Prevalence Of Undernutrition Research Articles

Dual-Energy X-Ray Absorptiometry and Anthropometry for Assessment of Nutritional Status at Diagnosis in Children with Cancer: A Single-Center Experience from India.

Gauri KapoorBackground The survival of children with cancer has improved owing to advances in chemotherapy and better supportive care, and nutritional support is an important component of the latter especially in low- and middle-income countries like India. Materials and Methods A prospective observational study of 137 newly diagnosed children with cancer aged less than 18 years was planned. Nutritional assessment was done using dual-energy X-ray absorptiometry (DXA), anthropometry, and serum albumin. Patients were followed for 3 months for assessment of treatment-related morbidity. Results Lean body mass (LBM; DXA), mid-upper arm circumference (MUAC), and body mass index detected undernutrition in 44, 45, and 14% patients, respectively. Combination of arm anthropometry (MUAC and triceps skinfold thickness) with serum albumin categorized patients as adequately nourished (32%), moderately depleted (18%), and severely depleted (49%). Patients with hematological malignancy had a higher prevalence of undernutrition but there was no difference in morbidities between the undernourished and adequately nourished children by any parameter. Hypoalbuminemia observed in 25% patients was associated with significant chemotherapy delays ( p , 0.01) and interval admissions ( p , 0.03). Using LBM as a criterion, linear regression analysis revealed MUAC ( R 2 = 0.681) as the best predictor of undernutrition with lowest standard error. Conclusion Our study reports undernutrition among two-fifths of newly diagnosed patients of childhood cancer associated with high prevalence of sarcopenia and adiposity. These findings are of utmost clinical relevance in planning interventional strategies.

Dual-Energy X-Ray Absorptiometry and Anthropometry for Assessment of Nutritional Status at Diagnosis in Children with Cancer: A Single-Center Experience from India

Background The survival of children with cancer has improved owing to advances in chemotherapy and better supportive care, and nutritional support is an important component of the latter especially in low- and middle-income countries like India. Materials and Methods A prospective observational study of 137 newly diagnosed children with cancer aged less than 18 years was planned. Nutritional assessment was done using dual-energy X-ray absorptiometry (DXA), anthropometry, and serum albumin. Patients were followed for 3 months for assessment of treatment-related morbidity. Results Lean body mass (LBM; DXA), mid-upper arm circumference (MUAC), and body mass index detected undernutrition in 44, 45, and 14% patients, respectively. Combination of arm anthropometry (MUAC and triceps skinfold thickness) with serum albumin categorized patients as adequately nourished (32%), moderately depleted (18%), and severely depleted (49%). Patients with hematological malignancy had a higher prevalence of undernutrition but there was no difference in morbidities between the undernourished and adequately nourished children by any parameter. Hypoalbuminemia observed in 25% patients was associated with significant chemotherapy delays (p, 0.01) and interval admissions (p, 0.03). Using LBM as a criterion, linear regression analysis revealed MUAC (R 2 = 0.681) as the best predictor of undernutrition with lowest standard error. Conclusion Our study reports undernutrition among two-fifths of newly diagnosed patients of childhood cancer associated with high prevalence of sarcopenia and adiposity. These findings are of utmost clinical relevance in planning interventional strategies.

Protein-Energy Supplementation in Early-Life Decreases the Odds of Mental Distress in Later Adulthood in Guatemala

BackgroundThe prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle-income countries, with a high prevalence of undernutrition. ObjectivesTo examine whether exposure to a protein-energy nutritional supplement during the first 1000 d of life decreased odds of mental distress in adulthood among men and women in Guatemala compared with receiving a low energy-no protein supplement or supplementation outside the 1000-d window. MethodsData from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early-life, supplementation data from 1969 to 1977, ages 0–7 y; life course, outcome data from 2017–2018 follow-up, ages 40–57 y) were analyzed for associations between nutrition in the first 1000 d and mental distress in adulthood (WHO Self-Reporting Questionnaire 20 [SRQ-20]), controlling for early-life variables and current life stress; life course variables (e.g. education) were examined as potential mediators of this relation. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized. ResultsBoth partial and full supplementation with Atole during the first 1000 d were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relations remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early-life and life course variables, including life stress. ConclusionsProtein-energy supplementation during the first 1000 d of life in Guatemala, where undernutrition is prevalent, may reduce the prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly, through pathways of life course variables such as education, wealth, and marital status.

