Nutrition-specific Interventions Research Articles

Underweight and Predictors Among Children Aged 6–59 Months in South Ethiopia

ObjectivesUnderweight remains the primary public health concern among under-five-year-old children in Ethiopia, despite numerous government-implemented nutrition-specific and sensitive interventions. Therefore, this study aimed to assess underweight and associated factors among children in South Ethiopia.MethodsBetween March and April 2021, 717 children in the South Ari district who were between the ages of 6 and 59 months participated in a cross-sectional study. To choose a sample of households containing a minimum of one child between the ages of 6 and 59 months, a multi-stage sampling procedure was used. Data were collected by interviewer-administered structured questionnaires from the mothers of the children. To determine the factors associated with being underweight, a binary logistic regression analysis was built. All variables with a p-value <0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. To assess the strength of the association, an adjusted odds ratio (AOR) with a 95% confidence interval was used. With a p-value below 0.05, statistical significance was declared.ResultsThe prevalence of underweight was determined to be 29.7% (95% CI: 26.5%, 33.2%). Child age 6–23 months [adjusted odds ratio (AOR) = 0.28; 95% confidence interval (CI): 0.18, 0.44], food insecurity (AOR = 1.48; 95% CI: 1.04, 2.10), sub-optimal child dietary diversity (AOR = 1.44; 95% CI: 1.01, 2.03), birth interval <24 months (AOR = 2.49; 95% CI: 1.75, 3.54), and common childhood illness (AOR = 2.21; 95% CI: 1.52, 3.21) were associated with being underweight.ConclusionUnderweight among children is predicted by household food insecurity, suboptimal dietary diversity, and common childhood illnesses, necessitating further efforts to improve food security and manage common illnesses.

Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review

BackgroundChildhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0–18 years old.MethodsEmbase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist.ResultsSeventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0–11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children’s growth and eating behaviours, but there is a lack of data on childhood obesity.ConclusionThis finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

Feasibility of caregiver-administered anthropometric measurements of children under age 5: evidence from Zambia

BackgroundAccurate measurement of children’s anthropometry is of central importance for the assessment of nutritional status as well as for the evaluation of nutrition-specific interventions. Social distancing requirements during the recent Covid-19 pandemic made administration of standard assessor-led measurement protocols infeasible in many settings, creating demand for alternative assessment modalities.ObjectiveTo assess the feasibility and reliability of caregiver-administered anthropometric assessments of children under age 5.DesignWe compared standard and caregiver-administered assessments within an ongoing nutrition trial in Zambia (NCT05120427). We developed a “no-contact” protocol whereby trained staff verbally instruct caregivers from an appropriate distance to measure the height, weight and MUAC of their children. We captured measurements of height, weight and MUAC among a sample of caregivers and infants in Zambia using both the “no-contact” protocol and a standard assessor-led protocol. We analyzed each anthropometric variable, comparing means between protocol group, the proportions yielding standardized z-scores outside the plausible ± 6SD range and the proportions of children classified stunted, underweight and wasted.ResultsAnthropometric measurements were captured for 76 children using both the no-contact protocol and the standard protocol. An additional 1430 children were assessed by the standard protocol only and an additional 748 children by the no-contact protocol only. For the 76 children measured by both methods, we find no differences in average height, weight and MUAC between caregivers and interviewer assessments. The estimated kappa for the binary stunting and underweight classifications were 0.84 and 0.93, respectively. In the larger samples measured only following one protocol, we find no differences in average outcomes after adjusting for child, caregiver and household characteristics.ConclusionsAnthropometric measurement protocols administered by caregivers with verbal instruction from trained assessors are a promising alternative to standard protocols in situations where study staff are unable to come in close contact with study participants.Clinical trials registration This study was conducted within a larger trial registered at clinicaltrials.gov as trial NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.

