Malnutrition In sub-Saharan Africa Research Articles

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.

Association between Sociodemographic Factors and Diarrhea in Children Under 5 Years in Rwanda.

Diarrheal disease is the second leading cause of mortality and morbidity in children under 5 years old worldwide, and is the most common cause of malnutrition in sub-Saharan Africa. In Rwanda, diarrhea is the third leading cause of death in children under 5 years old. This study examined the association between sociodemographic factors and diarrhea in children under 5 years using the data of 7,474 households in the 2014–2015 Rwanda Demographic and Health Survey. Overall prevalence of diarrhea in this study was 12.7% in children. An increased risk for diarrhea was found for children aged 12–23 months (odds ratio (OR)=4.514), those with a low economic status (OR=1.64), those from the Western province (OR=1.439), those with poorly-educated mothers (OR=5.163), and those with families engaged in agricultural activities (OR=1.624). In conclusion, sociodemographic factors significantly affect the risk of developing diarrhea in children under 5 years in Rwanda. Designing and implementing health education promoting awareness of early interventions and rotavirus vaccination are essential to reduce diarrheal diseases for the Rwandan community.

Nutritional Quality of Formulated Complementary Foods and their Biological Effects for Tackling Malnutrition in Sub-Saharan Africa (SSA) Countries

Toddlers malnutrition is a health problem in developing countries like those found in Sub-Saharan Africa. Owing to prevalence of poverty, families are generally not able to afford the commercial complementary foods available in the market stalls, since such complementary foods are imported and made from non-local foodstuffs. In order to overcome these issues, FAO/WHO recommends the use of local foodstuffs in formulation of complementary foods and defines the virtues that the complementary foods should possess. In this light, researchers in Sub-Saharan Africa have proposed several formulations of complementary foods. The present work reviews these research findings on complementary foods available in the Sub-Saharan Africa utilizing the local food materials, the treatment that is required to be meted to such food ingredients, nutritional quality of formulated complementary foods and ultimately their biological effects. The limitations of the research work, if any, has been highlighted and the means to take such research forward that would be helpful in the production and commercialization of cost-effective complementary foods possessing requisite nutritional quality and biological effects as per dietary norms laid down by competent authorities.

Growth, morphology and haematology of Double-spurred Francolin (Francolinus bicalcaratus): A prelude to its captive breeding and domestication

It has been documented that broadening the genetic diversity of the livestock population through captive breeding and eventual domestication of game animals could be one of the palliatives for reducing animal protein malnutrition in sub-Saharan Africa. One of the game birds with wide culinary appeal in West Africa that can easily be captive-bred is the Doublespurred Francolin (Francolinus bicalcaratus). This study was therefore conducted to determine the growth, morphology and haematological indices of Double-spurred Francolin reared under intensive management condition. Eighteen eggs of Double-spurred Francolin collected from the wild were artificially incubated and hatched into chicks. These chicks were subsequently reared intensively for 24 weeks while taking data on their feed intake, growth, plumage development, vocalization and haematological indices. The growth curve of F. bicalcaratus was modelled from which the peri-pubertal period of this bird was determined. Also the number of rectrices and remiges from day old to the 24th week of age were determined while the first adult vocalization was observed in the fifth month. Francolinus bicalcaratus displays sexual dimorphism in terms of body size, vocalization and tarsal spur number and development. Double-spurred Francolin has growth and morphometric parameters that are similar to its other phasianid relatives and can therefore fit into the food security equation geared towards solving the perennial animal protein malnutrition problem especially in the West African sub-region. It is concluded that the bird is a good candidate for domestication and conservation, a two-in-one effort that could re-write its current global signature as an endangered bird species of West Africa.

Fertility is a key predictor of the double burden of malnutrition among women of child-bearing age in sub-Saharan Africa.

