Maternal Mid-upper Arm Circumference Research Articles

Determinants of Low Birth Weight Among Women Who Gave Birth at Public Health Facilities in North Shewa Zone: Unmatched Case-Control Study.

Globally, more than 20 million newborns are born with low birth weight (LBW) every year. Most of the LBW occurs in low- and middle-income countries. It is the most critical risk of neonate mortality. Therefore, this study aims to identify determinants of low birth weight among women who gave birth in public health facilities in the North Shewa zone. Institutional-based unmatched case–control study was conducted from February to June 2020 to select 180 cases and 380 controls. Interviewer-administered questionnaire was used to collect data. Data were entered through EPI Info and exported to Statistical Package for Social Science (SPSS) for analysis. Text, percentage and tables were used to present data. Bivariate and multivariate logistic regression analyses were performed to see the association and adjusted odds ratios with 95% confidence interval (CI), and P-value < .05 was considered to declare statistical significance. Lack of nutritional counseling (adjusted odds ratio [AOR] = 2.14; 95% CI = [1.13, 4.04]), unable to take iron-folate supplement (AOR = 2.3.78; 95% CI = [2.1, 6.85]), insufficient additional meal in take (AOR = 6.93; 95% CI = [3.92, 12.26]), restriction of foods (AOR=2.29; 95% CI =[1.81, 4.09]), maternal mid upper arm circumference (MUAC) < 23 cm (AOR=2.85; 95% CI = [ 1.68, 4.85]), maternal height ≤155 cm (AOR=3.58; 95% CI = [1.92, 6.7]), anemia (AOR = 2.34; 95% CI = [1.21, 4.53]), pregnancy-related complications (AOR=3.39; 95% CI = [2.02, 5.68]), and alcohol drinking during pregnancy (AOR = 2.25; 95% CI = [1.24, 4.08]) were significantly associated with LBW. Nutritional counseling, iron-folate supplementation, additional meal intake, restriction of some foods in pregnancy, MUAC of the mother, maternal stature, maternal anemia status, pregnancy-related complications, and a history of alcohol drinking during pregnancy were identified as determinants of low birth weight. The intervention-targeted nutritional counseling, early detection and treatment of anemia, and behavioral change communication to pregnant women are mandatory.

Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019

BackgroundAfter prematurity, intrauterine growth restriction (IUGR) is the second leading cause of perinatal mortality. IUGR has significant consequences in fetal, neonatal, and adult life. Currently, Ethiopia lacks information on IUGR’s prevalence and its determinants. This study aimed to assess the proportion of IUGR at birth and its associated factors.MethodsA cross-sectional study was carried out among women who give birth in four hospitals of south Gonder zone from November 2018 to February 2019. Multi-stage sampling was applied to select the required samples. IUGR was assessed using a standardized cutoff percentile/mean for each measurement. Data were collected by trained MSc clinical midwives. Bi-variable and multivariable logistic analyses were deployed to identify the association.ResultsA total of 803 maternity women were participating in this study with a response rate of 95%. The proportion of IUGR 23.5% (95% CI: 20.7–26.6), low birth weight 13.3%, small-for- gestational-age 19.7%,and preterm birth 23.16%. Women who was unable to read and write, (AOR; 2.46, 95% CI: 1.02–5.92), total family size ≥7 (AOR; 1.67, 95% CI: 1.04–2.66), maternal mid-upper arm circumference (MUAC) < 23 cm (AOR; 2.10, 95% CI: 1.39–3.01), body mass index (BMI) < 18.5 kg/m2 (AOR; 2.57, 95% CI: 1.72–3.83), altitude > 3000 m (AOR; 1.89 95% CI: 1.19–3.01), small placental size (< 350 g) (AOR; 2.42, 95% CI: 1.67–3.54) and small-for-gestational-age (AOR; 1.94, 95% CI:1.86–4.52) were the most predictors of IUGR.ConclusionsIUGR was a major public health concern in this study. Women who were unable to read and write, small-for-gestational-age, maternal BMI < 18.5 kg/m2, family size ≥7, maternal MUAC < 23 cm, small placental size, and altitude > 3000 m were found the most predictor variables. Strengthen female education, nutritional intervention before and during pregnancy, and routine maternity care is critical. Further clinical follow-up research is essential which includes maternal, fetal, and placental gens.

