Child Nutrition Outcomes Research Articles

Rural–urban analysis of parental time poverty and child over-nutrition in ghana

ABSTRACT This study examines the link between parental time poverty and child body mass index, prevalence of overweight and obsesity. The study relied on data from the seventh round of the Ghana Living Standards Survey (GLSS), a nationally representative household level data. Employing the standard instrumental variable (IV) to control for endogeneity indicates that parental time poverty is associated with a higher BMI z-score and higher likelihood of children being overweight and obese, particularly in rural Ghana. Additionally, there is evidence of heterogeneity in the effect of parental time poverty on the prevalence of children being overweight and obese based on income classification and gender. The implications of these findings suggest that interventions aimed at providing labor-saving technologies and improving social and physical environments in rural areas may help reduce parental time poverty and improve child nutrition outcomes.

How do gender norms contribute to stunting in Ntchisi District, Malawi? a qualitative study.

Despite adequate food production and nutrition intervention coverage, stunting remains an enduring problem in Ntchisi, Malawi. Globally, gender and social norms are known to influence nutritional outcomes in children. This study explores how gender norms contribute to child stunting, in Ntchisi district, Central Malawi. Informed by the UNICEF Framework for Malnutrition, nine focus group discussions were conducted with a target population of mothers (n = 24), fathers (n = 23) purposively targeted through growth monitoring sessions, and members of policy and health treatment committees (n = 21), spanning three different areas of Ntchisi district. Data were analysed through inductive thematic analysis, guided by the framework for Research in Gender and Ethics (RinGs). Three primary themes were identified: 1) gender unequal decision making on the consumption, sale and distribution of food; 2) enshrined community norms influence feeding practices underpinned by gender-based violence; and 3) policy disconnections and gaps that reinforce gender norms regarding nutrition. Themes encompassed practices across household, health treatment, and policy level. Gender norms that underpin inequalities in decision making for production and consumption of food undermine children's nourishment and contributes towards sustained child malnutrition in Ntchisi. Existing policy documents should revise their guidelines to incorporate gender norms as key determinants of malnutrition.

Intergenerational effects of affirmative action in higher education: Evidence from India

We study the intergenerational effects of affirmative action in higher education on children's nutritional outcomes. Our context is India, where we exploit a policy-induced introduction of reservation of seats in higher education for the socially disadvantaged Other Backward Classes. We find that children of exposed mothers are less likely to be stunted. The effect is more pronounced for daughters. Higher levels of education and greater autonomy amongst treated mothers plausibly drive these results.

Women’s Bargaining Power and Children’s Nutritional Status: Evidence from Indonesia

Child stunting is a serious challenge in Indonesia, one of the largest middle-income countries in the world. Beyond the influence of bio-behavioral determinants, mothers’ bargaining power in the household is expected to have an overarching contribution to stunting, particularly as the primary caregivers of their children. Using a dataset from the fifth wave of the Indonesia Family Life Survey (IFLS-5), this study examines whether and to what extent a mother’s bargaining power influences children’s nutritional status. The study uses the instrumental variables method to correct the potential endogeneity of the mother’s bargaining power. Results suggest that children of mothers with higher intrahousehold bargaining power have a lower prevalence of stunting and better anthropometric outcomes. However, other members of the household matter, in the sense that improved outcomes are evidenced when the mother exercises her choice in decision making in a more consensual manner, by consultation with other household members. HIGHLIGHTS In Indonesia, higher women’s bargaining power enhances child nutritional long-term outcomes. Child nutrition improves when women make decisions jointly with other family members. Boys appear to be the main beneficiaries of mothers’ higher bargaining power. Policies to increase women’s agency need to consider family support and social norms.

Caregivers’ knowledge, attitude, and practices on complementary feeding of young children aged 6-23 months in Naga City, Philippines

A cross-sectional study was conducted to investigate the knowledge, attitudes, and practices of 60 caregivers regarding complementary feeding and its impact on the nutritional status of their children aged 6–23 months in Panicuason, Naga City, Philippines. Face-to-face interviews were conducted to collect data using pre-designed and pre-tested questionnaires. Descriptive statistics and Pearson’s R Correlation tests were used to analyze the data at p<0.05. The results indicated that the households involved had poor conditions in terms of educational attainment, occupation, and household income of the caregivers. The prevalence rates revealed a medium level of underweight (10.0%) and stunting (23.4%), and a poor level of wasting (5.0%). The KAP results demonstrated medium knowledge, positive attitudes, and poor practices among the caregivers. Several KAP components were found to be significantly associated with socioeconomic factors and water sanitation practices. The study found a weak positive correlation between weight-for-age and employment and a weak negative correlation between height-for-age and caregiver-child relationship. This study highlights the urgent need for nutrition education interventions focused on complementary feeding to improve the knowledge and practices of the caregivers. Such interventions are essential for enhancing child nutrition outcomes and potentially influencing positive changes in the attitudes of the caregivers.

