Prevalence and determinants of multiple chronic conditions (MCC) among young adults in Indian households: an analysis of NFHS-5.

BACKGROUND: Multiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households. METHODS: Data used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019-21. Data sets of men (15-54 years) and women (15-49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results. RESULTS: A prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33-0.39)), urban areas (AOR 1.11 (1.02-1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81-0.97)), and ST (AOR 1.30 (1.17-1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress. CONCLUSION: A 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.

Processed food consumption and risk of non-communicable diseases (NCDs) in South Africa: evidence from Demographic and Health Survey (DHS) VII.

We aimed to analyse the association between processed food consumption and the risk of non-communicable diseases (NCDs) in South Africa. In this empirical study, we analysed nationally representative secondary data obtained from the South African Demographic and Health Survey (SADHS) VII. The survey included 13,288 occupied households, of which 11,083 were interviewed. In the interviewed households, 12,717 eligible adults aged 15 and older were identified and 10,336 were successfully interviewed. The study included four processed food groups (i.e. fried foods, takeaway foods/fast foods, salty snacks/packed chips, and processed meats) and eight NCDs (i.e. hypertension, cardiac arrest, cancer, stroke, hypercholesterolaemia, diabetes, chronic bronchitis, and asthma). As per the logistic regression results following adjustment, none of the disease states showed association with all four processed food groups. However, at least three processed food groups showed a significant positive association with hypertension, cardiac arrest, and diabetes. Two processed food groups showed significant positive association with stroke, and chronic bronchitis; one with hypercholesterolaemia and asthma; and cancer was not associated with any food groups. Processed meat and salted snacks/packed chips were each associated with five chronic conditions. In summary, we found that the consumption of any of the processed food groups increased the risk of NCDs in the South African population. Enabling policy and regulatory efforts in the production and distribution of processed foods, combined with improved awareness among the population need to be prioritised for immediate action. Facilitating the populations to choose traditional healthy diets would be a sustainable strategy for the prevention of NCDs.

Auditing causality of the multiple-burden of malnutrition in India and South Africa: a critical need for directions.

Developing economies are shaped by the current predicament of urbanisation and its impact on health is inevitable. In the post-pandemic times, India and South Africa witnessed a GDP growth rate of about 1·7 % and 1·9 %, respectively, while the developed economies like Europe and the USA have bounced back with more than 2 % GDP. The similarities and differences between India and South Africa provide potential candidates to study nutrition transition with the elements of urbanisation. In both countries, increased access to convenience foods is a consequence of the rapid expansion of small and medium enterprises, open international markets and expanding food supply chains. Also, there has been significant acculturation and people have moved away from traditional diets in these two countries. A spate of similar changes in the food environment is a telling sign of serious ill-health consequences in both countries. Generating evidence on causality is fundamental to informing policy. India and South Africa qualify as potential candidates to study the multiple burdens of malnutrition. Collaborating with different disciplines such as data sciences and capacitating analytic skills are key to progress in this direction.

Determinants of early initiation of breastfeeding in The Gambia: a population-based study using the 2019-2020 demographic and health survey data.

BACKGROUND: Early initiation of breastfeeding within the first hour of life prevents neonatal and infant mortality. Sustainable Development Goals (SDGs) Target 3.2 aims to reduce neonatal mortality and under 5 mortality globally. The decline in the early initiation of breastfeeding in The Gambia coincides with deviations from the SDGs, due to poor indicators of child survival. Our work studied the determinants of early initiation of breastfeeding in The Gambia. METHODS: We used the 2019-2020 Gambia Demographic Health Survey (GDHS) conducted across all regions of the country. Since our population of interest was children born two years preceding the study, we only included children less than 24 months of age, living with an eligible respondent. Thus, a weighted sample of 5691 mother-child pairs was applied in the analysis. We reported summary statistics of individuals' sociodemographic, obstetrics and antenatal, household, and community-level factors. A logistic regression model was used to determine associations between early initiation of breastfeeding and covariates. RESULTS: The prevalence of early initiation of breastfeeding was 64.3% (n = 3659). Mothers who had secondary education or higher educational level had higher odds of early initiation of breastfeeding (AOR 1.22; 95% CI 1.07, 1.40). Regions with rural population notably Lower and Central and Upper River Region had lower odds of early initiation of breastfeeding [Mansakonko (AOR 0.37; 95% CI 0.26, 0.15), Kerewan (AOR 0.26; 95% CI 0.19, 0.36), Kuntaur (AOR 0.39; 95% CI 0.28, 0.54), Janjanbureh (AOR 0.48; 95% CI 0.35, 0.66) and Basse (AOR 0.64; 95%CI 0.49, 0.85)]. Also, women in the high quintile of the wealth index were more likely to initiate breastfeeding early (AOR 1.29; 95% CI 1.06, 1.57). Four or more antenatal care visits did not increase early initiation of breastfeeding. CONCLUSIONS: The results of the analyses demand affirmative action to improve maternal education, reduce poverty and inequality and empower rural communities in The Gambia. The IYCF component in antenatal care needs to be strengthened. Programs and policies on IYCF must resonate to address determinants of timely breastfeeding initiation to chart progress towards the SDG.