Impact of a two-way short message service (SMS) to support maternally administered childhood mid-upper arm circumference monitoring and expand malnutrition screening in Kenya: the Mama Aweza trial protocol

IntroductionOver 52 million children under 5 years of age become wasted each year, but only 17% of these children receive treatment. Novel methods to identify and deliver treatment to malnourished...

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

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

Comparison of WHO growth standard and national Indonesian growth reference in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district.

Background: Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are "below" the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference. Methods: This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis. Results: The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education. Conclusions: The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.

Comparison of WHO growth standard and national Indonesian growth reference in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district

Background:Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference.Methods:This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis.Results:The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p &lt; 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education.Conclusions:The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.

Comparison of WHO growth standard and national Indonesian growth reference in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district

Background: Determination of stunting and wasting always uses the WHO growth standard in Indonesia. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the prevalence and determinants of stunting and underweight using WHO growth standard and national Indonesian growth reference. Methods: This was a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO standard and national Indonesian reference. Univariate and multivariate binomial logistic regression were used for statistical analysis. Results: The prevalence of stunting and underweight were higher for the WHO standard than the national reference (53.9% vs 10.7% and 29.17% vs 17.7%; all p < 0.001). After adjusted for confounding factors, when the WHO standard was used, determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm; determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities. When the national reference was used, no determinants was found for stunting; the determinants of underweight were intrauterine growth restriction and maternal education. Conclusions: The WHO standard is not suitable for representing child growth in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the national Indonesian reference.

Comparison of WHO and Indonesian growth standards in determining prevalence and determinants of stunting and underweight in children under five: a cross-sectional study from Musi sub-district

Background:Undernutrition among children under five continues to be a critical global public health challenge, especially in developing countries. However, it is believed that Indonesian children are “below” the global standard, thus the WHO standard is not reliable to present the actual prevalence. This study aims to compare the difference between WHO and Indonesian growth standards regarding prevalence of stunting and underweight and its determinants.Methods:This is a cross-sectional study carried out in Musi sub-district, East Nusa Tenggara province in July 2019. East Nusa Tenggara province had the highest prevalence of stunting and underweight in Indonesia. The study population were children under five, and total sampling method was used for this study. Length/height-for-age and weight-for-age were plotted using WHO and national standards. Univariate and multivariate binomial logistic regression were used for statistical analysis.Results:The prevalence of stunting and underweight were higher for the WHO than the national standard (53.9% vs 10.7% and 29.17% vs 17.7%; all p &lt; 0.001). Determinants of stunting were maternal mid-upper arm circumference below 23.5cm and maternal height below 150cm when the WHO standard was used, and no determinant was found when the national standard was used. Determinants of underweight were intrauterine growth restriction, young maternal age during pregnancy, and multiple parities when the WHO standard was used. When the national standard was used, the determinants of underweight were intrauterine growth restriction and maternal education.Conclusions:The WHO standard over-diagnosed stunting and underweight in Musi sub-district. Future studies should be done to re-evaluate the prevalence and determinants of stunting and underweight nationwide using the Indonesian standard.

Association of maternal anthropometry, hemoglobin and serum zinc concentration during pregnancy with birth weight

Low birthweight (LBW) infants in general are at greater risk of early mortality. Evidence also suggests increased risk of lifelong adverse health and social consequences of LBW. Several bio-psychosocial variables influence birth weight; identifying significant influencers is important to develop effective interventions. Pregnant women (n = 341), in the first eight weeks of pregnancy, visiting antenatal care units in Addis Ababa, Ethiopia were recruited and followed until delivery. Socio-demographic and economic condition, parity, household food security, dietary intake, iron-folic acid supplementation, and maternal anthropometric measurement were captured. In addition, hemoglobin and serum zinc concentration were determined. Furthermore, birth weight was recorded. During the first trimester, 10.9% participants were underweight, 19.4% were overweight, and 3.5% were obese. Low serum zinc was found in 36.7% of women. In addition, 18.4% of women were anemic. Two-third of women had less than the minimum adequate dietary diversity. Of the newborns (n = 329), 13.4% were underweight. Maternal mid upper arm circumference (MUAC), body mass index (BMI), serum zinc and hemoglobin concentration, and amount of money spent on food were positively correlated with birth weight (p < 0.05).The odds of LBW were greater among women with low hemoglobin concentration [AOR 4.8, 95% CI 1.7–13.4, p = 0.002] or MUAC <23 cm [AOR 3.4, 95% CI 1.2–11.0, p = 0.03] in the first trimester, and those not taking iron-folic acid supplement during the second trimester [AOR 0.2, 95% CI 0.02–0.4, p < 0.001]. Various maternal and household factors were associated with the odds of LBW, and intervention studies are required to determine causality.