The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review

Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131). We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity. There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM. President's Scholarship (Imperial College London) and National Institute for Health and Care Research. For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

Chronic Energy Deficiency Associated with Body Mass Index of Adolescent Girls

Chronic Energy Deficiency (CED) is a nutritional issue that poses a threat to adolescents in Indonesia, particularly to adolescent girls. According to the 2018 Basic Health Survey (Riskesdas), the proportion of CED among adolescent girls in Indonesia was 36.3%. This study aimed to identify the factors associated with CED among adolescent girls in the catchment area of Poka-Rumah Tiga, Ambon City. The study was conducted in August 2022 and used a cross-sectional approach with total sampling. The respondents were students aged 15-19 years from three high schools/equivalents in the catchment area of Poka-Rumah Tiga Health Center (SMKN 5 Ambon, SMAN 3 Ambon, and MA Al-Mabrur), with a total of 441 respondents. CED was determined based on the mid-upper arm circumference size being less than 23.5 cm. Logistic regression analysis was used to identify factors associated with CED in adolescent girls. Of the 441 adolescent girls who participated in this study, 45.80% were found to have CED. The odds of CED were lower in adolescent girls with normal BMI (18.5-22.9 kg/m2) (OR=0.09; 95%CI: 0.05-0.15; p&lt;0.001) and overweight (≥23 kg/m2) (OR=0.01; 95%CI: 0.00-0.07; p&lt;0.001) compared to those who were underweight (BMI&lt;18.5 kg/m2). This study highlights the importance of conducting nutrition-specific and nutrition-sensitive interventions for adolescent girls. This includes raising the awareness and knowledge of adolescent girls, family members, and school teachers regarding the importance of balanced nutrition to reduce CED.

Effect of a Center-Based Early Childhood Care and Education Program on Child Nutritional Status: A Secondary Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial in Rural Sindh, Pakistan

BackgroundHigh-quality early childhood care and education (ECCE) programs can positively impact children’s development. However, as an unintended consequence, ECCE attendance may also affect children’s nutritional status. ObjectiveWe evaluated the effect of a center-based ECCE intervention on child nutritional outcomes in rural Pakistan. MethodsThis study utilized data from a stepped-wedge cluster randomized controlled trial of a center-based ECCE program that trained female youth to run high-quality preschools for children aged 3.5–5.5 y (Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) program) in rural Sindh, Pakistan. The program did not include any school meals. A total of 99 village clusters were randomized to receive the LEAPS intervention in 3 steps, and repeated cross-sectional surveys were conducted to assess the impact on children (age: 4.5–5.5 y) at 4- time points. ITT analyses with multilevel mixed-effect models were used to estimate the effect of the intervention on child anthropometric outcomes. ResultsThe analysis included 3858 children with anthropometric data from 4 cross-sectional survey rounds. The LEAPS intervention was found to have a positive effect on child height-for-age z score (mean difference: 0.13 z-scores; 95% confidence interval [CI]: 0.02, 0.24). However, there was a negative effect on weight-based anthropometric indicators, −0.29 weight-for-height z score (WHZ) (95% CI: −0.42, −0.15), −0.13 BMI z score (BMIZ) (95% CI: −0.23, −0.03), and −0.16 mid-upper arm circumference-for-age z score MUACZ (95% CI: −0.25, −0.05). An exploratory analysis suggested that the magnitude of the negative effect of LEAPS on WHZ, BMIZ, and weight-for-age z score (WAZ) was greater in the survey round during the COVID-19 lockdown. DiscussionThe LEAPS intervention positively affected child linear growth but had negative effects on multiple weight-based anthropometric measures. ECCE programs in low- and middle-income country settings should evaluate the integration of nutrition-specific interventions (eg school lunch, counseling on healthy diets) and infection control strategies to promote children's healthy growth and development. Clinical Trial Registryclinicaltrials.gov, NCT03764436, https://clinicaltrials.gov/ct2/show/NCT03764436

Structural readiness of health facilities in Mozambique: how is Mozambique positioned to deliver nutrition-specific interventions to women and children?

Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each province and the country as a whole, we calculated the proportion of people with access to a ready facility for maternal and child nutrition interventions. Results At the national level, 29.1% and 37.3% of the population were within 10 kilometers of a facility ready to deliver all maternal and child nutrition services, respectively. Pregnancy growth monitoring (73.8%) and vitamin A supplementation (72.4%) were the most available interventions to the population. In contrast, anemia testing/iron supplementation (45.1%) was the least available nutritional intervention. The Center (30.5%) and North (26.9%) regions of Mozambique had much lower coverage than the South region (71.7%) across the maternal and child nutrition interventions. Nampula (14.9%) and Zambézia (17.9%) provinces were the least ready to deliver maternal nutrition services while Nampula (20.4%) and Cabo Delgado (21.2%) provinces were the least ready to deliver nutrition services to children. Conclusions To achieve high coverage of nutrition interventions, facilities need a full suite of commodities and equipment. Currently, too many facilities in Mozambique have only some of these supplies, meaning that only a minority of the children and pregnant women will receive effective nutrition services when they need them. Multi-sectoral efforts, including those outside the health system, are necessary to improve nutrition in Mozambique.

Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets

BackgroundSouth Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country’s progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries.MethodsA systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings.ResultsAll eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans.ConclusionThere is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition.

Risk factors for 6-to-24-month-old toddlers in district of Tanara: survey of hygiene sectors, worm infection, and complementary feeding to reduce stunting

Background: Children in Indonesia still struggle against being stunted, wasted, and underweight. In 2018, 30.8 % of children under five years old were stunted, in 2022, it had decreased to 21.6%. The stunting rate in Pandeglang Regency in 2019 was 41.6%, whereas the incidence in Banten Province was 24.1%. This study aims to determine factors that influence the occurrence of stunting in children aged 6–24 months in Tanara District, Serang Regency, Indonesia. Methods: A cross-sectional approach was used on a sample consisting of 40 mothers with children aged 6–24 months in September 2020, selected using consecutive sampling from nine subdistricts. Results: Of the total respondents, 21 (52.5%) have stunted children aged 6–24 months, 28 (70%) children had completed exclusive breastfeeding, and 65% had poor knowledge of complementary feeding. Findings reveal a relationship between the incidence of stunting and the history of infectious disease, a lack of complementary feeding knowledge, and a lack of a healthy life attitude. Conclusions: The most influential factor in stunting in children aged 6–24 months was the history of infectious disease and the attitude toward a healthy life. A lower history of infectious disease in children under five will give a low incidence of stunting; conversely, a higher attitude toward healthy living lowers the incidence of stunting. In this study, the specific nutrition intervention programs required are learning classes for mothers, whether they are mothers of infants/toddlers or pregnant women. Moreover, the improvement of sensitive intervention programs for environmental hygiene needs to be encouraged, which is conducted by the local government and the community. The need to integrate nutrition-specific and sensitive interventions into efforts to improve children’s health should be met so that the handling of nutritional problems can be sustainable.

Protocol for integrated solutions for healthy birth, growth and development: a cluster-randomised controlled trial to evaluate the effectiveness of a mixed nutrition intervention package in reducing child undernutrition in Lao People’s Democratic Republic

IntroductionWhile Lao People’s Democratic Republic has seen economic gains in recent years, one-third of children aged 5 years and under are stunted. There is a need for evidence around clinically...

P17-067-23 Peripheral Nerve Conduction Velocities in Malnourished Bangladeshi Children Before and After Nutrition-Specific Intervention

P17-067-23 Peripheral Nerve Conduction Velocities in Malnourished Bangladeshi Children Before and After Nutrition-Specific Intervention

Nutritional Indicators for Gujarat, Its Determinants and Recommendations: A Comparative Study of National Family Health Survey-4 and National Family Health Survey-5.

