Malnutrition In sub-Saharan Africa Research Articles

Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa

ObjectiveEnergy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of...

Effect of Hydroxyurea Treatment on Body Composition in Children with Sickle Cell Anemia in Uganda Using Bioelectrical Impedance Analysis (BIA)

Introduction Children with sickle cell anemia (SCA) experience severe illness and risk of malnutrition in sub-Saharan Africa. Treatment with hydroxyurea (HU) decreases SCA complications. In high-income regions, hydroxyurea also improves pediatric growth and overall quality of life. We assessed the effects of hydroxyurea on growth and body composition of children with SCA in Uganda. Methods This study was nested in an open-label, single-arm pediatric clinical trial of hydroxyurea 20-30mg/kg/day for prevention of neurological and cognitive impairment. In all, 267 study participants with SCA, ages 3-9 years, initiated hydroxyurea treatment at the Mulago Hospital SCA Clinic in Kampala, Uganda. Anthropometric measurements (weight, height) were obtained at enrollment and at month 18 of therapy; age- and sex-specific z-scores were assigned, per World Health Organization (WHO) international standards. Non-invasive bioelectric impedance analysis (BIA), was used to estimate total body fat mass (FM) and fat-free mass (FFM) at both timepoints. A control sample of110 siblings/family members without SCA, aged 3-12 years, established local z-scores for BIA assessments. Results Among SCA participants and controls, 50.6% and 57.3% were female, respectively. Mean age was younger foror the SCA sample: 5.1±0.1 and 7.1±0.3 years ( p<.001). At trial month 18, mean hydroxyurea dose 25.4mg/kg, SCA hemoglobin rose from 7.8±1.2 to 8.9±1.5 g/dL( p<.001), remaining lower than mean hemoglobin level of non-SCA controls 12.5±1.1 ( p<.001). Using the World Health Organization definition of “wasting,” SCA participants at enrollment had a higher proportion of low weight-for-height than controls: 9.8% vs 3.8%, p=.009). By body composition, the SCA sample also had lower FFM (-0.67±0.56 vs. 0.00 ±1.00, p < .001) and FM (-0.68±0.60 vs. 0.00 ±1.00, p<.001) than controls. At month 18, for the 254 active SCA participants (95.1%), the proportion with wasting was unchanged. In contrast, z-scores for FFM (-0.65±0.57 to -0.16±0.57, p < .001) and FM (-0.66±0.61 to -0.18±0.61, p<.001) significantly increased (Figure) to near control levels. Conclusion Hydroxyurea therapy in children with SCA increased hemoglobin yet did not reduce the proportion with wasting after 18 months. Nonetheless, treatment led to significantly improved FM and FFM to near normal levels. These results suggest that hydroxyurea therapy may play a crucial role in enhancing body composition of children with SCA in the region. The ongoing hydroxyurea trial will enable assessment of longer-term impact on health-related growth and body composition in children with SCA in Uganda.

Climate variability, armed conflicts and child malnutrition in sub-saharan Africa: A spatial analysis in Ethiopia, Kenya and Nigeria

BackgroundSub-Saharan Africa (SSA) has one of the highest prevalence of malnutrition among children under 5 in the world. It is also the region most vulnerable to the adverse effect of climate change, and the one that records the most armed conflicts. The chains of causality suggested in the literature on the relationship between climate change, armed conflict, and malnutrition have rarely been supported by empirical evidence for SSA countries. MethodsThis study proposes to highlight, under the hypothesis of spatial non-stationarity, the influence of climatic variations and armed conflicts on malnutrition in children under 5 in Ethiopia, Kenya, and Nigeria. To do this, we use spatial analysis on data from Demographic and Health Surveys (DHS), Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED), Climate Hazards center InfraRed Precipitation with Station data (CHIRPS) and Moderate Resolution Imaging Spectroradiometer (MODIS). ResultsThe results show that there is a spatial autocorrelation of malnutrition measured by the prevalence of underweight children in the three countries. Also, local geographically weighted analysis shows that armed conflict, temperature and rainfall are positively associated with the prevalence of underweight children in localities of Somali in Ethiopia, Mandera and Turkana of Wajir in Kenya, Borno and Yobe in Nigeria. ConclusionIn conclusion, the results of our spatial analysis support the implementation of conflict-sensitive climate change adaptation strategies.