Relationship Between Maternal Nutritional Status and Birth Outcome Among Pregnant Women Attending Antenatal Clinic at Yusuf Dantsoho Memorial Hospital Kaduna

This study was undertaken to find out the relationship between maternal dietary pattern, anthropometric indices with birth outcome among pregnant women in their 3^rd trimester attending antenatal clinic at Yusuf Dantsoho Memorial Hospital, Tudun Wada, Kaduna. Sixty-seven mothers – baby pair participated in the study. Weight, height, and Mid Upper Arm Circumference (MUAC) of mothers were measured with unclothed newborn length, weight, head and chest circumference also taken. Results obtained shows mean maternal age, weight, height, and MUAC of 31.20±8.40 years, 70.37±12.73 kg, 1.620±0.07 m, 26.65±4.08 cm, and 26.63±3.80 kg/m² respectively. Majority of the pregnant women (77.60%) had good nutritional status while 16.40%, 6.00% are moderately and severely malnourished respectively. Maternal dietary pattern showed daily to weekly intake of all the food groups with less than 50% except for bread and cereals which is more than 50%. Maternal mean intake of total protein and total calories was close to the recommended daily intake of 60- 75 kg/day, and 2500 – 3000 kcal respectively. Newborn anthropometric measurements indicated that 61.20% were mildly stunted, 70.10% mildly underweight, and 62.70% moderately wasted neonates. Head and chest circumference are within the normal range. Maternal anthropometry and dietary pattern showed a positive correlation with birth outcome.

Patterns of maternal nutritional status based on mid upper arm circumference.

Objective:To determine the patterns of maternal nutrition status by using mid upper arm circumference (MUAC) and to examine the association of maternal nutritional status with the nutritional status of malnourished children under two years of age.Methods:Descriptive study conducted at the Department of Pediatric Medicine of the Children’s Hospital, Lahore from January 2017 to March 2018. A total of 227 mother accompanying their children admitted for nutritional rehabilitation were included. Demographics of participants along with MUAC of every mother was taken. Data analysis was done by SPSS 22.Results:Mean maternal age was 28.29±5.30 years and mean age of children was 9.22 ± 6.05 months. Mean maternal MUAC was 25.53±3.63 cm. Normal nutrition was present in only 70 (31%), 35 (15.4%) had moderate to severe under nutrition and 68 (30%) were overweight and 17 (7.5%) were obese. Maternal illiteracy was common 150 (66%) and 203 (89%) belong to poor social class. Majority 150 (75%) children had <-3SD WHZ score. Only 42 (18.5%) children were exclusively breast fed. Maternal malnutrition was significantly associated with severity of child’s undernutrition (p=0.045) and low rates of exclusive breast feeding practices (p=0.049).Conclusion:Malnutrition, in the form of both under nutrition and obesity is prevalent in mothers of malnourished children belonging to lower social class. Maternal illiteracy and low income are the major contributor in maternal malnutrition which in turn has an impact on child nutrition and breast feeding practices.

