Prevalence Of Severe Stunting Research Articles

Prevalence of Stunting Among Under 5 Children in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen

Background: Yemen is one of the low-income countries, with 80% of the population living below the poverty line and almost half the population lacks adequate access to nutritious food. The low-birth-weight rate is 24.6%, and the overall infant mortality rate is 47 per 1,000 births. The risk of death of newborns varies depending on social, demographic, and economic factors. Objectives: This study aims to evaluate the effect of the ongoing war on stunting prevalence among children under five years in Al-Rajaiya Health Center, Ash-Shamayatayn District - Taiz, Yemen. Methods: This study is an observational analytic with a cross-sectional design. It was conducted from January to June 2022, following purposive sampling gathered 254 participants. Results: The data revealed that the prevalence of severe stunting in 6- to 23-month-old children was higher in urban areas than in rural areas (45% vs. 43.7%); it was also higher in girls than in boys (58.4% vs. 30.3%). Furthermore, in 24- to 59-month-old children, it was higher in urban areas than in rural areas (50% vs. 12.5%) and higher in girls than in boys (42.9% vs. 19.6%) with p-value (0.040, 0.018, 0.001 and >.001) respectively. Conclusions: Findings demonstrated that the ongoing war has a significant effect on the stunting prevalence among children under five years. Early childhood undernutrition is linked to several adverse outcomes in adulthood, and it is plausible that undernutrition in early childhood may be a significant factor in explaining the health disparities faced by Yemeni children under five.

A STUDY ON MALNUTRITION AMONG CHILDREN UNDER THE AGE OF 5 IN MANDLA DISTRICT OF MADHYA PRADESH

Objectives: To determine the prevalence and socio-demographic determinants of malnutrition among under-5 years old children in Mandla district. Methods: This cross-sectional study was conducted in three blocks (Bijadandi, Narayanganj, and Niwas) of Mandla district of M.P. For this study, the calculated sample size was 276 children under 5 years of age. Multistage Random sampling was used, and the required sample size was collected from 12 villages in these 3 blocks. A predesigned and pretested schedule was administered by asking for a history from the mother, and anthropometric measurements of the children were recorded. Results: The overall prevalence of underweight (<median-2SD) was found to be 51.81%. Whereas 18.12% were severe underweight (<median- 3SD) and 33.70% were moderate underweight (<median 3SD to-2SD). The prevalence of stunting among under-5-year-old children was found to be 46.74% (<median-2SD). The prevalence of severe stunting (<median-3SD) was 15.94%, while that of moderate stunting (<median 3SD to-2SD) was 30.80%. The overall prevalence of wasting was 24.72%. In which 21.01% were moderately wasted, and 4.71% were severely wasted. Conclusion: The findings of the present study revealed the widespread prevalence of undernutrition among under-5-year-old children. Data show that 51.81% of children under 5 years of age are underweight, 46.74% are stunted, and 24.72% are wasted in our study area, which is much higher than national figures and highlights the need for an integrated approach toward improving child health as well as nutritional status in this area.

Nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals living in Bhasan Char relocation camp, Bangladesh: a cross-sectional survey

ObjectiveTo generate baseline evidence regarding the nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals (FDMN) relocated to Bhasan Char relocation camp of...

Spatiotemporal Variations and Determinants of Under-Five Stunting in Ethiopia.

Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context. This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016). Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses. The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting. Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.

Impact of seasonal RTS,S/AS01E vaccination plus seasonal malaria chemoprevention on the nutritional status of children in Burkina Faso and Mali

BackgroundA recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition.MethodsIn Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01E alone, or SMC combined with RTS,S/AS01E for three malaria transmission seasons (2017–2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below − 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression.ResultsIn 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01E, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01E alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older.ConclusionsDespite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas.Trial registration: https://www.clinicaltrials.gov/ct2/show/NCT03143218, registered 8th May 2017.