BackgroundThe ongoing nutrition transition in sub-Saharan Africa (SSA) is exhibiting spatial heterogeneity and temporal variability leading to different forms of malnutrition burden across SSA, with some regions exhibiting the double burden of malnutrition. This study aimed to develop a predictive understanding of the malnutrition burden among women of child-bearing age.MethodsData from 34 SSA countries were acquired from the Demographic and Health Survey, World Bank, and Swiss Federal Institute of Technology. The SSA countries were classified into malnutrition classes based on their national prevalence of underweight, overweight, and obesity using a 10% threshold. Next, random forest analysis was used to examine the association between country-level demographic variables and the national prevalence of underweight, overweight and obesity. Finally, random forest analysis and multinomial logistic regression models were utilized to investigate the association between individual-level social and demographic variables and Body Mass Index (BMI) categories of underweight, normal weight, and combined overweight and obesity.ResultsFour malnutrition classes were identified: Class A had 5 countries with ≥10% of the women underweight; Class B had 11 countries with ≥10% each of underweight and overweight; Class C1 had 7 countries with ≥10% overweight; and Class C2 had 11 countries with ≥10% obesity. At the country-level, fertility rate predicted underweight, overweight and obesity prevalence, but economic indicators were also important, including the gross domestic product per capita – a measure of economic opportunity that predicted both overweight and obesity prevalence, and the GINI coefficient – a measure of economic inequality that predicted both underweight and overweight prevalence. At the individual-level, parity was a risk factor for underweight in underweight burdened countries and a risk factor for overweight/obesity in overweight/obesity burdened countries, whereas age and wealth were protective factors for underweight but risk factors for overweight/obesity.ConclusionsBeyond the effect of economic indicators, this study revealed the important role of fertility rate and parity, which may represent risk factors for both underweight and combined overweight and obesity among women of child-bearing age. Health professionals should consider combining reproductive health services with nutritional programs when addressing the challenge of malnutrition in SSA.

Double Burden of Malnutrition: Evidence from a Selected Nigerian Population.

Indices reflecting the double burden of malnutrition in sub-Saharan Africa are increasing. Evidence to support this claim in households of Africa's most populous country—Nigeria—is scant. This study, therefore, presents results from a study of mother-child pairs sampled from Akwa Ibom State in the southern region of Nigeria. Anthropometric measures for 660 mother-child pairs were collected according to standard procedures. Indices were expressed as the standard deviation of units from the median for the reference group. Chi-square analysis was used to test significant differences in proportion, and p < 0.05 was taken as significant. A total of 37.4% of the children were stunted out of which 19.8% were moderately stunted, and 17.6% were severely stunted. Prevalence of wasting was 13.1%, 6.2% were moderately wasted, and 6.9% were severely wasted. Mean maternal body mass index was (23.54 ± 4.60) kgm2. 9.0% were underweight mothers, 23.2% were overweight, and 9.3% were obese. The co-existence of undernutrition among children and overnutrition in women of child-bearing age is prevalent in this population. We recommend that more effort be placed on active nutrition surveillance to ascertain malnutrition prevalence and periodically reassess priority challenges.

Predictors of stunting among pediatric children living with HIV/AIDS, Eastern Ethiopia

Globally, there were about 3.4 million pediatric children (&amp;lt;15 years of age) who were living with HIV/AIDS. Ethiopia has one of the highest rates of malnutrition in Sub-Saharan Africa. As of 2013, there were about 160,000 pediatric children living with HIV/AIDS in Ethiopia. Even though undernutrition makes it difficult to combat HIV/AIDS, there is paucity of information on the magnitude of stunting and its predictors among seropositive pediatric children in low-income countries like Ethiopia. Institution based quantitative cross sectional study design was employed on 414 randomly selected pediatric (5-15 years) children living with HIV/AIDS in Harari Region and Dire Dawa City Administration Public Hospitals, Eastern Ethiopia. Pretested interviewer administered questionnaire and patient card review was held to collect data. Data were entered through Epi-data and exported to SPSS for analysis. The WHO Anthros plus software was used to calculate the anthropometric indices. Bivariate and Multivariable analysis along with 95%CI were done to identify predictors of stunting. Level of statistical significance was declared at P-value &amp;lt;0.05. The prevalence of stunting was found to be 30.9% (95%CI: 26.0-36.0%). Rural residence [AOR=4.0, (95%CI: 2.22, 7.17)], family monthly income of ≤500 ETB [AOR=5.79, (95%CI: 2.82, 11.60)], being anemic [AOR=3.17, (95% CI: 2.13, 4.93)] and the presence of diarrhea [AOR=6.21, 95% (CI: 3.39, 9.24)] were predictors of stunting. Thus, collaborative measures should be undertaken (to decrease frequent infections and to improve the economic status) to combat chronic malnutrition during HIV/AIDS treatment.