Determinants of complementary feeding practices among children aged 6-24 months in urban slums of Pune, Maharashtra, in India.

BACKGROUND: Inequalities in child feeding practices are evident in urban slums in developing nations. Our study identified the determinants of complementary feeding (CF) practices in the informal settings of Pune, India, a district close to the business capital of India. METHODS: Employing a cross-sectional study design, 1066 mother-children dyads were surveyed. Five indicators defined by the WHO were used to study complementary feeding practices. Determinants of complementary feeding practices were identified using multivariate analyses. RESULTS: Timely initiation of CF was reported by 42%. Minimum acceptable diet (MAD), minimum meal frequency (MMF), and Diet Diversity Score > 4 were achieved by 14.9%, 76.5%, and 16.4%, respectively. Continued breastfeeding (CBF) at 2 years, and feeding processed foods were practiced by 94% and 50%, respectively. Among the maternal characteristics, a mother's age > 30 years at pregnancy was less likely to achieve DD [AOR: 0.195 (CI 0.047-0.809)] and MAD [AOR: 0.231 (CI 0.056-0.960)]. Mothers with lower education were less likely to meet MMF [AOR: 0.302 (0.113-0.807)], MAD [AOR: 0.505 (CI 0.295-0.867)] and to introduce formula feeds (FF) [AOR: 0.417 (0.193- 0.899)]. Among obstetric characteristics, birth spacing < 33 months was less likely to achieve DD [AOR: 0.594 (CI 0.365-0.965)] and CBF [AOR: 0.562 (CI: 0.322-0.982)]. Receiving IYCF counseling only during postnatal care hindered the timely initiation of CF [AOR: 0.638 (0.415-0.981)]. Very Low Birth Weight increased the odds of achieving DD [AOR: 2.384 (1.007-5.644)] and MAD [AOR: 2.588(CI: 1.054-6.352)], while low birth weight increased the odds of children being introduced to processed foods [AOR: 1.370 (CI: 1.056-1.776)]. Concerning socio-economic status, being above the poverty line increased the odds of achieving MMF, [AOR: 1.851 (1.005-3.407)]. Other backward castes showed higher odds of achieving MAD [AOR: 2.191 (1.208-3.973)] and undisclosed caste in our study setting decreased the odds of FF [AOR: 0.339 (0.170-0.677)]. Bottle feeding interfered with MMF [AOR: 0.440 (0.317-0.611)] and CBF [AOR: 0.153 (0.105-0.224)]. CONCLUSION: Investing in maternal education and IYCF counseling during both ANC and PNC to provide nutritious complementary foods alongside addressing poverty should be a national priority to prevent the double burden of undernutrition at an early age in informal settings.

Socio-demographic and economic determinants of household expenditure on eating out in India - Evidence from India Human Development Survey (IHDS) II.

