Improve Child Nutritional Status Research Articles

Continuum of care for maternal and child health and child undernutrition in Angola

BackgroundContinuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status.MethodsWe used nationally representative data from the Angola 2015–2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels.ResultsThe prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight.ConclusionsThe completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.

Transfers, nutrition programming, and economic well-being: Experimental evidence from Bangladesh

Many cash transfer programs include complementary nutrition training, with the aim of encouraging households to use transfer resources toward improving child nutrition. Evidence indicates that these bundled programs, if intensive and well-implemented, can be effective in improving child nutritional status. However, little is known about how adding nutrition training to transfer programs affects their economic impacts. In particular, few studies have assessed whether nutrition programming may induce reallocation of transfer resources from physical capital to human capital. Scarce evidence also exists as to whether these tradeoffs depend on the transfer modality. We study a pilot program called the Transfer Modality Research Initiative in Bangladesh (TMRI), designed as a randomized controlled trial. TMRI provided cash or food transfers, with or without intensive group-based nutrition behavior change communication (BCC), to mothers of young children in poor rural households. We find that adding nutrition BCC to cash or food transfers leads to larger impacts on both consumption and assets – potentially surprising, given that the transfer value is unchanged. Analysis of mechanisms suggests that these effects occur through the BCC inducing increases in income generation, through investments in livelihoods. Suggestive evidence indicates that the effects of TMRI’s BCC are plausibly due to the intensive group-based format, which increased social capital for participant women and their household members, as well as improved participant women’s agency and self-confidence, knowledge, and input into household decisions. Results indicate that adding nutrition BCC to cash or food transfer programs do not necessarily induce a tradeoff between investing in human capital versus physical capital, but can rather strengthen impacts on both if appropriately designed.

Comparative Study on Integrated Psychosocial Stimulation, Nutritional Support, Water Sanitation Hygiene Interventions among Malnourished Children in Kanam, North Central Nigeria

This study is determined to compare the effect of integrated psychosocial stimulation, nutritional support, and water sanitation hygiene interventions on malnourished children. An individual randomized trial design comprising weekly home visits for 3 months in four locations of Kanam Local Government Area, Plateau state, was adopted. The eligible malnourished children were identified through a door–to–door survey using standard procedures of anthropometric measurements (weight, height, mid-upper arm circumference) and children with body mass index (BMI) &lt; 16Kg/m2 were selected. A focus group discussion session, follow-up home visitation on weekly and monthly facilitation/support of mother-to-mother, weekly distribution of food supplements, home stimulation environment through the provision of WASH material and age-specific psychosocial stimulation activities were part of intervention strategies adopted for the study. The result shows a significant difference between base-line and end-line data, impacted by integrated package delivery which enhanced and improved nutritional and developmental outcomes of malnourished children over the period of intervention. Furthermore, the findings reveal that there is a non-significant difference among the study groups. However, the observed effect on outcomes based on average BMI indicators is at causal pathways to improve child nutritional status outcomes. The study concludes that the integrated intervention package improved the developmental and nutritional outcomes in malnourished children. Implementation of these integration packages over a longer duration is needed to witness a significant improvement.

Does Neighborhood Social Capital Longitudinally Affect the Nutritional Status of School-Aged Children? Evidence from China.

Previous research linking social capital to child nutritional status primarily constitutes cross-sectional studies. To investigate whether a longitudinal relationship exists, by conducting fixed-effects analyses with 16,977 repeatedly measured observations of 6193 children from the 2012, 2014, 2016, and 2018 China Family Panel Studies, this study explored the longitudinal effects of neighborhood participation, bonding trust, and bridging trust on the BMI-for-age z-score (BAZ) and BMI categories of school-aged children, differentiating between urban and rural residence. We found an increasing average BAZ, a decreasing prevalence of underweight, an increasing prevalence of overweight/obesity, and a reducing urban/rural gap in nutritional status. The levels of social capital components descended faster in the urban area. Bonding trust was predictive of a lower BAZ, a higher likelihood of being underweight, and a lower likelihood of being overweight/obese. Bridging trust was predictive of a higher BAZ. The longitudinal effects of bonding trust were significant among only the rural children. Our findings indicate that neighborhood social capital may impose causal impacts on the nutritional status of children. To effectively improve child nutritional status, a more empathetic governmental approach that promotes a more supportive distal social environment is needed.

Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study.

Poor mental health may diminish a mother's capacity to adequately care for her child, resulting in a negative impact on the child's nutrition. This study aims to determine the association between maternal mental health and child nutritional status in a poor urban population in Bangladesh. We carried out a cross-sectional study among 264 mother-child pairs in an urban slum area of Bangladesh. The Self-Reporting Questionnaire-20 (SRQ-20) was used to assess maternal mental health. An SRQ-20 score ≥7 was considered a common mental disorder (CMD). Anthropometric measurements were performed to assess nutritional status of the children. The prevalence of maternal CMD was 46.2%. Maternal CMD was associated with poorer child feeding practice (p<0.001), poorer hygiene practice (p<0.001), poorer preventive care service use (p = 0.016), and suffering from diarrheal diseases (p = 0.049). The prevalence of stunting, wasting and underweight in children was 44.3%, 18.2% and 33.7%, respectively. A poorer child feeding practice was associated with wasting (p = 0.004) and underweight (p<0.001) but not with stunting. Poorer hygiene practices and suffering from diarrheal diseases were associated with stunting and underweight, but not with wasting. In multivariable analysis, maternal CMD was associated with child wasting (adjusted odds ratio, aOR = 2.25, 95% CI = 1.15-4.43). The association between maternal CMD and child underweight found in the bivariate analysis was attenuated and no longer statistically significant after multivariable analysis (aOR = 1.77, 95% CI = 0.94-3.33). No statistically significant association was observed between maternal CMD and stunting in this study (aOR = 1.46, 95% CI = 0.84-2.54). Maternal mental health affects nutritional status of the children where child feeding practice, hygiene practice and preventive care use might play a role. Interventions to address maternal mental health in child nutrition programs might improve child nutritional status.

Fathers' level of involvement in childcare activities and its association with the diet quality of children in Northern Ghana.

This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. A community-based comparative analytical cross-sectional study. A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months. The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Labour-saving technologies mitigate the effect of women’s agriculture time-use constraints on stunting in rural Uganda

Women’s time allocation is a dimension of women’s empowerment in agriculture, and is recognised as a pathway through which agriculture can affect child nutritional status in developing countries. Longer hours of farm work can potentially increase women’s time constraints, reducing the time allocated to child-caring responsibilities and raising the risk of poor child nutritional status. Using a three-wave household panel dataset from the Feed the Future Innovation Lab on Nutrition surveys in the north and southwest of Uganda, we tested the hypothesis that the negative effect of women’s agriculture time-use constraints on child stunting is mitigated for households that use labour or timesaving agricultural technologies (LSATs). The results show a positive and significant association between the number of hours per day that women spend on agricultural work and the risk of stunting in children aged zero to 23 months who live in households that do not use animal traction for ploughing. However, this association is statistically insignificant, and even turns negative for households that adopted the labour-saving technology. Our findings indicate that LSATs have the potential to lessen a household’s agricultural workload, giving mothers more child-caring time, and hence improving child nutritional status. Therefore, agriculture could have better nutritional outcomes if policies and programmes were designed to have interventions that reduce the workload in farming activities and thus reduce pressure on women’s time.