Deforestation and Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa.

Although forests and forest-based ecosystems have been shown to influence health and sustainable diets, there is limited evidence on how deforestation affects the current nutrition transition and the double burden of malnutrition. We examined the relationship between deforestation and the individual- and household-level double burden of malnutrition in 15 countries in Sub-Saharan Africa. We combined data from geolocated Demographic and Health Surveys and the Global Forest Change dataset. We defined household-level double burden of malnutrition as the co-occurrence of an overweight woman of childbearing age (WCBA) and a stunted pre-school child (PSC) within the same household. We defined individual-level double burden in two ways: 1) as the co-occurrence of overweight and anemia within an individual WCBA, and 2) as the co-occurrence of overweight and stunting within a PSC. We used logistic regression analysis to examine the association between forest cover loss and these three measures after adjusting for potential confounders. We also assessed the mechanisms linking forest cover loss and nutritional status, such as livestock ownership and access to clean water. In our sample, the prevalence rates of the three measures of the double burden were: overweight and anemic WCBA: 8.4%, overweight WCBA and stunted PSC: 6.9%, overweight and stunted PSC: 2.7%. After adjusting for the confounders as well as country fixed effects and the month of the survey, forest cover loss was marginally associated with a higher odds of an overweight WCBA and stunted PSC (odds ratio (95% CI): 4.80 (0.82, 28.25)). We found no association between forest cover loss and odds of an overweight and stunted PSC (odds ratio (95% CI): 2.47 (0.80, 7.60)) or the odds of an anemic and overweight WCBA (odds ratio (95% CI): 0.71 (0.15, 3.32)). Deforestation does not seem to be an important driver of the double burden of malnutrition in SSA. However, deforestation influences several intermediate factors which, in turn, may influence the double burden. The overall weak association between forest cover loss and double burden measures mask significant heterogeneity across regions within SSA. Future research should unpack the mechanisms behind these regional differences.

What does women\u2019s empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries

BackgroundThe reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries. The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development, labour supply, productivity, economic growth and development. This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries.MethodsThe study utilized secondary datasets of women in their child bearing age (15–49 years) from the latest Demographic and Health Survey (DHS) conducted in 2011–2017 across 30 sub Saharan Africa countries. The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence. Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status.ResultsWomen’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status (stunted and underweight) at p < 0.001. These characteristics were also statistically significantly associated with empowerment status of women (Decision-making, Violence attitudes and Experience of violence) at p < 0.001 except for child age and sex. The association between childhood nutritional statuses and women’s empowerment (all three empowerment measures) was significant after controlling for other covariates that could also influence childhood nutrition statuses at p < 001. Two of the empowerment measures (attitudes towards violence and experience of violence) showed positive association with childhood nutritional statuses while the third (decision-making) showed negative association.ConclusionThere is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries. Women’s empowerment was found to be related to childhood nutritional status. Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa.

Determinants of Household Food Insecurity and Its Association with Child Malnutrition in Sub-Saharan Africa: A Review of the Literature

Food insecurity is a global public health challenge. Household food insecurity is the leading risk factor of malnutrition, claiming approximately 300,000 deaths each year. Whether directly or indirectly, due to inadequate food consumption and poor diet quality, it is also accountable for over half of all deaths among children in Sub-Saharan Africa. It is estimated that the prevalence of food-insecure individuals in the area will reach 17 million by the year 2021. Inadequate nutrition may result in low immunity, impaired physical and mental development and reduced productivity among children under five years and throughout the life course. This review article attempts to discuss the various household food insecurity determinants and their association with child malnutrition in a Sub-Saharan Africa context. The purposes of this article are to inform governments, policymakers and service providers regarding the importance of household food security and its determinants on child malnutrition, and to plan strategies to improve the household food security status in Sub-Saharan Africa.