Determinants of Low Birth Weight in Cilacap District

Background: Low birth weight (LBW) is closely related to the increased risk of child morbidity and mortality, disruption of developmental growth and in the long-run has an increased risk of chronic disease in their adulthood. This study aims to analyze the effect of nutritional status at the beginning of pregnancy, maternal education and family expenditure on the incidence of low birth weight (LBW) in Cilacap District. Subjects and Method: This study is an obser­vational analytic study with a cross sectional approach. The study was conducted in three health centers in Cilacap District, Central Java, in 2016. A sample of 144 children aged less than 1 year was selected by cluster sampling. The depen­dent variable was birth weight. The independent variables were maternal MUAC, maternal educa­tion, and family income. The data are collected with medical records. The data were analyzed using multiple logistic regression analysis. Results: Maternal MUAC ≥23.5 cm (OR = 0.22; 95% CI = 0.57 to 0.89; p = 0.033) reduced the risk of LBW and it was statistically significant. Maternal education (OR = 0.51; 95% CI = 0.12 to 2.13; p = 0.356) and high family income (OR = 0.47; 95% CI = 0.09 to 2.47; p = 0.376) reduced the risk of LBW but it is statistically insignificant. Conclusion: Maternal MUAC ≥23.5 cm, high maternal education, and high family income reduced the risk of LBW. Keywords: low birth weight, maternal mid-upper arm circumference Correspondence: Majestika Septikasari. School of Health Sciences Al-Irsyad Al-Islamiyyah Cilacap, Central Java, Indonesia. Email: majestika86@gmail.com. Journal of Maternal and Child Health (2020), 5(2): 141-146 https://doi.org/10.26911/thejmch.2020.05.02.03

Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study.

Studies to date demonstrated the relatedness of mid‐upper arm circumference (MUAC) measurement of pregnant women to their anthropometry/weight. Hence, the objective was to determine whether maternal MUAC at different gestational age predicted birthweight, and if so, to identify which cut‐offs provided the best prediction of low birthweight (LBW) in pregnant women cohort. A total of 928 pregnant women, free of any obstetrical and medical complications known to affect fetal growth, were followed from 20 to 24 weeks' gestation till delivery. Weight, height, and MUAC were determined for the pregnant women, and gestational age along with newborns anthropometry was collected. The mean birthweight was 2.6 ± 0.460 kg. Maternal age, height, weight, MUAC (three time points), gestational age at delivery, and post‐natal weight showed positive correlation with birthweight, crown heel length, and head circumference of the neonates. The cut‐off limit with the best sensitivity–specificity (54.0 and 59.8, respectively) for MUAC was 23 cm, whereas maternal weight of 55 kg had sensitivity and specificity of 62.5 and 59.9 for predicting LBW. Maternal weight of 55 kg and MUAC value of 23 cm had almost similar sensitivity and specificity for predicting LBW. MUAC (≤23 cm) can be considered as a potential indicator of LBW where weighing of pregnant women is not feasible or when presentation for antenatal care is late, especially where pre‐pregnancy weights are not available.

Dietary Diversity and Anthropometric Status of Mother-Child Pairs from Enset (False Banana) Staple Areas: A Panel Evidence from Southern Ethiopia.

Background: A sizable cross-sectional studies demonstrated a low dietary diversity in Southern Ethiopia. However, its seasonal trend has not been well studied in areas where nutrient-poor enset (false banana (Ensete ventricosum)) foods are major staple. Moreover, there is scarcity of information on seasonal nature of anthropometric status of mother–child pairs (MCP) from the same areas in Southern Ethiopia. Therefore, the present study aimed to investigate the dietary diversity and anthropometric status of MCP in postharvest dry and lean wet seasons and identify factors associated with anthropometric status. Methods: The dietary intake and anthropometric data were collected from 578 households (578 mothers and 578 children) January–June 2017. The study compared data of the two seasons using McNemar’s test for dichotomous, Wilcoxon signed-rank test for non-normally distributed, and paired samples t-test for normally distributed continuous data. Logistic regression was conducted to identify risk factors for malnutrition. In addition, Spearman’s Rho test was used to determine correlations between maternal and child variables. Results: Over 94% of the mothers did not fulfil the minimum diet diversity score in both seasons. The meal frequency and pulses/legumes intake significantly declined in lean wet season; however, dark green leaves consumption increased. Meat, poultry, and fish consumption dropped to almost zero in the lean wet season. The dietary diversity and anthropometric status of the MCP were correlated. Weight-for-age (WAZ) and weight-for-height (WHZ) of children significantly declined in the lean wet season. In the same way, maternal mid upper arm circumference (MUAC), body weight, and body mass index (BMI) dropped (p < 0.001) in this season. Being pregnant and a lactating mother, poverty, and the ability to make decisions independently predicted maternal undernutrition (low MUAC). On the other hand, maternal undernutrition and education were associated with child underweight. Conclusions: The results demonstrated that the dietary diversity of MCP is low in both postharvest dry and lean wet seasons. This suggests the need for continuous nutrition intervention to improve the dietary diversity. In addition, the anthropometric status of MCP declines in lean wet season. This may provide some clue for policy targeting on improving nutritional status of mothers and children in rural Southern Ethiopia.