Background: 'Eating out (EO)' has witnessed a significant increase across nations and in India. Understanding food behaviour from an economic standpoint is essential to recognize food systems and nutrition transition. Aim: Our work compared the macro-data on per capita income and gross state domestic product from India with household expenditure on eating out. Using the India Human Development Survey II micro-data we studied the socio-demographic and economic determinants of household expenditure on eating out. Methods: The study design is a secondary data analysis of India Human Development Survey II from a sample of N = 42,152 households. It included socio-demographic and economic predictors, such as religion, caste, residence, migration for work, education, number of household members, income source, total annual income, consumption expenditure and poverty status. Results: No consistent trends emerged in the macroeconomic comparisons using gross state domestic product and per capita income. Results of logistic regression showed that the reserved caste categories OBC [COR 1.2 (1.1-1.2)] and SC/ST/Others [COR 1.1 (1-1.1)], household heads education up to secondary [COR 0.4 (0.4-0.5)] and higher secondary and above [COR 0.7 (0.6-0.8)], urban place of residence [COR 0.55 (0.53-0.58)], organised sector [COR 0.7 (0.6-0.7)] as the income source, higher annual income [COR 0.52 (0.50-0.54)], higher annual consumption expenditure [COR 0.44 (0.42-0.46)] and above poverty line [COR 2.1 (1.9-2.2)] were significantly positively associated with expenditure on eating out (p = <0.05). All these variables stayed significant in the multinomial regression model as well. Conclusion: This analysis confirms the increase in household income along with other demographics, increases the frequency of eating out. However, such trends remained inconsistent in macroeconomic assessments using gross state domestic product and per capita income.

Is Infant and Young Child-feeding (IYCF) a potential double-duty strategy to prevent the double burden of malnutrition among children at the critical age? Evidence of association from urban slums in Pune, Maharashtra, India.

BACKGROUND: This study characterized undernutrition among children (0-24 months) by age groups specified for Infant and Young Child-feeding (IYCF) and determined the association between child malnutrition and IYCF. METHODS: This cross-sectional survey recruited mother-children dyads (N = 1443). WHO standards were used to assess nutritional status and IYCF indicators. Multivariate analyses were performed to assess the association between IYCF and nutritional indicators. RESULTS: Stunting, underweight, wasting, overweight, and obesity were prevalent in 33.1%, 26%, 20.2%, 4.6%, and 2.9% of the children, respectively. Age-wise distribution of undernutrition identified severity of stunting and underweight at 10-24 months (median < -1.6 SD; < -1.2 SD; 25th percentile at -2.6 & -2.2 SD respectively) and wasting highest at 0-6 months (25th percentile close to -2SD). Boys manifested higher stunting (lower value -5.2 SD) and were more wasted (lower value -4.7 SD). IYCF prevalence recorded early initiation at 45.2%, exclusive breastfeeding at 23.1%, and prelacteal and bottle-feeding at 37.5 and 22.5% respectively. Child minimum diet diversity (MDD) ≥4 was not achieved by 84%. Minimum meal frequency and minimum acceptable diet were achieved by 75% and 14% respectively. Bottle-feeding increased the odds of wasting [AOR: 1.501 (95% CI: 1.062-2.121)], severe stunting [AOR: 1.595 (95% CI: 1.079-2.358)] and underweight [AOR: 1.519 (95% CI 1.102-2.094)]. Wasting according to BAZ scores was associated with delayed initiation of breastfeeding [AOR: 1.387 (95% CI: 1.018-1.889)] and bottle feeding [AOR: 1.538 (95% CI: 1.087-2.175)]. Delayed introduction of complementary feeding increased the odds of severe stunting [AOR: 2.189 (95% CI: 1.090-4.399)]. Formula feeding increased the odds of underweight [AOR: 1.738 (95% CI: 1.046-2.888)] and obesity [AOR: 4.664 (95% CI: 1.351-16.10)]. Prelacteal feeding increased the odds of severe forms of stunting and underweight by 56% and 79% respectively, and overweight by 96%. CONCLUSION: Setting and age-specific interventions to improve age-appropriate child-feeding practices are vital to address the double burden of malnutrition in the critical age group.

Pooled prevalence of food away from home (FAFH) and associated non-communicable disease (NCD) markers: a systematic review and meta-analysis.

