Child undernutrition in Brazil: the wound that never healed

Abstract Objective To describe the scenario of child undernutrition in Brazil and its determinants. Data source Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). Conclusion Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.

Application of the infant and young child feeding index and the evaluation of its relationship with nutritional status in 6-24 months children / Aplicação do índice de alimentação de lactentes e crianças pequenas e avaliação de sua relação com o estado nutricional de crianças de 6 a 24 meses

ABSTRACT Objective To evaluate the complementary feeding practices of mothers in infant and child nutrition using Infant and Young Child Feeding Indicator and Infant and Child Feeding Index and to determine their relationship with nutritional status. Methods Study data were collected through an online questionnaire administered to 141 parents on healthy 6-24 month infants/children. Complementary feeding practices for infants/children were evaluated in line with the Infant and Child Feeding Index and Infant and Young Child Feeding Indicator. In the evaluation of growth, weight for age z-scores, length for age z-scores, and weight for length z-scores of infants/children were calculated with the World Health Organization Anthro program. Results 74.5% of 141 infants and children (71 boys, 70 girls) evaluated in the study are breastfed. The prevalence of stunting, wasted, and underweight was determined as 6.4%, 0.7%, and 4.3%, respectively. When evaluated using Infant and Young Child Feeding Indicator, it was determined that 82.3% of children met the minimum meal frequency, 80.9% met the minimum dietary diversity, and 67.4% met the minimum acceptable diet. Regarding Infant and Child Feeding Index evaluations of the children, while there was no difference between 9-11 and 12-24 month age groups, the mean Infant and Child Feeding Index score in the 6-8 month group was significantly lower than the other age groups (p=0.000). The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were found to be high in most infants/children. No clear relationship was found between stunting and minimum acceptable diet, minimum dietary diversity or minimum meal frequency, which are indicators of both Infant and Child Feeding Index scores and World Health Organization, Infant and Young Child Feeding Indicator. Conclusion The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were high in most infants/children. In addition, the high rates of MMF, minimum dietary diversity, and minimum acceptable diet coverage in evaluating infants/children in terms of World Health Organization indicators show that they have appropriate complementary feeding practices. However, study found no clear relationship between stunting and minimum acceptable diet, minimum dietary diversity or MMF, which are indicators of both Infant and Child Feeding Index I scores and WHO Infant and Young Child Feeding Indicator. It was concluded that World Health Organization Infant and Young Child Feeding Indicator indicators may be better than length for age z-scores in the weight for length z-scores explanation.

RESUMO Objetivo Avaliar as práticas de alimentação complementar das mães na nutrição de lactentes e crianças utilizando o Indicador de Alimentação de Lactentes e Crianças Pequenas e o Índice de Alimentação de Lactentes e Crianças e determinar sua relação com o estado nutricional. Métodos Os dados do estudo foram coletados por meio de um questionário online administrado a 141 pais de bebês/crianças saudáveis de 6 a 24 meses. As práticas de alimentação complementar de lactentes/crianças foram avaliadas de acordo com o Índice de Alimentação de Lactentes e Crianças e o Indicador de Alimentação de Lactentes e Crianças Pequenas. Na avaliação do crescimento, os escores z de peso para idade, escores z de comprimento para idade e escores z de peso para comprimento de bebês/crianças foram calculados com o programa Organização Mundial da Saúde Anthro. Resultados Quando avaliadas por meio do Indicador de Alimentação de Lactentes e Crianças Pequenas, constatou-se que 82,3% das crianças atendiam à frequência mínima de refeições, 80,9% atingiam a diversidade alimentar mínima e 67,4% atingiam a dieta mínima aceitável. Em relação às avaliações do Índice de Alimentação de Lactentes e Crianças das crianças, embora não tenha havido diferença entre as faixas etárias de 9 a 11 e 12 a 24 meses, a pontuação média do Índice de Alimentação de Lactentes e Crianças no grupo de 6 a 8 meses foi significativamente menor do que nas outras faixas etárias (p=0,000). Os escores do Índice de Alimentação de Lactentes e Crianças utilizados para avaliar as práticas de alimentação complementar em nosso estudo foram elevados na maioria dos bebês/crianças. Não foi encontrada nenhuma relação clara entre o atraso no crescimento e a dieta mínima aceitável, diversidade alimentar mínima ou frequência mínima de refeição ,que são indicadores tanto das pontuações do Índice de Alimentação de Lactentes e Crianças como do Indicador de Alimentação de Lactentes e Crianças Pequenas da Organização Mundial da Saúde. Conclusão Escores altos do Índice de Alimentação de Lactentes e Crianças na maioria dos bebês/crianças são um bom indicador de Indicador de Alimentação de Lactentes e Crianças Pequenas nessa população. No entanto, nenhuma relação clara foi encontrada entre o déficit de estatura e os escores do Índice de Alimentação de Lactentes e Crianças e do Indicador de Alimentação de Lactentes e Crianças Pequenas neste estudo.

Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review / Preditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático: Uma revisão do escopo / Indicadores de la desnutrición crónica entre niños de 0 a 24 meses en el Sudeste Asiático: Una revisión del alcance

ABSTRACT Objective: To identify predictors of stunting among children 0-24 months in Southeast Asia. Methods: This scoping review focused on articles with observational study design in English published from 2012 to 2023 from five international databases. The primary keyword used were: "stunting" OR "growth disorder" AND "newborn" AND "predict" AND "Southeast Asia". Results: Of the 27 articles selected for the final analysis there are thirteen predictors of stunting in seven Southeast Asia countries. The thirteen predictors include the child, mother, home, inadequate complementary feeding, inadequate breastfeeding, inadequate care, poor quality foods, food and water safety, infection, political economy, health and healthcare, water, sanitation, and environment, and social culture factor. Conclusion: All these predictors can lead to stunting in Southeast Asia. To prevent it, health service providers and other related sectors need to carry out health promotion and health prevention according to the predictors found.

RESUMO Objetivo: Identificar preditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático. Métodos: Esta revisão de escopo se concentrou em artigos com desenho de estudo observacional em inglês publicados de 2012 a 2023 em cinco bases de dados internacionais. As palavras-chave primárias usadas foram: "stunting" (nanismo) OU "growth disorder" (distúrbio de crescimento) E "newborn" (recém-nascido) E "predict" (previsão) E "Southeast Asia" (Sudeste Asiático). Resultados: Dos 27 artigos selecionados para análise final, existem treze preditores de nanismo em sete países do Sudeste Asiático. Os treze preditores incluem a criança, a mãe, a casa, a alimentação complementar inadequada, a amamentação inadequada, os cuidados inadequados, os alimentos de má qualidade, a segurança alimentar e da água, a infeção, a economia política, a saúde e os cuidados de saúde, a água, o saneamento e o meio ambiente, e o fator cultura social. Conclusão: Todos estes preditores podem levar ao nanismo no Sudeste Asiático. Para preveni-lo, os prestadores de serviços de saúde e outros setores relacionados precisam realizar a promoção e a prevenção da saúde de acordo com os preditores encontrados.

RESUMEN Objetivo: Identificar indicadores de desnutrición crónica entre niños de 0 a 24 meses en el Sudeste Asiático. Métodos: Esta revisión de alcance se centró en artículos con diseño de estudio observacional publicados en inglés, entre los años 2012 y 2023 de cinco bases de datos internacionales. Las principales palabras clave utilizadas fueron: "stunting (Desnutrición crónica)" o "growth disorder (Desorden del crecimiento)", y "newborn (Recién nacido)", y "predict (Predecir)", y "Southeast Asia (Sudeste Asiático)". Resultados: De los 27 artículos seleccionados para el análisis final, se encontraron trece indicadores que influyen en la desnutrición crónica en siete países del Sudeste Asiático. Los trece indicadores incluyen el niño, la madre, el hogar, la alimentación inadequada complementaria, la lactancia materna inadecuada, la atención inadecuada, los alimentos de mala calidad, la seguridad de los alimentos y el agua, la infección, la economía política, la salud y la asistencia sanitaria, el agua, el saneamiento y el medio ambiente, y por último el factor sociocultural. Conclusión: Todos estos indicadores pueden provocar desnutrición crónica en niños del Sudeste Asiático. Para poder prevenirlo los prestadores de servicios de salud y otros sectores relacionados, necesitan realizar actividades de promoción y prevención de la salud de acuerdo con los indicadores encontrados en este artículo.