Factors associated with plasma n-3 and n-6 polyunsaturated fatty acid levels in Tanzanian infants.

To identify factors associated with plasma polyunsaturated fatty acid (PUFA) levels among 3-month-old Tanzanian infants. Infants (n = 238) and mothers (n = 193) randomly selected from participants in the neonatal vitamin A supplementation randomized controlled trial. A cross-sectional study of maternal-infant pairs at 3 months postpartum. All infant total, n-3, n-6, and individual PUFA levels were correlated with maternal levels. Infant plasma n-3 PUFA levels were higher when maternal n-3 PUFA levels were higher (mean difference in infant % fatty acid per unit increase in maternal levels ± standard error: 0.79 ± 0.08; P < 0.01). Infant plasma docosahexaenoic acid (DHA) levels were positively associated with maternal DHA levels (0.77 ± 0.09; P < 0.01) but were lower for twin births (-0.55 ± 0.27; P = 0.03). Greater birth weight in kilograms (1.00 ± 0.43; P = 0.02) and higher maternal n-6 PUFA levels (0.20 ± 0.07; P < 0.01) were positively associated with higher infant n-6 PUFA levels, whereas maternal mono-unsaturated fatty acid (MUFA) levels (-0.26 ± 0.08; P < 0.01), maternal mid upper arm circumference (MUAC) (-0.22 ± 0.11; P = 0.04), and male sex (-0.99 ± 0.45; P = 0.03) were associated with lower infant plasma n-6 PUFA levels. Infant plasma arachidonic acid (AA) levels were positively associated with maternal plasma AA levels (0.38 ± 0.09; P < 0.01), but inversely associated with twin births (-1.37 ± 0.67; P = 0.04). Greater birth weight and higher maternal plasma PUFA levels at 3 months postpartum were significantly associated with higher infant plasma PUFA levels at 3 months age. Twin births, male sex, and higher maternal MUFA levels were associated with lower infant plasma PUFA levels. Nutrition counseling for optimal intake of PUFA-rich foods, to lactating mothers in resource-limited settings may be beneficial for improved infant health.

Human milk sIgA antibody in relation to maternal nutrition and infant vulnerability in northern Kenya.

BackgroundThe maternal buffering hypothesis posits that human lactation biology can buffer milk against the mild-to-moderate malnutrition that occurred routinely in evolutionary history through the mobilization of maternal body reserves. This perspective may provide insights for understanding human milk immune content variation, such as milk sIgA, which protects infants’ intestines from microbial colonization and prevents diarrheal disease.ObjectiveTo investigate how maternal delivery of sIgA to milk may vary in a way that can buffer milk against maternal malnutrition, while taking into consideration infants’ varying needs for immune protection across age or by sex.MethodologyA cross-sectional study analyzed archived milk specimens from breastfeeding mothers in Ariaal communities of northern Kenya surveyed during the 2006 Horn-of-Africa drought. Multiple regression models for ln-transformed sIgA were constructed using maternal nutrition, infant age/sex and their interactions as predictors. Maternal nutrition variables included iron-deficiency anemia (IDA), vitamin A deficiency (VAD) and mid-upper arm circumference (MUAC). Infant vulnerability was considered high in young age and/or male sex.Results and implicationsMilk sIgA did not significantly differ by maternal IDA. Milk sIgA increased with infant age and maternal MUAC (n = 202). Significant interactions were observed between infant age and maternal VAD and between infant sex and maternal MUAC, such that milk sIgA content was low for younger infants particularly among VAD mothers, while among mothers with low MUAC, sIgA was lower for male infants. Results imply that mothers’ ability to deliver/buffer milk sIgA may be lowered when nutritional stress is combined with high infant vulnerability to infection.Lay SummaryHuman milk sIgA antibody content was low for younger infants among vitamin A deficient mothers. Among mothers with small arm-circumference, milk sIgA was lower for sons. Double burden of raising young or male infants with high needs for immune protection and being malnourished, might lower maternal sIgA delivery to milk.