Social protection as a nutrition-sensitive instrument to address malnutrition in sub-Saharan Africa: Examining the utility of the UNICEF conceptual model of care for maternal and child nutrition

AbstractChild nutrition, health and development are closely tied to maternal nutrition, health and well-being. The underlying drivers of poor maternal and child nutritional outcomes in sub-Saharan Africa are structural in nature. These risks include social, economic, and environmental factors that together compound vulnerability to poor outcomes. Poverty, as a driver of poor maternal and child health outcomes, is an important determinant that is both a cause and a consequence of malnutrition. The United Nations’ Children’s Fund (UNICEF)’s conceptual model for determinants of maternal and child nutrition outcomes released in 2020, is the agency’s latest iteration of child nutrition frameworks. The model identifies the underlying causes of malnutrition as extending beyond food and diets, to include household level dynamics, maternal factors, and the external environment. The manuscript discusses UNICEF’s conceptual model and its applicability in sub-Saharan Africa. It also considers the evidence on interventions aimed at addressing maternal and child nutrition in the region and the location of social protection among these policy tools, with a special focus on the extent to which these resonate with the conceptual model. It concludes by considering the conditions required for social protection instruments to work in the region and similar settings in the Global South. In this way, the manuscript provides a critical reflection about the role of social protection as a nutrition-sensitive instrument in sub-Saharan Africa, in the context of maternal and child nutrition outcomes.

Chinese aid and nutrition improvement in Sub-Saharan Africa

ABSTRACT The efficacy of foreign aid, especially escalating Chinese aid, has been controversial. Considering the widespread malnutrition in Sub-Saharan Africa and the substantial concerns about Chinese aid, we investigate whether and how Chinese development assistance improves the nutrition of the African recipients, particularly children and women. We match Chinese aid projects and Demographic and Health Surveys (DHS) covering 24 SSA countries during 2000–2016. We address the causality by comparing the individuals who lived near a Chinese aid project that was effective at the time of the interview to those who were not exposed to Chinese aid projects while a nearby Chinese aid project would be initiated after the interview. We measure malnutrition by hemoglobin haemoglobin and anemia anaemia which are more relevant and reliable than other indicators. Our results show that Chinese aid significantly increased hemoglobin haemoglobin and decreased the likelihood of anemia anaemia, and the effects are more pronounced among children. In contrast to the popular expectation, health aid does not significantly improve nutrition conditions, at least in the short run. Instead, other aid projects that promote earnings and job opportunities substantially reduced malnutrition among children and women. Heterogeneity analysis further shows that Chinese aid strongly improved nutrition mainly among disadvantaged residents.

How food preparation and food choice influence the nutritional growth of children: a rising matter for the nutritionists and dietitians in Nigeria.

This current work describes how the nutritionists and dietitians in Nigeria to tackle the nutritional deficiencies among the under-5 children in Nigeria due to poor food preparation by the parents and caregivers as well as how the food is chosen for these children. Studies have shown that the resultant effects of poor food preparation and the skewness of food choices on particularly the more vulnerable group of under-5s are malnutrition. According to the State of the World's Children, published by the United Nations International Children's Emergency Fund, the prevalence of child malnutrition in Sub-Saharan Africa, including Nigeria, is particularly high. Thus, it is high time for the nutritionists and dietitians in Nigeria to step up their advocacy, community sensitization, and awareness campaigns on appropriate diet and approach to food issues, especially on how food is prepared by most Nigerian parents and caregivers, and also work on their decision-making process governing the food choices they make for their children.

Does maternal empowerment influence childhood stunting and wasting in Cameroon? A cross-sectional study

ABSTRACT Malnutrition during childhood remains a major public health concern in developing countries. Within the household, the responsibility of the mother in child nutrition is crucial. Their empowerment is recognized by previous research as a social factor associated with low rates of malnutrition in Sub-Saharan Africa. Using data from the Cameroon Demographic and Health Survey of 2018, this study investigates the associations between the dimensions of maternal empowerment and childhood stunting and wasting. A logistic regression model was used to estimate these associations. Considering each dimension of maternal empowerment, the results suggest that mother’s economic status was associated with greater odds of childhood stunting (OR = 1.110; 95% CI:1.014, 1.215; p < 0.05), and lower odds of childhood wasting (OR = 0.456; 95% CI: 0.373, 0.557; p < 0.01). Mother’s control over financial resources was associated with lower odds of childhood stunting (OR = 0.696; 95% CI: 0.642, 0.756; p < 0.01) and wasting (OR = 0.362; 95% CI: 0.309, 0.424; p < 0.01). Mother’s participation in decision-making was related to lower odds of childhood stunting (OR = 0.878; 95% CI: 0.826, 0.933; p < 0.01) and wasting (OR = 0.699; 95% CI: 0.622, 0.786; p < 0.01). Thus, the findings of this study suggest that maternal empowerment dimensions associated differently with childhood stunting and wasting. For a better effectiveness of any policy intervention, it is important to clarify the contribution of each dimension of maternal empowerment when analyzing its relationship with the nutritional status of children.