Maternal and child social support and food availability in relation to child growth in four low- and middle-income countries

Previous studies showed positive associations between specific types of social capital and child nutritional status. Our study examined whether improved food availability mediates the impact of maternal and child social support on child nutritional status in four low- and middle-income countries. We used data from the Young Lives cohort study, comprising 1,000 children aged 8 and 12 in Vietnam and Ethiopia, 1008 in India, and 714 in Peru. The outcome variables were the z-scores for height for age and body mass index (HAZ and BAZ, respectively). The causal mediation analysis framework was used. In Peru, above-median values of maternal social support and receiving child financial support were positively associated with HAZ at age 12. The level of maternal financial support was positively associated with BAZ among 12-year-old children in India. Peru was the only country where a positive association was found between food availability and maternal financial support among children aged 12. However, food availability did not mediate the effect of maternal financial support on HAZ at age 12. Strengthening social support to improve child nutritional status, especially by improving food availability, may not be a sufficient intervention in resource-poor settings because sources of support may lack sufficient food resources to share. However, more comprehensive measurements of social support and food security are necessary to better understand the mechanism of social support and child nutritional status.

Infant and Young Child Feeding Practices and Nutritional Status in Two Health Zones of South Kivu, Eastern Democratic Republic of Congo: A Community-Based Study

Background: In DRC, childhood undernutrition remains a serious public health concern. Internationally recommended infant and young child feeding (IYCF) practices may improve child nutritional status. This study aimed to describe IYCF practices, factors associated with inappropriate complementary feeding, and infant’s nutritional status.

The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis.

This systematic review and meta‐analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer‐reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random‐effects models. Eighty studies were included in this review: Fifty‐one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi‐experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z‐scores (HAZ), 23 (29%) measured weight for height z‐scores (WHZ), 27 (34%) measured weight for age z‐scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35–2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17–0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004–0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02–0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions.

What Were the Drivers of Improving Child Nutritional Status in Bangladesh? An Analysis of National Household Data from 1992 to 2005 Guided by the UNICEF Framework

Bangladesh has experienced rapid reductions in child undernutrition and poverty, increases in maternal education, and dietary change over the past 3 decades. We aimed to quantify the determinants of the improvement in child nutritional status among preschool-aged children in Bangladesh from 1992 to 2005. We utilized data from 4 rounds of 2 linked and seasonally balanced survey systems: the Bangladesh Household [Income and] Expenditure Surveys (H[I]ES) and the Child [and Mother] Nutrition Survey (C[M]NS). We analyzed 10,780 children aged 6-59 mo, divided into 2 age groups (6-23 mo and 24-59 mo). We used Blinder-Oaxaca decomposition to assess the impact of changing determinants on nutritional status over time, guided by the UNICEF conceptual framework for the causes of child malnutrition. There were significant improvements in child growth over time for all z-score measures-length/height-for-age (LAZ/HAZ), weight-for-length/height (WLZ/WHZ), and weight-for-age (WAZ)-and in many potential determinants of child growth across domains of the UNICEF framework. Among younger children, decomposition explained 67% of the observed change in LAZ, 130% of WLZ, and 73% of WAZ. Among older children, decomposition explained 41% of the observed change in HAZ and 36% of WAZ. Drivers varied, with improvements in care of children as the only driver in both age groups and for all growth measures. Declines in disease prevalence drove improvements in weight-based measures. For younger children, household diets and household environments were significant drivers of improvement in LAZ and WAZ. For older children, increasing income was the largest driver of HAZ and WAZ. Increasing income did not independently drive improvements for younger children but drove improved growth among children aged 2-4 y. This points to the need to focus on nutrition-specific and nutrition-sensitive interventions to decrease child undernutrition in the vulnerable first 1000 days of life.

Access to Improved Sanitation and Nutritional Status among Preschool Children in Nouna District, Burkina Faso.

ABSTRACTAccess to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6–59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in children living in households with an unimproved latrine than those with an improved latrine (adjusted odds ratio: 1.60; 95% CI: 1.11–2.31). Children in households with unimproved latrines and households that practiced open defection had approximate 0.15 cm reduced MUAC compared with those in households with an improved latrine. There was a small, but statistically significant, association between improved latrine and nutritional status in preschool children as measured by MUAC.