BACKGROUND: Food away from home (FAFH) is an 'eating behavior' widely practiced across nations, more common in developed nations. Likewise, in developing countries an increase of close to 50% indicates an upsurge in FAFH consumption. While various indices and tools are used to assess diet quality, diversity, or healthy eating, FAFH is less utilized to study dietary behaviors and the associated disease risk. OBJECTIVE: To calculate the pooled estimate of FAFH and identify the associated non-communicable disease (NCD) markers. DESIGN: Systematic review and meta-analysis. METHODS: Independent electronic searches were conducted across 6 databases: Medline, Web of Science, Scopus, Cochrane library, Ingenta, and CAB direct. Observational studies investigating the association between FAFH and NCD markers published between the year 2011 and 2021 were eligible for inclusion. Studies that included overweight or obese participants, pregnant women, or those under institutional care at baseline were excluded. The guidelines for reporting meta-analysis of observational studies in epidemiology were adhered to in the preparation of this systematic review. RESULTS: The random effects combined estimate for the overall prevalence of FAFH was 39.96% (95% CI 29.97-53.29). High heterogeneity (τ2 = 0.63, I2 = 100%) and high risk of bias were observed among the selected studies. The test for overall effect was observed to be z = 25.11 (p < 0.001). Eleven out of fourteen studies showed a positive association between FAFH and anthropometric changes. Twelve out of seventeen studies showed a positive association between FAFH and cardiovascular disease (CVD) biomarkers. CONCLUSION: Our work confirms FAFH as an evolving dietary behavior in both developing and developed countries, emphasizing the lack of representation from low-income countries. The association of FAFH with obesity and non-communicable disease risk is reinforced by our analyses. These findings should enable policy decisions to meet the rising demand of FAFH with healthier options to prevent the risk of NCD.

Loss of Livelihood, Wages, and Employment During the COVID-19 Pandemic in Selected Districts of Chhattisgarh in India, and Its Impact on Food Insecurity and Hunger.

The COVID-19 pandemic has exacerbated the existing food insecurity in developing nations. The cumulative effect of restricted mobility to curtail the spread of the infection, loss of livelihood and income, worst affected the economically weaker sections. Our work examined the availability, accessibility, and affordability of food during the first wave of the pandemic using the FAO, HFIAS questionnaire, in a random sample (N = 401) from Kanker and Narayanpur districts in Chattisgarh, an Empowered Action Group state, in India. Total food security scores were derived by summing the individual scores. Percentages above and below the median scores were used to assess food insecurity. Proportion Z test was used to compare settings and a generalized linear model was used to determine the association between dependent and independent variables. Of the 63% non-tribal population, a greater percent experienced income loss (13.4%) and worried about not having sufficient food (40%). A significantly higher proportion from the non-tribal regions reported food scarcity in the household (34%) and experienced hunger (15%). Non-tribal participants (77%) scored ≤ median (score 8) demonstrating high food insecurity. The odds of poor food access increased in the non-tribal settings (B: 0.024, 95% CI: 0.011-0.051, P < 0.001), income between Rs. 10,000-29,000/- per month (B: 0.385, 95% CI: 0.146-1.014, P < 0.05) and among those experiencing total or partial income loss (B: 0.505, 95% CI: 0.252-1.011, P < 0.05). Urban residence increased the odds of poor food availability (B: 15.933, 95% CI: 3.473-73.096, P < 0.001). Being male (B: 0.450, 95% CI: 0.208-0.972, P < 0.05), and not experiencing income loss (B: 0.367, 95% CI: 0.139-0.969, P < 0.05) decreased the odds of poor availability and affordability (B: 0.153, 95% CI: 0.067-0.349, P < 0.001). Non-tribal setting increased the odds of poor affordability (B: 11.512, 95% CI: 5.577-23.765, P < 0.001) and hunger (B: 19.532, 95% CI: 7.705-49.515, P < 0.001). Being male (B: 0.445, 95% CI: 0.277-0.715, P < 0.05) and higher age (B: 0.936, 95% CI: 0.936-0.906, P < 0.001) decreased the odds of food insecurity as per the total food security score. While India is likely to experience multiple waves, actions urgent and targeted toward the needs of the vulnerable sections be prioritized to endure and overcome the impact of the pandemic.

Sustainability of integrated anaemia prevention activities implemented through non-government organizations and schools, and its effect on haemoglobin status of adolescent girls in urban slums of Pune, in Maharashtra, India.