Prevalence and Risk Factors for Severe Acute Malnutrition among Less Than Five Children from an Urban Locality of Surat City, Western India

Introduction Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. The percentage of undernutrition, stunting and wasting in children under 5 years of the age in India are 35.7, 38.4 and 21.0 respectively. The etiology of malnutrition is complex and multi-factorial usually a consequence of inadequate dietary intake and various diseases.
 Methodology: A community based case-control study was conducted among children aged 6 to 59 months, registered at the Anganwadi centers in an urban locality of Surat city, Gujrat. Study population was divided into cases and controls using WHO classification based on anthropometric measurements.
 Result: The prevalence of undernutrition and severe acute malnutrition among the under-five children were 26.2 and 8.7% respectively. Significant association was found between nutritional status of the children and type of the family( OR 3.84, 95% CI =1.87-7.86, p = 0.000), low birth weight (OR 4.85, 95% CI =2.29 – 10.26, p = 0.000), poor appetite (OR = 2.89, 95% CI = 1.38-6.01, p = 0.004), bottle feeding (OR = 5.41, 95% CI = 1.91-15.29, p= 0.001) and children with habits of eating wafers/candies (OR = 21.99, 95% CI = 9.02-53.60, p = 0.000).
 Conclusion: Severe acute malnutrition continues to be an important health concern among under five children in the urban area and is affected by many risk factors which can be mitigated through structured and timely interventions using IEC materials.

Nutritional status of Indian pre-school children and WHO nutrition targets for 2025

Background: India has been food secure and has been implementing food supplementation programmes for decades but prevalence of under-nutrition in pre-school children is high. The WHO has set nutrition targets for reduction in low birthweight, stunting, wasting and halting rise in over-nutrition in children to be achieved by 2025.Methods: District level household survey 4 and annual health survey (2013-2015) undertook height and weight measurements in pre-school children (DLHS4 74717 and AHS 139157 children). Mean weight, height and BMI-for-age were computed for girls and boys in 0-5 years and compared with WHO MGRS growth standards. Prevalence of stunting, under-weight, wasting, over-nutrition, combined stunting and wasting were computed in each survey in relation to age.Results: The mean height and weight-for-age in boys and girls during 6-60 months was around the -2SD and mean BMI-for-age was between the mean and -1SD of the WHO standards. Frequency distribution of Z scores for all three indices in Indian children were to the left of the WHO standards. In under-five children stunting rates were highest, wasting rates lower and over-nutrition rates the lowest. Prevalence of stunting increased and wasting decreased with increasing age of the children. Prevalence of under-nutrition was higher in children surveyed in AHS.Conclusions: It might not be possible to achieve rapid reduction in low birthweight or stunting. It might be possible to achieve the targets for sustained reduction in wasting in some states. Early detection and management of over-nutrition in children can prevent the rise in over-nutrition.

Undernutrition And Associated Factors Among Reproductive Age Groups of Women on Antiretroviral Therapy In Public Health Facilities of South Borena Pastoralist Zone, Oromia Regional State, Ethiopia, 2021