Effects of sanitation on child growth in Serbian Roma communities

Abstract Poor sanitation may be associated with growth faltering, but empirical evidence on the association between household sanitation infrastructure and child nutrition has been mixed. This article assessed whether sanitation infrastructure is associated with growth penalties for Roma children. Design This is a Roma nationally representative population-based study. Proxies of child nutritional outcomes included children’s height-for-age Z scores below two standard deviations from the median of WHO’s reference population. Multiple and logistic regressions estimated the association between the type of toilet usage, outcomes, and sociodemographic determinants. Setting Data were from UNICEF’s fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements. Subjects Children aged 0–24 (n = 1,150) and 25–59 (n = 2,024) months born to women aged 15–48 years were included in this study. Results About 16% of children resided in households with no toilet service, and 23% of children were stunted. Roma children aged 25–59 months in households with no toilet service and in rural areas were more likely to be stunted and of significantly shorter stature than their counterparts. Children up to 24 months of age were not affected by the type of toilet, likely due to protective effects of breastfeeding. Child’s age, number of siblings, and birth spacing negatively influenced growth outcomes, while maternal age, birthweight above 2.5 kg, and being a female mitigated against poor growth outcomes. Conclusions The relationship between the type of toilet and growth outcomes among Roma children varied with age and area: having no toilet and living in rural areas were associated with compromised child growth for children aged 25–59 months. Maternal and child characteristics additionally accounted for children’s growth.

Influence of child marriage on nutritional status among their under‐five children in Bangladesh: Evidence from Bangladesh Demographic and Health Survey data 2011, 2014 and 2017–18

AbstractObjectiveChild marriage remains a significant concern in Bangladesh, where 38 million girls are married before reaching the age of 18. Child marriage contributes adversely to the health and nutritional status of their offspring. The current analysis investigated the association between maternal child marriage and nutritional outcomes including stunting, wasting and underweight of their under‐five children.MethodThis study analyzed data from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 2011, 2014 and 2017–2018. The researchers used descriptive statistics and multiple logistic regression analyses, controlling for potential socioeconomic and demographic variables, and adjusted the sample weight in all analyses using Stata.ResultThe analyses included pooled data of 25 323 ever‐married women and their under‐five children. Results showed that 73% of women were married before the age of 18. Children born to mothers married as children themselves were 19% more likely to be stunted and 13% was underweight but wasting wasn't directly linked to maternal child marriage. Adjusted analysis showed that child marriage was significantly associated with stunting [adjusted odds ratio (aOR): 1.19; 95% confidence interval (CI): 1.08, 1.33], underweight (aOR: 1.13; 95% CI: 1.01, 1.26), wasting (aOR: 1.05; 95% CI: 0.97, 1.13).ConclusionThis study observed a high prevalence of child marriage. Maternal child marriage was significantly associated with stunting, and underweight of their under‐five children. Mechanisms underlying these associations need to be explored to develop effective interventions to address these issues.

Associations of Intrahousehold Allocation of Animal Source Food With Mother and Child Nutrition Outcomes in Low-Income Informal Settlements of Nairobi, Kenya

Associations of Intrahousehold Allocation of Animal Source Food With Mother and Child Nutrition Outcomes in Low-Income Informal Settlements of Nairobi, Kenya

Beyond WASH: Testing Additional Connections Between Household Water Insecurity and Child Nutrition Outcomes in Multi-Country Contexts

ABSTRACT This study identifies multiple pathways connecting household water insecurity with child nutrition. Using nationally representative samples for 18 countries, we examine the mediating role of child’s dietary diversity as a function of household water status, while also accounting for sanitation. We construct a latent household water insecurity score (HWI) and use Structural Equation approach to model underlying pathways. HWI affected child’s HAZ score and hemoglobin both directly and indirectly, with a mediation from child feeding alongside effects from sanitation. Broadening the conception of household water insecurity and accommodating the indirect effects of water could improve explanations of child under-nutrition.

