Height-for-age Z-score Research Articles

Nutritional status of tribal and non-tribal school-going children in rural Bangladesh: A comparative study

BackgroundInadequate nutrition of school-going children is a major concern in Bangladesh, and it can negatively affect their productivity. It is important to consider the food pattern, socio-cultural, and economic differences between tribal (T) and non-tribal (NT) communities in Bangladesh when evaluating their nutritional status. This study aimed to investigate the nutritional status of school-going children in the rural area of Rajshahi district’s High Barind Tract (HBT) region of Bangladesh. Additionally, we compared the nutritional status between T and NT school-going children in the same area.MethodsThis was a cross sectional household study. Data were collected from T and NT households in the HBT region in the Rajshahi district of Bangladesh, from January to June of 2019. A total of 500 (T 81, NT 419) school-going children aged 6–13 years were selected as samples using mixed sampling, including convenience sampling (non-probability) and simple random sampling (probability) methods. Nutritional status was assessed using body mass index-for-age z-score (BAZ) and height-for-age z-score (HAZ) according to WHO guidelines. Thinness was defined as BAZ < -2SD and stunting as HAZ < -2SD. Descriptive statistics, Z-proportional test, and logistic regression model were used to analyze the effect of selected independent variables on nutritional status of T and NT children.ResultsAmong school-going children, 15.20% were suffering from thinness (T 12.30% and NT 15.80%) and 17.80% stunting (T 13.60% and NT 18.60%), respectively. The difference in thinness (p > 0.05) and stunting (p > 0.05) were not significant between T and NT. The distribution of BAZ and HAZ of T and NT children were normally distributed, and were positioned negatively compared to the WHO standards. The logistic model identified the following factors for thinness: (i) mother with non-or-primary education (aOR = 1.89, 95% CI: 1.05–3.43, p < 0.05), (ii) underweight mother (aOR = 3.86, 95% CI: 1.48–10.06, p < 0.01), and (iii) underweight father (aOR = 4.12, 95% CI: 1.50-11.29, p < 0.01). For stunting, the factors were: (i) mother as a housewife (aOR = 2.79, 95% CI: 1.16–6.71, p < 0.05), (ii) father working as labour (aOR = 1.77, 95% CI: 1.01–3.278, p < 0.05), (iii) severe food insecurity in the household (aOR = 2.37, 95% CI: 1.23–4.54, p < 0.05), and (iv) children playing outside regularly more than 2 h (aOR = 2.19, 95% CI: 1.31–3.67, p < 0.01).ConclusionIn rural Bangladesh, the nutritional status of T and NT school-going children did not show significant defferences. However, the mean z-score values for both groups of children were lower than the WHO standard, indicating that both communities have poor nutritional status.

Examining the burden and relationship between stunting and wasting among Timor-Leste under five rural children.

Globally and in Timor-Leste, wasting and stunting remain major public health problems among 'under five years children, but the interrelationship between the two has been poorly investigated. A better understanding of this interrelationship is a prerequisite to improving wasting and stunting programming. In our study, we assessed the influence of age on the prevalence of wasting and stunting, the overlap between the two conditions, and the effect of wasting parameters on linear growth catch-up using the data of 401 children recruited at 0 to 54 months of age [median (IQR) of 17 (7-32) months] with repeated anthropometric assessments [median (IQR) follow-up time was 25 (16-39) months]. At recruitment, prevalences of stunting, wasting and concurrence of the two conditions were 54.6%, 9.5% and 4.6%, respectively. These prevalences were already high and above the thresholds for public health importance among children below months of age and remained high throughouttheir childhood. Over the follow-up period, the change (95%CI) in Height-for-Age Z-score (HAZ) was -0.01 (-0.13; 0.11) (p = 0.850), and that of the Height-for-Age Difference (HAD) was -3.74 (-4.28; -3.21) cm (p<0.001). Stunting reversal was observed in 25.6% of those stunted at recruitment, while a positive change in HAD was observed in only 19.6% of assessed children. Path analysis by structural equation modelling showed no significant direct effect of WHZ at recruitment on the likelihood of positive change in HAD, with its influence being fully mediated by its change over the follow-up period. This change had an inverse relationship with the occurrence of a positive change in HAD. On the contrary, Mid-Upper Arm Circumference at recruitment had a significant positive direct effect on the likelihood of a positive HAD change. These results show that interventions to combat wasting and stunting need to be integrated.