Background: Undernutrition refers to deficiencies or imbalances in a person’s intake of energy and/or nutrients. HIV/AIDS leads to undernutrition, and undernutrition leads to immune impairment, worsening the effect of HIV, and contributing to more rapid progression to AIDS. The increased energy needs as well the negative effects of common HIV-related infections increase the nutrition risk of HIV-infected women of reproductive age group at large population segments. The study aims at assessing the prevalence of undernutrition and its associated factors among this group. Objectives: To study undernutrition and associated factors among reproductive age group women on antiretroviral therapy in Borana zone public health facilities, from October 15/2020 to November 30, 2020. Methods: Health institution-based Cross-sectional study was conducted on 237 Women of Reproductive age group on Antiretroviral Therapy/Prevention of Mother to Child Transmission in Borana zone public health facilities. Study participants were selected using a systematic random sampling technique. Data was collected through reviewing medical records and interviewing selected patients. The collected data were entered into the computer using Epi-Info version 7 and exported to SPSS version 20 for data processing and analysis. The prevalence of undernutrition was estimated using 95% CI for a single proportion. Multinomial logistic regression is used to identify factors associated with viral suppression. The magnitude of association is estimated using an odds ratio of 95%CI. The significance of association is declared for P-Value ≤ 0.05. Result: The majority of the respondents’ age groups were between 25-29 (28.3%) and followed by 30-34 (23.6%) and 35- 39 (21.1%), 109 (46%) were housewives and 47 (20.7%) were merchant by, 114 (48.1%) were illiterate and 43 (18.1%) of them were read and write, 171 (72.12%) were married and 28(11.8%) were Divorced by marital. The prevalence of undernutrition was 35.9%. Conclusion: Undernutrition is the most prevalent in this area and educational status, WHO stage, and occupation was among the common factors.

Undernutrition is associated with mortality, exacerbation, and poorer quality of life in patients with chronic obstructive pulmonary disease: A systematic review with meta-analysis of observational studies.

Impaired nutrition status is recognized as a risk factor for worse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate how undernutrition is diagnosed, its prevalence, and whether there is an association between this condition and clinical outcomes in patients with COPD. The search for this systematic review of observational studies (PROSPERO: CRD42020191888) was performed in the PubMed, Embase, and Scopus databases, with no date or language restrictions. The studies had to report data on the diagnosis of undernutrition and its association with mortality, exacerbation, length of hospital stay, or quality of life in adult patients with COPD. A meta-analysis with a random-effects model was performed to combine data. Forty-nine studies were included (20 of them classified as having a low risk of bias), and the most common diagnostic method of undernutrition was body mass index (BMI) (n = 36). The pooled prevalence of undernutrition was equal to 20% (95% CI, 0.15-0.25; I² = 100%), and it was associated with mortality (risk ratio = 1.97; 95% CI, 1.55-2.50; I² = 98%), exacerbation (risk ratio = 1.73; 95% CI, 1.03-2.91; I² = 96%), and poorer quality of life (mean difference = 8.25; 95% CI, 5.40-11.10; I² = 79%). For all outcomes, the certainty of evidence was very low. In conclusion, undernutrition is prevalent and is associated with poorer outcomes in patients with COPD. However, undernutrition is mainly diagnosed by BMI, which underreports its prevalence, and the certainty of the evidence is very low.

Prevalence and associated factors for stunting, underweight and wasting among children under 6 years of age in rural Hunan Province, China: a community-based cross-sectional study