Maternal caregiving capabilities are associated with child linear growth in rural Zimbabwe.

Between birth and 2 years, children's well‐being depends on the quality of care they receive from caregivers, primarily their mothers. We developed a quantitative survey instrument to assess seven psychosocial characteristics of women that determine their caregiving ability (‘maternal capabilities’: physical health, mental health, decision‐making autonomy, social support, mothering self‐efficacy, workload and time stress, and gender norm attitudes). We measured maternal capabilities in 4,025 mothers and growth in their 4,073 children participating in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. We used generalized estimating equation models with exchangeable correlation structure to test the association between each maternal capability during pregnancy, and infant length‐for‐age Z (LAZ) at 18 months, accounting only for within‐cluster correlation and intervention arms in unadjusted analyses and for potential confounders in adjusted analyses to examine the association between each capability, assessed during pregnancy, with child LAZ at 18 months of age. In adjusted models, each unit increase in gender norm attitudes score (reflecting more equitable gender norm attitudes) was associated with +0.09 LAZ (95% CI: 0.02, 0.16) and a decreased odds of stunting (adjusted odds ratio [AOR]: 0.86; 95% CI: 0.74, 1.01); each unit increase in social support score was associated with +0.11 LAZ (95% CI: 0.05, 0.17, p < 0.010) and decreased odds of stunting (AOR: 0.83; 95% CI: 0.73, 0.96). Each unit increase in decision‐making autonomy was associated with a 6% reduced odds of stunting (AOR: 0.94; 95% CI: 0.89, 0.996, p = 0.04). Interventions and social programming that strengthen these maternal capabilities may improve child nutritional status.

Maternal mid-upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life.

Stunting prevalence among children under 5 years remains high in Cambodia, affecting about one‐third of children. In most low‐ and middle‐income countries, linear growth faltering of young children starts in the womb. The 1,000‐days window of opportunity to improve child nutritional status includes pregnancy, as maternal nutritional status is an important determinant of birthweight and child development. In Cambodia, nutritional status of pregnant women is poor, with some studies reporting >20% of pregnant women having a low mid‐upper arm circumference (MUAC < 23 cm). Few studies have investigated associations between maternal nutritional status during pregnancy and neonatal growth. Using data from a Cambodian cohort study conducted from 2016 through 2018 in selected districts of Phnom Penh, Kratie, and Ratanakiri provinces, we investigated associations between maternal MUAC during pregnancy as indicator of maternal nutritional status and their offspring linear growth during early life. Multivariate regression models were used to assess the associations between maternal MUAC during the last trimester of pregnancy and infant's length‐for‐age z‐scores during the first 3.5 months of life. Maternal MUAC was significantly associated with infant's length‐for‐age z‐scores (regression coefficient 0.06, 95% CI [0.03, 0.09]). Infants born from mothers with a low MUAC during pregnancy had a 1.6 times higher risk (odds ratio 1.621, 95% CI [0.998, 2.636]) of being stunted during the first 3.5 months of life compared with infants born from mothers with a MUAC >23 cm. This study underlines the importance of optimum maternal MUAC during pregnancy for optimal infant growth. Interventions that aim to tackle stunting in infants should integrate improving maternal MUAC during pregnancy.

Improving Child Nutritional Status in Order to Fill the Demographic Dividend in East Java Province, Indonesia

All Indonesian children are national assets where the future of the nation depends on their quality. East Java Province experienced a demographic bonus period and the peak occurred in 2019 and a third of the population of East Java were children aged 0-17 years. Now the government of East Java Province has implemented five strategies in dealing with demographic bonuses, namely improving the quality of youth human resources, creating quality human resources, placing the elderly population as assets, improving health efforts, and economic empowerment. In the strategy of increasing health efforts, it is necessary to evaluate the nutritional status of children and toddlers. Improving the nutritional status of the community is one of the efforts that has a significant impact and is one of the determining factors for improving the quality of human resources. At the individual level, nutritional conditions are influenced by nutritional intake and related infectious diseases. The first two years of life is a critical period, if there are nutritional disorders in this period, the impact is permanent.