Predictors of Low Birth Weight in Newborn Delivered in Public Hospital of Gurage Zone, Southern Ethiopia: A Case-Control Study

Worldwide, low birth weight is one of the most common causes of neonatal morbidity and mortality. Though factors associated with low birth weight vary from one region to another, in Gurage Zone, there is no sound analytical study done to examine the local determinants of low birth weight. Because of this, the study aimed to elucidate the predictors of low birth weight in public hospital of Gurage zone. Methods: A facility based unmatched case-control study design was employed to detect the existing exposure difference between cases and controls. The study included a total of 270 controls (normal weight) and 134 cases (low birth weight baby). Control and case participants were selected through consecutively. To collect the data, structured interviewer administered questionnaires and anthropometric measurement were used. The data were entered through Epi-data 3.1 computer program and analyzed through Statistical package for Social Sciences version 21 (SPSS v. 21). Univariate, Bivariate and Multivariate analysis were done. Result: Multiple logistic regression model analysis indicated that low birth weight was independently associated with maternal mid upper arm circumference less than 23 cm (AOR 1.79 (95% CI = 1.01 - 3.16)), gestational age less than 37 weeks (AOR 24.94 (95% CI = 12.38 - 50.27)), presence of malaria infection during period of pregnancy (AOR 3.02 (95% CI = 1.39 - 6.51)), presence of preclampsia, multiparity (AOR 2.19 (95% CI = 1.21 - 3.96)) and twining (AOR 5.42 95% CI = 2.01 - 14.59). Conclusion: Gestational age < 37 weeks, twining, malaria infection during pregnancy and maternal undernutrition were a significant predictor of LBW in the region of Gurage zone. Hence, to effectively prevent low birth weight, Gurage zone health departments should work on promotion of maternal nutrition during pregnancy, prevention of malaria during pregnancy.

Logistic Regression Analysis on the Determinants of Stunting among Children Aged 6-24 Months in Purworejo Regency, Central Java

Background: Stunting is a representation of the state of chronic malnutrition in the first 1000 days of life that occurred in the world at an incidence of 22.2% in 2017. Stunting in children has impact on morbidity and mortality, resulting in a long-term decline socio-economic productivity of the community. The purpose of this study was to analyze the determinants of stunting in children aged 6-24 months in Purworejo, Central Java. Sub j e cts an d Method: This was an analytic observational study with a case control design. It was conducted in 25 integrated community health posts (posyandu) in Purworejo, from October to December 2018. A sample 200 children under five was selected using by simple random sampling. The dependent variable was stunting. The independent variables were maternal mid-upper arm circumference (MUAC) at pregnancy, maternal education, paternal education, family income, family food allocation, infant birth weight, exclusive breastfeeding, complementary feeding (CF), posyandu strata, stunting monitoring at posyandu, and posyandu stunting intervention. The data was collected by questionnaire and analyzed by a multiple logistic regression. Results: Maternal MUAC at pregnancy ≥23.5 cm (b= -1.56; 95% CI= 0.06 to 0.67; p = 0.009), high maternal education (b= -1.70; CI95% = 0.06 to 0.57; p = 0.003), high paternal education (b= -1.90; 95% CI= 0.05 to 0.51; p= 0.002), high family income (b= -1.85; 95% CI= 0.05 to 0.50; p = 0.002), family food allocation (b= -2.26; 95% CI= 0.03 to 0.37; p<0.001), birth weight ≥2,500 g (b= -1.39; 95% CI= 0.08 to 0.83; p= 0.024), exclusive breastfeeding (b = -2.04; 95% CI= 0.04 to 0.48; p= 0.002), and adequate complementary feeding (b= -1.61; 95% CI= 0.06 to 0.65; p= 0.007) reduced the risk of stunting in children aged 6-24 months. Conclusions: Maternal MUAC at pregnancy ≥23.5 cm, high maternal education, high paternal education, high family income, family food allocation, birth weight ≥2,500 g, exclusive breastfeeding, and adequate complementary feeding reduce the risk of stunting in children aged 6-24 months. Keywords: stunting, determinants, children aged 6-24 months Correspondence: Atika Rakhmahayu. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta, Indonesia. Email: tikarakhmahayu@gmail.com. Mobile: 083124386960. Journal of Maternal and Child Health 4(3): 158-169 https://doi.org/10.26911/thejmch.2019.04.03.03