BackgroundThe existing epidemiological data cannot represent the situation of undernutrition among Chinese children, particularly those in rural China. Hence, in this community-based cross-sectional study, the prevalence and associated factors of stunting, underweight and wasting among children (age < 6 years) from rural Hunan Province were analyzed.MethodsTotally 5529 children aged 0 to 71 months and their caregivers were randomly chosen by multistage stratified cluster sampling from 72 villages from rural Hunan, which were distributed in 24 towns of 12 counties. Data about the children and their mothers, caregivers and family conditions was acquired using unified questionnaire, and the length/height and weight of each child were measured using unified instruments. The prevalence of undernutrition among children was evaluated using the length/height for age, weight for age, weight for length/height, and body mass index for age z scores, which were computed according to the 2006 and 2007 WHO Child Growth Standards.ResultsThe prevalence of stunting, underweight, and wasting among the 5529 children were 4.4% (241), 3.9% (217), and 4.0% (221), respectively. The significant associated factors on higher risks of undernutrition in the children were low birth weight, maternal gestational weight gain <10 kg (stunting); low birth weight, maternal gestational weight gain <10 kg, ethnicity of caregivers being minority, large family size (underweight); low birth weight, ethnicity of caregivers being minority, large family size (wasting). High education level of caregivers and high family food expenditure were common protective factors for all three types of undernutrition, except that high family food expenditure was not protective against wasting.ConclusionsThe prevalence of stunting, underweight and wasting is low among rural children under age of 6 years in Hunan. As for the measures, the gestational care and reasonable diet of mothers should be strengthened, and nutritional deficiency during pregnancy be avoided, which will prevent low birth weight. The local economic development and the education level of caregivers need to be further improved, especially for minorities.

Comparison of Child Undernutrition Anthropometric Indicators Across 56 Low- and Middle-Income Countries

The United Nations' Sustainable Development Goal Target 2.2 seeks to end all forms of malnutrition by 2030 by meeting targets, including the elimination of stunting and wasting in all children younger than 5 years. Such indicators are used to monitor childhood undernutrition but may not provide a complete picture at a population level. To compare global estimates of the prevalence of undernutrition using conventional indicators of anthropometric failure (AF; stunting, underweight, and wasting); the Composite Index of Anthropometric Failure (CIAF); and a proposed classification system called Categories of Anthropometric Failure (CAF) as well as to investigate the association of the conventional indicators, CIAF, and CAF with diarrheal disease as an assessment of the validity of each measure. Cross-sectional study of the prevalence of undernutrition among children in 56 low- and middle-income countries using data from the nationally representative Demographic and Health Surveys. The study included 530 906 children younger than 5 years. Data were collected from June 2005 to December 2018 and analyzed from September 27, 2020, to February 4, 2021. Undernutrition identified according to conventional indicators (stunting, underweight, and wasting), the CIAF, and the proposed CAF classification system was estimated and compared. Six logistic regression models were used to examine the association between different classifications of anthropometric failure (AF) and morbidity. A total of 530 906 children (mean [SD] age, 29.0 [17.2] months; 272 355 [51.3%] boys and 258 551 [48.7%] girls) from 56 low- and middle-income countries were included in the analysis. Estimates of undernutrition generated using the conventional indicators of stunting, underweight, and wasting were lower than estimates generated using the CIAF in all countries. The CAF classification system pointed to considerable variation across countries in children with multiple AFs, which does not correspond to the overall prevalence of undernutrition. For example, 7.5% of children in Niger and 7.1% of children in Timor-Leste were stunted, underweight, and wasted, while 56.0% of children in Niger and 71.1% of children in Timor-Leste were undernourished according to the CIAF. In addition, children who had stunting, underweight, and wasting had 1.52 (95% CI, 1.45-1.61) times the odds of diarrhea compared with children who exhibited no AFs. The results of this study highlight the importance of using different approaches to aid understanding of the entire spectrum of AF with regard to research and development of policies and programs to address AF. The use of the CIAF and the CAF classification system may be useful for treatment to prevent AFs and could accelerate progress in meeting targets for the Sustainable Development Goal.

Attributable is preventable: Corrected and revised estimates of population attributable fraction of TB related to undernutrition in 30 high TB burden countries