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.

Changes in peripheral quantitative computed tomography measured bone density, size and strength in Zimbabwean children with and without HIV over one year: a cohort study.

Understanding bone accrual in adolescents may inform approaches to improve skeletal health and reduce adult fracture risk. We investigated the effect of HIV on bone mineral accrual assessed by peripheral Quantitative Computed tomography (pQCT). Children with HIV (CWH) on ART for ≥2years, and children without HIV (CWOH), aged 8-16years (n = 609), had tibial pQCT scans at 0 and 12months. Linear regression estimated sex stratified differences in change (∆) and mean pQCT bone density (trabecular and cortical), size (total cross-sectional area [CSA]) and strength (SSI) between CWH and CWOH, adjusting for socio-economic status (SES) and orphanhood and incorporating an interaction term for baseline pubertal status (Tanner 1-2[pre/early] vs 3-5[mid/late]). Structural equation modelling tested whether baseline height-for-age-Z-scores (HAZ) mediate the effect of HIV on ∆bone outcomes. CWH were more likely than CWOH to be orphans (44% vs 7%), of lower SES (43% vs 27%) and be stunted (30% vs 8%); but similar in age. At baseline and follow up, CWH had lower trabecular density, CSA and SSI than CWOH. After adjustment, bone density and strength increased similarly in CWH and CWOH. CWH in mid/late puberty at baseline had greater 12months increases in CSA than CWOH, particularly males (mean difference [31.3(95%CI:-3.1, 65.6) mm2 in mid/late puberty vs. -2.04(-23.8, 19.7) mm2 in pre/early puberty; interaction P-value = 0.013]. HAZ mediated the effect of HIV on ∆bone outcomes only in females as follows: indirect pathways from HIV to ∆trabecular density [-1.85(-3.5, -0.2) mg/cm3], ∆cortical density [-2.01(-3.9, -0.01) mg/cm3], ∆CSA [-2.59(-4.7, -0.5) mm] and ∆SSI [-18.36(-29.6, -7.2) mm3]. In conclusion, CWH show bone deficits at follow up. Investigations of bone mineral accrual earlier in life and post-puberty to peak bone mass are needed.

Meet-in-metabonomics: Insights into associations between hair heavy metal and adverse child growth in e-waste recycling area

Heavy metal pollution from informal e-waste recycling may adversely affect child growth. However, the potential toxic mechanisms from a population perspective remain unknown. Herein, 18 hair heavy metals, urinary metabolomics, and three child growth indices [i.e., weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and BMI Z-score (BMIZ)] were measured in children from e-waste recycling (ER, N = 426) and control areas (CR, N = 247). We examined longitudinal changes in heavy metal exposure and child growth after e-waste control to further elucidate causal relationships. Results showed that children in regulated ER site were still exposed to higher levels of several heavy metals and experienced poorer growth compared to those in control areas. Elevated exposure to heavy metals like tin, antimony, lead, cadmium, and cobalt correlated with poor child growth, particularly affecting girls and younger children. Tin, rather than traditionally concerning heavy metals, exhibited the most crucial role in driving the adverse effects of metal mixtures on child growth. Reducing heavy metal exposure through e-waste control could notably improve child growth, confirming the causal relationship between heavy metal exposure and poor child growth and underscoring the health benefits of e-waste regulation. Our research identified the roles of steroid biosynthesis, folate biosynthesis, amino acid metabolism, and purine metabolism in mediating the effects of metal exposure on child growth. Testosterone glucuronide, riboflavin, folic acid, xanthosine, and xanthine emerged as key mediators, potentially serving as metabolic signatures of heavy metal exposure. These findings illuminate the toxic mechanisms underlying poor child growth resulted from heavy metal exposure, offering important insights from a population-based perspective. In addition to lead and cadmium, monitoring and regulating tin and antimony are crucial to mitigate their negative impact on child growth in e-waste recycling areas.