Prevalence and Implementation Characteristics of Weekend Food Assistance Programs in U.S. Schools

IntroductionAmid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings. MethodsThe prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n=413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022-2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index (HEI) 2015 scores of foods provided. ResultsHalf of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged an HEI-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources. ConclusionsDespite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security.

Improved drinking water, healthier children? Evidence from Pakistan

Purpose One of the United Nations’ sustainable development goals is to ensure the availability of improved drinking water for everyone. In this study, we examine the association between access to improved drinking water at the district level and child nutritional outcomes in Pakistan.Design/methodology/approach We employ district-level unbalanced panel data from Pakistan from various rounds of Pakistan Social and Living Standards Measurement Surveys and Multiple Indicators Cluster Surveys compiled by the Data4Pakistan, Pakistan District Development Portal. We examine the impact of the percentage of the population in a given district with access to clean drinking water on the percentage of stunted, underweight and wasted children in the district. The analysis proceeds in two steps. In the first step, we explore the spatial distribution of improved drinking water coverage and child development outcomes across districts. In the second step, we study their relationship by employing standard panel estimation methods and controlling for district characteristics.Findings The spatial analysis reveals the large disparity among districts and provinces in terms of improved drinking water coverage and child nutrition. The estimation results indicate that there is a significant association between the accessibility of improved drinking water and child development outcomes. The effect is significant for child stunting and underweight but not for child wasting. The impact appears to be stronger in rural districts. These findings are robust to alternate empirical strategies.Originality/value This is the first such study to examine the provision of improved drinking water at the district level in relation to child developmental outcomes in a developing country context.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-09-2023-0739

Assessing groundwater quality and its association with child undernutrition in India

Background and objectivesGroundwater contamination poses a significant health challenge in India, particularly impacting children. Despite its importance, limited research has explored the nexus between groundwater quality and child nutrition outcomes. This study addresses this gap, examining the association between groundwater quality and child undernutrition, offering pertinent insights for policymakers. Data and methodsThe study uses data from the fifth round of the National Family Health Survey (NFHS) and the Central Groundwater Board (CGWB) to analyze the association between groundwater quality and child nutritional status. The groundwater quality data were collected by nationwide monitoring stations programmed by CGWB, and the child undernutrition data were obtained from the NFHS-5, 2019–21. The analysis included descriptive and logistic regression model. The study also considers various demographic and socio-economic factors as potential moderators of the relationship between groundwater quality and child undernutrition. FindingsSignificant variation in groundwater quality was observed across India, with numerous regions displaying poor performance. Approximately 26.53 % of geographical areas were deemed unfit for consuming groundwater. Environmental factors such as high temperatures, low precipitation, and arid, alluvial, laterite-type soils are linked to poorer groundwater quality. Unfit-for-consumption groundwater quality increased the odds of undernutrition, revealing a 35 %, 38 %, and 11 % higher likelihood of stunting, underweight, and wasting in children, with higher pH, Magnesium, Sulphate, Nitrate, Total Dissolved Solids, and Arsenic, levels associated with increased odds of stunting, underweight, and wasting. Higher temperatures (>25 °C), high elevations (>1000 m), and proximity to cultivated or industrial areas all contribute to heightened risks of child undernutrition. Children consuming groundwater, lacking access to improved toilets, or living in rural areas are more likely to be undernourished, while females, higher-income households, and those consuming dairy, vegetables, and fruits daily exhibit lower odds of undernutrition. Policy implicationsPolicy implications highlight the urgent need for investment in piped water supply systems. Additionally, focused efforts are required to monitor and improve groundwater quality in regions with poor water quality. Policies should emphasize safe sanitation practices and enhance public awareness about the critical role of safe drinking water in improving child health.

Are children with disabilities more likely to be malnourished than children without disabilities? Evidence from the Multiple Indicator Cluster Surveys in 30 countries

IntroductionA key Sustainable Development Goal target is to eliminate all forms of malnutrition. Existing evidence suggests children with disabilities are at greater risks of malnutrition, exclusion from nutrition programmes and...

Weekly iron-folic acid supplementation and its impact on children and adolescents iron status, mental health and school performance: a systematic review and meta-analysis in sub-Saharan Africa

ObjectiveThis systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan...