IntroductionThe Global TB Report 2020 estimated the population attributable fractions (PAF) for the major risk factors of TB. Undernourishment emerged as the leading risk factor accounting for 19% of the cases. The WHO however used the terms undernourishment and undernutrition interchangeably in its computation of PAF. Undernourishment is an indirect model derived estimate of decreased per capita energy availability, while undernutrition is defined by direct anthropometric measurements of nutritional status. An estimate of PAF for a risk factor should use the prevalence and the risk ratio of the same risk factor, which is not the case with the current methodology. MethodsWe re- estimated the PAF of undernutrition (instead of undernourishment) in 30 high TB burden countries as defined by WHO for the period 2016–2020, using the prevalence of undernutrition (age standardized estimate of BMI < 18.5 kg/m2 in adults for both sexes), and the relative risk (RR) of 3.2. Further, we revised PAF estimates of undernutrition with an RR of 4.49 (95% CI: 2.28, 8.86), in light of recent evidence. FindingsIn 30 high TB burden countries, 24.1% (95% CI: 17.6,30.0) of incident TB is attributable to undernutrition. The PAF of undernutrition was highest in Asian countries, unlike the PAF of undernourishment that was highest in Africa. The corrected estimate led up to 65% increase in number of cases attributable to undernutrition in Asian countries. If a revised relative risk was used, 33.0% (95% CI: 10.1, 60.1) of incident TB cases in the selected countries could be attributable to undernutrition. More than one-third to nearly half of incident TB cases in India could be attributable to undernutrition. InterpretationEstimation of the PAF of TB related to undernutrition is methodologically valid and operationally relevant, rather than PAF related to undernourishment, and should be used for future Global TB reports by WHO. Addressing undernutrition, the leading driver of TB in high TB burden countries (especially Asia) could enable achievement of END TB milestones of TB incidence for 2025.

Determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India.

Background: Undernutrition is a significant public health problem and the leading risk factor for India's disease burden. Aim: To understand the determinants of nutritional status among under-five children receiving Integrated Child Development Services (ICDS) in India. Methods: The study used the National Family Health Survey-4 (2015-16) data. The analysis was carried out for under-five children who have availed of any ICDS services in the 12 months preceding the survey (n = 1,27,813). Stunting, wasting, and underweight were estimated following the World Health Organization guideline and used as the outcome variables. The binary logistic regression was conducted to examine the association of ICDS utilization and socioeconomic-demographic predictors with under-five children's nutritional status. STATA (V 13) was used for statistical analyses. Results: A sizable proportion of under-five children receiving any ICDS services suffer from undernutrition. The undernutrition prevalence varied considerably by socioeconomic and demographic characteristics. Logistic regression found an insignificant association of ICDS utilization with the nutritional status of under-five children. Children not immunized in ICDS centers were less likely to be stunted (OR: 0.93; P < 0.01), wasted (OR: 0.93; P < 0.01), and underweight (OR: 0.90; P < 0.01) than their counterparts. The child's age and gender, maternal education and nutrition status, wealth index, social group, region, residence, and region were significant determinants of undernutrition among ICDS beneficiaries. Conclusion: The study suggests the need to ensure all available services to children enrolled in the Anganwadi Center (AWC). The program should also emphasize feeding practices and educate parents about improving child health and nutrition.

Determinants of Undernutrition and Associated Factors of Low Muscle Mass and High Fat Mass among Older Men and Women in the Colombo District of Sri Lanka.

Undernutrition is a health challenge due to an expanding older population. The aims of the study were to assess the prevalence and determinants of undernutrition and, associated factors of low muscle and high fat mass among older men and women in the Colombo district of Sri Lanka. A cross sectional study was conducted using a multistage cluster sampling technique. Undernutrition was defined based on anthropometry and body composition assessed using bio-electrical impedance. Sex-specific multivariable logistic regression analyses were conducted. Of 800 participants (30.6% men), 35.3% were undernourished. The factors significantly associated with undernutrition among older women were hypertension with an adjusted odds ratio (aOR) (1.97; 1.36–2.88) and musculoskeletal disabilities aOR (2.19; 1.36–3.53). Among women, age ≥ 70 (1.79; 1.18–3.34) and diabetes (1.77; 1.10–2.84) were associated with low muscle mass and age ≥ 70 (2.05; 1.21–3.47), diabetes (2.20; 1.35–3.59) and disability in chewing (2.39; 1.30–4.40) were associated with high fat mass. Among men, age ≥ 70 years, no/up to grade 5 education, diabetes, visual disability, little/no responsibility in food shopping and not getting nutritional advice from media were associated with reduced odds of low muscle mass and no/up to grade 5 school education, disability in chewing and little/no responsibility in food shopping were associated with reduced odds of high fat mass. Undernutrition among older people is common in Sri Lanka. We have identified key factors associated with low muscle mass and high fat mass in this setting. Given the potential consequences of these conditions, our study provides potential targets for prevention of undernutrition and sarcopenic obesity.