Progress in reaching unvaccinated (zero-dose) children in India, 1992–2016: a multilevel, geospatial analysis of repeated cross-sectional surveys

Reaching zero-dose children (infants who receive no routine vaccinations) is a global strategic priority. We studied zero-dose children in India over 24 years to clarify aggregate trends and the contribution of large-scale social, economic, and geographical inequalities to these. We did a multilevel, geospatial analysis of repeated cross-sectional surveys of all four rounds (1992-2016) of India's National Family Health Survey to study the prevalence, distribution, and drivers of zero-dose (no first dose of diphtheria, tetanus, and pertussis) vaccination status. We included all children born to participating women who were aged 12-23 months at the time of the survey, as this is the standard age at which immunisation data are assessed. Children who died before the survey and those missing data on key outcomes or correlates were excluded. The outcome was child zero-dose vaccination status. We also compared the prevalence of nutritional deficits among zero-dose versus vaccinated children. For the most recent survey, we produced geospatial estimates identifying the prevalence of zero-dose children across states and districts and used these to project head count. We examined 393 167 children for eligibility. 72 848 children were included in the final analytic data set. The proportion of zero-dose children in India declined from 33·4% (95% CI 32·5-34·2) in 1992 to 10·1% (9·8-10·4) in 2016. Progress notwithstanding, in 2016, zero-dose children remained concentrated among disadvantaged groups (prevalence in the bottom wealth quintile 15·3%, 95% CI 14·6-16·0; prevalence among mothers with no education 16·8%, 16·1-17·4). Compared with vaccinated children, zero-dose children were more likely to suffer from malnutrition in all survey rounds (prevalence of severe stunting in 1992: zero dose 41·3%, 95% CI 39·2-43·8 vs vaccinated 28·5%, 27·2-29·7; 2016: zero dose 24·9%, 23·6-26·2 vs vaccinated 18·7%, 18·3-19·1). In 2016, there were an estimated 2·88 (95% CI 2·86-2·89) million zero-dose children in India, concentrated in less developed states and districts and several urban areas. Over a 24-year period in India, child zero-dose status was shaped by large-scale social inequalities and remained a consistent marker of generalised vulnerability. Interventions that address this cycle of intergenerational inequities should be prioritised. None. For the French, Spanish, and Hindi translations of the abstract see Supplementary Materials section.

A longitudinal impact evaluation of a comprehensive nutrition program for reducing stunting among children aged 6–23 months in rural Malawi

Growth failure in sub-Saharan Africa leads to a high prevalence of child stunting starting in infancy, and is attributed to dietary inadequacy, poor hygiene, and morbidity. To evaluate the impact of a program in Malawi providing a lipid-based nutrient supplement to infants from 6-23 months of age, accompanied by a social and behavior change communication intervention to optimize caregiver feeding and handwashing practices. This impact evaluation was a quasi-experimental, longitudinal study with 1 program and 1 comparison district. Infants were enrolled at 6-7 months of age. Anthropometry, child morbidity, and caregiver feeding and handwashing practices were assessed at enrollment and at 6, 12, and 18 month follow-ups (ages 6, 12, 18, and 24 months, respectively). Changes in the length-for-age z-score (LAZ), weight-for-length z-score (WLZ), and midupper arm circumference (MUAC) were compared using mixed-effects models. Program impacts on child stunting (LAZ < -2), wasting (WLZ < -2), morbidity, and feeding and handwashing practices were estimated using difference-in-differences. We enrolled 367 infants across the program (n = 176) and comparison (n = 191) districts. The combined prevalences of stunting and wasting at enrollment were 42.1% and 1.4%, respectively, and did not differ by district. At enrollment, the prevalence of severe stunting (LAZ < -3) was higher in the program (15.5%) versus comparison (7.6%) district (P = 0.02), with corresponding lower LAZ scores (-1.9 vs. -1.7, respectively; P = 0.12). Growth velocities favored program children, such that LAZ, WLZ, and MUAC measurements increased by +0.12/y (P = 0.06), +0.12/y (P = 0.04), and +0.24 cm/y (P < 0.001), respectively, leading to comparable LAZ distributions across districts by 24 months of age. Program exposure was associated with 19.8 percentage point (pp) and 13.8 pp reductions in the prevalences of malaria (P = 0.001) and fever (P = 0.02), respectively, at the 18-month follow-up. Improvements of 20 pp (P < 0.01) in minimum dietary diversity and minimum acceptable diet were seen in the program versus comparison district at 18 months of follow-up. The program improved child growth patterns, with benefits to health and diet apparent after 18 months of exposure. This trial was registered at clinicaltrials.gov as NCT02985359.