Examining Dietary Change as a Determinant of Improving Child Nutritional Status in Bangladesh from 1992 to 2005 (OR10-07-19)

ObjectivesWe sought to quantify the impact of the transition in household diets in Bangladesh on the reduction of stunting in children from six months to two years of age over the 13-year period from 1992 to 2005. MethodsThis study utilizes data from four rounds of two linked survey systems: the Bangladesh Household [Income and] Expenditure Surveys (H[I]ES) and the Child [and Mother] Nutrition survey (C[M]NS). The households included in the C[M]NS were a subsample of those contained in the H[I]ES. Across all years, we analyzed 3484 children who were six to twenty-three months of age at the time of C[M]NS. Dietary change was measured through dietary patterns previously derived using principal component analysis. We used Blinder-Oaxaca decomposition to assess the impact of changing diets, other socioeconomic characteristics of households, and child level characteristics on child nutritional status over time. ResultsFor six dietary patterns, the prevalence of adherence changed over time. In a fully adjusted model, only the “modern” dietary pattern – characterized by processed soybean/palm oil, poultry and beef, beverages, generally more diversity, and less rice – was significantly associated with changes in child nutritional status. Indicators included in the decomposition models explained 64% of the observed change in length-for-age z-score (LAZ), 84% of the observed change in weight-for-age z-score (WAZ), and 180% of the observed change in weight-for-length z-scores (WFL). The dietary transition towards the “modern” diet over time was a significant predictor of better child LAZ and WAZ, but not quite significant for WFL (p-values: 0.005, 0.005, and 0.07, respectively). Other significant predictors of LAZ and WAZ included changes in household access to improved latrines and increased caregiver education. Increased household real income was not a significant predictor of improved nutritional status. ConclusionsChanges in household characteristics, namely more diverse diets and improved latrines, along with increasing caregiver education, were able to largely explain the changes in child nutritional status over time. Increasing income, however, did not independently improve child growth. This points to the need to focus on nutrition-specific and -sensitive interventions to continue to decrease child malnutrition. Funding SourcesThis publication has been produced with the assistance of the European Union and the UK Department for International Development. The contents of this publication are the sole responsibility of its authors and do not necessarily reflect the views of the European Union or the UK Department for International Development. Supporting Tables, Images and/or Graphs▪▪

Is women's empowerment a pathway to improving child nutrition outcomes in a nutrition-sensitive agriculture program?: Evidence from a randomized controlled trial in Burkina Faso

Nutrition-sensitive programs in low- and middle-income countries often aim to improve child nutrition outcomes in part by empowering women. Although previous studies have found cross-sectional associations linking women's empowerment and child nutritional status, there is limited empirical evidence supporting the hypothesis that empowering women as part of an intervention will, in turn, improve child nutritional outcomes. We tested this hypothesis using two waves of data from a cluster-randomized controlled trial of a nutrition-sensitive agricultural program in Burkina Faso. With structural equation models, we examined whether four domains of women's empowerment—purchasing decisions, healthcare decisions, family planning decisions, and spousal communication—mediated the program's impact on reducing wasting and increasing hemoglobin among children who were three to 12 months old at the start of the two-year program. We found that improvements in women's empowerment in the domains of spousal communication, purchasing decisions, healthcare decisions, and family planning decisions contributed to the program's impact on reducing wasting with the largest share being attributable to spousal communication. Improvements in women's empowerment did not contribute to the increase in hemoglobin. These findings provide the first evidence from a randomized controlled trial that women's empowerment is a pathway by which a nutrition-sensitive program can improve child wasting. Programs that aim to improve child nutritional status should incorporate interventions designed to empower women.