Households' Food Insecurity and Their Association With Dietary Intakes, Nutrition-Related Knowledge, Attitudes and Practices Among Under-five Children in Gaza Strip, Palestine.

The present study aimed to determine the households' food insecurity and their association with dietary intakes, nutrition-related knowledge, attitudes and practices (KAP) among under-five children in the Gaza Strip, Palestine. This cross-sectional study was conducted in 2021 among a representative sample of under-five children. A total of 350 children and their proxy were selected from all Gaza strip governorates, using a cluster random sampling method. The Radimer/Cornell food-security scale was used. A 24-h dietary recall was employed for dietary intakes assessment. Nutrition-related KAP for feeding under-five children, anthropometric measurements, and demographic-socioeconomic characteristics were obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 25. The children from food-insecure households had a high prevalence of moderate underweight (30.4%), stunting (32.8%), wasting (9.6%), and acute undernutrition (30.4%). Between food-insecure and food-secure groups there were significant differences in weight, height/length, mid-upper arm circumference, weight-for-age and mid-upper arm circumference z-scores, underweight, acute undernutrition, intakes of protein, fat, vitamin D, zinc, continued breastfeeding, having nutrition-related adequate knowledge, having nutrition-related positive attitudes, and achieved minimum dietary diversity score (P < 0.05 for all). Additionally, about (56.0%) food-insecure households have inadequate nutrition-related knowledge, (77.6%) have nutrition-related negative attitudes, and (95.2%) did not achieve a minimum dietary diversity score. In conclusion, the children from food-insecure households had a high prevalence of moderate underweight, stunting, wasting, and acute undernutrition. Moreover, low economic status, poor dietary intakes, low levels of nutrition-related KAP, and lack of dietary diversity could contribute to the high levels of food insecurity among under-five children.

Nutritional status and associated factors among lactating women in Dire Dawa, Ethiopia.

Lactating women's nutritional status is critical since it influences the health of their infants. However, there was a scarcity of data on maternal nutrition in low-income countries such as Ethiopia, particularly in the study area. Institutional-based cross-sectional study was conducted among 401 lactating women in Dire Dawa town health facilities from February 10, 2019 to March 30, 2019. The sum of the number of food categories consumed by each respondent over the 24-h recall period is the women's diet diversity score. To identify factors linked to undernutrition, all variables with a p-value of less than 0.25 were included into multivariate logistic regression. Prevalence of undernutrition was 22%. Women who age 15-25 years were four times more likely undernourished than older (adjusted odd ratio [AOR]=4.04; confidence interval [CI]: [1.74, 9.40]). Unable to read and write women were almost five times more likely to be undernourished than formal education (AOR=4.76; CI: [2.31, 9.81]). Women who have family size >7 were six times more likely to be undernourished than family size <3 (AOR=5.53; CI: [1.15, 26.53]). Women not take additional food during lactating were 4.5 times more likely undernourished than take additional food (AOR=4.56; CI [1.50, 13.9]). DD score <5 were four times more likely to be undernourished than (≥5) DD (AOR=4; CI: [2.02, 7.90]). Prevalence of undernutrition in the study area was high. Factors associated with undernutrion were: age of lactating women, education status, family size, additional food during lactation and DD score. Thus, multisectoral collaboration targeted at improving women's educational status and increasing food during lactation need to be emphasized.