Effect of Maternal Age and Occupation on Feeding Habits and Nutritional Status of under Five Children in Kibiya and Dala Local Government Areas, Kano Nigeria

Background: Children less than five years worldwide are known to be vulnerable and susceptible in many respects, especially on matters on health. Nutritional deficiencies and malnutrition generally affect children more than any other group. Poor nutrition occurs in developing countries, as well as in more prosperous areas of the world.&#x0D; Objective: The objective of this study focused on the effect of maternal Occupation and Age on feeding habit, and nutritional status of under-five children in Kibiya (rural) and Dala (Urban) local government areas of Kano State Nigeria,&#x0D; Study Design: A descriptive research design was adopted by this study to assess the level of nutritional status of under-five-children and to determine the relationship between age, occupation, economic status, attitudes and practices of mothers. Structured questionnaire was used to collect data on nutritional status, knowledge, attitudes and nutrition-related practices for a limited time period.&#x0D; Place and Duration of the Study: The study was conducted in two local government areas in Kano State, DALA and KIBIYA LGA, between February, 2019 to July, 2019.&#x0D; Methods: Descriptive research design was used for data collection. 198 and 170 mothers with their children from Kibiya and Dala respectively, were used for the study. Data generated was analyzed using Spss, Excel and was presented using frequency table, percentage, mean, standard deviation and correlation.&#x0D; Results: In Kibiya, there was a very weak, positive correlation between maternal age under-five nutritional status with the exception of weight-for-height, which was found to be statistically significant (p&lt;0.005). In Dala, the relationship was a very weak negative correlation with the exception of height-for-age which is positive correlated (p&lt;0.005). Majority of the children were severely stunted with 44.1% in Dala and 56.1% in Kibya, but there was no significant difference in the prevalence of severe stunting between the two LGAs. Furthermore, majority of the under-fives were within the range of adequate weight: 45.5% Dala and 58.2% Kibiya. However, the prevalence of severely underweight children in Kibiya is 11.2%. This is significantly higher compared to Dala with 2.4% which means severe underweight children in Kibiya is almost five times that in Dala. Prevalence of wasting (mild, moderate and severe) among under-five children were significantly higher in Dala compared to Kibiya (p&lt;0.01).&#x0D; Conclusion: The findings from this study shows that maternal Age is a significant factor that affect the nutritional status of the children in both local government but maternal Occupation has less impact on nutritional status of the children.

Undernutrition Among HIV-Positive Adolescents on Antiretroviral Therapy in Southern Ethiopia.

PurposeAdolescents living with HIV are vulnerable to undernutrition secondary to elevated nutritional needs imposed by growth spurt and HIV-infection. Yet, in low-income countries, evidence on the epidemiology of undernutrition among adolescents living with HIV is scarce. We assessed the prevalence and predictors of stunting and thinness among adolescents receiving anti-retroviral therapy (ART) in Hawassa city, Southern Ethiopia.MethodsIn this facility-based cross-sectional study, we enrolled 260 adolescents (10–19 years of age) living with HIV on ART in two public hospitals and three health centers. Anthropometric measurements, household food insecurity and dietary diversity were measured following standard approaches. Predictors of stunting and thinness were identified using multivariable logistic regression analyses and interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).ResultsOne-third of the adolescents were stunted, and 20% were thin. The prevalence of severe stunting (7.7%) and severe thinness (7.3%) was also high. Significant proportions of the adolescents (38.5%) were from food insecure households, and 28.1% had low or medium dietary diversity. Significant predictors of stunting were lack of food or financial support (AOR=2.71; 95% CI: 1.36–5.39); meal skipping (AOR=2.13; 95% CI: 1.16–3.91); recent history of opportunistic infections (AOR=2.25; 95% CI: 1.11–4.55) and disclosure of HIV status to the adolescent (AOR=1.88; 95% CI: 1.12–4.34). History of opportunistic infection was the only significant predictor of thinness (AOR=3.21; 95% CI: 1.54–6.73).ConclusionThe burden of undernutrition among adolescents living with HIV is disturbingly high. Prevention of opportunistic infections promoting social support and discouraging practice of meal skipping may help to reduce the problem.

