy eating practices across age groups.Originality/valueGiven China’s economic and cultural context, healthy eating interventions should consider the individual characteristics and food preferences of the different age groups. This approach can optimize targeted healthy eating interventions, and media communications related to healthy eating.

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.

A Decision Support System for Machine Learning-Based Determination of Zinc Deficiency: A Study in Adolescent Patients

Background: Over the past three years, zinc deficiency among adolescents has varied based on region and access to healthcare. Globally, zinc deficiency affects approximately 2 billion people, leading to serious issues such as immune problems and growth delays, particularly in developing countries. In the U.S., around 10% of adolescents experienced zinc deficiency in 2021, with a higher prevalence among teenage girls. In Europe, deficiency rates are generally low but can be significant in Eastern Europe and Central Asia. In Asia, particularly in rural and low-income areas, deficiency rates range from 20 - 30%. In Turkey, the prevalence is high due to poor nutrition. Objectives: This study aimed to develop a machine learning-based decision support system to determine zinc deficiency in children and adolescents aged 10 - 18 years. Methods: This machine learning-based study was conducted with 370 adolescents aged 10 - 18 years to assess their zinc deficiency. The dataset consists of 8 feature vectors and an output vector. The machine learning methods used in the analysis include Logistic Regression, Naive Bayes, Decision Tree (CART), K-NN (K-Nearest Neighbors), SVM (Support Vector Machine), Gradient Boosting Classifier, AdaBoost Classifier, Bagging Classifier, Random Forest Classifier, MLP Classifier (Multilayer Perceptron), and XGB Classifier (XGBoost Classifier). Evaluation metrics such as accuracy, precision, recall, and F1 score were used to assess the performance of these methods. Including specific values for these metrics, such as "SVM achieved 94.6% accuracy," would allow readers to quickly compare the effectiveness of the models. Different metrics serve various purposes: Accuracy provides an overall view of performance, precision and recall highlight specific aspects, and the F1 score balances precision and recall. Results: The mean age of the patients in the dataset was 13.79 ± 1.18 years. Of the children, 64.32% (n = 238) were female and 35.68% (n = 132) were male. It was found that 62.7% (n = 232) of the children had low zinc levels, while 37.3% (n = 138) did not require zinc supplementation. Thirteen different machine learning methods were applied to a 70% training and 30% testing set. As a result, the SVM method provided the most successful outcome with 94.6% accuracy. Implementing the SVM-based system in pediatric clinics could improve efficiency and patient care by automatically detecting high-risk zinc deficiency patients based on lab results, providing early intervention alerts for faster treatment, and improving health outcomes. Highlighting these practical applications could increase the study’s appeal to healthcare professionals by demonstrating its real-world benefits. Providing detailed information on these applications would enhance the study’s clarity and practical value, making it more valuable for researchers and healthcare providers interested in AI tools for adolescent health. Conclusions: This study concluded that machine learning methods can effectively determine zinc deficiency in children. The SVM method demonstrated superior classification performance compared to the other methods. An SVM-based decision support system could be integrated into pediatric outpatient clinics to enhance diagnostic accuracy and patient care.

Determinants of rural‑urban child malnutrition disparities in Ethiopia

Child malnutrition is a significant issue in Ethiopia, with high prevalence rates. However, there is limited information on the rural‑urban disparities in child malnutrition of all its forms (stunting, wasting, and underweight) in the country. Therefore, this study aimed to address this gap by analysing data from the 2019 Ethiopian Demographic Health Survey (EDHS). This study examined the rural‑urban child malnutrition gaps in Ethiopia using an extended Oaxaca-Blinder decomposition technique. The analysis reveals significant ruralurban disparities in prevalence rates of wasting, underweight, and stunting. The findings highlighted that children in rural areas are more malnourished than their urban counterparts. Additionally, the study identified key determinants of these disparities, including maternal and parental education, household economic status, women’s age at first birth, childbirth size, and working status of women. The results also indicate that institutional delivery, household size, and dependency ratio contribute to widening the rural‑urban disparities in child malnutrition. This study highlighted the importance of targeted policies and interventions to address these disparities and reduce child malnutrition at the national level.