Dietary diversity, nutritional status and associated factors among lactating mothers visiting government health facilities at Dessie town, Amhara region, Ethiopia.

Maternal undernutrition is one of the most common causes of maternal morbidity and mortality in developing countries. Severe undernutrition among mothers leads to reduced lactation performance which further contributes to an increased risk of infant mortality. However, data regarding nutritional status of lactating mothers at Dessie town and its surrounding areas is lacking. This study assessed dietary diversity, nutritional status and associated factors of lactating mothers visiting health facilities at Dessie town, Amhara region, Ethiopia. Institutional based cross-sectional study was conducted from March to April, 2017 among 408 lactating mothers. Systematic random sampling technique was employed to select the study participants. Data on socio-demographic and economic characteristics, health related characteristics, dietary diversity and food security status of participants were collected using interviewer administered questionnaire. Data were entered into EPI-INFO and analyzed using SPSS Version 22. Bivariate and multivariate analyses were performed to identify factors associated with dietary diversity and nutritional status of lactating mothers. More than half (55.6%) of lactating mothers had inadequate dietary diversity (DDS<5.3) and about 21% were undernourished (BMI<18.5 kg/m2). Household monthly income [AOR = 2.0, 95% CI (1.15, 3.65)], type of house [AOR = 1.8, 95% CI (1.15, 2.94)], nutrition information [AOR = 1.6, 95% CI (1.05, 2.61)] and household food insecurity [AOR = 1.8, 95% CI (1.05, 3.06)] were factors associated with dietary diversity of lactating mothers. Being young in age 15-19 years [AOR = 10.3, 95% CI (2.89, 36.39)] & 20-29 years [AOR = 3.4, 95% CI (1.57, 7.36)], being divorced/separated [AOR = 10.1, 95% CI (1.42, 72.06)], inadequate dietary diversity [AOR = 3.8, 95% CI (2.08, 7.03)] and household food insecurity [AOR = 3.1, 95% CI (1.81, 5.32)] were factors associated with maternal undernutrition. The dietary diversity of lactating mothers in the study area was sub optimal and the prevalence of undernutrition was relatively high. Public health nutrition interventions such as improving accessibility of affordable and diversified nutrient rich foods are important to improve the nutritional status of mothers and their children in the study area.

The Shishu Pushti Trial-Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial.

BackgroundThe aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age.ObjectiveLack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development.MethodsThis study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months).ResultsWe identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses.ConclusionsThis study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development.Trial RegistrationClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995International Registered Report Identifier (IRRID)DERR1-10.2196/31475

STUDY ON KNOWLEDGE AND ATTITUDES OF MOTHERS ABOUT NUTRITION STATUS FOR INFANTS AND TODDLERS IN CENTRAL INDIA

BACKGROUND: Nutrition is one of the factors that can be used as a determinant of the quality of human resources. The number of malnourished sufferers in the world reaches 104 million children. The prevalence of underweight children is very high in the state of Madhya Pradesh. As per NFHS-4 data the prevalence of undernutrition in M. P. is 42.8%. METHODS: This study was an observational cross-sectional design. It was conducted from November 2019 to January 2020. The study population was mothers who had infants and or toddlers in Bhopal city of M. P. The sampling was carried out using random sampling with inclusion criteria of mothers who have infants and or toddlers residing in Bhopal M. P. Based on the established inclusion and exclusion criteria, a sample of 300 was obtained. The research instrument was a questionnaire. Statistical tests were performed using chi-square test. RESULTS: Chi-square test results showed a signicant value (p&lt;0.05), which means that there is signicant relationship between maternal knowledge of maternal attitudes about nutritional status in infants and toddlers. The risk ratio value is 2.33 (&gt;1) and the CI value between 1.083 and 4.897 so that it does not exceed 1, meaning that the knowledge of mothers which is not really good is at risk of 2.33 times compared to mothers who have good knowledge. CONCLUSIONS: Knowledge is a risk factor for maternal attitudes about nutritional status in infants and toddlers but it is not statistically signicant.