Prevalence and associated factors of malnutrition among under-five children living in slum areas of Bahir Dar Town, Ethiopia

Introduction: child malnutrition is one of the most serious and least addressed health problems in the world and in Ethiopia. The prevalence of malnutrition, underweight, and wasting was 44%, 29%, and 10% respectively. The Amhara region has the highest rates of malnutrition at 52%, 33.4%, and 9.9% for children under five. The aim of this study was to assess the prevalence of malnutrition and its associated factors among children under five living in the slum areas of Bahir Dar City. Methods: a community-based cross-sectional study was conducted with 680 children aged 6-59 months in slum areas of Bahir Dar Town. Study participants were selected using a mass sampling technique and data were collected from April to June 2018 using a pre-tested structured questionnaire and anthropometric measurements. Finally, the collected data were coded, entered, cleaned, recorded, and stored, and the data were processed using EPI INFO and exported to the SPSS version 25.0 statistical package. Logistic regression analysis and interpretation were performed using bivariate and multivariate analysis. Results: a total of 680 children participated. The prevalence of lameness, underweight, and wasting was 46.2% (95% CI; 42.5-49.1), 24.3% (95% CI; 21.2-27.6), and 11.3% ( 95% CI; CI; 9.2-13.9). Income groups included children [AOR=3.476 (95% CI, 1.959-6.167)], male children [AOR=2.586 (95% CI; 1.532-4.365)] and mother's educational level [(AOR=2.600) (1.623) - 4.164)] were significantly associated with malnutrition. Conclusion: the results of this study showed that the prevalence of malnutrition due to stunting and wasting was high among children under five years of age. The gender of the child, the educational level of the mother, and the monthly income of the family were found to be significantly related to malnutrition. Promoting the use of family planning, preventing diarrheal diseases, and vaccinating children through nutrition education programs are important activities to improve the nutritional status of children.

The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017

Abstract Objective: To analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017. Methods: Ecological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables. Results: The Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting. Conclusions: There is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

Potential risk of stunting in children under five years living by the riverside: A systematic review

@#Introduction: Stunting, or linear growth failure, is defined by a height-for-age z-score of below -2SD according to WHO growth standard. Stunting can have short-, medium-, and long-term consequences. Rivers have an important role in human life. In several riverside areas, households still depend on the river for their livelihoods and health. This study aimed to explore the prevalence of stunting in children living by the riverside and its related factors. Methods: Epidemiological studies published from PUBMED, MEDLINE via EBSCOHost, Science Direct, ProQuest, and Research Gate databases were systematically searched. The publication period was not restricted. Only open-access and English articles were examined. Results: A total of 20 from 1200 studies were reviewed. The prevalence of stunting ranged from 20% to 48.3%. The other outcomes besides stunting were wasting and underweight status. There were 83 risk factors studied, and the most studied variables were age, gender, diarrhoea, water source, parent’s education, immunisation, and inappropriate complementary feeding practices (6 to 13 studies). Household water sources from rivers and economic status were consistently correlated with stunting. Majority of the risk factors studied were related to nutrition. From the environmental aspect, the most studied risk factors were water sources and sanitation. Conclusion: Children living by the riverside face a significant risk of stunting attributed to the consistent correlation between household water sources from rivers and economic status, affecting various aspects of daily life beyond drinking water. Future research is needed to examine the impact of environmental factors and the behaviours of riverside communities.

Investigation of influencing factors of stunting in children aged 3‒4 years in Changning District， Shanghai / 上海预防医学

ObjectiveTo analyze the influencing factors of stunting among 3 to 4-year-old children in Changning District， Shanghai， in order to provide a scientific basis for early prevention and intervention for stunting. MethodsRandom cluster sampling was employed to select1 514 children from 16 kindergartens in Changning District， Shanghai as the survey subjects. Basic information such as height， weight， perinatal and infant feeding status， diet and lifestyle， as well as parental information was collected. The detection rate of stunting was calculated， and the influencing factors of stunted growth were analyzed. ResultsThe stunting detection rate of the 1 514 children was 5.4%. In terms of family-related factors， parents of stunted children had lower heights and a lower proportion of accessing growth and developmental knowledge from professional platforms compared to parents of non-stunted children （both P<0.05）. Among individual-related factors， the proportion of premature birth， low birth weight， short birth length， twin or multiple births， low fruit consumption， vitamin D intake， short outdoor playtime， and frequent nighttime waking was higher in the stunting group than in the control group （P<0.05）. Binary logistic multivariate regression analysis showed that shorter parental height （OR=4.35， 95%CI：1.20‒15.84 and OR=3.49， 95%CI：1.43‒8.51）， low birth weight （OR=2.99，95%CI：1.28‒7.05）， multiple or twin pregnancies （OR=3.78，95%CI：1.29‒11.06）， short outdoor playtime during weekends and holidays （OR=2.34，95%CI：1.02‒5.46）， frequent nighttime waking （OR=1.89， 95%CI：1.06‒3.39）， and consuming fewer fruits daily （OR=1.81， 95%CI： 1.01‒3.26） significantly increased the risk of stunting. ConclusionLow parental height， low birth weight， being twins or multiples， limited outdoor playtime during holidays， frequent nighttime waking， and low daily fruit consumption are major risk factors for stunting in infants and children.