Relationship between breastfeeding duration and undernutrition conditions among children aged 0-3Years in Pakistan.

BackgroundThe World Health Organization recommends that a child should be breastfed up to 2 years of age as it is essential for proper growth and development but population-based studies around the world have found conflicting results on the subject. Our study aims to analyze whether there is a relationship between the duration of breastfeeding and undernutrition among children aged from birth up to 3 years of age in Pakistan.MethodsA secondary analysis of the Pakistan Demographic and Health Survey 2013-2014 with 1072 children aged 3 years and under was conducted. The relationship between breastfeeding duration and undernutrition status was estimated through multiple logistic regression analysis.ResultsThe prevalence of stunting, wasting and underweight were 40.6%, 15.8% and 33.9% respectively, while prevalence of severe stunting is at 22.5%; severe wasting at 4.5% and severe underweight at 12.2% in children in our study. Odds of being stunted were significantly higher for children in their 3rd year of life [AOR: 4.35, CI 95% = (2.01, 9.33)] compared to children being breastfed in their 2nd year of life [AOR: 2.43, CI 95% = (1.55, 3.79) after being adjusted for maternal, child, demographic and healthcare access variables. Similarly, children being breastfed in their third year of life were more susceptible to developing severe stunting [AOR: 6.19, CI 95% = (3.31, 11.56)] in comparison to children in their second year [AOR: 2.84, CI 95% = (1.81, 4.46)]. There was no significant association between breastfeeding and wasting/severe wasting, or between breastfeeding and underweight/severe underweight.ConclusionBreastfeeding in the 2nd and 3rd year of life was found to have significant relationship with stunting and severe stunting. Mothers need to be educated about the risks of prolonged breastfeeding to reduce the burden of undernutrition in the country.

The effect of young children's faeces disposal practices on child growth: evidence from 34 countries.

To characterize the relationship between child faeces disposal and child growth in low- and middle-income countries. We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014) for 202614 children under five and 82949 children under two to examine the association between child faeces disposal and child growth. Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR)=0.90, 95% confidence interval (CI) 0.89-0.92] and a 0.12 increase in height-for-age z-score (HAZ; 95% CI: 0.10-0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR=0.94, 95% CI: 0.91-0.96) and a 0.09 increase in HAZ (95% CI: 0.06-0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight-for-age z-score (WAZ), but not an increase in weight-for-height z-score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75-100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting. Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as 'safe' regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet.

Under-nutrition and Related Factors among Children Aged 6-59 Months in Gida Ayana District, Oromiya Region, West Ethiopia: A Community Based Quantitative Study

Background: Under-nutrition is the most known significant public health problems in developing countries of the world including Ethiopia that cause a shocking effect on children under five years of age. However, the extent of the problem and its several risk factors were not uniformly addressed enough across the various corner of the country. Thus, the objective of this study was to estimate the extent of under-nutritional status and to identify factors related to under-nutrition among children aged 6-59 months in Gida Ayana district, West Ethiopia. Method: A community based cross sectional study was conducted in August/September, 2015. A total of 588 children aged 6-59 months with their respective mothers/caregivers/were used for this study. Weight, height and Mid- upper Arm Circumference (MUAC) were measured using instruments that are recommended by UNICEF (United Nations Children’s Fund) and data regarding socioeconomic, demographic, child and maternal characteristics were collected using a pretested structured questionnaire through interview. Statistical Package for Social Sciences (SPSS) software version 20.0 was used to perform descriptive statistics as well as to perform bivariate and multivariate logistic regression analysis to identify factors related to under-nutritional status of children. World Health Organization (WHO) Anthro 2007 software version 1.0.4 was used to analyze anthropometric indices. Results: The overall prevalence of stunting, wasting, and underweight were 40.5%, 10.9% and 19.2% respectively. In addition, prevalence of severe stunting; wasting and underweight were 13.4%, 2.9% and 4.6% respectively. Wasting was significantly higher in male children, 24-35 months aged children, House Holds (HHs) of illiterate fathers and HHs with lack of access to safe drinking water. Stunting were significantly higher in male children, children aged 36-59 months, HHs with lack of ownership of farm animals, children with diarrhea, children with fever and HHs with low monthly income. In addition, male children, urban children, children aged 24 months and above, HHs having more than one under five children and diarrhea were the factors that showed significant association with underweight. Conclusion: The prevalence of wasting and stunting among under five children were high confirming nutritional situation in the study area is serious. Wasting, stunting and underweight were significantly higher among boys than girls. In addition; child age, residence, parent’s formal education status, visiting antenatal clinic, and diarrhea becomes the main risk factors that contribute for the occurrence of at least two forms of under-nutritional status of children in the study area. Thus, efforts should be made to improve sources of drinking water and parental education, to prevent and control childhood illness, to implement child’s age, residence and sex specific interventions as well as to establish therapeutic and supplementary feeding programs.