Guest Editors’ Introduction: The role of policy in reducing malnutrition in sub-Saharan Africa

Sub-Saharan African countries experience various market failures and other constraints in food production, marketing, and food consumption. Consequently, sub-Saharan Africa governments have put in place a myriad of policies to counter these failures. Agricultural, food and nutrition policies address nutrition outcomes, such as hunger, undernourishment, wasting, stunting, child mortality, inadequate food consumption, food insecurity, and volatile food prices, thus improve nutrition outcomes among the population. However, malnutrition persists among the population in the region. To mitigate this challenge, informed, evidence-based policy development and implementation by policy practitioners is of essence. The solutions to the double burden of undernutrition and obesity cut across the agriculture, rural development, and public health sectors. This essay introduces twenty papers of this Special Issue of the Food Policy journal which analyzes 8 policy domains, contributes to the debate on the linkages and pathways through which policies influence food security, nutrition outcomes, and related indicators and points to policy directions in these domains.

Malnutrition: An underlying health condition faced in sub Saharan Africa: Challenges and recommendations.

In Sub-Saharan Africa, the morbidity and mortality rate from malnutrition is increasing more than in any place in the world. Malnutrition has been a public health challenge in Sub-Saharan Africa that has not received enough attention. This commentary discussed the causes, effects and the need to prioritize the prevention and control of Malnutrition in Africa, together with practical recommendations. Several factors contribute to the high prevalence of malnutrition in sub-Saharan Africa. Some are poverty, overpopulation, unsuccessful small-scale agriculture, low educational status, climate change, corruption, wars and conflicts, fluctuation of food prices, etc.Conversely, the effects of malnutrition on individuals have resulted in the development of illnesses and chronic health issues. Hence, there is a need to reach out to malnourished individuals, encourage the government, investors, and non-governmental organizations (NGOs) to take action, educate health staff to detect and react to early indicators of malnutrition, enhance agricultural product output, manage and preserve the environment, and use technology to its full potential. All of these suggestions will significantly impact the incidence of malnutrition in Sub-Saharan Africa.

Food insufficiency and its associated factors: Experiences of in-school adolescents in Sagamu Township, southwest Nigeria.

Background: The burden of hunger, food insecurity and malnutrition in sub-Saharan Africa is enormous. A higher proportion of the population suffer the consequences of food insecurity, hunger and undernourishment than previously assumed. Food insecurity among adolescents has been documented to be associated with malnutrition, poor health outcomes, low educational attainment and other negative consequences. Aim: This study therefore assessed food insecurity and its associated factors among adolescents in Sagamu, Ogun State, Nigeria. Methods: A cross-sectional study was conducted among 1300 in-school adolescents in Sagamu Township, Ogun State in southwestern Nigeria, selected via multi-stage sampling. A semi-structured, self-administered questionnaire was used for data collection. Data were analyzed with the aid of SPSS 20.0. Relevant descriptive and inferential statistics were calculated, with p < 0.05. Result: The prevalence of food insecurity was 45%, of which 34.6% had mild food insecurity, 34.7% had moderate food insecurity, while others experienced the severe form of food insecurity. Gender, age; maternal occupation, maternal education, living arrangement, low sense of self-worth, alcohol intake and cigarette smoking were associated (p < 0.05) with food insecurity. Predictors of food insecurity were: age; maternal education, living arrangement and some behavioral factors. Conclusion: The prevalence of food insecurity among adolescents in Sagamu was high. Multi-sectorial action is essential in tackling the challenges of food insecurity and its numerous consequences among adolescents, at all levels of governance.

COVID-19 Pandemic and its Implication for Nutritional Status of Children in Nigeria: A Call for Transformation to a Sustainable Food System

Background: Nigeria contributes the highest burden of childhood malnutrition in sub-Saharan Africa and this has been worsened by the COVID-19 pandemic. Food system unsustainability has been shown to be the main driver for continued food insecurity and subsequent malnutrition. This paper discusses key issues pertaining to child nutritional status in Nigeria within the context of the COVID-19 pandemic and highlights the importance of adopting a sustainable food system framework that ensures food and nutrition security for all including children.Discussion: The COVID-19 pandemic has exposed the weaknesses in the food system, in addition to those already caused by other factors such as conflicts, climate change, demographic and economic factors, amongst others. Food systems, through diets, give rise to nutrition and health outcomes as well as those related to the dimensions of sustainability (environmental, economic, and social). The complex nature of the food system and its interactions with food and nutrition security requires adoption and practice of more effective food policy framework that embraces four critical policy shifts that support all dimensions of food security and transformation pathways which address the negative impacts of the drivers of food security.Conclusion: The need for the government to adopt a sustainable, resilient, and efficient food policy that appreciates the complexity of food systems drivers and outcomes cannot be overemphasized. This is essential for upholding the right to adequate food as well as ending hunger, and malnutrition in all its forms for all children.

Exploring the risk factors of child malnutrition in Sub-Sahara Africa: A scoping review.

Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub-Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.

Combining Ability and Performance of Extra-Early Maturing Provitamin A Maize Inbreds and Derived Hybrids in Multiple Environments.

Availability of maize (Zea mays L.) hybrids with elevated provitamin A (PVA) levels and tolerance to contrasting stresses would improve food self-sufficiency and combat malnutrition in sub-Saharan Africa (SSA). This study was conducted to (i) analyze selected PVA inbreds of extra-early maturity for carotenoid content, (ii) estimate the combining abilities of the inbred lines for grain yield and other agronomic traits, (iii) assign inbred lines to distinct heterotic groups (HGs), (iv) identify testers among the inbred lines, and (v) determine grain yield and stability of the PVA hybrids across contrasting environments. Thirty-three extra-early maturing inbred lines selected for high carotenoid content were crossed with four inbred testers to obtain 132 testcrosses. The testcrosses, six tester × tester crosses and two hybrid checks, were evaluated across three Striga-infested, four drought and five optimal growing environments in Nigeria, 2014–2016. Results of the chemical analysis revealed that inbred lines TZEEIOR 109, TZEEIOR 30, TZEEIOR 41, TZEEIOR 97, TZEEIOR 42, and TZEEIOR 140 had intermediate PVA levels. Both additive and nonadditive gene actions were important in the inheritance of grain yield and other measured traits under stress and optimal environments. However, additive gene action was preponderant over the nonadditive gene action. The inbred lines were classified into three HGs across environments. Inbreds TZEEIOR 249 and TZEEIOR 30 were identified as testers for HGs I and II, respectively. The hybrid TZEEI 79 × TZEEIOR 30 was the most outstanding in terms of grain yield and was stable across environments. This hybrid should be tested extensively in on-farm trials for consistency in performance and commercialized to combat malnutrition and food insecurity in SSA.

Effect of incorporation of snail meat powder on sensory attributes and consumer acceptability of sorghum-wheat buns.

Formulation of foods from –low‐lysine cereals fortified with animal protein is a potentially sustainable approach to enhance protein quality in diet due to nutritional compensation while buns are valuable vehicles to deliver nutrients to human body because of their relatively noble eating quality and extended shelf life. The aim of this study was to evaluate the sensory attributes and consumer acceptability of sorghum‐wheat buns containing snail meat powder (SMP). Buns were prepared by replacing 5, 10, 15, 20, and 25% of sorghum‐wheat composite flour with SMP. Principal component analysis (PCA) revealed 99% total variation of 23 attributes for buns scored by a descriptive sensory panel, of which 98% was due to the proportion of SMP that replaced sorghum‐wheat composite flour in buns and the remainder 1% was due to the buns’ physical appearance. Compositing sorghum‐wheat buns with SMP imparted positive consumer attributes of fine crumb, sponginess, and crumby texture. It also resulted in buns with reasonably high sensory acceptability as evaluated by 8‐ to 9‐year‐old school children. The buns can serve as supplementary rich sources of protein for alleviating the menace of protein energy malnutrition in sub‐Saharan Africa.