Social network of malnourished children and its association with family's food and nutritional security / Rede social de crianças desnutridas e sua relação com a segurança alimentar e nutricional da família

Abstract Objectives: evaluate the relationship between family's food and nutrition insecurity (FNI) and the social network of malnourished children. Methods: cross-sectional study with 92 children, included in the economic class D-E. For the analysis of the children's social network, the mothers answered four simple questions. To investigate the FNI, the Brazilian Scale of Food Insecurity was used. The association between variables was analyzed by Poisson regression with robust analysis of variances. Results: 56.5% of the children had a weak social network (<10 individuals), and the prevalence of FNI was 72.8%. An inverse association was observed between children of the daily social network and FNI family (OR=0.94; CI95%=0.89-0.99], p=0.03). The number of individuals in the children's daily social network was negatively associated with the likelihood of FNI. The mother's educational level was also related to FNI (OR=2.20 [CI95%=1.11-4.34]; p=0.02), being the child up to 2.2 times more likely to be in FNI when the mother has less than four years of study. Conclusion: these results suggest that social network is associated with the FNI of malnourished children. Interventions designed to strengthen instrumental and other forms of support among small social networks can improve the health/nutrition of malnourished children with FNI.

Resumo Objetivos: avaliar a relação entre a insegurança alimentar e nutricional (IAN) da família e a rede social de crianças desnutridas. Métodos: estudo transversal com 92 crianças, inseridas na classe econômica D-E. Para a análise da rede social das crianças, as mães responderam quatro perguntas simples. Para investigar a IAN foi utilizada a Escala Brasileira de Insegurança Alimentar. A associação entre as variáveis foi analisada por regressão de Poisson com análise robusta das variâncias. Resultados: 56,5% das crianças apresentaram rede social fraca (<10 indivíduos), e a prevalência de IAN foi de 72,8%. Foi observada uma associação inversa entre rede social diária das crianças e IAN da família (RP=0,94, [IC95%=0,89-0,99]; p=0,03). O número de indivíduos na rede social diária das crianças se associou negativamente com a probabilidade de IAN. O nível de escolaridade materno também estava relacionado com a IAN (RP=2,20 [IC95%=1,11-4,34]; p=0,02), tendo a criança até 2,2 vezes mais probabilidade de estar em IAN quando a mãe apresenta menos de quatro anos de estudo. Conclusão: esses resultados sugerem que a rede social está associada à IAN de crianças desnutridas. Intervenções destinadas a fortalecer maneiras instrumentais e outras formas de apoio entre pequenas redes sociais podem melhorar a saúde/nutrição de crianças desnutridas com IAN.

Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India.

Aim: The study aimed to investigate the prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight among children up to 3 years of age. Materials and Methods: We recruited 150 children of the Bhoksa Tribe aged between 2 to 36 months. Information related to nutritional indicators (length-for-age, weight-for-age, and weight-for-length) of the child and socio-demographic variables of the household were collected. Results: The prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight was 15.4%, 32%, 29.98%, and 36.66%, respectively. The prevalence percentage of undernutrition was high among girls but the difference based on sex was not significant. A significant difference in mean birth weight was observed between low and high SES (2.45 kg v/s 2.93 kg). Conclusion: High prevalence of undernutrition concerning birth weight among the children of the Bhoksa Tribe was observed which may be due to socioeconomic inequality in the population.

Nutritional Status of Pre-School Children Attending Anganwadi Centres in Chittoor, Andhra Pradesh, India

Context/Background: Malnutrition among children is a major public health problem in India. The objective of the study is to assess the nutritional status of pre-school children and to identify the so-cio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ <-2 standard deviation (SD)), stunt-ing (HAZ <-2SD), and wasting (WHZ <-2SD) were calculated along with the determinants. Results: The mean age of the participants was 40.5 months (SD- 9.1 months), 101 (52.1%) were from rural areas, and 96 (495%) females. The HAZ values were significantly low in- urban children (-0.81; 95%CI: -0.4, -1.21), among the non-Hindu children (-0.92; 95%CI: -0.35, -1.5). The overall prevalence of underweight, stunting, and wasting were- 13.4% (95%CI: 8.5%, 18.3%), 23.7% (95%CI: 17.6%, 29.8%), and 19.6% (95%CI: 11.9%, 25.3%) respectively. Urban residence (OR 6.75; 95% CI: 3.03 – 15.04) was a strong predictor of stunting. Conclusion: Malnutrition remains to be a public health problem in this area. Strengthening of existing programs should be the key strategy in combating malnutrition.