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea.

To evaluate the nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea. Children <18years diagnosed with HIV between 2009 and 2017 were included. Clinical, immunological and nutritional data were collected. Weight-for-height, weight-for-age and height-for-age Z-scores were calculated using WHO Child Growth Standards. The population was assessed in two equal periods (2009-2013 and 2014-2017) from the time of diagnosis. A total of 213 children were diagnosed with HIV (49.3% males), median age 3.8years (IQR: 1.5-8.2). A total of 121 cases (56.8%) were at WHO clinical stage III, and 53 (24.9%) were at WHO clinical stage IV. CDC immunological stage II was diagnosed in 51/130 (39.2%) and CDC stage III in 44/130 (33.8%). About 56.2% of children were underweight (weight-for-age <-2 SD); 20.1% moderately and 36.1% severely so. About 27.6% of children were wasted (weight-for-height <-2 SD); 11.9% moderately and 15.7% severely so. About 56.3% of children were stunted (height-for-age <-2 SD); 20.7% moderately and 35.6% severely so. The prevalence of wasting was higher in children ≤5years than in children >5years (36.4% vs. 19.1%, P=0.026). In the second period, the prevalence of moderate-severe immunodeficiency decreased (87.2% to 67.0%, P=0.018), without significant differences in the other nutritional or clinical data. Severe underweight was a risk factor for moderate-severe immunodeficiency (aOR: 4 [95% CI: 1.4-11.4], P=0.010). We highlight a high proportion of malnutrition at the time of HIV diagnosis in Guinea´s paediatric population. Early diagnosis of HIV infection is a priority, achievable by training Guinea´s physicians to suspect HIV early, introducing HIV molecular diagnostic techniques and ensuring intensive nutritional treatment.

Spatial analysis and mapping of child malnutrition in Burkina Faso

Abstract Background Approximately 45% of all child deaths are associated with malnutrition in sub-Saharan Africa. However, information on the geographical variations of child malnutrition in Burkina Faso is limited. This study examined the geographical distribution and the community characteristics associated with child malnutrition in Burkina Faso using spatial regression analysis. Methods Data from the 2011 Burkina Faso Demographic Health Survey were analyzed. A representative sample of 572 communities and 6,120 children under age of five were in the survey. A general Kriging interpolation method was used to generate spatial malnutrition patterns. The Local Indicator of Spatial Autocorrelation was used to identify particular communities clustering with high and low child malnutrition scores. In the spatial regression analysis, we used a two-step procedure combining generalized estimating equation models (GEE) and spatial lag modeling techniques. Results The average rates of stunting and wasting were 32.48%, and 15.05%, respectively. Stunting hotspots were observed to be in the eastern and northeastern part of Burkina Faso (i.e. Oudolan, Séno), while high rates of wasting were observed in the central-north part. The results of the spatial regression analysis revealed lower stunting rates in communities with a higher percentage of households with improved sanitation. Communities with higher rates of professionally assisted births were associated with low wasting rates while communities with higher rates of households with low wealth index reported higher rates of wasting. Spatial lag models appeared to estimate the relationship between community-level risk factors and stunting and wasting more accurately than the ordinary least squares models. Conclusions This study revealed significant geographical patterns and community factors associated with childhood malnutrition. These factors should be considered for future programs aiming at reducing child malnutrition in Burkina Faso. Key messages The study identifies spatial trends and contextual factors associated with child malnutrition in Burkina Faso. Public health programs should focus on the regions identified as hot spots of child malnutrition in Burkina Faso.