Impact of food price inflation on stunting in under five aged children in Bangladesh

BackgroundCurrently, food price inflation is a widespread issue in Bangladesh as well as the rest of the world. Malnutrition is a common issue among children that can have long-lasting effects on their development and overall health. There have been lots of studies conducted to identify the factors responsible for child malnutrition, but inflation is rarely considered a factor in child malnutrition. We aimed to determine the relationship between food price inflation and stunting (Height-for-Age Z-score (HAZ)) in children under five years of age in Bangladesh.MethodThe study utilized food price data from the World Food Programme database and malnutrition (stunting) information from the 2014 and 2017-18 Bangladesh Demographic Health Surveys (BDHS). This includes the total study period from 2009 to 2018. Food prices were linked to the BDHS dataset using each child’s birth month. For each child, the average food prices from 9 months prior to 5 months post-birth, including their birth month, were recorded to calculate month-to-month inflation. This inflation was computed for rice (coarse), oil, wheat flour, and lentils by comparing the price sum of each item from one month to the previous month and dividing by the total price of the preceding month. A generalized linear regression model was used to assess the relationship between food price inflation and stunting, with stunting as the dependent variable. Other explanatory variables included wealth index, sex of the child, height, weight, mother’s education, respondent’s current pregnancy, and breastfeeding status.ResultsOur study has revealed that food price inflation has a significant negative effect on stunting, with a coefficient of -0.127 (p < 0.001). Furthermore, we have identified several other factors that have also significantly negative associations with stunting, including the wealth index (p < 0.001), mother’s education level (p < 0.001), mother’s pregnancy status (p < 0.001), breastfeeding (p < 0.001), child’s age (p < 0.001). child’s weight (p < 0.001) has significantly positive effect on stunting. However, we did not find any significant differences in stunting between boys and girls.ConclusionIn conclusion, the findings of this study underscore the significant negative impact of food price inflation on child stunting, emphasizing the need to acknowledge this factor alongside others. These results highlight the critical role of addressing food price inflation as a key determinant of stunting, in conjunction with various other contributing factors, in efforts to combat childhood malnutrition.

The effect of nutritional risk management program on the growth and development of infants and toddlers with congenital heart disease after discharge.

To evaluate the effect of nutritional risk management program on the growth and development of infants and toddlers with congenital heart disease (CHD) after discharge. Infants and toddlers with CHD discharged from a children's specialized hospital in southeast China were selected as the research subjects. The subjects were divided into the intervention group and the control group. The intervention group underwent a nutritional risk management program combined with traditional follow-up after discharge, whereas the control group received traditional follow-up after discharge. The primary outcome measure were the height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height Z-score (WHZ) at different time point and the percentage of growth and development curves were also recorded and analyzed. There were no statistically significant differences in general characteristics between the two groups. However, in the intervention group, the percentages of HAZ < -2, WAZ < -2, and WHZ < -2 were lower than those in the control group at 3rd and 6th months after discharge (P < 0.05). The percentage of growth and development curves (3%-97%) was higher than that in the control group (P < 0.05). The readmission rate within 6 months after discharge in the intervention group was lower than that in the control group (P < 0.05). Implementing nutritional risk management program for infants and toddlers with CHD after discharge can help improve postoperative malnutrition, promote growth and development and achieve catch-up growth as soon as possible.

A Web-Based Thai School Lunch Program Promotes Children's Heights: A Cross-Sectional Study in Rural Schools.