Providing Advanced Processed Food in an Effort to Reduce Stunting Rates in Sigar Penjalin Village

Stunting is a nutritional problem in Indonesia for toddlers and toddlers which is characterized by a height that is shorter than the average age of other children, apart from that, a body weight that is not appropriate for age also affects the child's growth and development, so the child is said to be stunted. There are several problems that cause children to become stunted, not from the age of one year or 2 years, but from within the womb, such as a child in the stomach lacking nutrition and when the child is born, the child does not receive exclusive breast milk from the mother, so the nutrition of the food consumed is not paid attention to by the mother. it will be difficult for the child to develop. Stunting is also a common form of malnutrition in children. How to care is the most important thing to avoid inhibiting growth and development in children. This research aims to determine the number of stunting in toddlers and toddlers aged 20-49 months, and to seek changes to reduce the number of stunted children from the total data of 128 children in Sigar Penjalin village. This research uses qualitative research with a case study approach. Data was obtained by means of in-depth interviews and observations on 40 target children by collecting key information from the B2SA Sigar Penjalin food house, nutrition officers, and posyandu cadres, in areas throughout the Sigar Penjalin village hamlets. The results of the research using in-depth interviews were carried out in collaboration with Rumah Pangan B2SA Sigar Penjalin, following their program, namely providing 4 healthy 5 perfect breakfasts to 40 targets over a period of 3 times a week, 60 times. And our efforts are 6 times providing further preparations (providing vegetables as further preparations at home for children targeted at reducing stunting). Overall, it is hoped that the local government can pay more attention to the community to find out the causes of stunting earlier

Malnutrition and associated co-morbidities among infants affected by Boko Haram Insurgency in some IDP Camps in Borno state, Nigeria

Malnutrition is a major problem in developing countries. In recent times, diet related diseases have been recorded in Borno state, Nigeria due to insurgency. The study assessed the socio demographics and comorbidities in malnourished children from six months to fifty-nine months. Ethically approved permission was obtained. Retrospective cohort study of severe acute malnutrition was carried out in 1558 patients from January 2021 to December 2021 in five IDP camp clinics. The minimum and maximum stay in the program were 8 weeks and 12 weeks, respectively. Data collected were analysed using SPSS version 18. The female patients dominated the study with 868 (55.7 %) while the males were 690 (44.3 %). Patients who completed their treatment, recovered and were discharged were 1488 (95.5 %), defaulters were 64 (4.1 %) and deaths were 6 (0.4 %). The co-morbidities recorded in the SAM patients were cough, diarrhoea, vomiting and fever with 184 (11.8 %), 183 (11.7 %), 31 (2.0%) and 11 (7%), respectively. Severe acute malnutrition (SAM) patients with multiple co-morbidities of cough and diarrhoea were 136 (8.7 %) while those with cough, vomiting and diarrhoea were 5 (0.3%). Timely interventions can save the lives of children presenting with SAM and recommend that therapeutic feeding programs be extended to the wider society to prevent death and compromised future of SAM sufferers, effective nutritional education for care givers and parents of SAM children should be encouraged to stay in the program until their children recover.

Mediating between schools and families: experiences of teachers in privately-run migrant schools in South-West China

ABSTRACT This paper examines the experiences of 23 teachers who work in privately-run migrant schools (PMSs) in South-West China. Such schools cater for the needs of internal migrant children who do not often have access to free state education provision because of their lack of status in their new cities. We draw data from an ethnographic-informed qualitative study conducted in Guiyang City. The spillover effect as the theoretical lens, enables us to understand our participants’ experiences within and beyond the school gates. Different from existing research focusing on how home environment characteristics affect school-related outcomes, this study shifted towards investigating whether factors within the school domain can mitigate children’s home-related disadvantages or risks. The findings show that teachers support the students and their families by mediating family conflicts, supplementing often poor nutrition and assisting with homework. Overall, similar to educators in disadvantaged school settings elsewhere, the study demonstrates that teaching and managerial staff in PMSs go beyond their paid roles as educators and they are actively committed to breaking the cycle of poverty and transforming the lives of their students.

The Influence of Prenatal Vitamin use and Community Health Programs on Reducing Teratogenic Medication Exposure and Improving Perinatal Nutrition among African American Adolescents with Limited Access to Healthcare

This review paper examines the critical influence of prenatal vitamin use and community health programs on reducing teratogenic medication exposure and improving perinatal nutrition among African American adolescents with limited access to healthcare. African American adolescents face disproportionate barriers to healthcare access, including socioeconomic challenges and systemic healthcare inequities, which contribute to heightened risks of teratogenic exposure and poor prenatal nutrition. The paper explores the role of prenatal vitamins such as folic acid, iron, and calcium in preventing congenital disabilities and enhancing maternal health. It also highlights the impact of community-based health programs and education initiatives that aim to bridge healthcare gaps for vulnerable populations. By focusing on adolescent pregnancy in African American communities, this review identifies key challenges such as limited healthcare access, inadequate educational resources, and socio-economic constraints. Furthermore, the paper assesses the effectiveness of current health interventions and policies, offering recommendations for improving healthcare access and expanding community programs. The review underscores the necessity for long-term research to address gaps in the intersection of race, adolescent health, and prenatal care, ultimately aiming to inform policy and program development that promotes equitable maternal and fetal health outcomes.

Comparative Assessment of Fetal Malnutrition Using the Clinical Assessment of Nutritional Score and Anthropometry Among Newborns Delivered at Debre Markos Comprehensive Specialized Hospital, Ethiopia

Comparative Assessment of Fetal Malnutrition Using the Clinical Assessment of Nutritional Score and Anthropometry Among Newborns Delivered at Debre Markos Comprehensive Specialized Hospital, Ethiopia

Protein quality malnutrition.

Protein quality refers to the evaluation of a food or a diet based on its amino acid composition, protein digestibility, and protein bioavailability. When these parameters are specified, either through direct measurement or estimation, the amino acids provided by the diet are compared to those required by a healthy individual, and based on this comparison, an adequacy ratio or score is assigned. Two widely used protein quality scoring systems are the protein digestibility-corrected amino acid score (PDCAAS) and the digestible indispensable amino acid score (DIAAS), neither of which account for the dietary source of the protein. In malnourished children, metabolic adaptations reduce the endogenous availability of amino acids and increase the demand for protein synthesis. These increased amino acid requirements are primarily driven by the presence of acute infection and the need for tissue accretion. This review examines two large clinical feeding trials involving moderately malnourished children, where dietary protein quality was carefully measured. The finding s suggest that protein quality scores alone do not reliably predict weight gain or recovery in these children and that consuming milk protein provides distinct advantages over vegetable-based proteins.

Assessment of the Scholastic Performance and Cognitive Functions in Malnourished Children of Primary and Secondary Class Students

Abstract Background: Malnutrition is the consequence of a combination of deficiencies in protein, carbohydrates, and micronutrients. It includes undernutrition, overnutrition, and micronutrient deficiencies. Malnutrition is associated with both structural and functional pathology of the brain and reflects in poor scholastic performance and less cognitive functions in children. Aim: The aim of the study was to assess the scholastic performance and cognitive functions in malnourished children of primary and secondary classes studying in a school. Methodology: The study was conducted on 375 school children of primary and secondary classes. The nutritional status was assessed using the World Health Organization growth charts and classified based on their weight, height, and body mass index with malnutrition considered with values <−2 standard deviation for the age group. The scholastic performance was assessed using the school annual examination records and classified as good or poor scholastic performance with cutoff mark criteria of 50%. The cognitive function was assessed using the child mini–mental state examination (MMSE) test with the mean score for the age group. The scholastic performance and cognitive function were compared between the normal and malnourished groups. The variables were compared with respect to age, gender, standard, and P value obtained to see its significance. The variables were compared between the two groups in each class and test results were obtained. The correlation between each of the variables was also done. Results: Malnourished children were more in the primary classes (30%) than the secondary classes (13.2%). The scholastic performance in the normal group was increased than the malnourished group in both primary and secondary classes. The cognitive function based on the child MMSE score was also more in the normal group than in the malnourished group in both primary and secondary classes. There was a positive correlation between scholastic performance and cognitive function. Conclusion: The study results showed that the scholastic performance and cognitive function were decreased in the malnourished group than the normal group in both primary and secondary classes, implying that malnutrition affects the functionality of the brain and can cause long-term effects like poor cognition.

Effect of antenatal use of high energy nutritional supplements on cardio metabolic risk markers in underweight primi gravidas; a randomized controlled trial

BackgroudPregnancy is a state of increased metabolic demand, and poor maternal nutrition can exacerbate these changes, potentially increasing the risk of cardiometabolic disorders.This study is significant as it investigates the effect of high energy nutritional supplements on cardio metabolic risk markers in underweight primigravidas.MethodologyA single blinded randomized controlled trial was conducted from April 2018- August 2019 among the Pakistani tertiary care facilities of Khyber Pakhtunkhwa. A total of thirty six participants were randomized into two groups receiving either high energy nutritional supplement ‘MAAMTA’ or Placebo. They were instructed to take Placebo/Supplement alongside to their regular prenatal care and food from their first antenatal visit till a week postnatally. Anthropometric measurements and blood samples for biochemical parameters insulinlevels, fasting blood glucose & lipid profile were taken at baseline visit, between 16 and 20 weeks gestation and a post natal visit.ResultsThe two-way repeated measures ANOVA showed that there was a highly significant time effect on participant’s Insulin level (F (1.8, 53.6) = 10.64, P < 0 0.000, ηp2 = 0.269). A highly significant time effect on participant’s insulin resistance (F (2, 68) = 8.116,P < 0 0.001, ηp2 = 0.193) was also observed. There was a highly significant time effect on participant’s LDL level as well (F (2, 68) = 11.82, P < 0 0.000, ηp2 = 0.258).ConclusionSupplementation with high energy nutritional supplements may improve insulin levels and insulin sensitivity in underweight primigravidas.Trial registrationhttps://www.ClinicalTrials.govClinicalTrials.gov Identifier: ISRCTN 10088578. Registered on 27 March 2018. https://www.isrctn.com/ISRCTN10088578.

Cryptosporidium lysyl-tRNA synthetase inhibitors define the interplay between solubility and permeability required to achieve efficacy.

Cryptosporidiosis is a diarrheal disease caused by infection with Cryptosporidium spp. parasites and is a leading cause of death in malnourished children worldwide. The only approved treatment, nitazoxanide, has limited efficacy in this at-risk patient population. Additional safe therapeutics are urgently required to tackle this unmet medical need. However, the development of anti-cryptosporidial drugs is hindered by a lack of understanding of the optimal compound properties required to treat this gastrointestinal infection. To address this knowledge gap, a diverse set of potent lysyl-tRNA synthetase inhibitors was profiled to identify optimal physicochemical and pharmacokinetic properties required for efficacy in a chronic mouse model of infection. The results from this comprehensive study illustrated the importance of balancing solubility and permeability to achieve efficacy in vivo. Our results establish in vitro criteria for solubility and permeability that are predictive of compound efficacy in vivo to guide the optimization of anti-cryptosporidial drugs. Two compounds from chemically distinct series (DDD489 and DDD508) were identified as demonstrating superior efficacy and prioritized for further evaluation. Both compounds achieved marked parasite reduction in immunocompromised mouse models and a disease-relevant calf model of infection. On the basis of these promising data, these compounds have been selected for progression to preclinical safety studies, expanding the portfolio of potential treatments for this neglected infectious disease.

Determinants of stunting among children under 5 years in Bangladesh: a quantile regression analysis.

Child undernutrition is a major public health problem in developing countries that contributes to increased incidence of morbidity and mortality. Stunting is a valid and widely acknowledged measure of chronic child malnutrition. This study extracted data of 7778 under-5 children from the 2017-2018 Bangladesh Demographic and Health Survey and aims to explore the relationship between socio-demographic factors and the nutritional status of children under the age of 5. The anthropometric indicator height-for-age z-score (HAZ) was used as the target variable. The quantile regression method was employed to examine the heterogeneous relationship between the covariates and the conditional HAZ distribution across five different quantiles. This study found that 31.4% of children were severely to moderately stunted and a negative association between children's age and their HAZ. Additionally, children whose mothers had attained at least a secondary education exhibited a positive correlation with their HAZ. Another important factor was the mother's body mass index, which had a two-fold effect on the HAZ. Among the administrative divisions, children from the Sylhet division exhibited a negative association with the HAZ. Additionally, children with a high wealth index exhibited a positive association with the HAZ. Collaborative efforts from different organisations, as well as small and large communities in rural and urban areas, are necessary to improve nutritional status of children in Bangladesh.

Exploring value propositions and service innovation: the outsourcing of the National School Feeding Program

The National School Feeding Program, knowing as PNAE, is a public policy responsible for providing meals to students in Brazil. This program exists since 1940s and was created to combating child malnutrition. The program evolved over the years until the passing, on 16 June 2009, of Act 11,947, which establishes that at least 30% of food purchases for school meals must come from family farmers. In this context, there is a perception that outsourced management does not aim to encourage local agriculture, and consequently the use of fresh foods in school meals, which is recommended by Act 11,947. Therefore, the purpose of this article is to describe the forms of value co-creation in the PNAE outsourcing process in two cities that meet the requirements of Act 11,947. Then, a qualitative-descriptive study and abductive logic were chosen, using, as a strategy, a multiple-case study in the cities of Aracaju and Taubaté. The implementation of the PNAE by the municipality depends on the multiple influences and interventions, such as institutional values and relationships between stakeholders. Based on the understanding of this dynamic, the practices of the stakeholders involved in the management of the PNAE begin to organize a value proposition according to the students’ needs, promoting meaning and structure for its recipients. There are different ways to practice outsourcing in this program. So, these different possibilities make a study on this topic relevant, as it highlights that the positive results of outsourcing depend on the implementation of a well-planned project. Thus, use co-creation value, originally from Marketing Research, in public policy can bring new perspectives of analyses.