Nutrient and Antinutrient Composition of Winged Bean (Psophocarpus tetragonolobus (L.) DC.) Seeds and Tubers

Many people in sub-Saharan Africa suffer from protein malnutrition; this results in negative health and economic impacts. Winged bean (Psophocarpus tetragonolobus (L.) DC.) is a tropical underutilized legume with beneficial nutritional characteristics such as high protein content, which may help to alleviate these problems. The proximate composition (fat, moisture content, crude protein, ash, and carbohydrate) and antinutrient (tannin and phytate) level of winged bean seeds and tubers were determined using 50 accessions. In the processed seeds, accession Tpt17 had the highest protein content (40.30%) and Tpt48 the lowest (34.18%). In the unprocessed seeds, Tpt17 also recorded the highest crude protein (31.13%) with Tpt125 having the lowest (28.43%). In the tubers, protein content ranged from 19.07% (Tpt42) to 12.26% (Tpt10). The moisture content in the processed seeds ranged from 8.51% (Tpt42) to 6.72% (Tpt6); in the unprocessed seeds, it was between 8.53% (Tpt53) and 3.76% (Tpt14). In the processed seeds, the values of ash ranged from 4.93% (Tpt126) to 4.45% (Tpt15-4); in the unprocessed seeds, it ranged from 4.98% (Tpt17) to 4.55% (Tpt125). In the processed seeds, the fat content ranged from 18.91% (Tpt51) to 14.09% (Tp43) while in the unprocessed seeds, the values ranged from 19.01% (Tpt15) to 13.87% (Tpt3-B). The crude fiber in the processed samples ranged from 13.82% (Tpt6) to 10.40% (Tpt125) while in the unprocessed seeds, it ranged from 7.29% in Tpt51 to 4.83% in Tpt11. Carbohydrate content in the processed seeds ranged from 26.30% (Tpt3-B) to 20.94% (Tpt125) and 39.76% in Tpt3-B to 34.53% in Tpt18 in the unprocessed seeds. The tannin and phytate contents showed remarkably significant differences. In the tubers harvested, significant variation was observed in the parameters evaluated. Winged bean flour could be formulated into various meals for children and adults to reduce malnutrition in sub-Saharan Africa.

Joint spatial mapping of childhood anemia and malnutrition in sub-Saharan Africa: a cross-sectional study of small-scale geographical disparities

In epidemiological studies, several diseases share common risk factors or co-exist in their spatial prevalence. Disease mapping allows the health practitioners and epidemiologists to hypothesize the disease aetiology and gain better understanding of the geographical prevalence of the disease risks. This paper investigates the differences in small scale geographical variations and the underlying risk factors of child's health outcomes (anemia, stunting and wasting) in Sub-Saharan Africa using spatial epidemiology. The study first carried out an independent univariate analysis on each malnutrition indicator to identify underlying risk factors. A multivariate conditional autoregressive prior was explored to jointly model the spatial correlation between the undernutrition indicators and the small area-geographical disparities at sub-national levels in two sub-Saharan African countries. The approach was implemented on data from National cross-sectional household- based demographic and health surveys conducted in 17,307 under-five children in Burkina Faso and Mozambique in 2010-012. Out of these children, 31.8% are found to be stunted, 15.5% wasted and 30.9% had anemia among Burkina Faso children, while 42.5% of Mozambican children were stunted, 5.9% wasted and 30.9% suffered from iron-deficiency anemia. The multivariate analysis revealed that the spatial prevalence existed across regions in Burkina Faso with geographical variations in stunting estimated as: 0.7549, CI (0.4693, 1.264); wasting 0.9197; (95%CI: 0.535, 1.591)and anemia: 0.734; (0.4606, 1.214). In additin, the spatial correlation between stunting and wasting was negatively correlated: -0.998; 95% CI (-1.000, -0.984), and a perfect negative correlation;(-1) between stunting and anemia, and positive for wasting and anemia: 0.997; (0.978, 1.000). The spatial occurrence across provinces in Mozambique indicated that there was strong positive correlation between stunting and wasting; 0.986; (0.899, 1.000) and a significant negative correlation between stunting and anemia: -0.720, (-0.934, -0.308) and wasting and anemia: -0.640; (-0.903 -0.174) with individual geographical variability in child stunting: 1427, (913.6, 2268); wasting:1751, (1117, 2803) and anemia: 556, (279.5, 978.9). These extra random effect parameters computed in our multivariate approach would outperform a univariate analysis in similar studies. Our model further detected high prevalent of malnutrition and anemia in the northern Burkina Faso, but high anemia prevalent found in central Mozambique, and high stunting and wasting identified Southern Mozambique. In addition, the risk factors of malnutrition and iron deficiency anemia included household poverty, morbidity, short birth interval (less 18 months), breast feeding, antenatal attendance and maternal literacy. The statistical relevance of the identified risk factors in this study is useful to target specific individual interventions and the maps of the geographical inequalities in sub-national region can be used for designing nutrition interventions and allocation of scarce health resources.

