Malnutrition In Young Children Research Articles

Does acute malnutrition in young children increase the risk of treatment failure following artemisinin-based combination therapy? A WWARN individual patient data meta-analysis

The geographical, demographic, and socioeconomic distributions of malaria and malnutrition largely overlap. It remains unknown whether malnutrition affects the efficacy of WHO-recommended artemisinin-based combination therapies (ACTs). A previous systematic review was inconclusive as data were sparse and heterogeneous, indicating that other methodological approaches, such as individual patient data meta-analysis, should be considered. The objective of this study was to conduct such a meta-analysis to assess the effect of malnutrition (wasting and stunting) on treatment outcomes in children younger than 5 years treated with an ACT for uncomplicated falciparum malaria. We conducted a meta-analysis of individual patient data from studies identified through a systematic review of literature published between 1980 and 2018 in PubMed, Global Health, and Cochrane Libraries (PROSPERO CRD42017056934) and inspection of the WorldWide Antimalarial Resistance Network (WWARN) repository for ACT efficacy studies, including children younger than 5 years with uncomplicated falciparum malaria. The association of either acute (wasting) or chronic (stunting) malnutrition with day 42 PCR-adjusted risk of recrudescence (ie, return of the same infection) or reinfection after therapy was investigated using Cox regression, and with day 2 parasite positivity using logistic regression. Data were included from all 36 studies targeted, 31 from Africa. Of 11 301 eligible children in 75 study sites, 11·5% were wasted (weight-for-height Z score [WHZ] <-2), and 31·8% were stunted (height-for-age Z score [HAZ] <-2). Decrease in WHZ was associated with increased risk of day 2 positivity (adjusted odds ratio 1·12, 95% CI 1·05-1·18 per unit; p=0·0002), treatment failure (adjusted hazard ratio [AHR] 1·14, 95% CI 1·02-1·26, p=0·016), and reinfection after therapy (AHR 1·09, 1·04-1·13, p=0·0003). Children with milder wasting (WHZ -2 to -1) also had a higher risk of recrudescence (AHR 1·85, 1·29-2·65, p=0·0008 vs WHZ ≥0). Stunting was not associated with reduced ACT efficacy. Children younger than 5 years with acute malnutrition and presenting with uncomplicated falciparum malaria were at higher risk of delayed parasite clearance, ACT treatment failure, and reinfections. Stunting was more prevalent, but not associated with changes in ACT efficacy. Acute malnutrition is known to impact medicine absorption and metabolism. Further study to inform dose optimisation of ACTs in wasted children is urgently needed. Bill & Melinda Gates Foundation. For the French translation of the abstract see Supplementary Materials section.

Rempah Lombok: Pendekatan Kearifan Lokal sebagai Strategi Penguatan Praktik MPASI bagi Kader Posyandu

Stunting is a problem of chronic malnutrition in young children. Some of the causes of stunting were inappropriate of complementary feeding practices and lack of support from health cadres. One of the stunting locus areas in Indonesia is East Lombok Regency. An education programme needs to be conducted for stunting prevention, such as education of complementary feeding practices and socialisation of the book called "Rempah Lombok". The book was prepared as a guideline for cadres and mothers to provide recommended complementary feeding with local Lombok recipes. The indicator of the success of this activity was done by giving a question-and-answer quiz directly before and after the education process related to complementary feeding practices. The existence of programmes was expected to guide the cadres and mothers more easily and confidently in providing appropriate complementary feeding practices and improving the nutritional status of under-five children in East Lombok.

Pendampingan Penggunaan Buku Kesehatan Ibu dan Anak (KIA) sebagai Upaya Pencegahan Stunting di Nagari Tanjung Bingkung Kabupaten Solok

Stunting is chronic malnutrition in young children caused by long-term undernutrition and usually followed by frequent illnesses. Mothers of toddlers do not know how to use maternal and child health books for various reasons. To improve the service of mother class participants in the use of the MCH manual in the Tanjung Bingkung Health Centre working area, especially in Jorong Koto Tangah, it is necessary to carry out activities in the form of community service. This service was carried out by lecturers and students of the Muhammad Yamin Biology Education Programme at Mahaputra University, helping use MCH manuals and building the capacity of health workers to prevent stunting. This community service programme aims to provide an understanding to pregnant and breastfeeding mothers in Jorong Koto Tangah about the importance of MCH books in stunting prevention. The community service resulted in the number of pregnant and lactating mothers who brought the MCH book to the next month's Posyandu activity.

What is missing in our understanding of urban slum environments and maternal, infant and young child nutrition from publicly available data in Asia and the Pacific?

Given the recent, rapid urbanisation in Asia and the Pacific region, coupled with increases in the triple burden of malnutrition, we need to better understand maternal, infant and young child nutrition (MIYCN) for populations living in urban slum environments. This research used existing large-scale datasets to explore MIYCN indicators for those living in urban slum, compared with urban nonslum, areas. Data since 2015 from available Demographic and Health Surveys (DHS; Afghanistan, India, Indonesia, Myanmar, Pakistan and the Philippines) and Multiple Indicator Cluster Surveys (MICS; Bangladesh, Fiji, Kiribati, Mongolia, Nepal, Thailand and Tuvalu) were analysed. Most urban children in the 13 countries from the region were breastfed within 24 h of birth, with slightly higher rates for those living in slums. Conversely, almost all indicators of infant and young child malnutrition were worse for those in urban slums. For mothers living in slums, underweight prevalence and iron deficiency anaemia were higher while maternal overweight and obesity prevalence were lower. Analysis revealed disparities across countries in the wealth status of those living in slum versus nonslum areas. What is currently missing is representative sampling of households, adequate collection of data both within and across countries, and accurate representation of slum-dwellers in large-scale surveys. Given that limited data for the region show urban poor slum populations are vulnerable to poor nutrition indicators, more data are needed on the poorest urban slum populations to enable effective resource allocation to support optimal MIYCN.

Is "small quantity lipid nutrition supplement" (SQ-LNS) a sustainable and pragmatic strategy to prevent malnutrition?

Young child malnutrition and food insecurity is the result of many factors including social and economic inequities, disempowerment of women, inadequate support for breastfeeding, degraded environments, poor sanitation, unsafe water, violence and conflict. In this complex context, humanitarian agencies have a responsibility to guard against unintended consequences and ensure that the promotion of “quick fix” interventions do no harm. One such intervention is the Small Quantity Lipid Nutrition Supplement (SQ-LNS), that UNICEF is recommending for introduction into national nutrition programs to reduce mortality. The authors believe this recommendation is based on questionable evidence. They point to a fundamental flaw that trials compared “an intervention (SQ-LNS)” with “no comparable food-based intervention.” In effect, a pre-determined outcome. Also present is a conflict of interest, with support and intellectual input coming from interested food companies. Many other concerns are listed: SQ-LNS is an ultra-processed food (UPF), as defined by Nova Classification; daily feeding to children with poor diets will not improve dietary diversity and may undermine confidence in more culturally appropriate and nutritious family foods; the double burden of malnutrition and the emerging pandemic of overnutrition; the environmental impact of packaging and most importantly the clear potential for commercial exploitation. The widespread use of SQ-LNS in the face of food poverty is viewed as an unsustainable, unsafe and nutritionally inappropriate response. UN and humanitarian agencies should use their considerable diplomatic influence to challenge corporate-led food systems and support governments in their efforts to protect, promote and support breastfeeding and the provision of diverse complementary foods.

Comparative Study of Breastfeeding Practices for Infants Aged 0 to 6 Months in the Communes of Abobo, Bingerville and Yopougon (Abidjan, Ivory Coast)

This work was carried out in the localities of Abobo, Bingerville and Yopougon with the aim of comparing the complexities of exclusive breastfeeding of newborns from birth to 6 months with a view to identifying high frequency difficulties and providing efficient solutions for its implementation. In each of the localities, a descriptive and analytical cross-sectional study was conducted on 200 low-income female households. The survey was conducted from October 2020 to February 2021. After the survey, it was found that the difficulties related to the decline of exclusive breastfeeding are related to the insufficient production of breast milk, the daily occupation of the mother, the precarious health status of the mother. Exclusive breastfeeding ensures the quality and quantity of breast milk to guarantee infant food safety and the competitiveness of breast milk compared to artificial and mixed milk. Availability and use of food plants among breastfeeding mothers through the production of breast milk could be a means of combating acute and chronic malnutrition in young children and very premature babies. Recommendations related to the identified problems will allow first improve the production of breast milk. Secondly, the availability of breast milk for infants could significantly reduce the prevalence of child malnutrition and could constitute an approach to reach the challenges of the WHO and UNICEF; that is to say to feed the newborn from birth until six months only with breast milk, also the possibility of giving breast milk to the young child from six months until thirty months. Good practices of exclusive breastfeeding could contribute to the reduction of child malnutrition and to a lesser degree that of the breastfeeding mother.

Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction

This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.

Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren.

Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors. This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets. Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods. Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.

Implications of Young Child Malnutrition on Health and Development: Prioritize Nutrition Interventions in the First 1000 Days of Life

Implications of child undernutrition is not limited to adverse impact on physical growth but on optimum brain growth, mental health and cognitive development. The adverse effects of micronutrient deficiencies in mothers and children are serious with impact on morbidity, mortality, anemia, school performance, overall productivity and national development. Only in the last two decades, studies on the month-wise trend in the prevalence rate of child undernutrition in under five years has drawn attention to the fact that the stunting and underweight rate increases steadily up to 24 months, peaks at about two years of age and then stabilises. Efforts are therefore being directed to the significance of concentrating on implementation of child undernutrition preventive measure in the first 1000 days of life. As per the globally accepted conceptual framework of child malnutrition and the evidence available of effective interventions, emphasis is to ensure universal coverage of selected package of essential nutrition interventions (ENIs) and coupling these with nutrition sensitive interventions. Priority interventions in the first 1000 days comprise nutrition care package linked to antenatal care services, intensive efforts for universal adoption of appropriate infant and young child feeding practices and context specific nutrition sensitive measures .For effective implementation, special attention to mapping of the ’at risk’ households having a member falling in the 1000 days window needs special attention. The contacts of health workers with antenatal care and routine child immunization services need to be effectively used for promoting appropriate maternal nutrition care and breastfeeding and complementary feeding practices in the first 1000 days of life. Along with universal coverage of ‘at risk’ households with ENIs, it is imperative to ensure that the context specific nutrition sensitive interventions are simultaneously addressed, as reflected in the design of India’s National Nutrition Mission/Poshan2.0.

Stunting as a Risk Factor of Soil-Transmitted Helminthiasis in Children: A Literature Review.

As a high-burden neglected tropical disease, soil-transmitted helminth (STH) infections remain a major problem in the world, especially among children under five years of age. Since young children are at high risk of being infected, STH infection can have a long-term negative impact on their life, including impaired growth and development. Stunting, a form of malnutrition in young children, has been long assumed as one of the risk factors in acquiring the STH infections. However, the studies on STH infection in children under five with stunting have been lacking, resulting in poor identification of the risk. Accordingly, we collected and reviewed existing related research articles to provide an overview of STH infection in a susceptible population of stunted children under five years of age in terms of prevalence and risk factors. There were 17 studies included in this review related to infection with Ascaris lumbricoides, Trichuris trichiura, hookworm, and Strongyloides stercoralis from various countries. The prevalence of STH infection in stunted children ranged from 12.5% to 56.5%. Increased inflammatory markers and intestinal microbiota dysbiosis might have increased the intensity of STH infection in stunted children that caused impairment in the immune system. While the age from 2 to 5 years along with poor hygiene and sanitation has shown to be the most common risk factors of STH infections in stunted children; currently there are no studies that show direct results of stunting as a risk factor for STH infection. While stunting itself may affect the pathogenesis of STH infection, further research on stunting as a risk factor for STH infection is encouraged.

Burden and risk factors for relapse following successful treatment of uncomplicated severe acute malnutrition in young children: Secondary analysis from a randomised trial in Niger.

This study aimed to quantify the burden of relapse following successful treatment for uncomplicated severe acute malnutrition (SAM) and to identify associated risk factors in rural Niger. We used data from 1490 children aged 6−59 months discharged as recovered from an outpatient nutritional programme for SAM and followed for up to 12 weeks after admission. Postdischarge SAM relapse was defined as weight‐for‐height Z‐score <−3, mid‐upper arm circumference (MUAC) <115 mm or bipedal oedema after having been discharged as recovered. Postdischarge hospitalisation was defined as admission to inpatient SAM treatment or hospitalisation for any cause after having been discharged as recovered. We used multivariate log‐binomial models to identify independent risk factors. After programmatic discharge, 114 (8%) children relapsed to SAM and 89 (6%) were hospitalised. Factors associated with SAM relapse were discharge during the lean season (relative risk [RR] = 1.80 [95% confidence interval [CI] = 1.22−2.67]) and larger household size (RR = 1.56 [95% CI = 1.01−2.41]), whereas older child age (RR = 0.94 [95% CI = 0.88−1.00]), higher child MUAC at discharge (RR = 0.93 [95% CI = 0.87−1.00]) and maternal literacy (RR = 0.54 [95% CI = 0.29−0.98]) were protective factors. Discharge during the lean season (RR = 2.27 [95% CI = 1.46−3.51]) was independently associated with postdischarge hospitalisation. Future nutritional programmes in the context of Niger may consider modification of anthropometric discharge criteria or the provision of additional home support or follow‐up during the lean season as potential interventions to prevent relapse. More research including postdischarge follow‐up is needed to better understand the sustainability of treatment outcomes after discharge and the type of intervention that may best sustain recovery over time. Clinical Trial Registration: ClinicalTrials.gov number, NCT01613547.

Anthropometry, body composition, early growth and chronic disease risk factors among Zambian adolescents exposed or not to perinatal maternal HIV.

Early life exposures and growth patterns may affect long-term risk of chronic non-communicable diseases (NCD). We followed up in adolescence two Zambian cohorts (n 322) recruited in infancy to investigate how two early exposures - maternal HIV exposure without HIV infection (HEU) and early growth profile - were associated with later anthropometry, body composition, blood lipids, Hb and HbA1c, blood pressure and grip strength. Although in analyses controlled for age and sex, HEU children were thinner, but not shorter, than HIV-unexposed, uninfected (HUU) children, with further control for socio-demographic factors, these differences were not significant. HEU children had higher HDL-cholesterol than HUU children and marginally lower HbA1c but no other biochemical or clinical differences. We identified three early growth profiles - adequate growth, declining and malnourished - which tracked into adolescence when differences in anthropometry and body fat were still seen. In adolescence, the early malnourished group, compared with the adequate group, had lower blood TAG and higher HDL, lower grip strength (difference: -1·87 kg, 95 % CI -3·47, -0·27; P = 0·02) and higher HbA1c (difference: 0·5 %, 95 % CI 0·2, 0·9; P = 0·005). Lower grip strength and higher HbA1c suggest the early malnourished children could be at increased risk of NCD in later life. Including early growth profile in analyses of HIV exposure reduced the associations between HIV and outcomes. The results suggest that perinatal HIV exposure may have no long-term effects unless accompanied by poor early growth. Reducing the risk of young child malnutrition may lessen children's risk of later NCD.

Growth performance, biochemical and haematological parameters of BALB/c mice fed on staple grains and bee larvae (Apis Mellifera) blended complementary foods

In Sub-Saharan Africa, inadequate complementary feeding practices and being nutritionally inadequate are primary factors in infant and young child malnutrition, growth failure, and high morbidity and mortality. Therefore, novel complementary foods need to be developed to alleviate malnutrition problems in IYC. Therefore, this experimental study aimed to assess the effects of newly developed grain-bee larvae blended complementary foods on the growth performance, haematological, and biochemical parameters of BALB/c mice. A complete randomized design was used and a total of 75 BALB/c mice were assigned to each of the five treatments. The treatments were: T1 = Casein diet; T2 = 57 % Maize, 29 % Teff, 14 % Soybean; T3 = 58 % Maize, 29 % Teff, 13 % Bee larvae; T4 = Commercial wean mix; and T5 = Basal diet alone. The in vivo experiment trial was done for 28 days along with seven days of adaptation. Dietary intake was not significantly different (P = 0.96) between treatments, but it was noted that T3 had gained the highest final body weight (38.52 g). The examined biochemical parameters showed T4 had the lowest serum protein (6.27 mg/dl) and globulin (3.61 mg/dl). Compared to others, T3 significantly (P < 0.001) increased WBC (4 × 106 mm3), RBC (11.37 × 103 mm3), Haemoglobin (16.42 g/dl), and Hematocrit (63.04 %). The highest serum levels of zinc (0.55 mg/dl) and iron (2.08 mg/dl) were reported on T2, while the highest serum calcium content (10.64 mg/dl) was reported on T1. The results indicated that T3 can aid body growth, health, and prevent malnutrition in infants and young children.

3.1 Moderate and Severe Acute Malnutrition in Young Children.

3.1 Moderate and Severe Acute Malnutrition in Young Children.

The Effect of Family Income on Stunting Incident in Preschool Children at Bogor City During COVID-19 Pandemic

Background: The global COVID-19 pandemic has increased the risk of malnutrition in young children,including stunting,especially those under five years old. Stunting incident was often found in low incomefamilies who were unable to afford nutritious food. During COVID-19 pandemic, certain types of foodmight not be available and affordable for some families. The stunting incident could be increased due todecline in family income, change in food availability and disruption to health and social services.Objective: To determine the effect of family income during COVID-19 pandemic on the incidence ofstunting in preschool children at PuspaBangsa Kindergarten, Bogor City.Method: This type of research was analytical survey with cross sectional approach. The total sample was35 families who had their children studied at PuspaBangsa Kindergarten. The instrument in this studywas filling out a questionnaire using Google Form on family income and weight of preschool children todetermine the incidence of stunting in preschool children.Conclusion: 7 participants (20%) were found with family income less than the Regional Minimum Wage.The results of univariate analysis for stunting incident variables were as followed: normal height category23 (65.7%) and very short height category 4 (11.4%). The statistical analysis obtained p-value = 0.02, whichmeans there was significant relationship between family income and the incidence of stunting at PuspaBangsa Kindergarten, Bogor City.

Awareness Regarding Complementary Feeding Among Mothers in a Municipality of Nawalparasi District, Nepal

INTRODUCTION&#x0D; Complementary feeding is key to promoting healthy growth and development, particularly during the first two years of a child’s life. Lack of awareness and inappropriate feeding practices are a major cause of the onset of malnutrition in young children. The aim of the study was to find out the awareness regarding complementary feeding among mothers in a Municipality of Nawalparasi District, Nepal.&#x0D; MATERIAL AND METHODS&#x0D; Community based descriptive cross-sectional study was conducted to find out the awareness regarding complementary feeding among 67 mothers selected through non-probability convenient sampling technique. Data was collected by using semi-structured interview schedule and was analyzed by using descriptive (frequency, percentage, mean, standard deviation) and inferential statistics (chi square) with Statistical Package for Social Science software (SPSS) version 20.0. The total duration of the study was from September 5, 2018 to September 19, 2018.&#x0D; RESULTS&#x0D; The findings of the study revealed that almost half (47.8%) of the mothers had low level awareness regarding complementary feeding. There was no statistically significant association between respondents’ level of awareness regarding complementary feeding and socio- demographic variables.&#x0D; CONCLUSION&#x0D; Based on the study findings, it is concluded that still half of the respondents had low awareness regarding complementary feeding. If all the mothers were aware regarding complementary feeding. They can prevent the consequences of under-nutrition thereby enabling children to receive appropriate nutrition. Thus it would be recommended to concerned authority to conduct awareness program to mothers regarding complementary feeding.

Knowledge, Attitude and Practices among Mothers of Children 6 to 24 months of Age Regarding Complementary Feeding.

Complementary foods fill the gap between the total nutritional needs of the child and the amounts provided by breast milk. Inappropriate feeding practices are a major cause of the onset of malnutrition in young children. The objective of this study was to assess the knowledge, attitude, and practices of mothers of children between 6 to 24 months of age regarding complementary feeding. This Knowledge, Attitude, and Practice Study was conducted among 250 mothers in Kathmandu Medical College and Teaching Hospital from June 2019 to November 2019 after obtaining ethical approval from the institutional review committee (Ref no. 150320199). Convenient sampling method was applied. The mothers of children between 6 to 24 months were interviewed using a structured questionnaire to ascertain the knowledge, attitude, and practices regarding complementary feeding. Statistical analysis was done using SPSS version 20. Two hundred and fifty mothers were interviewed. 151 (60.4%) mothers knew initiation of breastfeeding soon after birth and 179 (71.6%) were knowledgeable about exclusive breastfeeding for 6 months. 161 (64.4%) mothers knew the proper age of initiating complementary feeding but only 139 (55.6%) mothers practiced it. Early initiation of complementary feeding was done by 87 (34.8%) mothers while 24 (9.6%) mothers delayed it beyond 6 months. There was a gap in knowledge and practice among mothers regarding adequate age of initiation of complementary feeding, complementary foods, preparation, and practices.

Social circumstances and cultural beliefs influence maternal nutrition, breastfeeding and child feeding practices in South Africa

BackgroundMaternal and child undernutrition remain prevalent in developing countries with 45 and 11% of child deaths linked to poor nutrition and suboptimal breastfeeding, respectively. This also has adverse effects on child growth and development. The study determined maternal dietary diversity, breastfeeding and, infant and young child feeding (IYCF) practices and identified reasons for such behavior in five rural communities in South Africa, in the context of cultural beliefs and social aspects.MethodsThe study used mixed methodology technique. Questionnaires were administered to 84 households, pairing mother/caregiver and a child (0–24 months old) to obtain information on maternal dietary diversity, IYCF and breastfeeding practices. Qualitative data on breastfeeding perceptions, IYCF practices, perceived eating habits for lactating mothers and cultural beliefs related to mothers’ decision on IYCF and breastfeeding practices were obtained through focus group discussions.ResultsMaternal dietary diversity was very low and exclusive breastfeeding for the first 6 months of life was rarely practiced, with young children exposed to poor-quality diets lacking essential nutrients for child growth and development. Social circumstances including lack of income, dependence on food purchasing, young mothers’ feelings regarding breastfeeding and cultural beliefs were the major drivers of mothers’ eating habits, breastfeeding behaviour and IYCF practices. Fathers were left out in breastfeeding and IYCF decision making and young mothers were unwilling to employ indigenous knowledge when preparing food (especially traditional foods) and feeding their children.ConclusionThe study provides comprehensive information for South African context that can be used as an intervention measure to fight against malnutrition in young children. Finding a balance between mothers’ income, dietary diversity, cultural beliefs, breastfeeding and considering life of lactating mothers so that they won’t feel burdened and isolated when breastfeeding and taking care of their children is crucial. Paternal inclusion in breastfeeding decisions and safeguarding indigenous knowledge on IYCF practices is recommended.

Child Dietary Diversity and Associated Factors Among Children in Somalian IDP Camps.

Malnutrition and food insecurity are major challenges in Somalia, particularly among small children living in internally displaced person (IDP) camps. Poor diet has been identified as a key driver of malnutrition in young children who depend for their diets on their household's socioeconomic standing and access to food, as well as on the family's caring and feeding practices. To assess the dietary diversity and identify the factors associated with it among children (6-23 months) in Somalian IDP camps. We used a cross-sectional survey conducted in 11 IDP camps in Somalia in June 2014 and in June 2015. A total of 3188 children aged 6 to 23 months were surveyed. Child diets were assessed using food frequency questionnaires, and dietary diversity was categorized using the minimum child dietary diversity (MDDC) indicator. Multivariable logistic regressions were used to identify the factors associated with the children's dietary diversity. We built and compared 2 models using alternatively the household dietary diversity score (HDDS) and the food consumption score (FCS) as food security proxies. Around 15% of children in IDP camps reached the minimum dietary diversity. Overall, our results confirm that not only are food security proxies the factors most associated with MDDC, but HDDS performs better than FCS. In addition, results identify that women as key decision-maker in the household, duration of household permanence in the settlement, women's physiological status, frequency of milk feeding to child, type of toilet, and measles vaccination are positively associated with MDDC. To improve child dietary diversity in IDP camps, food security interventions should be broadened to include female empowerment and inclusive nutrition education (encouraging male participation) programs, as well as initiatives targeting children who do not live with pregnant or lactating women and that can support families beyond the first months after their arrival.

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey.

Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6-59 months) and non-pregnant women (15-49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana's food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.