Impact of Health and Nutrition Interventions in the Prevention and Recovery of Child Malnutrition in Sub-Saharan Africa from 2010 to 2020: Review Article

Malnutrition is still a widespread public health problem worldwide. The objective of this review is to identify the most effective nutrition programs used in the prevention and management of child malnutrition in children under five years. Also, it is to suggest courses of action to improve interventions in the fight against malnutrition. The promotion of exclusive breastfeeding and food diversification improves the mothers’ knowledge and contributes to prevention of malnutrition. Food supplementation increases the weight/height ratio of malnourished children. The two programs combined bring better results on mothers’ feeding practices and children’s anthropometric data. This review has highlighted the importance of food supplementation and nutritional education in the management and prevention of child malnutrition. In addition, the combination of several approaches to good dietary practices brings better results. Finally, primary prevention can protect children from the harmful consequences of malnutrition.

Climate Variability, Armed Conflicts and Child Malnutrition in Sub-Saharan Africa: A Spatial Analysis in Ethiopia, Kenya and Nigeria

Climate Variability, Armed Conflicts and Child Malnutrition in Sub-Saharan Africa: A Spatial Analysis in Ethiopia, Kenya and Nigeria

Household Food Insecurity, Dietary Diversity, and Stunting in Sub-Saharan Africa: A Systematic Review.

Background: The significant public health problem in Sub-Saharan Africa of household food insecurity is an underlying cause of malnutrition in Sub-Saharan Africa. This study aims to systematically study the association between household food insecurity, dietary diversity, and stunting. Methods: This review was carried out based on the recommendations of PRISMA (2015). We searched the literature in six bibliographic databases: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar, and Scopus. The research was based on studies conducted in Sub-Saharan Africa about household food insecurity, dietary diversity, and stunting and was published between 2009 and 2020. Results: Out of 2398 original articles identified, only 21 articles met the specific requirements of this review. Two-thirds of the articles selected showed that stunting was linked to household food insecurity and dietary diversity. Conclusions: This study found that household food insecurity and dietary diversity are significantly associated with stunting in Sub-Saharan Africa. This review recommends that in order to yield a sustainable fight against childhood malnutrition in Sub-Saharan Africa, reliable guidelines and strategies are needed to address these factors related to malnutrition.

Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries

ObjectiveThis study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA).DesignData of 127, 487 under-5 children from...

Combined application of ammonium nitrate and goat manure: Effects on soil nutrients availability, Okra performance and sustainable food security

Many see organic agriculture as the most sustainable form of farming and as the paradigm for global food production in the future. One of the solutions to food insecurity and malnutrition in Sub-Saharan Africa is to promote local crops, encourage the use of locally source materials as amendment, improve their traditional system of production, and so diversify subsistence crop. The major reasons are the lack of knowledge and skill in land preparation and agronomic practices, weather uncertainties, pest outbreak and above all the use of fertilizer. Hence, this research will be carried out to investigate the effects of integrated application of Urea fertilizer and Goat Manure on soil Nutrient Availability and Okra performance. Field trials were conducted with four treatments replicated three times in a Randomized Complete Block Design (RCBD). The treatments were Control (no Urea, no goat manure), 8t/ha-1 goat manure + 200kg/ha-1 urea fertilizer; 8t/ha-1 goat manure + 175kg/ha-1 urea fertilizer and 8t/ha-1 goat manure + 150kg/ha-1 urea fertilizer. Treatments were applied three weeks after planting by ring method with Urea and goat manure mixed. Soil physical and chemical properties, growth and yield parameters were evaluated. Data were analyzed using Analysis of Variance (ANOVA) and Duncan Multiple Range. 8t/ha-1 goat manure + 200kg/ha-1 urea fertilizer gave the highest plant height, leaf area as well as number of leaves than other treatment. However, the fruits weight, days of 50% flowering, number of fruit, fruits diameter and fruits length were significantly increased at 8t/ha-1 goat manure + 200kg/ha-1 urea fertilizer.

Profiling household double and triple burden of malnutrition in sub-Saharan Africa: prevalence and influencing household factors.

Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA. The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017. The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15-49 years and children under 5 years). Logistic regression analyses were used to determine household correlates of household burden of malnutrition. Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition. The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.