BACKGROUND: Programmes for the prevention of iron deficiency anaemia among adolescent girls need sustainable inputs for maximum benefits. AIM: To assess the interventions sustained for anaemia prevention implemented through NGOs and schools. METHODS: An intervention study followed longitudinally in three phases. Phase I comprised (a) needs assessment of the community and (b) capacity assessment of service providers through a cross-sectional survey in nine slums, through six NGOs and three schools. Based on needs assessment, an integrated intervention for anaemia prevention was provided for adolescent girls (n = 384) in the community. To ensure sustainability the capacity of stakeholders (n = 67) was built by providing training in the components of the integrated intervention and establishing linkages with the public health system. Refresher training was conducted during phase II (n = 69) for reinforcing and strengthening of activities introduced in phase I. In phase II and III continuations of activities by the NGOs and schools that were initiated in phase I were monitored. Sustainability of activities was measured using an index that comprised technical, programmatic, social, and financial indicators. The impact of sustained interventions was assessed by comparing the mean rank haemoglobin concentrations of centres with varying levels of coverage. RESULTS: Scores of sustainability indicators decreased from phase II to phase III. Organizations that showed > 50% coverage showed significantly higher mean rank haemoglobin (p = < 0.05) during phases II and III. CONCLUSION: There is a need to identify and address barriers that prevent sustainable interventions for anaemia control.

Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis.

BACKGROUND: Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis. METHODS: Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women. RESULTS: The random effects combined estimate was 32.35% (95% CI, (12.58-117.48). High heterogeneity (tau2 = 0.39, I2 = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54(P = 0.01). CONCLUSION: Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

Determinants of Anthropometric Failure Among Tribal Children Younger than 5 Years of Age in Palghar, Maharashtra, India.

BACKGROUND: Measuring undernutrition using composite index of anthropometric failure (CIAF) and identifying its determinants in tribal regions is essential to recognize the true burden of undernutrition in these settings. OBJECTIVE: To determine anthropometric failure and its determinants among tribal children younger than 5 years in Palghar, Maharashtra, India. METHODS: A cross-sectional survey employing CIAF was performed in children <5 years to estimate undernutrition in the tribal district of Palghar in Maharashtra, India. Anthropometric measurements, maternal and child characteristics were recorded from 577 mother-child pairs in 9 villages. RESULTS: As per Z score, prevalence of stunting, wasting, and underweight were 48%, 13%, and 43%, respectively. According to CIAF, 66% of children had at least one manifestation of undernutrition and 40% had more than one manifestation of undernutrition. Odds of anthropometric failure were 1.5 times higher among children of mothers who were illiterate (adjusted odds ratio [AOR] =1.57, 95% CI: 1.0-2.3), children who had birth weight >2.5 kg had lesser odds (AOR: 0.63, 95% CI: 0.4-0.9) of anthropometric failure, and children who had initiated early breastfeeding had 1.5 times higher odds of anthropometric failure (crude odds ratio: 1.5, 95% CI: 1.0-2.1). However, when adjusted for other independent variables, the results were not significant. CONCLUSION: The alarming proportion of anthropometric failure among tribal children calls for urgent short-term interventions to correct undernutrition and long-term interventions to improve maternal literacy and awareness to prevent and manage child undernutrition.

Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra.

Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city.A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators.Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding.Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.

Water, sanitation and hygiene (WaSH) practices and diarrhoea prevalence among children under five years in a tribal setting in Palghar, Maharashtra, India.

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Prevalence and Risk Factors of Undernutrition among Children Less than 2 Years in Urban Slums of Pune, Maharashtra, India.

Undernutrition and its risk factors among children aged 0-23 months in urban slums of Pune was studied. Maternal and child characteristics, household food security and anthropometric measurements of 400 children were recorded. Results identified prevalence of stunting to be 34%, wasting 15.3% and underweight 21.8%. Odds of stunting was higher among children 7 to 12 months of age (AOR=7.064, 95% CI: 1.908-26.150). Odds of wasting was higher among children 7 to 12 months (AOR=3.144, 95% CI: 1.631-6.060), age < 6 months (AOR=2.546, 95% CI: 1.259-5.149) and not feeding colostrum (AOR=2.806, 95% CI=1.059 -7.478). Birth weight < 2500gm increased the risk of all three manifests of undernutrition. Children who were not immunised or received partial immunization had 1.5 times greater risk of being underweight (AOR=1.933, 95% CI: 1.118-3.342). Age specific interventions to address specific risk factors is a priority to address this public health issue.