Better soils for healthier lives? An econometric assessment of the link between soil nutrients and malnutrition in Sub-Saharan Africa.

Malnutrition, the suboptimal consumption of essential nutrients like zinc, severely affects human health. This burden of malnutrition falls disproportionally heavy on developing countries, directly increasing child mortality and childhood stunting, or reducing people’s ability mending diseases. One option to combat malnutrition is to blend missing nutrients in crop fertilizers, thereby increasing crop yields and possibly the nutrient density in harvested crop products, thus enriching crop products destined for human consumption. But, the effectiveness of so-called agronomic fortification remains ill-understood, primarily due to a paucity of field trials. We hypothesize that, if at all this is an effective strategy, there should exist a causal link between malnutrition and natural variation in the quality of soils to begin with. Until now, data limitations prevented the establishment of such a link, but new soil micronutrient maps for Sub-Saharan Africa allow for a detailed assessment. In doing so, we find statistically significant relations between soil nutrients and child mortality, stunting, wasting and underweight. For instance, a simultaneous increase in soil densities of copper, manganese and zinc by one standard deviation reduces child mortality by 4–6 per mille points, but only when malaria pressure is modest. The effects of soil nutrients on health dissipate when malaria pressure increases. Yet, the effects are fairly small in magnitude suggesting that except for a few regions, agronomic fortification is a relatively cost ineffective means to combat malnutrition.

Stratification and characterisation of complex medico-psychosocial conditions at primary health care level in Eastern DR Congo: methodological approaches

Background: The importance of medico-psychosocial conditions MPSCs at primary health care level is deemed high among people with chronic comorbidities and mother-infant pairs with history of child malnutrition in sub-Saharan Africa. In Eastern DR Congo where up to 8% of children younger than 5 years are acutely malnourished, more than 1 in very 2 children are stunted and nearly 60% of diabetic patients present with high blood pressure, the real burden of MPSCs is unknown. Besides, there is dearth of evidence-based stratification of such complex conditions in low- and middle-income countries. This hinders integrated care of different medico-psychosocial sub-populations particularly in resource-constrained countries. This study sets out to suggest a rigorous approach to stratifying complex MPSCs and understanding their natural history in adults with chronic diseases and mother-infant pairs with acute malnutrition in post-war rural eastern DR Congo settings. Method: This will be a community-based cohort study in adults with diabetes and hypertension and mother-infant pairs with acute malnutrition in four rural and two sub-urban health areas in South-Kivu Province, Eastern DR Congo. Participants will be identified through health centres record review and community health workers search. Pre-tested structured enrolment questionnaires, WHO Disability Assessment Schedule 2.0 WHODAS, Diabetes self-efficacy management scale, questionnaire and eight-item modified Medical Outcomes Study Social Support Survey mMOS-SS questionnaires will be administered by trained data collectors. Participants will be followed up as per 6 months scheduled visits. Principal component analyses with clustering will be run on social determinants of health, clinical factors, WHODAS and mMOS-SS scores to determine the CMPSCs levels at baseline. We shall use the R markovchain package for analyses and predictions of CMPCs trends over time. To identify the predictors of CMPSCs patterns, we shall fit multilevel mixed-effects regression models to account for repeated measurements in the same individual and possible variability in CMSPCs determinants by health areas. In addition to statistical predictions, we shall study the dynamic of CMPSCs in the six health zones through the 2 years follow-up period by agent-based modelling using NetLogo software. The agents under this study will comprise of mother-infant pairs with history of SAM, adults with multi-morbidities and health centres. We shall integrate the role of history and conditional if-then rules in ABM to account for the inherent contextual and human factors in development of CMPSCs. Discussion: Well-defined CMSCs categories could ease understanding of their evolution patterns and predictors, foster adequate and efficient integrated care and enhancequalityof life at individual and community levels in low- and middle-income countries.