Malnutrition is a public health problem globally. Gujarat is one of the states facing challenges in dealing with malnutrition and anemia. The NFHS-5 (National Family Health Survey-5)data reveals that the gains made in NFHS-4 (National Family Health Survey-4)were reversed in NFHS-5. Despite numerous schemes and policies in place, Gujarat has yet to reach the full potential of these mandated policies to showcase exponential results in malnutrition and anemia. This study presents an overview of the nutritional status of districts in Gujarat, compared with NFHS-4, by illuminating its potential determinants and inter-district variabilities. An increased prevalence was seen in children under five who are stunted andseverely wasted; however, the prevalence of children under five who are wasted improved in Gujarat. The prevalence of anemia increased across all age groups, showing an immediate sign of caution. The study observed decreased prevalence of immediate determinants and increased coverage of nutrition-specific interventions in NFHS-5 compared to NFHS-4 for nutritional indicators in Gujarat. Underlying determinants like households with electricity and improved drinking water have improved drastically in Gujarat. Furthermore, it elaborates on the gaps and improvements observed in inter-district variabilities amongdeterminants in their coverage. This study also consists of actions taken by states that have fared better concerning nutritional indicators instead of improving the nutritionalindicators for Gujarat. The study has categorized the districts into top-priority, priority, average, and front-runner districts of Gujarat based on the prevalence of nutritional indicators.

Association of Women Leading Land Use with Energy and Nutrient Intakes Among Children Aged 6 to 59 Months in Oromia, Ethiopia

Nutrition-specific interventions alone will not help countries to end child malnutrition; nutrition-sensitive interventions such as women empowerment are also needed. Therefore, this cross sectional study was conducted to assess the association of women leading land use with nutrient intakes among children aged 6 to 59 months in Oromia, Ethiopia. Three hundred thirty-two caregivers participated in the study. A pretested questionnaire was used to collect data on background characteristics of child caregivers, women leading land use status, and caregivers’ exposure to mass media. Dietary assessment for nutrients intake was collected using a 24-hour recall. The survey data was analyzed using SPSS software version 25. Descriptive statistics were presented in frequency and percentages and in the form of mean ± SD. The nutrient intakes were compared with recommended dietary allowances to analyze the gap between the intakes and the recommendations were presented as percentages. Any difference in the variables was compared, based on women leading land use, using Chi square test and Mann Whitney u test, depending on the type of data. Results were considered statistically significant at P<0.05. Starchy staples were consumed by more than 90% of the children; close to ¾ of the children consumed legumes and nuts; animal source foods consumption was below 20% except dairy products (84%). Vitamin A rich fruits and vegetables were consumed by 33% of the children on average; and the minimum dietary diversity score was achieved by 48% of the children. The median energy intakes for children aged above a year and calcium intakes during the second half of the first year were more than 90%. On the other hand, the intakes of energy, at the stage of the second 6 months, fat, the calcium (>1 year) and the ascorbic acid intake were below 90%. Intake of Fat and Ascorbic acid was very low. Interestingly, iron intake for the children of 6-12 months age was more than 100%. However, there was statistical difference (p<0.05) in the proportion children of women with land leading power and without land leading power who consumed starchy staples, legumes and nuts, dairy products as well as ascorbic acid. Women empowerment in deciding land use issues affect about their child feeding practices and ultimately nutritional outcome and therefore, Women empowerment should be ensured for better child feeding practices and nutrients intake.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review.

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

Covid-19 related factors to food security and dietary diversity among urban households in western Oromia, Ethiopia