Effects of food price changes on child undernutrition among agricultural households in Nigeria

This study examines the effects of changing food prices on the nutritional outcomes of children under five years old in Nigeria, utilising data from the 2013 and 2016 Nigeria Living Standards Measurement Study – Integrated Surveys on Agriculture (LSMS-ISA). We applied correlated random-effects probit and fixed-effects regression models to analyse the data. Results indicate an increase in stunting and decreases in wasting and underweight conditions among children over the years studied. Specifically, higher prices for fish, eggs, beef, rice, and cooking oil have a significant association with increased stunting, while increases in the prices of maize and garri are associated with greater wasting. Underweight increase with higher prices of milk, maize, and rice. In contrast, modest increases in yam and beans prices have not exacerbated undernutrition. The study also highlights the importance of household income growth and women's involvement in financial decisions in reducing child undernutrition. We advocate for agriculture-led, nutrition-sensitive policies that address the high costs of animal proteins and staples such as rice, maize, and garri, while monitoring and carefully regulating upticks in the prices of yam and beans.

Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis

The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies. Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD-0.028, 95% CI-0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD-0.045, 95% CI-0.079 to-0.011) but not in highly educated populations (MD 0.003, 95% CI-0.093 to 0.098). Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).

Application of the integrated gateway model on child nutrition behaviors in Niger: An exploratory analysis.

To identify potential gateway factors and behaviors that are associated with infant and young child feeding (IYCF) practices in the Maradi and Zinder regions of Niger through application of the Integrated Gateway Model. We analyzed data from 2,727 married women of reproductive age including details on child feeding practices for their 2,551 children between the ages of 0 to 23 months. We assessed the association of three gateway behaviors (i.e., any antenatal care, facility delivery, and communication on nutrition practices) and gateway factors (i.e., behavioral determinants, exposure to information, decision-making agency, and woman's group participation) on four IYCF practices (i.e., early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency, and minimum dietary diversity) while controlling for age, parity, educational attainment, and household wealth. We found antenatal care was associated with exclusive breastfeeding of children 0-5 months [adjusted odds ratio (aOR): 1.17 (95% confidence interval (CI): 1.03-1.33)], and minimum meal frequency of children 6-23 months [aOR: 1.10 (95% CI: 1.03-1.17)], and facility delivery was associated with early initiation of breastfeeding among children 0-5 months [aOR: 2.08 (95% CI: 1.39-3.12)]. We found negative associations with exclusive breastfeeding and communication on nutrition practices with husbands, family/friends, and health workers. Exposure to nutrition messages through radio, women's groups participation, and with health workers was positively associated with minimum dietary diversity. Self-efficacy was positively associated with both early initiation of breastfeeding, exclusive breastfeeding among children 0-5 months and minimum dietary diversity among children 6-23 months. Women's agency was positively associated with early initiation of breastfeeding. The association of antenatal care and facility delivery with child nutrition outcomes suggest intervening before a woman becomes pregnant or early in her pregnancy could improve nutrition outcomes. Programs strengthening the continuum of care should identify gateway behaviors to maximize adoption of priority health behaviors.

Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment.

A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs]. We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs. We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children. Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial

BackgroundGlobally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.MethodsEngaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers’ groups, with or without fathers’ groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers’ and fathers’ groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers’ groups receiving a nutrition program, (2) mothers’ groups receiving a bundled nutrition and parenting program, (3) mothers’ and fathers’ groups receiving a nutrition program, (4) mothers’ and fathers’ groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).DiscussionEFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.Trial registrationClinicalTrials.gov NCT03759821. Registered on November 30, 2018

The effect of women's decision-making on child nutritional outcomes in South Africa

Women’s decision-making is a phenomenon in children's nutritional outcomes. This study investigated the causal effect of women’s decision-making on child nutritional outcomes using a panel dataset from the South African National Income Dynamic Survey (NIDS) from 2014/15–2017. The child's nutritional outcomes comprised three anthropometric measurements, which included weight-for-height, weight-for-age, and height-for-age. The study used variables, which include daily expenditure, large purchases, where children attended school, who lived with the family, and where the household lived, to create a decision-making index using Multiple Correspondence Analysis (MCA). A control function approach (CFA) was used to control for endogeneity issues. Using this approach, the findings suggested that women’s decision-making had a significant positive effect on the child's nutritional outcomes. While women's decision-making improves a child’s weight-for-age and weight-for-height, the result was inconclusive on the child’s height-for-age. The policy implications of these findings indicate that the role of women's empowerment is important and could significantly help in achieving better child nutritional outcomes. Overall, the findings suggest the evaluation of policies that ameliorate gender inequality and children's health and well-being.