A systematic review and meta-analysis of prevalence of vitamin D deficiency among adolescent girls in selected Indian states.

BACKGROUND:: Vitamin D deficiency among adolescents is an emerging public health priority as adolescence marks a period of rapid growth and the onset of the reproductive phase. However, lack of national prevalence data and intervention strategies is of public health concern. OBJECTIVE:: The objective of this study was to determine the pooled prevalence of vitamin D deficiency among adolescent girls in selected Indian states. METHODS:: A systematic literature review was performed using three different search engines. The searches yielded nine eligible articles. Study quality was assessed for 10 different criteria. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among adolescent girls and to assess the heterogeneity among selected studies. RESULTS:: A sample of n=1352 was used to study prevalence among adolescent girls. The random effects combined estimate for overall prevalence was 25.70% (95% CI 3.89-2137.9). High heterogeneity (tau2=1.71, I2=100%) was observed and seven out of nine studies showed low to moderate risk and two showed high risk of bias. The test for overall effect was observed to be Z=0.77 ( p=0.44). CONCLUSIONS:: High prevalence of vitamin D deficiency among adolescent girls identifies the need to introduce screening of adolescents and introduce proven public-health interventions such as fortification of foods to address deficiency.

Is lack of breakfast contributing to nutrient deficits and poor nutritional indicators among adolescent girls?

BACKGROUND: Breakfast is considered the first and most important meal of the day. Missing the first meal may result in significant nutritional deficits, if not compensated in subsequent meals. AIM: To describe the nutrient intake through breakfast and to study its association with nutritional indicators among adolescent girls. METHODS: A cross-sectional study among adolescent girls ( n = 565) 16-18 years was carried out in urban slums of Pune, Maharashtra, India. Haemoglobin was assessed by cyanmethemoglobin method. Nutritional status was assessed through anthropometry and three 24-hours diet recall. Z scores, independent sample test, and linear logistic regression were used to assess undernutrition, to compare means of nutrient intake and to associate nutrient intake with nutritional status, respectively. RESULTS: Almost 50% did not consume solid food for breakfast and 99% of the participants consumed inadequate breakfast (<610 kcal). Two types of breakfast emerged: I (bakery products + beverage) and II (traditional breakfast + beverage). Although the mean energy intake of type II breakfast (235±100.55 kcal) and the mean micronutrient intake was significantly higher than type I (micronutrients: vitamin C and folate ( p = 0.001), iron ( p = 0.01)) it did not meet the adequacy norms for breakfast. Among nutritional indicators breakfast intake was not directly associated with body mass index. However, mean intake of nutrients such as energy, protein and iron through the day were significantly lesser ( p = 0.001, p = 0.01 and p = 0.01 respectively) among anaemic adolescents. Linear regression showed significant association between energy, fat intake and BAZ scores. CONCLUSIONS: Compensating dietary deficits that arise in the first meal would directly address the day's nutrient deficit. The results highlight the need for a food-based approach to address undernutrition among adolescent girls in resource-poor settings.

Beneficial effect of iron pot cooking on iron status.

OBJECTIVES: To develop iron rich snacks using locally available iron rich foods and analyze their iron content when cooked in iron pots. Further, the efficacy of the developed snacks, cooked in iron pots was examined on the hemoglobin status of pre-school children through a three month randomized trial. METHODS: Four iron rich snacks (mean iron content 2.1mg/serving) were cooked in iron pots and 27 preschool children (mean age 2.9 ± 0.9 y, 12 boys) were supplemented with the snacks for 4 mo. Anthropometry and dietary intake data were collected. Hemoglobin, serum iron and transferrin saturation were assessed. RESULTS: An increase of 16.2 % in the iron content was found in the snacks cooked in iron pots than cooked in Teflon coated non-stick pots. After 4 mo of supplementation, a significant increase of 7.9 % was seen in the hemoglobin of the children. CONCLUSION: This pilot study demonstrated that iron rich recipes cooked in iron pot have a beneficial effect on iron status of children. Therefore, such food based strategies have the potential to alleviate iron deficiency anemia not only in children but also in other vulnerable sections of society like in pregnant women.