Factors Affecting Stunting in Children under 5 Years of Age in Indonesia using Spatial Model

Background: Stunting in children under 5 years of age is a condition where they have a length or height that is less than ?2 standard deviations of the growth standard of Indonesian children. Stunting is caused by chronic malnutrition in the first 1000 days of life. The spatial panel data method was developed to solve problems related to spatial objects that are measured periodically by involving elements of area and time. Objectives: The purpose of this study was to determine the best model and factors that influence stunting in children under 5 years of age in Indonesia using spatial panel data. Methods: The data used were from the website of the Central Statistics Agency and the publications of the Ministry of Health of the Republic of Indonesia in 2015–2019. Determination of the selected model is done by comparing the random effect spatial autoregressive model and spatial error model (SEM) random effect based on the value and Akaike information criterion (AIC). SEM random effect produces the largest value and the smallest AIC. Results: The selected spatial panel data model in determining the factors that influence stunting in children under 5 years of age in Indonesia is the SEM random effect based on the largest and AIC compared to other models. Conclusion: Based on the selected model, children under five with malnutrition and poor nutrition, receiving Vitamin A, and the average monthly per capita expenditure on food have a significant effect on the percentage of stunting in children under five in Indonesia.

Assessment for Nutritional Status Among Pre - School Children in South Delhi, India

Background: Weight is an important metric to measure protein energy status, and women from underdeveloped or developed nations who are heavier at pre - pregnancy deliver heavier babies. Methods: This study was conducted in JJ Colony, Madanpur Khadar Extension of South Delhi and included 50 children each in two groups (between 24 - 35 months and 36 - 47 months of age), with equal number of both genders. Anthropometric measurements of weight and height were measured. Results: Underweight in age 24 - 47 months: 51 (51%), 36 (36% ), 11 (11%) and 2 (2%) children were found to be in the ranges of normal weight, Grade - I, Grade - II, and severely underweight, respectively by Indian Academy of Paediatrics or IAP classification. By Gomez classification, the same were estimated to be 28 (28 %), 45 (45%), 25 (25%), and 2 (2%). Stunting and wasting in age 24 - 47 months: 52 (52%), 11 (11%), 16 (16%), and 21 (21%) children were found to be normal, in Grade - I, Grade - II and in Grade - III stunting respectively in height for age, while 82 (82%), 13 (13 %), 4 (4%), and 1 (1%) children were found to be normal, in Grade - I, Grade - II and Grade - III wasting in weight for height respectively; using the Waterlow classification. Conclusion: The most extensively used markers of nutritional quality in a population are anthropometric measures. In a total of 100 children, three types of assessments based on weight and height were done - weight for age to rule out underweight, height for age to rule out stunting and weight for height to rule out wasting.

Stunting and its determinants among adolescents in four schools of Bangalore city: Height for age- a vital metric for nutritional assessment

Background: National Family Health Surveys in India have not included nutritional status of the crucial age group of 10-14 years, when pubertal growth spurt typically occurs. BMI-for-age is commonly used to assess adolescent nutritional status which may misclassify stunted adolescents as normal or overweight. Objectives: To estimate prevalence and determinants of stunting among adolescents (10 to 19 years) in Bangalore city and to estimate the proportion of adolescents who are stunted, but otherwise assessed as normal or overweight using BMI-for-age. Methods: Cross sectional study conducted in four schools of Bangalore city using a self-administered questionnaire to capture socio-demographic details, dietary patterns and physical activity. WHO Anthroplus software was used to classify nutritional status based on height-for-age and BMI-forage. Multiple logistic regression analysis was done to calculate adjusted odds ratios of independent co-variates associated with stunting. Results: Overall prevalence of stunting was 14% (95%CI:11.5-16.5%); 14.3% among females (95%CI:10.7-17.9%) and 13.6% among males (95%CI: 10.2-17.0%). Determinants of stunting were late adolescence [AOR=1.90(1.24-2.90),P=0.03], lower socio-economic class [AOR=2.75(1.39-5.41),P=0.03] and not taking weekly iron and folic acid supplements [AOR=2.78(1.48-5.21),P=0.001] Four of every five stunted children (81%) were classified as normal/ overweight/ obese using BMI-for-age. Conclusion: Stunting is a problem among urban adolescents in Bangalore. Height-for-age is a vital metric for assessing nutritional status of adolescents along with other metrics. We recommend strengthening of weekly iron and folic acid supplementation in schools and culturally specific targeted nutritional interventions for adolescents from economically weaker sections of society using a multi-sectoral and participatory approach.