BackgroundThis study aims to assess factors associated with food security and dietary diversity among poor urban households of western Oromia, Ethiopia, after the outbreak of the Covid-19 pandemic. MethodA cross-sectional, community-based study was conducted in May to June 2021 with 361 poor urban households in the Horo Guduru Wollega zone, western Oromia, Ethiopia. A pre-tested structured questionnaire was used to collect primary data. Twenty-four hour reminder points were used to assess household dietary diversity, and household food security was assessed using the Household Food Insecurity Access Scale tool. Data were evaluated using the statistical software SPSS version 25.0. ResultsThis study showed a prevalence of food insecurity in households of 59.6%. The mean and standard deviation of household dietary diversity values were 4.19 ± 1.844. Family size (AOR = 8.5; 95% CI:3.295–21.92), monthly income (AOR = 3.52; 95% CI; 1.771–6.986), dietary diversity (AOR = 8.5; 95% CI; 3.92–18.59), knowledge (AOR = 3.0, 95% CI = 1.08–)8.347), attitude (AOR = 8.35, 95% CI:3.112–22.39) and practices against Covid-19 (AOR = 2.12; 95% CI:1.299–11.4) were factors significantly associated with food insecurity. Variables like educational status (AOR = 3.46; 95% CI:1.44–8.312), increased family size after the Covid-19 pandemic (AOR = 2.26; 95% CI:1.02–5.04), food security (AOR = 6.7; 95% CI:4.01–19.01), knowledge (AOR = 3.96; 95% CI:1.57–10.0), attitude (AOR = 3.9; 95% CI:1.75–8.82) and practices toward coronavirus (AOR = 2.23; 95% CI:2.18–23.95) were predictors significantly associated with dietary diversity. ConclusionThis study concluded that family size, monthly income, and dietary diversity were factors contributed to household food security. On the other hand, variables such as educational status, family size, and food security were highly relevant factors for dietary diversity after the outbreak of the Covid-19 pandemic. Knowledge, attitudes, and practices were also variables related to both household food security and dietary diversity. Therefore, immediate interventions such as nutrition-specific interventions can be suggested to address food insecurity and problems of inadequate food intake in poor urban households. In addition, governmental and non-governmental organizations should raise awareness and policies to support those at higher risk by developing affordable, sustainable and targeted social protection systems that ensure food security and adequate dietary intake at the household level.

Factors associated with wasting and stunting among children aged 06–59 months in South Ari District, Southern Ethiopia: a community-based cross-sectional study

BackgroundChild undernutrition is a major public health problem in Ethiopia despite different nutrition-specific and sensitive interventions implemented by the government. However, evidence regarding the burden and responsible factors is limited in the South Ari district. Hence, this study aimed to assess factors associated with wasting and stunting among children aged 06–59 months in the South Ari district, Southern Ethiopia, 2021.MethodsA community-based cross-sectional study was conducted from March 11 to April 11, 2021, among 717 households with at least one child aged 06–59 months. Anthropometric measurements were taken using standard procedures and were converted to height for age Z score and weight-for-height using WHO Anthro software Version 3.2.2. Data were checked and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25.0. Binary logistic regression analysis was fitted to identify predictors of wasting and stunting. A p-value < 0.05 was used to declare statistical significance.ResultThe prevalence of wasting and stunting among children aged 06–59 months in the district was 9.1% (95% CI: 7.07%, 11.41%) and 59.97% (95% CI: 56.28%, 63.58%), respectively. Family size (8 and above) (AOR = 3.03, 95% CI: 1.31, 7.03), family size (5 to 7) (AOR = 2.05, 95% CI: 1.11, 3.81), poor and medium wealth index (AOR = 3.69, 95% CI: 1.65, 8.26) and (AOR = 2.29, 95% CI: 1.01, 5.16), insufficient maternal knowledge on child feeding practice (AOR = 2.58, 95% CI: 1.31, 5.07), presence of diarrhea in the past two weeks (AOR = 2.05, 95% CI: 1.10, 3.85), non-exclusive breastfeeding (AOR = 2.65, 95% CI: 1.51, 4.65), and birth interval of < 24 months (AOR = 4.49, 95% CI: 2.40, 8.37) were factors significantly associated with wasting. Whereas, children in the age group of 24–59 months (AOR = 2.24, 95% CI: 1.58, 3.16), non-exclusive breastfeeding (AOR = 1.81, 95% CI: 1.24, 2.65), birth interval of fewer than 24 months (AOR = 1.54, 95% CI: 1.11, 2.14), sub-optimal child dietary diversity score (AOR = 1.59, 95% CI: 1.14, 2.22), being a non-beneficiary of productive safety-net program (AOR = 1.91, 95% CI: 1.24, 2.95), and household food insecurity (AOR = 2.60, 95% CI: 1.86, 3.64) were factors significantly associated with stunting.ConclusionsWasting and stunting were found to be key public health problems in the South Ari District. Hence, further interventions should consider strategies to enhance household food security and integration of productive safety net programs with primary health care services. Rigorous work is required in advocating and strengthening the provision of family planning services, child care, and integrated management of common childhood illnesses. Moreover, behavioral change communication is highly demanded to improve child feeding practices.