Better Soils for Healthier Lives? Assessing the Link Between Soil Nutrients and Malnutrition in Sub-Saharan Africa.

Malnutrition, the sub-optimal consumption of essential nutrients like zinc, severely affects human health. This burden of malnutrition falls disproportionally heavy on developing countries, directly increasing child mortality and childhood stunting, or reducing people’s ability mending diseases. One option to combat malnutrition is to blend missing nutrients in crop fertilizers, thereby increasing crop yields and possibly the nutrient density in harvested crop products, thus enriching crop products destined for human consumption. But, the effectiveness of so-called agronomic fortification remains ill-understood, primarily due to a paucity of field trials. We hypothesize that, if at all this is an effective strategy, there should exist a causal link between malnutrition and natural variation in the quality of soils to begin with. Until now, data limitations prevented the establishment of such a link, but new soil micronutrient maps for Sub-Saharan Africa allow for a detailed assessment. In doing so, we find statistically significant relations between soil nutrients and child mortality, stunting, wasting and underweight. For instance, a simultaneous increase in soil densities of copper, manganese and zinc by one standard deviation reduces child mortality by 4-6 per mille points, but only when malaria pressure is modest. The effects of soil nutrients on health dissipate when malaria pressure increases. Yet, the effects are fairly small in magnitude suggesting that except for a few regions agronomic fortification is a relatively cost ineffective means to combat malnutrition.

Living arrangements and nutritional status of under-five children in Sub-Saharan Africa

Despite efforts aimed at improving the nutritional status of children under-five years, only a slow progress has been made in Sub-Saharan Africa (SSA). Using data from the latest Demographic and Health Surveys of 17 countries in SSA, we illuminate the association between living arrangement and the nutritional status of 144,765 children under five years. Results showed that living with only the father compared to both parents was associated with a higher risk of malnutrition in SSA [OR:1.18, CI:1.03-1.30] while not living with both parents was associated with a higher risk of malnutrition in West Africa [OR:1.25, CI:1.02-1.54]. Lower risk of malnutrition was observed among children residing in households headed by their mother compared to those headed by their father in West Africa [OR:0.76, CI:0.66-0.87] and SSA [OR:0.83, CI:0.77-0.90]. These results suggest that with whom and where children live as well as biological relationships are vital in improving children’s nutritional status in SSA.

Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016).

BackgroundSub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa.MethodsCross-sectional data from the most recent Demographic and Health Surveys (2006–2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2.ResultsStunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa.ConclusionThe prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.

Gene action controlling grain yield and other agronomic traits of extra-early quality protein maize under stress and non-stress conditions

Extra-early quality protein maize (QPM) hybrids with combined tolerance to drought and low soil nitrogen (N) are crucial for reduced food insecurity and malnutrition in sub-Saharan Africa (SSA). Ninety six extra-early QPM single-crosses derived from 24 extra-early QPM inbreds using the North Carolina Design II plus four checks were evaluated under stress (drought and low-N) and non-stress environments in Nigeria, 2012 and 2013. The objectives were to (i) determine the gene action for grain yield and other agronomic traits in the QPM inbreds (ii) identify the best inbred testers across environments (iii) classify the inbreds into heterotic groups and (iv) evaluate the performance and stability of the hybrids. General combining ability (GCA) effects contributed more to the total variation among the hybrids for grain yield and most measured traits under each and across environments suggesting that additive gene effects were more important in the inheritance of the traits. The inbreds were classified into three heterotic groups. Inbreds TZEEQI 7 and TZEEQI 134 were the best testers while TZEEQI 7, TZEEQI 60, TZEEQI 61, TZEEQI 8, TZEEQI 11, TZEEQI 137, TZEEQI 63, TZEEQI 66, TZEEQI 44, and TZEEQI 157 possessed favorable alleles for stress tolerance and could be used for population improvement and development of stress tolerant hybrids. The hybrids TZEEQI 183 × TZEEQI 7, TZEEQI 181 × TZEEQI 7 and TZEEQI 144 × TZEEQI 183 were high yielding and the most stable across environments and should be tested extensively in on-farm trials and commercialized in the sub-region.