Effect of Household Cooking Fuel and Breastfeeding on Infant Growth: Findings from the National Family Health Survey-4, India.

Objective: Malnutrition is a critical public health concern in India. We aimed to understand the prevalence of stunting and its association between cooking fuel type and breastfeeding among Indian infants (? 6 months of age). Methods: This study used information from a National Family Health Survey-4 (NFHS) conducted between 2015 and 2016. From all eligible infants, information on socio-demographic and clinical characteristics was obtained. Univariate and multivariable binary logistic regression was performed to examine the factors associated with stunted children. Results: Of the 15,120 infants, the median (Inter Quartile Range) age was 4 (2-5) months with a female/male ratio of 1:1.06. The prevalence of polluting fuel use and stunting was 68.10% and 20.13% respectively. Stunting among polluting fuel and clean fuel was 22.17% and 15.78%. Stunting among exclusive breastfed and not exclusive breastfed was 20.62% and 19.53%. In adjusted analysis, households using clean fuel (Adjusted Odds Ratio 0.75; 95% Confidence Interval, 0.66-0.86) had lower odds of infants being stunted compared to polluting fuel. A infant currently being breastfed (aOR 0.76; 95% CI, 0.62-0.93) had lower odds of being stunted than infants currently not being breastfed. Conclusion: The present study indicates that polluting cooking fuel and not being breastfed was associated with an increased risk of infant being stunted. A community-based randomized control trial was required to study child and maternal health risks on polluting cooking fuel. Furthermore, the study highlights the urgent need to raise awareness on the importance of exclusive breastfeeding practices.

Malnutrition among Under Five Children in Peri-Tribal areas: A study on Prevalence and Factors associated in Vadodara District of Gujarat State in India.

Background: Malnutrition among under-five children is a foremost public health problem across India. United Nation estimates that 6.3 million under age-five mortality were occurred in India, of which 45% died due to malnutrition. The objective of the study was to find out the prevalence and factor associated with malnutrition in term of underweight, stunning, and wasting in children under five years of age in peri-tribal areas. Methods: Cross sectional study was conducted at the Anganwadi centres in 6 villages under the Rural Health Training Centre. Out of nine Anganwadi centres, five were selected using systematic random sampling method. Total of 370 children aged below five years were selected. Results: Among the 370 children aged 0-5 years, (29.1%) children were normally nourished, (70.79%) children were malnourished and had one or more form of malnutrition. Only stunting was present in (19.5%) children and only wasting was present in (8.9%) children. Children (5.94%) was suffering from underweight and stunting both. Stunting and wasting both was present in (22.16%) children and wasting and underweight both was present in (10.5%) children. respectively, (1%) Children were suffering from underweight, stunting and wasting. All three indices (Underweight, Stunting & Wasting) of under nutrition were found to be higher in low-birth-weight children. Conclusion: Mother's educational qualification is strongly associated with nutritional status of their children. This might be due to better health care practices in terms of proper exclusive breast feeding, in-time complementary feeding and quality and quantity of complementary feeding among literate mothers as compared to illiterate mothers.

Prevalence and predictor stunting, wasting and underweight in Timor Leste children under five years: An analysis of DHS data in 2016

Stunting, wasting, and being underweight are indicators of malnutrition in a country. The high status reflects the poor nutritional and health status of children under five. We analyzed data from the Demographic and Health Survey conducted in Timor Leste from 2009 to 2016 to identify the prevalence and predictor stunting, wasting, and underweight. The variables analyzed were the mother's education, mother's age, mother BMI, mother's height, number of ANC visits, birth weight, sex of a child, sex of head household, type of residence, wealth index, toilet facility, source of drinking water and province. The sample in this study was 3,723 toddlers. Prevalence of stunting (44.4%), underweight (37.5%) and wasting (25.3%). In the bivariate analysis, the variables statistically significantly associated with stunting, underweight, and wasting was mother's education, sex of a child, type of residence, wealth index, and province. Improving the nutritional status of children in Timor Leste requires various nutrition and health interventions

Adherence to age-appropriate feeding practices among Filipino children under two: An analysis of the 2018- 2019 Expanded National Nutrition Survey

@#Introduction: Age-appropriate feeding in the first two years of life is essential to a child’s growth and development, with health implications that persist throughout life. This study examined the adherence to age-appropriate feeding practices among children 0-23.9 months old based on a constructed index, its association with anthropometric growth, and factors affecting adherence. Methods: A total of 9,138 children aged 0-23.9 months with complete information on infant and young child feeding practices (IYCF), anthropometric measurements, maternal information, and household characteristics were included in the study. Data were extracted from a nationwide survey conducted in 2018-2019. Results: Among children aged 0-23.9 months, 20.7% adhered to age-appropriate feeding criteria. More than half (57.7%) of children below six months adhered to age-appropriate exclusive breastfeeding practices, while 1.4% of children aged 6-8.9 months old started complementary feeding. Continued breastfeeding at 12 months of age while receiving complementary feeding was uncommon (11%). Significantly higher z-scores for weight-for-age (-0.6±0.04), height-for-age (-0.8±0.05), and weight-for-height (-0.2±0.05) were noted among children who adhered to age-appropriate feeding practices compared to those who did not. Child’s age and birth weight, as well as mother’s age, education, and working status, were found to significantly influence the likelihood of adhering to age-appropriate feeding index. Conclusion: Filipino infants and young children under two years of age have low adherence to age-appropriate feeding practices, putting them at a higher risk of repeated occurrence of infection that could lead to stunting in early life.

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan / Prevalência e determinantes da baixa estatura entre crianças em idade pré-escolar e em idade escolar nas áreas afetadas pelas enchentes do Paquistão

Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent's anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

A baixa estatura é um problema significativo de saúde pública em países de baixa e média renda. Este estudo avaliou a prevalência de nanismo e os fatores de risco associados de nanismo entre crianças em idade pré-escolar e em idade escolar em áreas afetadas por inundações do Paquistão. Foi realizado um estudo transversal visitando 656 domicílios por meio de amostragem em múltiplos estágios. As medidas antropométricas do entrevistado, informações sociodemográficas e instalações de saneamento foram exploradas. Um modelo de regressão logística foi usado para determinar os determinantes do nanismo, controlando todos os possíveis fatores de confusão. A prevalência geral de baixa estatura em crianças foi de 40,5%, entre as crianças 36,1% dos meninos e 46,3% das meninas com baixa estatura. A prevalência de baixa estatura em crianças menores de 5 anos foi de 50,7%. Crianças do sexo feminino (OR = 1,35, IC de 95%: 0,94-2,0), crianças de 13-24 meses (OR = 6,5, IC de 95%: 3,0-13,9), mães de 15-24 anos (OR = 4,4, IC de 95%: 2,6-7,2), família conjunta (OR = 2,1, IC 95%: 1,4-3,0) não tiveram acesso a água potável de qualidade (OR = 3,3, IC 95%: 1,9-5,9) e a banheiro (OR = 2,8, IC de 95%, 1,9-4,3), enquanto as crianças do distrito de Nowshera (OR = 1,7, IC de 95%: 0,9-3,2) foram significativamente (P < 0,05) associadas na análise univariada. O modelo de regressão revelou que a idade da criança, idade materna, tipo de família, qualidade da água e banheiro foram os fatores significativos (P < 0,05) que contribuíram para a baixa estatura infantil nas áreas afetadas pelas enchentes. A identificação de fatores-chave pode ser útil para os formuladores de políticas no planejamento de programas comunitários abrangentes para a redução da baixa estatura em áreas afetadas pelas enchentes. Em desastres como enchentes, as consequências prejudiciais do problema de baixa estatura podem ser ainda maiores para as crianças. Educação baseada em evidências e cuidados deve ser fornecida às famílias nas regiões afetadas pelas enchentes para reduzir o problema de nanismo. Os determinantes do retardo de crescimento devem ser almejados pela formulação de políticas abrangentes sobre nutrição adequada, meios de subsistência, água potável e instalações de saneamento nas regiões afetadas pelas enchentes.

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan / Prevalência e determinantes da baixa estatura entre crianças em idade pré escolar e em idade escolar nas áreas afetadas pelas enchentes do Paquistão

Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent's anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should [...].