A Growth and Nutritional Study of HIV Seropositive Children from West Bengal under Direct Care of Medical Caregivers.

To evaluate the nutritional status of HIV seropositive children, aged 2-10 years with age - matched controls and examine the role of nutritional intervention and HRT on their growth indices. It was a cross-sectional study done at a HIV Clinic of a teaching hospital. Fifty six seropositive children (age 2-10 year) classified as cases, and 60 seronegative age - matched controls were taken. Demographic and anthropometric characteristics were collected via valid instruments. HIV grading and adherence to HRT were assessed by using validated questionnaires. Of the cases majority (87.5%) were infected by vertical transmission from mother to child, the remaining were infected by blood transfusion out of which 1.78% were haemophiliacs and remaining were thalassaemics. The prevalence of underweight among cases was 64.3%, compared to prevalence of 61% among controls. The prevalence of stunting was 44.6% among cases, while the prevalence of severe stunting was 14.3%. The prevalence of wasting among cases was 30.35%, while 7% cases were severely wasted. Only 23.33% controls were wasted. There was a significant difference in the Height- for-age between cases and controls, in the age of 4 years, 5 years and 6 years (p-value <0.05). There was a significant difference in the Height- for-age between cases and controls, in the age of 4 years, 5 years and 6 years, indicating the need for proper nutritional intervention and timely HIV antiretroviral therapy to prevent stunting.

Nutritional Status of Children in Rural setting.

Introduction: The fight against Malnutrition may remain for a long time as long as vast population in developing countries remain within the range of poverty coupled with on-going chaos from political instability in some developing nations. Therefore public health investigation of nutritional status of children is a continuous process that requires several re-assessments especially in volatile environment. Anthropometry is a direct method and the commonest method of assessment of nutritional status in children in these developing nations. Our study therefore assesses the nutritional status of children in rural setting in a developing nation as Nigeria and the influencing factors prevailing for the observed variations; The significant difference between the private and government pupils through their body mass index and other anthropometric parameters. Method: A cross sectional survey of 191 children, aged 6-12 years were selected from local private and government school were used in the study. One of the private schools was randomly selected. The studied variables included; Age, sex of the pupils, religion of their parents, dietary pattern of the pupils and parents socio-economic status and educational background. Interview of pupils and parents was carried out using prepared questionnaire template. Research ethical clearance from the University, schools head, parent consent were obtained. Weight and height of the children were measured. Anthropometric indices were determined: Weight for height, weight for age, height for age and Body Mass Index (BMI). Data was analyzed using Microsoft excel, SPSS version 16 .The chi-square significance of association was determined at Level of significance less than 0.05. Results: The proportion of male student and female students are 50.8% and 49.2% respectively. A large proportion of fathers were Civil servants (12.6%) while most mothers were farmers (17.3%), the proportion of unemployed fathers 10.47% was more than unemployed mothers. 4.7%.However more mothers that had no formal education (28.8%) than the fathers (9.4%). The proportion of female students (51.7%) who were underweight were more than their male (48.3%) counterparts. The proportion of male students (65%) who were overweight was more than the females (35%). Stunting was more prevalent amongst the males than their female counterparts. Collectively prevalence of stunting was 15.7%, while prevalence of severe stunting was 5.23%. Wasting was more prevalent amongst females 56.3% than males 47.4%. Most of the children diet consisted mainly of carbohydrates (98.4%), while occasionally Protein (92.7%) , Fruit and Vegetable (95.8%). Low socio-economical status, low educational background of parents, cultural norm and low protein diet influences the children’s anthropometric parameters negatively and consequently their nutritional status. Other indirect indicators of the nutritional state of the children are the position of the child in the family, the school type attended by the child. Results showed that BMI does not indicate the specific type of under-nutrition compared to weight-height or weight for age. Conclusion: The fight against malnutrition in developing nation by UNICEF therefore should be encourages and supported and public enlightenment campaign should be stepped –up.

Does biofuel smoke contribute to anaemia and stunting in early childhood?

Reliance on biomass fuels for cooking and heating exposes many women and young children in developing countries to high levels of air pollution indoors. Exposure to biomass smoke has been linked to reduced birth weight, acute respiratory infections, and childhood mortality. This study examines the association between household use of biofuels (wood, dung, and crop residues) for cooking and heating and prevalence of anaemia and stunting in children. Data are from a 1998-99 national family health survey in India, which measured height, weight, and blood haemoglobin of 29 768 children aged 0-35 months in 92 486 households. Multinomial logistic regression is used to estimate the effects of biofuel use on prevalence of anaemia and stunting, controlling for exposure to tobacco smoke, recent episodes of illness, maternal education and nutrition, and other potentially confounding factors. Analysis shows that prevalence of moderate-to-severe anaemia was significantly higher among children in households using biofuels than among children in households using cleaner fuels (RRR = 1.58; 95% CI: 1.28, 1.94), independent of other factors. Prevalence of severe stunting was also significantly higher among children in biofuel-using households (RRR = 1.84; 95% CI: 1.44, 2.36). Thirty-one per cent of moderate-to-severe anaemia and 37% of severe stunting among children aged 6-35 months in India may be attributable to exposure to biofuel smoke. Effects on mild anaemia and moderate stunting were smaller, but positive and statistically significant. Effects of exposure to tobacco smoke on anaemia and stunting were small and not significant. The study provides a first evidence of the strong association between biofuel use and risks of anaemia and stunting in children, suggesting that exposure to biofuel smoke may contribute to chronic nutritional deficiencies in young children.

Introduction: High blood pressure control—challenges for the 1980s

The World Health Organization recommends that a child should be breastfed up to 2 years of age as it is essential for proper growth and development but population-based studies around the world have found conflicting results on the subject. Our study aims to analyze whether there is a relationship between the duration of breastfeeding and undernutrition among children aged from birth up to 3 years of age in Pakistan.A secondary analysis of the Pakistan Demographic and Health Survey 2013-2014 with 1072 children aged 3 years and under was conducted. The relationship between breastfeeding duration and undernutrition status was estimated through multiple logistic regression analysis.The prevalence of stunting, wasting and underweight were 40.6%, 15.8% and 33.9% respectively, while prevalence of severe stunting is at 22.5%; severe wasting at 4.5% and severe underweight at 12.2% in children in our study. Odds of being stunted were significantly higher for children in their 3rd year of life [AOR: 4.35, CI 95% = (2.01, 9.33)] compared to children being breastfed in their 2nd year of life [AOR: 2.43, CI 95% = (1.55, 3.79) after being adjusted for maternal, child, demographic and healthcare access variables. Similarly, children being breastfed in their third year of life were more susceptible to developing severe stunting [AOR: 6.19, CI 95% = (3.31, 11.56)] in comparison to children in their second year [AOR: 2.84, CI 95% = (1.81, 4.46)]. There was no significant association between breastfeeding and wasting/severe wasting, or between breastfeeding and underweight/severe underweight.Breastfeeding in the 2nd and 3rd year of life was found to have significant relationship with stunting and severe stunting. Mothers need to be educated about the risks of prolonged breastfeeding to reduce the burden of undernutrition in the country.