Nutrition has an impact on development and linear growth. However, a few studies examine the connections between children's age-standardized height and their nutritional status and diet quality. This study aimed to find a relationship between dietary consumption and height for age among school students under a web-based Thai school lunch program. Anthropometric data and nutrient consumption were obtained from 24-hour records. Nutrient consumption was calculated using Inmucal. The parent and custodian's data were from the electronic health records. Children's heights were not correlated with parents' heights (P<0.720). Moreover, children with low height-for-age Z-score (HAZ) had significantly lower intakes of minerals (iron, magnesium, and selenium) and vitamins (B6, B12, C, and E). On the other hand, magnesium, selenium, vitamin B12, and vitamin E intakes of the children with normal HAZ were higher than their custodians. The Thai school lunch program effectively maintains the normal HAZ of children. Nutritional education in the community is recommended.

Identification of Enteric Pathogen Reservoirs and Transmission Pathways Associated with Short Childhood Stature in the Kolkata Indian Site of the Global Enteric Multicenter Study.

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12-23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12-59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.

The impact of home-installed growth charts and small-quantity lipid-based nutrient supplements (SQ-LNS) on child growth in Zambia: a four-arm parallel open-label cluster randomised controlled trial

BackgroundChildhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.MethodsThe main objective of the study was to assess...

Using the Height-for-Age Z-score (HAZ) to predict protein-energy malnutrition in patients with congenital epidermolysis bullosa through the application of machine learning methods

Congenital epidermolysis bullosa (СЕВ) is a group of genetically and clinically heterogeneous diseases characterized by a tendency to form blisters and/or erosions on the skin and mucous membranes with minimal trauma. Nutritional deficiency stands as the most common complication observed in EB, with its development influenced by a multitude of contributing factors.Purpose of the study. To construct a predictive model for the development of protein-energy malnutrition in patients with various forms of EB, identify the main features affecting the sensitivity of the predictive model, and evaluate the model’s validity based on retrospective data on the presence of protein-energy malnutrition in this patient category.Methods. The study involved 101 patients aged 3 to 18 years with simplex (n=25), junctional (n=10), and dystrophic (n=66) СEB. The Birmingham EB Severity Score, laboratory and anthropometric parameters, as well as data on the presence of gastrointestinal complications, were used for the analysis of disease progression and predictive model construction. The Scikit-learn library of the programming language Python was utilized for building the machine learning model.Results. In the construction of the predictive model, the RandomForestClassifier model showed the best results. The developed machine learning model can correctly determine whether a patient has chronic protein-energy malnutrition (class 1, HAZ &lt; –2) or not (class 0, HAZ &gt; –2) with an accuracy of 92%, sensitivity of 85.7%, and specificity of 100%.Conclusions. The machine learning model presented in this study predicts the values of the Height-for-Age Z-score (HAZ) and can have practical significance in medical practice and clinical research. The model can be used for early diagnosis of protein-energy malnutrition in patients with EB, which may allow healthcare professionals to timely start nutritional support and prevent possible complications of the disease, as well as develop individual nutrition and treatment plans for patients.

Effects of New Complementary Feeding Guidelines on Eating Behaviour, Food Consumption and Growth in Colombian Children: 6-Year Follow-Up of a Randomised Controlled Trial.

Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6-12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed the effects of the NCFGs on food consumption, eating behaviour and growth at 6 years of age. Weight and height were measured using 50 children (58.8%) from the cohort. Feeding behaviour was measured using the Child Eating Behaviour Questionnaire (CEBQ) and maternal and child food consumption was measured using a semi-quantitative food frequency questionnaire. The control group (CG) had a significantly higher weekly consumption of chocolate milk drinks (p = 0.05). The mean food responsiveness (FR) score was significantly higher in the CG (p < 0.001). Although HAZ (height for age Z-score) at 6 years of age was significantly higher in the CG (p < 0.02), there was no significant difference between groups in the change in HAZ from 6 months and 12 months to 6 years of age. BMIZ (body mass index Z-score) and % overweight (CG 18.5% versus NCFG 13%) or obese (3.7% versus 0%) were not significantly different between groups. BMIZ was positively predicted by FR (β 0.293; p = 0.014) and negatively predicted by weekly red meat consumption episodes per week at 12 months (β -0.169; p = 0.020). Although there was no direct effect of an intervention on BMIZ at 6 years of age, the results were consistent with an indirect effect via intervention effects on meat consumption at an age of 12 months and FR at 6 years of age. However, further longitudinal studies with a larger sample size are needed.