Prevalence and determinants of undernutrition among adolescents in India: A protocol for systematic review and meta-analysis.

Undernutrition is one of the serious health problems among adolescents in India where 253 million adolescents are in the age group of 10-19 years. Since adolescents represent the next generation of adults, it is important to understand the nutritional status of adolescents. Even though several studies have been carried out in different states in India on adolescent undernutrition (stunting, wasting /underweight), there is no study or review that estimated the national pooled prevalence of adolescent undernutrition and its determinants. Therefore, this review aims to determine the pooled prevalence and determinants of undernutrition (stunting, underweight/wasting) among Indian adolescents. A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature will be made in Pub Med, EMBASE, SCOPUS, Google, Google Scholar, and Cochrane databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated risk factors or determinants with their 95% confidence interval will be computed using STATA version 16 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins's I2 test statistics and Cochran's Q-statistics based on chi-square with a 5% level of significance among reported prevalence. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be assessed through visual examination of funnel plots and objectively by Egger's regression test. This review protocol has been registered at PROSPERO (CRD42021286814). By collecting and summarizing information on adolescent undernutrition can be a step towards a better understanding of the prevalence of nutritional status of Indian adolescents and how the associated factors influence the prevalence of undernutrition. This review will provide directions for further research and healthcare practitioners. This summarized finding at the national level will provide impetus to build nutritional strategies and proper healthcare services to fight against undernutrition among the most ignored population.

Nutrition and Health Status of Indigenous Peoples (IPs) in the Philippines: Results of the 2013 National Nutrition Survey and 2015 Updating Survey

In the Philippines, there is little documentation about the population size of indigenous peoples (IPs) and more so on their health and nutrition status. This study aimed to address the gap in knowledge on the IPs’ nutrition and health status in the Philippines. Analysis of secondary data collected in the 8th National Nutrition Survey (NNS) 2013 and the 2015 Updating Survey of the Nutritional Status of Filipino Children and Other Population Groups conducted by the Department of Science and Technology–Food and Nutrition Research Institute (DOST-FNRI) was done. Face-to-face interviews, anthropometric measurements, blood extraction, urine collection, and blood pressure measurements were utilized as data collection methods. Findings illustrate that majority of the IPs belonged to the poorest and poor quintile, had low educational attainment, and were rural residents. The pervasive problem of undernutrition in the form of stunting and underweight was the most pronounced problem among children and adolescents. Overnutrition was prevalent among adults. Micronutrient deficiencies also exist in the form of anemia and iodine deficiency. There is also evidence of inadequate dietary consumption among the IPs. As evidenced by the results – compared with the non-IP individuals and households – the IP population was poorer, had a significantly higher prevalence of undernutrition and iodine deficiency, and had lower adequacy of energy and other nutrient intakes. On the other hand, the selected risk factors for non-communicable diseases such as hypertension, abdominal obesity, smoking, and alcohol consumption were more pronounced among non-IPs compared to the IPs. IPs remain a marginalized sector of society, making them highly vulnerable to the same persistent nutritional and health problems non-IPs experience. Therefore, culturally sensitive and appropriate interventions should be formulated to improve IPs’ nutrition and health status in the country.

Secular trends in low birth weight and child undernutrition in West Africa: evidence from complex nationwide surveys, 1985-2019.

We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985-2019 in West Africa (WA). Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian-Laird random effect model with the Knapp-Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses. West Africa. Children aged 0 to 59 months. Three distinct periods (1986-1990, 1993-1996 and 1997-2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = -0·20 %; 95 % CI -0·43 %, 0·03 %), log-wasting (β = -0·02 %; 95 % CI -0·02 %, -0·01 %), log-underweight (β = -0·02 %; 95 % CI -0·03 %, -0·01 %) anaemia (β = -0·44; 95 % CI -0·55 %, -0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI -0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985-2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively. Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA.