Health Organization Child Growth Standards Research Articles

Association Between Breastfeeding and Child Stunting in Mexico.

Background:Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting.Objective:To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico.Methods:Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors.Findings:Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models.Conclusions:According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

High Burden of Undernutrition among At-Risk Children in Neonatal Follow-Up Clinic in Rwanda.

Background:Sufficient knowledge of the disproportionate burden of undernutrition among vulnerable children is required for accelerating undernutrition reduction in low-income countries.Objectives:We aimed to assess the prevalence of stunting, underweight and wasting and associated factors among high-risk children born preterm, with low birth weight or other birth and neurodevelopmental injuries, who received nutritional support and clinical care follow-up in a Pediatric Development Clinic (PDC) in rural Rwanda.Methods:This cross-sectional study included all children from rural areas enrolled in PDC between April 2014–September 2017 aged 6–59 months at their last visit during this period. Anthropometric measurements, socioeconomic and clinical characteristics were extracted from an electronic medical records system. We used the World Health Organization child growth standards to classify stunting, underweight and wasting. Factors associated with undernutrition were identified using logistic regression analysis.Results:Of 641 children, 58.8% were stunted, 47.5% were underweight and 25.8% were wasted. Small for gestational age was associated with increased odds of stunting [OR 2.63; 95% CI 1.58–4.36] and underweight (OR 2.33; 95% CI 1.46–3.71), while history of feeding difficulties was significantly associated with wasting (OR: 3.36; 95% CI: 2.20–5.13) and underweight (OR: 2.68; 95% CI: 1.78–4.04). Later age at PDC enrollment was associated with increased odds of stunting (OR: 1.06; 95% CI: 1.01–1.11), underweight (OR: 1.09; 95% CI: 1.05–1.14) and wasting (OR: 1.07; 95% CI: 1.04–1.10).Conclusions:The prevalence of stunting, underweight and wasting are high in this at-risk population, highlighting the need for specific interventions to address undernutrition among children with similar characteristics. Early PDC enrollment of high-risk infants may reduce undernutrition risk.

Child HIV Exposure and CMV Seroprevalence in Botswana: No Associations With 24-Month Growth and Neurodevelopment.

BackgroundWe sought to identify predictors of child cytomegalovirus (CMV) infection overall and by maternal HIV status and to assess associations of child CMV status with growth and neurodevelopmental outcomes at 24 months of age in Botswana.MethodsData and samples were used from the Botswana-based observational Tshipidi study (2010–2014), enrolling pregnant women living with and without HIV and following their infants through 2 years of age. Child plasma samples were tested at 18 months of age for anti-CMV immunoglobulin G (IgG). Associations were assessed between detectable anti-CMV IgG and growth (using the World Health Organization Child Growth Standards) and neurodevelopment (using the Bayley Scales of Infant and Toddler Development III and the Developmental Milestones Checklist) at 24 months of age.ResultsOf 317 children, 215 (68%) had detectable anti-CMV IgG at 18 months of age. Comparatively, 83% (n = 178) of HIV-unexposed uninfected (HUU) children had positive CMV serology vs 47% (n = 139) of HIV-exposed uninfected (HEU) children (P < .01); 100% of HUU vs 10.5% of HEU children breastfed. Child CMV infection was not associated with weight-for-age, weight-for-length, or length-for-age z-scores at 24 months. In HUU children, CMV infection was associated with smaller head circumference (P < .01). No difference was observed by child CMV status in any neurodevelopmental domain at 24 months.ConclusionsWe observed high CMV seropositivity in 18-month-old children in Botswana, with higher seropositivity among breastfed (HUU) children. Positive CMV serostatus was not associated with 24-month child growth or neurodevelopmental outcomes, with the exception of smaller head circumference among HUU CMV-positive children.

Urinary arsenic is associated with wasting and underweight status in young children in rural Bangladesh

BackgroundDeficits in child growth are associated with poor cognitive outcomes and an increased risk for infection and mortality globally. One hundred forty million people are chronically exposed to arsenic from contaminated drinking water worldwide. While arsenic exposure has been associated with cognitive developmental delays in children, there is limited research on the association between arsenic exposure and growth deficits in young children. PurposeThe objective of this study was to assess the association between chronic arsenic exposure and deficits in growth among children under 5 years in a rural setting in Bangladesh. MethodsUrinary arsenic measurements were collected from 465 children between the ages of 28 days–59 months in rural Matlab, Bangladesh, and analyzed by graphite furnace atomic absorption. Height and weight measurements were collected from children according to World Health Organization child growth standards. A z-score cutoff2 standard deviations below the mean was used to define stunting (height-for-age z-score), underweight (weight-for-age z-score), and wasting (weight-for-height z-score). ResultsChildren under 5 years with urinary arsenic concentrations in the third tertile (greater than 31 μg per liter (μg/L)) had a two times higher odds of being underweight after adjustment for age, creatinine, paternal education, breastfeeding, number of individuals using the same sleeping room, and physician-diagnosed pneumonia (Odds Ratio (OR): 2.29 (95% Confidence Interval (CI): 1.16, 4.52)). Children under 2 years of age had a two times higher odds of being wasted after adjustment for age, creatinine, paternal education, breastfeeding, number of individuals using the same sleeping room, and physician-diagnosed pneumonia (OR: 2.85 (95% CI: 1.18, 6.89)). ConclusionsThese findings suggest that arsenic exposure is associated with an increased odds of being wasted and underweight among young children in rural Bangladesh.

Growth Assessment in Preterm Children from Birth to Preschool Age.

Preterm infant growth is a major health indicator and needs to be monitored with an appropriate growth curve to achieve the best developmental and growth potential while avoiding excessive caloric intake that is linked to metabolic syndrome and hypertension later in life. New international standards for size at birth and postnatal growth for preterm infants are available and need implementation in clinical practice. A prospective, single center observational study was conducted to evaluate the in-hospital and long-term growth of 80 preterm infants with a mean gestational age of 33.3 ± 2.2 weeks, 57% males. Size at birth and at discharge were assessed using the INTERGROWTH-21ST standards, at preschool age with World Health Organization (WHO) child growth standards. The employment of INTERGROWTH-21ST Preterm Postnatal longitudinal standards during the in-hospital follow-up significantly reduced the diagnosis of short term extrauterine growth restriction when compared to commonly used cross sectional neonatal charts, with significant lower loss of percentiles between birth and term corrected age (p < 0.0001). The implementation of a package of standards at birth, preterm postnatal growth standards and WHO child growth standards proved to be consistent, with correlation between centile at birth and at follow-up, and therefore effective in monitoring growth in a moderate and late preterm infant cohort without chronic or major morbidities. Infants identified as small for gestational age at birth showed significantly more frequently a need for auxological referral.

Feeding practices for toddlers with stunting in Jakarta: A case study.

Stunting represents a child’s failure to thrive. On the basis of the World Health Organization child growth standards, stunting is a height of <−2 SD of the z-score for the child’s age. There are several major causes of stunting. One is the inability to optimize child feeding practices. The aim of this study was to explore the feeding practices that lead to stunting in toddlers in Jakarta. The participants in this study were 15 mothers. Content analysis was the method that was chosen for this study. The data analysis revealed four themes that describe the feeding practices for toddlers with stunting in Jakarta: i) mothers providing instant porridge and ready-to-serve steamed chicken rice; ii) a feeding frequency of small portions only 2-3 times per day; iii) a lack of diet diversity; and iv) the suboptimal intake of iron-rich foods. The provision of effective education about appropriate feeding practices to pregnant women and mothers with toddlers is expected to reduce the incidence of stunting in Indonesia.

Nutritional survey in critically ill children: a single center study in China.

BackgroundThe incidence of malnutrition in children, who were admitted to the pediatric intensive care unit (PICU), has kept high level over the past 30 years. In addition, nutrition status of critically ill children deteriorates further during the changing of their conditions and may have a negative effect on patients’ outcomes. This study aimed to determine the nutritional status of critically ill children and to survey current nutrition practices and support in PICU.MethodsIn this prospective observational study, 360 critically ill children stayed in the PICU not less than 3 days from Feb. to Nov. in 2017 were enrolled. Each patient underwent nutrition assessment. Nutritional status was determined using Z-scores of length/height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), body mass index-for-age (BAZ), based on the World Health Organization child growth standards. We also observed the patients’ intake of calories and protein during the first 10 days after admission.ResultsThree hundred and sixty were enrolled in the study. One hundred and eighty-six patients (51.67%) were malnourished at PICU admission, above 50% and 56.45% (105/186) of malnourished patients had severe malnutrition. Except fasting in case of clinical instability in 5.3% (19/360), nutrition was provided in the form of oral feeding in 26.6% (96/360), enteral nutrition (EN) in 56.1% (202/360), parenteral nutrition (PN) in 6.4% (23/360) and mixed support (EN + PN) in 5.6% (20/360). Totally 384 times interruption of feeding happened in the process of EN, and 1.9 times feeding interruption happened to each patient. Twenty-seven point two percent of these patients had more than three times feeding interruption. The severe malnutrition group had significantly greater length of ICU stay and higher mechanical ventilation support rate (P=0.007, P=0.029). Total 44 (44/360, 12.22%) patients died in the study, and the malnutrition was not statistically different between survivor group and death group (P=0.379). More than 85% of the patients had lower daily nutritional intake compared with prescribed goals. Sixty-eight point three percent of the patients received the required calories during EN with median time of 2 [2–4] days. Only 32.7% of patients underwent EN received estimated protein requirements.ConclusionsThese results showed that malnutrition was common among children admitted to PICU. Furthermore, nutrition delivery was generally inadequate in critically ill children, and nutritional status was getting worsening during PICU.

Child Growth Curves in High-Altitude Ladakh: Results from a Cohort Study.

High prevalence of child underweight and stunting in high-altitude areas has often been reported. However, most previous studies on this topic were cross-sectional. Another critical concern is that using the World Health Organization (WHO) Child Growth Standards to evaluate child growth in high-altitude areas may lead to overestimations of underweight and stunting. Our study aimed to evaluate the long-term growth pattern of children (3 to 18 years) above the altitude of 3500 m in Ladakh, India. The participants’ body weight (BW), body height (BH), and body mass index (BMI) were measured annually according to the WHO Child Growth Standards for children under 5 years old and the WHO reference data for children aged 5 to 19 years. The generalized estimating equation (GEE) was used to estimate the means and z-scores of BW, BH, and BMI at different ages. A total of 401 children were enrolled from 2012 to 2018. Their mean z-scores of BW, BH, and BMI were −1.47, −1.44, and −0.85 in 2012 and increased to −0.74, −0.92, and −0.63 in 2018. This population’s specific growth curve was also depicted, which generally fell below the 85th percentile of the WHO standards. This is the first cohort study about long-term child growth patterns in a high-altitude area. The detailed underlying mechanisms of our findings need future research on more representative data of high-altitude populations.

US Evaluation of Bone Age in Rural Ecuadorian Children: Association with Anthropometry and Nutrition.

Background Stunted growth and development is a serious global public health problem. A limited number of field measures exist that can be used to evaluate stunting and its underlying biologic mechanisms. Purpose To assess bone age using tablet-based US in young children living in a rural community in Ecuador, where stunting is prevalent, and to evaluate the associations between bone age, anthropometry, and diet. Materials and Methods From June through August 2017, tablet-based US was used to assess bone age in young children within their homes in rural Cotopaxi, Ecuador. Bone age z scores (BAZs) were assigned using the standards of Greulich and Pyle. Anthropometric data were collected using international protocols; z scores were generated from World Health Organization Child Growth Standards. Groups were compared using the Student t test. Univariate analyses and generalized linear regression modeling were applied to test the association between bone age and anthropometry, adjusting for covariates including age, sex, dietary intake, and morbidities. Results A total of 128 children (mean age, 33.9 months ± 1.8 [standard deviation]; 59 girls, 69 boys) were evaluated. Mean BAZ was -1.20 ± 1.16. Mean BAZ was lower in children with stunted growth (-1.42 ± 1.18) than in children without stunted growth (-0.98 ± 1.10, P = .04). In adjusted analysis, BAZ was associated with the following variables: height-for-age z score (β coefficient, 0.26; 95% confidence interval [CI]: 0.05, 0.46; P = .01), female sex (β coefficient, 0.51; 95% CI: 0.15, 0.88; P = .006), number of times eggs were consumed in the previous 24 hours (β coefficient, 0.22; 95% CI: 0.05, 0.38; P = .009), number of times savory or salty snacks were consumed in the previous 24 hours (β coefficient, 0.42; 95% CI: 0.15, 0.68; P = .002), and ownership of pig livestock, which was a binary variable (β coefficient, -0.46; 95% CI: -0.82, -0.09; P = .01). Conclusion Bone age determined using tablet-based US was lower in children who had stunted growth and was associated with diet in a cohort of children living in rural Ecuador. © RSNA, 2020 See also the editorial by Dillman and Ayyala in this issue.

Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries

Evidence on the relative importance of various factors associated with child anthropometric failures (ie, stunting, underweight, and wasting) and their heterogeneity across countries can inform global and national health agendas. To assess the relative significance of factors associated with child anthropometric failures in 35 low- and middle-income countries (LMICs). This cross-sectional study of 299 353 children who were born singleton and aged 12 to 59 months with nonpregnant mothers and valid anthropometric measures assessed the strengths of associations of 26 factors with child stunting, underweight, and wasting, using Demographic and Health Surveys (2007-2018) from 35 LMICs. Data analysis was conducted from July 2019 to February 2020. A total of 9 direct factors (ie, dietary diversity score; breastfeeding initiation; vitamin A supplements; use of iodized salt; infectious disease in past 2 weeks; oral rehydration therapy for children with diarrhea; care seeking for suspected pneumonia; full vaccination; and indoor pollution) and 17 indirect factors (household wealth; maternal and paternal education; maternal and paternal height and body mass index; maternal autonomy for health care, movement, and money; water source; sanitation facility; stool disposal; antenatal care; skilled birth attendant at delivery; family planning needs; and maternal marriage age) were assessed. Three anthropometric failure outcomes were constructed based on the 2006 World Health Organization child growth standards: stunting (height-for-age z score less than -2 standard deviations [SDs]), underweight (weight-for-age z score less than -2 SDs), and wasting (weight-for-height z score less than -2 SDs). Among the 299 353 children aged 12 to 59 months included in the analysis, 38.8% (95% CI, 38.6%-38.9%) had stunting, 27.5% (95% CI, 27.3%-27.6%) had underweight, and 12.9% (95% CI, 12.8%-13.0%) had wasting. In the pooled sample, short maternal height was the strongest factor associated with child stunting (odds ratio [OR], 4.7; 95% CI, 4.5-5.0; P < .001), followed by lack of maternal education (OR, 1.9; 95% CI, 1.8-2.0; P < .001), poorest household wealth (OR, 1.7; 95% CI,1.6-1.8; P < .001), and low maternal body mass index (OR, 1.6; 95% CI, 1.6-1.7; P < .001). Short paternal height was also significantly associated with higher odds of stunting (OR, 1.9; 95% CI, 1.7-2.2; P < .001). Consistent results were found for underweight (eg, short maternal height: OR, 3.5; 95% CI, 3.3-3.7; P < .001; lack of maternal education: OR, 1.8; 95% CI, 1.7-2.0; P < .001) and wasting (eg, low maternal body mass index: OR, 2.3; 95% CI, 2.1-2,4; P < .001; poorest household wealth: OR, 1.2; 95% CI, 1.1-1.3; P < .001). Parental nutritional status and household socioeconomic conditions ranked the strongest (1st to 4th) for most countries, with a few exceptions (eg, lack of maternal education ranked 18th-20th in 8 countries for child wasting). Other factors were not associated with anthropometric failures in pooled analysis and had large country-level heterogeneity; for example, unsafe water was not associated with child underweight in the pooled analysis (OR, 0.97; 95% CI, 0.95-1.00; P < .001), and it ranked from 4th to 20th across countries. In this study, socioeconomic conditions and parental nutritional status were the strongest factors associated with child anthropometric failures. Poverty reduction, women's education, and nutrition programs for households could be important strategies for reducing child undernutrition; however, country-specific contexts should be considered in national policy discussions.

Visual Acuity Deficits in Otherwise Normally Developing Zika Virus Exposed Children

Background: The Zika virus (ZIKV) targets neural stem cells in the developing brain. It remains unclear whether ZIKV-Exposed Children (ZEC) with no apparent neurological manifestations at birth were protected from ZIKV neurotropism during gestation or harbor subtle pathology that might disrupt neurodevelopment. In this prospective study, we tracked a cohort of normocephalic ZIKV-exposed children (NZEC) in parallel with normocephalic unexposed controls (UC) from birth to 30 months of age to determine whether NZEC show higher rates of neurodevelopmental delays relative to UC. Methods: A total of 384 pregnant women were recruited from public health centers in Grenada, West Indies and enrolled between April 2016 and March 2017, which was a period of active ZIKV transmission. Serum samples were collected from mothers during the prenatal and postnatal period and assessed for ZIKV antibodies using a plasmonic-gold platform. Infants were classified as NZEC if their mothers tested positive for ZIKV infection during pregnancy and they were normocephalic, as defined by World Health Organization Child Growth Standards. Children were classified as UC if their mothers tested negative for ZIKV infection during and following pregnancy. Outcome measures included the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, which were administered and scored by research staff blinded to participants’ exposure status. Findings: A total of 68 NZEC and 63 UC completed outcome measures between 22 to 30 months of age. There were no group differences in socio-demographics. Visual acuity deficits were apparent in NZEC in the absence of any other cognitive, motor, language, or behavioral delays. Interpretation: The presence of visual acuity deficits in NZEC suggests that the visual system may be selectively vulnerable in otherwise normally developing children. Continued neurocognitive surveillance of this cohort will address whether early vision problems place NZEC at risk for future deficits in visuo-spatial functions and learning disorders. Funding Statement: TWINDREF GSP-SRGI-18009 (KB); USAID AID-OAA-A-14-00028 (ADL), NIH R21HD093551-01 (RW, BL, MF), Stanford Maternal Child Health Research Institute (ADL). MF is supported by an Academic Clinical Fellowship in Paediatrics from the National Institute for Health Research, UK, to the University of Southampton. Declaration of Interests: None of the authors have any conflicts of interest to disclose. Ethics Approval Statement: Institutional Review Board approval was obtained at St George’s University (IRB#16061) and Stanford University (IRB#45242). Informed consent was obtained from all mothers who participated in this study. There was no financial compensation.

Prevalence of Chronic Otitis Media among Undernourished Children

Abstract Objective This study aimed to identify the role of nutrition in the etiology of chronic suppurative otitis media (CSOM) by comparing the prevalence of CSOM between undernourished children with normal children aged between 10 and 12 years. Materials and Methods A total of 200 children aged between 10 and 12 years studying in government schools were selected for the study. All the children underwent a general and detailed ENT examination in addition to nutritional assessment based on body mass index calculation, using World Health Organization (WHO) Child Growth Standards Chart. The children were divided into two groups: Group A and Group B. Group A consisted of 100 children who were malnourished and Group B consisted of 100 children who were normal. The presence of CSOM in the two groups was noted. Results and Observations Of the total 200 children, 112 were boys (56%) and 88 were girls (44%). Of the 112 boys, 22 (19.64%) had CSOM and out of 88 girls, 24 (27.27%) had CSOM. Of the total 46 children found to have CSOM, 35 children (76.1%) belonged to Group A and 11 children (23.9%) belonged to Group B. Conclusion Our study shows that there is a higher prevalence of CSOM among undernourished children than in normal children. High prevalence of CSOM in undernourished children is a preventable health problem that needs health education and active intervention.

Local growth charts for an Iranian child population aged 2\u20135 years in comparison with the World Health Organization Child Growth Standards

BackgroundThere are no national reference charts in Iran for children aged under five. This study aimed to develop representative growth reference charts of height, weight, and BMI for children aged 2–5 years in Isfahan, Iran, and to compare them with the WHO reference curves.ResultsThis population-based study has a combination of longitudinal and cross-sectional design. It included 1325 and 761 healthy children, who were born between 2002 and 2015 in Isfahan, central Iran, in longitudinal and cross-sectional phases. Expert health care providers measured the height and weight of children in health centers. The lambda-mu-sigma method was used to construct the age- and sex-specific growth charts of anthropometric measures. The study sample comprised 1029 boys and 1057 girls. The centiles of height, weight, and BMI of boys were higher than that of girls in all age groups. The weight patterns of studied children were close to those of the WHO references in the lower percentiles. However, our study children, especially girls, were lighter compared with WHO standards based on the middle and upper percentiles of the weight distribution. Compared with WHO standards, boys of our study were taller especially at older ages. The percentiles of the BMI for our study samples were considerably lower than WHO standards.ConclusionThere are differences between our local growth charts for weight, height, and BMI with WHO standards. The local growth standards could be more precise for assessing growth problems in local and national settings. Due to notable differences between our results with WHO standards, future studies are warranted for constructing nationwide growth charts.

"Assessment of Nutritional Status of Rural Children (0-18 years) in Central India Using World Health Organization (WHO) Child Growth Standards 2007".

Background:The World Health Organization (WHO) Child Growth Standards (“WHO Standards”) 2007 are the most recent and updated indicators which provide a single international standard that represents the best description of physiological growth for all children.Objectives:The objective of the study was to estimate the prevalence of malnutrition as per anthropometric indicators, namely underweight, stunting, and wasting among rural children in Raipur district, Chhattisgarh, using the WHO Child Growth Standards.Materials and Methods:Nutritional assessment of children was conducted in rural areas using standard anthropometric measurements of height and weight. Totally 10,730 children were screened in 61 schools and 30 Anganwadis belonging to 26 villages across 3 major blocks in Raipur district, Chhattisgarh, during June 2013 to February 2018. Weight-for-age, height-for-age, and body mass index-for-age z-scores were calculated using WHO AnthroPlus software.Results:The prevalence of underweight (≤2 standard deviation) was 45.7% in the children examined. The prevalence of stunting and wasting was 40.4% and 22.0%, respectively. Twenty-two of the 26 villages screened reported malnutrition in more than 30.0% of children, namely every third child lags behind in his or her growth curve despite the Mid-Day Meal Program implemented across the nation including this region since several decades.Conclusion:Malnutrition remains an ongoing health problem in school-going children. WHO AnthroPlus software can be very useful for analysis of state- and national-level data of nutritional status of children and could be used to shape health policies for this age group accordingly.

Poor nutrition for under-five children from poor households in Ethiopia: Evidence from 2016 Demographic and Health Survey.

BackgroundEthiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly.MethodsEthiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI).ResultThe prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition.ConclusionThe burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target.

Women's decision-making power and undernutrition in their children under age five in the Democratic Republic of the Congo: A cross-sectional study.

Undernutrition in children remains a major global health issue and the prevalence of undernutrition in children under age five in the Democratic Republic of the Congo (DRC) is among the highest in the world. Both biological and socioeconomic factors contribute to undernutrition, and the literature reports an association between women’s empowerment and lower rates of child undernutrition in sub-Saharan Africa. However, the relationship between women’s decision-making power and child undernutrition is less understood. The objective of this study was to evaluate the association between women’s decision-making power and stunting/wasting in their children under age five in the DRC. This study used cross-sectional data from the 2013–2014 DRC Demographic and Health Survey, from which a sample of 3,721 woman-child pairs were identified. Women were classified as having decision-making power in five decision-making dimensions if they participated in the decision either alone or jointly with their husband or partner or someone else. Child height-for-age and weight-for-height Z-scores were used to determine stunting and wasting, respectively, according to the World Health Organization Child Growth Standards. Multivariate regression analyses demonstrated that none of the five dimensions of decision-making power were associated with stunting or wasting in children. Further research that evaluates women’s decision-making power with more detailed, relevant and context-specific measures is warranted to more accurately investigate women’s decision-making power and undernutrition in children.

Mobile terminal-based survey on the birth characteristics for Chinese newborns

Objective To describe the birth characteristics for Chinese newborns, to assess the feasibility of collecting basic data on maternal and child health, and to conduct relevant epidemiological studies by using mobile terminals. Methods From June 2016 to January 2017, pregnant women who delivered in hospitals were recruited in 166 hospitals scattered across 23 provinces of China. The data on their maternal and child health including delivery mode, gestational age and birth weight, were collected by self-administered questionnaires embedded in a mobile application. The incidences or means of cesarean section, preterm birth, birth weight, length and head circumference were calculated and compared with recognized national data, including 2005 Growth Standards for Chinese Children Under 7 Years of Age, 2006 World Health Organization Child Growth Standards and 2014 Chinese Neonatal Birth Weight Standards by Gestational Age. Results A total of 9 986 women were investigated, among whom those aged ≥35 years accounted for 11.7% and those received well education (college and above) accounted for 70.2%. The rate of cesarean section, preterm delivery, low birth weight and macrosomia were 38.1%, 4.5%, 2.2%, and 7.8%, respectively. The means were (3.33±0.44) kg [male (3.36±0.44) kg, female (3.29±0.43) kg] for birth weight, (50.97±2.32) cm [male (51.04±2.32) cm, female (50.89±2.32) cm] for birth length, and (33.99±1.56) cm [male (34.01±1.57) cm, female (33.97±1.55) cm] for head circumference, respectively. As compared with the national data, the cesarean section rate and birth weights by gestational age for term-born neonates were similar to the latest national data in 2014, while the means of birth weight and length were obviously higher than those of the 2005 Growth Standards for Chinese Children Under 7 Years of Age and 2006 World Health Organization Child Growth Standards. Conclusion As compared with the national data 10 years ago, the mean birth weights for male and female newborns were increased by 40 g and 80 g respectively and mean lengths by 0.6 cm and 1.3 cm, but changes for mean head circumferences were negligible, indicating that the physical health condition for Chinese newborns improved significantly over past 10 years and emerging information technology likely provided a new approach for epidemiological research.

Partially Hydrolysed Whey-Based Formulae with Reduced Protein Content Support Adequate Infant Growth and Are Well Tolerated: Results of a Randomised Controlled Trial in Healthy Term Infants.

The current study aimed to investigate growth, safety and tolerance of partially hydrolysed infant formulae in healthy full-term infants. Fully formula-fed infants were randomised ≤14 days of age to receive a partially hydrolysed whey formula with 2.27 g protein/100 kcal (pHF2.27) or the same formula with 1.8 g or 2.0 g protein/100 kcal (pHF1.8 and pHF2.0) until 4 months of age. The primary outcome was equivalence in daily weight gain within margins of ± 3 g/day; comparison with WHO Child Growth Standards; gastrointestinal tolerance parameters and number of (serious) adverse events were secondary outcomes. A total of 207 infants were randomised, and 61 (pHF1.8), 46 (pHF2.0) and 48 (pHF2.27) infants completed the study per protocol. Equivalence in daily weight gain was demonstrated for the comparison of pHF1.8 and pHF2.27, i.e., the estimated difference was −1.12 g/day (90% CI: [−2.72; 0.47]) but was inconclusive for the comparisons of pHF2.0 and pHF2.27 with a difference of −2.52 g/day (90% CI: [−4.23; −0.81]). All groups showed adequate infant growth in comparison with the World Health Organization (WHO) Child Growth Standards. To conclude, the evaluated partially hydrolysed formulae varying in protein content support adequate growth and are safe and well tolerated in healthy infants.

PG-1 Compromised growth among HIV exposed compared to unexposed children in Nigeria

Introduction: HIV exposed but uninfected (HEU) children may be at an increased risk of impaired growth and development when compared to their unexposed and uninfected (HUU) counterparts. We compared growth pattern between HEU and HUU children in Nigeria. Methods: HIV infected and uninfected pregnant women were enrolled at the Plateau State Specialist Hospital (PSSH) Jos Nigeria. Babies born to these mothers were recruited at birth and the mother-infant pairs followed up until 18 months. Weight, length, and head circumference of the babies were measured at each study visit. Age and gender standardized z scores were generated for each anthropometric measure using the World Health Organization Child Growth Standards. Children with length for age (LAZ), weight for age (WAZ) and weight for length (WLZ) z scores &lt;−2 were classified as stunted, underweight, and wasted respectively. Results: A total of 415 children (307 HEU and 108 HUU) were included in this analysis. At birth, 117 (28.4%), 9 (2.2%) and 32 (7.8%) babies were stunted, underweight and wasted respectively. In a multivariable longitudinal analysis, the odds of stunting was higher among HEU as compared to HUU children (OR: 2.4 [95% CI: 1.4 to 4.1]; P = 0.001). Similarly, odds of being underweight was higher among the HEU children (OR: 1.6 [95% CI: 1.1 to 2.2]; P = 0.009). While the odds of wasting appeared higher for the HEU children (OR: 1.5 [95% CI: 0.9 to 2.4]; P = 0.128), the difference did not reach statistical significance. Conclusions: We found strong evidence of greater impairment of linear and ponderal growth among HEU as compared to HUU children during the first 18 months of life in Nigeria. Further studies are needed to explore the causal basis for these differences.

A Report of Health Related Anthropometric Indices in 2–5 Years Old Children of Golestan Province of Iran in 2015

Pediatric malnutrition is an enormous health issue all around the world and its distribution is different in distinct areas of a country. This study has been designed to report the anthropometric status and some socio-economic factors among 2–5 years old children from Golestan province of Iran to show a better view of pediatric health status and better planning for future actions. This study was carried out by clustered-randomized sampling method on 1,382 of 2–5 years old children in urban and rural areas of Golestan province. Anthropometric measurements were performed and World Health Organization child growth standards were used for further analyses. The prevalence of stunting in boys and girls were 7.4% and 7.5% in urban and 4.1% and 5.4% in rural areas. The prevalence of underweight in boys and girls were 6.9% and 4.7% in urban and 5.7% and 4.4% in rural areas. The prevalence of subjects being at risk for overweight were 17.8% and 11.7% in boys and girls, respectively, in urban areas and were 11.1% and 9.2% in rural areas, respectively. There was a marginally significant difference between urban boys and girls in terms of weight status (p = 0.067). In this study remarkably high prevalence of malnutrition, especially a high dominance of overweight, was reported in Golestan province of Iran. Follow-up investigation to identify the cause of malnutrition and to establish public health policies are needed to revise these health issues in Golestan province of Iran.