The Associations between Maternal Education, Chronic Energy Deficit, and Anemia in Pregnant Women: An Evidence from Lhokseumawe, Indonesia

Background: Chronic Energy Deficiency (CED) and anemia in pregnant women have a health impact on the mother and child in the womb. This condition can increase the risk of babies with low birth weight, miscarriage, premature birth, even death in mothers and newborns. This study aims to determine the relationship between CED and anemia in pregnant women at the Muara I Health Center in Lhokseumawe City in 2017. Subjects and Method: This study was a cross-sectional study conducted at the Muara I Community Health Center, Lhokseumawe, in December 2017. A sample of 90 pregnant women was selected by consecutive sampling. The dependent variable was the anemia of pregnant women. The independent variables were education and CED. CED was measured based on maternal mid-upper arm circumference (MUAC) during pregnancy using MUAC tape. The hemoglobin level was measured by Hb Sahli. Other data were measured using a questionnaire. The data were analyzed using multiple logistic regression tests. Results: CED has a significant positive and statistically significant effect on anemia in pregnant women (OR = 64.34; 95% CI = 15.10 to 274.10; p <0.001). Low maternal education has a positive effect but was statistically significant towards anemia in pregnant women (OR = 3.15; 95% CI = 0.81 to 12.27; p = 0.099). Conclusion: CED and low maternal education have a positive effect on anemia in pregnant women. Keywords: anemia, pregnant women, education, chronic lack of energy Correspondence : Helliyana, Masters Program in Public Health, Faculty of Public Health, Universitas Sumatera Utara, Jl. Prof. T. Maas, Medan, Sumatera Utara. Email: andybaso11@gmail.com. Mobile: 0852­60­129999. Journal of Maternal and Child Health (2019), 4(5): 312-316 https://doi.org/10.26911/thejmch.2019.04.05.02

Life Course Factors Associated with Stunting in Children Aged 2-5 Years: A Path Analysis

Background: Worldwide, in 2014, 23.8% of the children under-five years of age were stunted following the WHO definition, 7.5% were wasted but 6.1% had overweight or were obese. Developing countries host the bulk of the global stunting and child mortality rate. This study aimed to examine life course factors associated with stunting in children aged 2-5 years, using path analysis model. Subjek dan Metode: A case control study was conducted in Tulungagung, East Java, from October to November 2018. A sample of 200 children under five was selected by fixed disease sampling. The dependent variable was stunting. The independent variables were maternal mid-upper arm circumference (MUAC), maternal height, exclusive breastfeeding, complementary feeding, birth weight, birth length, infection disease, and clean water supply and sanitation. Data on maternal height was measured by microtoise. The other data were collected by maternal and child health book and questionnaire. The data were analyzed by path analysis. Results: Stunting directly decreased with maternal MUAC (b= 2.47; 95% CI= 0.33 to 2.86; p= 0.013), maternal height (b=3.10; 95% CI= 0.79 to 3.54; p= 0.002), exclusive breastfeeding (b= 4.78; 95% CI= 2.05 to 4.91; p<0.001), complementary feeding (b= 2.35; 95% CI= 0.25 to 2.83; p= 0.019), normal birth weight (b= 3.64; 95% CI= 1.26 to 4.21; p<0.001), normal birth length (b= 4.10; 95% CI= 1.63 to 4.62; p<0.001), no infection disease (b= 3.28; 95% CI= 0.87 to 3.47; p= 0.001), and clean water supply (b= 2.99; 95% CI= 0.72 to 3.49; p<0.001). Stunting indirectly affected with infection disease and birth weight. Conclusion: Stunting directly decreases with maternal MUAC, maternal height, exclusive breastfeeding, complementary feeding, normal birth weight, normal birth length, no infection disease, and clean water supply. Stunting indirectly affects with infection disease and birth weight. Keywords: stunting, determinants, path analysis Correspondence : Ayu Rosita Dewi. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: ayrost2014@gmail.com. Mobile: +6285856852680. Journal of Maternal and Child Health (2019), 4(5): 358-367 https://doi.org/10.26911/thejmch.2019.04.05.09