Predictors of Anemia Among Pregnant Women Attending Public Healthcare Facilities in Bengaluru, South India

Background and Aims Anemia in pregnancy leads to poor outcomes. The Indian government has reduced anemia only at a marginal level from 58 in the National Family Health Survey NFHS-3 to 50.4 in the NFHS-4 survey. This study aims to determine the predictors of anemia among pregnant women in the maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin MAASTHI cohort of Bengaluru. This will help provide valuable information to design the appropriate intervention to lower the prevalence of anemia.Method The study was nested in the MAASTHI cohort study in public health facilities in Bengaluru. The present study was a multi-center prospective cohort study. Pregnant women attending health facilities for antenatal care were included in the study after obtaining their written consent. Socio-demographic information obstetric details smoking status and alcohol consumption among participant and their spouse were noted. Social support psychosocial stress and detailed anthropometry were recorded. All eligible pregnant women were asked to undergo a blood hemoglobin and oral glucose tolerance test after the completion of 26 weeks of gestation.Results A total of 2447 study participants with a mean age of 24.28 plusmn 4.07 years were included in the study. The overall prevalence of maternal anemia was 44.4 N 1375. Among them 24 had mild Hb 10ndash10.9 gmdl 15.8 had moderate Hb 7-9.9gmdl and 0.4 had severe anemia Hb lt7gmdl. Multivariate analysis showed that obstetric factors such as parity had a significant association with anemia. In contrast nutrition-related factors such as not consuming iron and folic acid IFA supplements and being underweight were positively associated with anemia.Conclusion Our study found a higher prevalence of maternal anemia during pregnancy in urban Bengaluru. The government should take proactive health promotion initiatives such as effective campaigns and nutrition-specific interventions especially iron supplementation. Integrated dietary interventions such as food fortification with iron and folate and IFA supplementation targeting from childhood to adolescence and reproductive age rather than targeting pregnant women may help to reduce the burden of anemia.

Assessing the multi-sectoral convergence of interventions impacting nutrition at the household level: Lessons from Sundarbans, West Bengal, India

Background: Malnutrition is a multifaceted problem requiring interventions that address the multi-sectoral determinants contributing to it. As per National Family Health Survey - 5 (2019-21), with 33.8% stunted, 20.3% wasted, and 32.2% underweight children, West Bengal is one of the high burden states for childhood undernutrition in India.&#x0D; Objectives: The objective of the study was to assess household-level access (i.e. the percentage of households availing select services) to various nutrition-specific and nutrition-sensitive interventions and understand the extent to which convergent action has taken place in the most hard-to-reach areas of the Sundarbans.&#x0D; Methods: Cross-sectional survey following 30 x 30 cluster sampling; the sampling was done based on population proportion to size (PPS) methodology. A total of 912 households were recruited for a quantitative survey, and the data was collected through computer-assisted personal interview (CAPI) tools. Data was collected from October 15-25, 2021 from households having at least one child in the age group of 6 – 24 months.&#x0D; Result: The study focused on 19 nutrition-specific and sensitive interventions. Household-level coverage of 13 of these interventions was 1.5%; coverage of the six others was 4.2%. The estimated coverage of all 19 interventions was found to be almost non-existent (0.2%).&#x0D; Conclusion: The conspicuously low coverage of services at the household level is a clear indicator of poor convergence of government schemes and programs, reflecting, in turn, disjointed action on the part of the various departments of the government. The results suggest the need for reconsidering the household-level delivery of services as a wholesome package of interventions rather than seeing them as discrete departmental deliverables.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey.

Low dietary diversity significantly interplays with children's growth failure. However, evidence of its crucial role in children's health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015-2016. A total of 67,278 mother-child pairs of children between the ages of 6-23 months and mothers aged 15-49 years were included in this study. Pearson's chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (&lt;4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21-1.38), wasted (AOR = 1.29; 95% CI; 1.21-1.38), and underweight (AOR = 1.47; 95% CI; 1.39-1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.