Mitigated Impact of Provision of Local Foods Combined with Nutrition Education and Counseling on Young Child Nutritional Status in Cambodia.

Background: In Cambodia, stunting and wasting affect, respectively, 32% and 10% of children 0–59 months while 55% are anemic. Our research aims to assess the efficiency of two local foods combined with nutritional education and counseling (CEN) activities as compared to CEN alone on improving child nutritional status and dietary intake. Methods: A cluster-randomized controlled trial was conducted in Soth Nikum area over a six-month period among children 6–23 months (n = 360) assigned to receive either moringa +CEN, cricket +CEN or CEN alone. Anthropometric measurements were performed and hemoglobin and ferritin levels assessed. Results: Overall, no significant increase in the mean length/height-for-age z-score was observed, although a small increase of the weight-for-length/height was noted in intervention groups. Hemoglobin and ferritin mean values increased in all groups. The degree of satisfaction of energy, proteins, iron, and zinc requirements improved in all groups, but to a greater extent in the intervention groups and more children were healthy. Conclusion: Our research shows no significant impact of the provision of two local foods combined with CEN on the improvement of child nutritional status as compared to CEN alone. However, children consuming them better fulfilled their energy, iron, and zinc requirements and were healthier.

Factors Associated with Undernutrition in Children under the Age of Two Years: Secondary Data Analysis Based on the Pakistan Demographic and Health Survey 2012⁻2013.

In Pakistan, 96% of the children under the age of two years do not receive an adequate diet. The main aim of this paper is to identify the sociodemographic, nutritional, and health-related factors associated with stunting, wasting, and underweight in children under the age of two years in Pakistan. Secondary data analysis was performed based on the Pakistan Demographic and Health Survey, 2012–2013. The analysis was limited to children under the age of two years (n = 984). Analysis was done using bivariate and multivariable binary logistic regression. The incidence of stunting, wasting, and underweight in children was 28.3%, 12.1%, and 27.9%, respectively. The odds of stunting, wasting, and underweight increased with the child’s age. The odds of stunting and underweight increased with the mother’s low body mass index, low access to information, high birth order of child, consanguineous marriages, father’s low education, rural settlement, poor toilet facilities, and low vitamin A consumption. The odds of wasting increased in children who were not being breastfed, but no significant relation was seen with stunting and underweight. There is a need to improve child nutritional status in Pakistan by addressing issues such as poverty, low parental education, low micronutrient intake, and targeting provinces where undernutrition was found to be higher.

Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life

To assess feeding difficulties and nutritional status among children with cerebral palsy (CP) in Ghana, and whether severity of feeding difficulties and malnutrition are independently associated with caregiver quality of life (QoL). This cross-sectional survey included 76 children with CP (18mo-12y) from four regions of Ghana. Severity of CP was classified using the Gross Motor Function Classification System and anthropometric measures were taken. Caregivers rated their QoL (using the Pediatric Quality of Life Inventory Family Impact Module) and difficulties with eight aspects of child feeding. Logistic regression analysis explored factors (socio-economic characteristics, severity of CP, and feeding difficulties) associated with being underweight. Linear regression was undertaken to assess the relationship between caregiver QoL and child malnutrition and feeding difficulties. Poor nutritional status was common: 65% of children aged under 5 years were categorized as underweight, 54% as stunted, and 58% as wasted. Reported difficulties with child's feeding were common and were associated with the child being underweight (odds ratio 10.7, 95% confidence interval 2.3-49.6) and poorer caregiver QoL (p<0.001). No association between caregiver QoL and nutritional status was evident. Among rural, low resource populations in Ghana, there is a need for appropriate, accessible caregiver training and support around feeding practices of children with CP, to improve child nutritional status and caregiver well-being. Malnutrition is very common among children with cerebral palsy in this rural population in Ghana. Feeding difficulties in this population were strongly associated with being underweight. Feeding difficulties were associated with poorer caregiver quality of life (QoL). Child nutritional status was not associated with caregiver QoL.