A baixa estatura é um problema significativo de saúde pública em países de baixa e média renda. Este estudo avaliou a prevalência de nanismo e os fatores de risco associados de nanismo entre crianças em idade pré-escolar e em idade escolar em áreas afetadas por inundações do Paquistão. Foi realizado um estudo transversal visitando 656 domicílios por meio de amostragem em múltiplos estágios. As medidas antropométricas do entrevistado, informações sociodemográficas e instalações de saneamento foram exploradas. Um modelo de regressão logística foi usado para determinar os determinantes do nanismo, controlando todos os possíveis fatores de confusão. A prevalência geral de baixa estatura em crianças foi de 40,5%, entre as crianças 36,1% dos meninos e 46,3% das meninas com baixa estatura. A prevalência de baixa estatura em crianças menores de 5 anos foi de 50,7%. Crianças do sexo feminino (OR = 1,35, IC de 95%: 0,94-2,0), crianças de 13-24 meses (OR = 6,5, IC de 95%: 3,0-13,9), mães de 15-24 anos (OR = 4,4, IC de 95%: 2,6-7,2), família conjunta (OR = 2,1, IC 95%: 1,4-3,0) não tiveram acesso a água potável de qualidade (OR = 3,3, IC 95%: 1,9-5,9) e a banheiro (OR = 2,8, IC de 95%, 1,9-4,3), enquanto as crianças do distrito de Nowshera (OR = 1,7, IC de 95%: 0,9-3,2) foram significativamente (P < 0,05) associadas na análise univariada. O modelo de regressão revelou que a idade da criança, idade materna, tipo de família, qualidade da água e banheiro foram os fatores significativos (P < 0,05) que contribuíram para a baixa estatura infantil nas áreas afetadas pelas enchentes. A identificação de fatores-chave pode ser útil para os formuladores de políticas no planejamento de programas comunitários abrangentes para a redução da baixa estatura em áreas afetadas pelas enchentes. Em desastres como enchentes, as consequências prejudiciais do problema de baixa estatura podem [...].

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan

Abstract Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondents anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P 0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P 0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

Resumo A baixa estatura é um problema significativo de saúde pública em países de baixa e média renda. Este estudo avaliou a prevalência de nanismo e os fatores de risco associados de nanismo entre crianças em idade pré-escolar e em idade escolar em áreas afetadas por inundações do Paquistão. Foi realizado um estudo transversal visitando 656 domicílios por meio de amostragem em múltiplos estágios. As medidas antropométricas do entrevistado, informações sociodemográficas e instalações de saneamento foram exploradas. Um modelo de regressão logística foi usado para determinar os determinantes do nanismo, controlando todos os possíveis fatores de confusão. A prevalência geral de baixa estatura em crianças foi de 40,5%, entre as crianças 36,1% dos meninos e 46,3% das meninas com baixa estatura. A prevalência de baixa estatura em crianças menores de 5 anos foi de 50,7%. Crianças do sexo feminino (OR = 1,35, IC de 95%: 0,94-2,0), crianças de 13-24 meses (OR = 6,5, IC de 95%: 3,0-13,9), mães de 15-24 anos (OR = 4,4, IC de 95%: 2,6-7,2), família conjunta (OR = 2,1, IC 95%: 1,4-3,0) não tiveram acesso a água potável de qualidade (OR = 3,3, IC 95%: 1,9-5,9) e a banheiro (OR = 2,8, IC de 95%, 1,9-4,3), enquanto as crianças do distrito de Nowshera (OR = 1,7, IC de 95%: 0,9-3,2) foram significativamente (P 0,05) associadas na análise univariada. O modelo de regressão revelou que a idade da criança, idade materna, tipo de família, qualidade da água e banheiro foram os fatores significativos (P 0,05) que contribuíram para a baixa estatura infantil nas áreas afetadas pelas enchentes. A identificação de fatores-chave pode ser útil para os formuladores de políticas no planejamento de programas comunitários abrangentes para a redução da baixa estatura em áreas afetadas pelas enchentes. Em desastres como enchentes, as consequências prejudiciais do problema de baixa estatura podem ser ainda maiores para as crianças. Educação baseada em evidências e cuidados deve ser fornecida às famílias nas regiões afetadas pelas enchentes para reduzir o problema de nanismo. Os determinantes do retardo de crescimento devem ser almejados pela formulação de políticas abrangentes sobre nutrição adequada, meios de subsistência, água potável e instalações de saneamento nas regiões afetadas pelas enchentes.