Quality of nutritional status assessment and its relationship with the effect of rainfall on childhood stunting: a cross-sectional study in rural Burkina Faso

ObjectivesIn Burkina Faso, one in every four children under 5 years is stunted. Climate change will exacerbate childhood stunting. Strengthening the health system, particularly the quality of nutrition care at primary health facilities, can minimise the adverse climate effect on stunting. Thus, we examined the quality of nutritional status assessment (QoNA) during curative childcare services in primary health facilities in rural Burkina Faso and its relationship with rainfall-induced childhood stunting. Study designWe conducted a cross-sectional analysis using anthropometric, rainfall, and clinical observation data. MethodsOur dependent variable was the height-for-age z-score (HAZ) of children under 2 years. Our focal climatic measure was mean rainfall deviation (MRD), calculated as the mean of the difference between 30-year monthly household-level rainfall means and the corresponding months for each child from conception to data collection. QoNA was based on the weight, height, general paleness and oedema assessment. We used a mixed-effect multilevel model and analysed heterogeneity by sex and socio-economic status. ResultsAmong 5027 young (3–23 months) children (mean age 12 ± 6 months), 21% were stunted (HAZ ≤ −2). The mean MRD was 11 ± 4 mm, and the mean QoNA was 2.86 ± 0.99. The proportion of children in low, medium, and high QoNA areas was 10%, 54%, and 36%, respectively. HAZ showed a negative correlation with MRD. Higher QoNA lowered the negative effect of MRD on HAZ (β = 0.017, P = 0.003, confidence interval = [0.006, 0.029]). Males and children from poor households benefited less from the moderating effect of QoNA. ConclusionImproving the quality of nutrition assessments can supplement existing efforts to reduce the adverse effects of climate change on children's nutritional well-being.

Protein and fat intake impact on growth of primary school girls in Kerman, Iran

The school age period is characterized by significant physical and intellectual growth, necessitating the monitoring of macronutrient intake and its impact on weight and height. The objective of this study is to investigate the association between the quality and quantity of protein and fat consumption with anthropometric indices in primary school girls in Kerman. This cross-sectional analysis was conducted on primary school girls aged 6–12 (n 330) from ten schools in Kerman, Iran. A validated and reliable dish-based 185-item food frequency questionnaire was used. We calculated the amount of proteins and fats as the percentage of daily calories and grams per day. Plant-based and animal-based proteins were used to assess the protein quality. To assess the fat quality, we considered trans fatty acids (TFA), cholesterol, vegetable oils, solid vegetable oils, animal oils, omega-6 Polyunsaturated fatty acids (PUFAs), omega-3 PUFA, and (PUFAs + Monounsaturated fatty acids (MUFAs))/Saturated fatty acids (SFAs), PUFAs/SFA, and (MUFA + PUFA)/(SFA + TFA). There was a significant positive association between height-for-age z-score (HAZ) and plant protein (p < 0.001) and vegetable oils (p = 0.038) after adjustment. In higher tertiles of animal protein, weight-for-age z-score (WAZ) (p = 0.024) were significantly higher. A significant positive association was observed between omega-3 PUFA and mid-upper arm circumference (MUAC) (p = 0.039) and BMI-for-age z-score (BAZ) (p = 0.016). Our study emphasizes the importance of monitoring protein and fat intake in primary school girls for optimal growth. Positive associations were found between plant-based protein, vegetable oils and HAZ, as well as animal protein and WAZ, highlighting the impact of protein quality on growth indicators.

Nutritional Status and Body Composition at Diagnosis, of South Indian Children with Acute Lymphoblastic Leukaemia (ALL).

Accurate estimation of body composition, particularly, Body Cell Mass (BCM), which is independent of hydration status is important in children with cancer. This study aimed to accurately measure the anthropometry and body composition of children with Acute Lymphoblastic Leukaemia (ALL) at diagnosis and compare them with healthy children from South India. This was a cross-sectional study in children aged 2 to 8 y with ALL from St. John's Medical College Hospital, Bengaluru, and age and sex-matched, normal-weight children recruited as controls from communities. Anthropometry (weight, height, circumferences), skinfolds and body composition measurements using a whole-body potassium counter were performed. Body mass index-for-age, weight and height for age z-scores were calculated using WHO child growth standards. Biochemical markers, dietary intake and physical activity details were recorded. Categorical and continuous variables were analyzed by chi-square and independent t-tests respectively. Results: The mean age of the children with ALL (n = 39) was 4.6±1.9 y and control group (n=39) was 4.7±1.9 y; 61.5% were boys. The prevalence of underweight, overweight/obesity and stunting were 17.9%, 7.7%, and 10.3% respectively. The mean weight and height, of children with ALL and children in the control group were 16.8±6.2 kg and 16.4±4.1 kg, 104.3±14.9 cm and 105.1±12.2 cm, respectively with no statistical difference. Children with ALL showed lower body cell mass index kg/m2 (4.6± 0.8), compared to children in the control group (4.7±0.9) p=0.527, but higher fat mass index kg/m2 (3.6±1.1 vs. 3.4±0.8) p=0.276. At diagnosis, anthropometric and body composition measurements were similar between children with ALL and children in the control group. The BCM showed a non-significant trend of being lower in children with ALL, which requires close monitoring during treatment. Evaluating early-stage nutritional status and body composition can help in planning appropriate interventions during treatment to prevent long term non-communicable diseases.

Analysis of anthropometric outcomes in Indian children during the COVID-19 pandemic using National Family Health Survey data

BackgroundDisruptions in food, health, and economic systems during the COVID-19 pandemic may have adversely affected child health. There is currently limited research on the potential effects of the COVID-19 pandemic on stunting, wasting, and underweight status of young children.MethodsWe examine the short-term associations between the pandemic and anthropometric outcomes of under-5 children (n = 232,920) in India, using data from the National Family Health Survey (2019–2021). Children surveyed after March 2020 are considered as the post-COVID group, while those surveyed earlier are considered as pre-COVID. Potential biases arising from differences in socioeconomic characteristics of the two groups are mitigated using propensity score matching methods.ResultsPost-COVID children surveyed in 2020 and 2021 have 1.2% higher underweight rates, 1.2% lower wasting rates, 0.1 lower height-for-age z-scores (HAZ), and 0.04 lower weight-for-height z-scores as compared with matched pre-COVID children. Post-COVID children surveyed in 2020 have 1.6%, 4.6%, and 2.4% higher stunting, underweight, and wasting rates, respectively, and 0.07 lower HAZ, as compared with matched pre-COVID children. Reductions in nutritional status are largest among children from households in the poorest wealth quintiles.ConclusionsThese findings indicate a trend towards a recovery in child anthropometric outcomes in 2021 after the initial post-pandemic reductions. The resilience of health and food systems to shocks such as COVID-19 should be strengthened while immediate investments are required to decrease child malnutrition and improve broader child health outcomes.

Impact of weekly iron-folic acid supplementation on nutritional status and parasitic reinfection among school-age children and adolescents in Sub-Saharan Africa: a systematic review and meta-analysis.

Two significant etiological factors contributing to iron deficiency anemia, and undernutrition posing substantial public health challenges in Sub-Saharan Africa, are soil-transmitted helminths and malaria. This study carried out the effect of weekly iron-folic acid supplementation (WIFAS) on the nutrition and general health of school-age children and adolescents in Sub-Saharan Africa, a systematic review and meta-analysis have been conducted. To find pertinent publications for this study, a thorough search was carried out on May 20, 2023, across five databases: Pubmed (MEDLINE), Web of Science, Scopus, Cochrane Library, and Google Scholar. In addition, a search was conducted on August 23, 2023, to capture any new records. The inclusion criteria for the studies were based on school-age children and adolescent populations, randomized controlled trials, and investigations into the effects of WIFAS. The outcomes of interest were measured through anthropometric changes, malaria, and helminthic reinfection. A systematic review of 11 articles revealed that WIFAS significantly decreased the risk of schistosomiasis reinfection by 21% among adolescents (risk ratio = 0.79, 95%CI: 0.66, 0.97; heterogeneity I 2 = 0.00%, P = 0.02). However, no significant impact was observed on the risk of malaria reinfection (risk ratio = 1.02, 95%CI: 0.92, 1.13; heterogeneity I 2 = 0.00%, P = 0.67) or A. Lumbricoides reinfection (risk ratio = 0.95, 95%CI: 0.75, 1.19; heterogeneity I 2 = 0.00%, P = 0.65). Moreover, the analysis demonstrated that there is no significant effect of iron-folic acid supplementation in measured height and height for age Z-score (HAZ) of the school-age children (Hedge's g -0.05, 95%CI: -0.3, 0.2; test for heterogeneity I 2 = 0.00%, P = 0.7) and (Hedge's g 0.12, 95%CI: -0.13, 0.37; test for heterogeneity I 2 = 0.00%, P = 0.36) respectively. The effectiveness of WIFAS in reducing the risk of schistosomiasis reinfection in adolescents has been demonstrated to be greater than that of a placebo or no intervention. Additionally, the narrative synthesis of iron-folic acid supplementation has emerged as a potential public health intervention for promoting weight change. However, there was no significant association between WIFAS and Ascariasis, trichuriasis, and hookworm. Moreover, the certainty of the evidence for the effects of WIFAS on height and malaria is low and therefore inconclusive. Whereas, the certainty of the evidence for the effectiveness of WIFAS on Schistosomiasis is moderate. Even though the mechanisms need further research WIFAS may be implemented as part of a comprehensive public health strategy to address schistosomiasis in adolescents. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397898, PROSPERO (CRD42023397898).

Results of Turner Syndrome Treatment with Recombinant Human Growth Hormone in Albania

Background: There is no doubt that the use of rhGH in patients with TS brings satisfactory results regarding the improvement of height growth, realizing the improvement of the final adult height. This study aimed to evaluate the influence of the type/characteristic of the genetic anomaly on sex chromosome X on the outcome of treatment with rhGH among Albanian children diagnosed with TS. Methods and Results: This analytical-observational study was conducted at the Pediatric Endocrine Unit at University Hospital Centre Mother Teresa in Tirana, the only one of its kind treating TS pediatrics in Albania. Only TS patients who had attained near-adult height (NAH) by December 2023 were included in the analysis of this study. Near-adult height was obtained for 44(72.1%) patients. The mean age of starting treatment was 12.68±3.03 years. After a treatment duration of 3.60±2.26 years, the patients recovered 0.88±0.56 in height-for-age Z-score (HAZ), resulting in HAZ at the end of treatment of -2.73±0.87. They achieved their NAH of 144.56±6.53cm. Conclusion: Despite starting treatment late, our patients managed to gain 17.70±12.53cm in length. The progression of height improvement under rhGH treatment showed differences between chromosomal groups. The non-monosomy group had better results regarding NAH and HAZ at the treatment's end than the monosomy group.

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

BackgroundPoor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children’s linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6–59 months in Ethiopia.MethodsWe used pooled Ethiopia Demographic and Health Survey data (2005–2016) comprising 21,918 (weighted data) children aged 6–59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.ResultsOur analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18–1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.ConclusionOpen defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) &lt; −2 SD), thinness (BMI-for-age z-score (BAZ) &lt; −2 SD) and overweight (BAZ &gt; 1). Iron deficiency was defined as serum ferritin&lt;15μg/L (&lt;70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol&lt;1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein &gt;5 mg/L or α1-acid glycoprotein &gt;1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.