Malaria in under-five children: prevalence and multi-factor analysis of high-risk African countries.

BACKGROUND: Malaria remains a significant public health challenge in Sub-Saharan Africa (SSA), particularly affecting under-five (UN5) children. Despite global efforts to control the disease, its prevalence in high-risk African countries continues to be alarming, with records of substantial morbidity and mortality rates. Understanding the association of multiple childhood, maternal, and household factors with malaria prevalence, especially among vulnerable young populations, is crucial for effective intervention strategies. OBJECTIVE: This study examines the prevalence of malaria among UN5 children in selected high-risk SSA countries and analyzes its association with various childhood, maternal, and household factors. METHODS: Data from the Malaria Indicator Surveys (MIS) spanning from 2010 to 2023 were analyzed. A weighted sample of 35,624 UN5 children from seven countries in sub-Saharan Africa (SSA) known for high malaria prevalence was considered in the analyses. Descriptive statistics and modified Poisson regression analysis were used to assess the association of multiple factors with malaria prevalence. Stata version 15 software was used in analyzing the data and statistical significance was set at a 5% significance level. RESULTS: The overall pooled prevalence of malaria among the studied population was 26.2%, with substantial country-specific variations observed. In terms of child factors, a child's age was significantly associated with malaria prevalence (APR = 1.010, 95% CI: 1.007-1.012). Children of mothers with higher education levels (APR for higher education = 0.586, 95% CI: 0.425-0.806) and Fansidar uptake during pregnancy (APR = 0.731, 95% CI: 0.666-0.802) were associated with lower malaria risk. Children from middle-wealth (APR = 0.783, 95% CI: 0.706-0.869) and rich (APR = 0.499, 95% CI: 0.426-0.584) households had considerably lower malaria prevalence compared to those from poor households. Additionally, rural residency was associated with a higher risk of malaria compared to urban residency (APR = 1.545, 95% CI: 1.255-1.903). CONCLUSION: The study highlights a notable malaria prevalence among under-five (UN5) children in high-risk SSA countries, influenced significantly by factors such as maternal education, Fansidar uptake during pregnancy, socioeconomic status, and residency. These findings underscore the importance of targeted malaria prevention strategies that address these key determinants to effectively reduce the malaria burden in this vulnerable population.

Co-occurrence of Overweight, Stunting, and Anemia among Adolescents (10-19 Years) in Tanzania Mainland: A School-Based Cross-Sectional Study.

Background: Evidence on double and triple burdens of malnutrition among adolescents is an essential key to informing policy design, implementation, and tracking progress of adolescent nutritional programs. Tanzania has a scarcity of studies on the double and triple burden of malnutrition among adolescents. Objective: The aim of this study was to assess the co-occurrence of malnutrition (overweight, stunting, and anemia) among adolescents (10-19 y) in mainland Tanzania. Methods: A school-based cross-sectional study was conducted among 44,120 primary school adolescents aged 10 to 19 y in mainland Tanzania. Anthropometric assessments (weight, height, and body mass index), dietary assessments, and hemoglobin levels were used to calculate the single, double, and triple burden of malnutrition. Data were analyzed using Stata software 15. The chi-square test was used to test the association between the nutrition condition and social demographic variables, physical activity, and dietary quality. Log-binomial models were used to determine factors associated with stunting, overweight, and anemia. Multivariable log-binomial models were used to control confounders. All analyses were 2-tailed, and the significance level was set at 5%. Results: The prevalence of anemia was 34.1%, while stunting and overweight had a prevalence of 32% and 4.2%, respectively. Approximately 41.7%, 13.5%, and 0.3% had single, double, and triple burden malnutrition-related conditions, respectively. Females were found to have a higher risk of being overweight compared with males (relative risk [RR]: 1.33; 95% confidence interval [CI]: 1.21, 1.45), while engaging in moderate to low levels of physical activity was associated with a decreased risk of being overweight. Additionally, residing in urban areas was linked to a decreased risk of stunting (RR: 0.78; 95% CI: 0.75, 0.80) and a 27% lower risk of anemia when compared with participants from rural areas. Conclusion: The findings from this study suggest that the complex nature of malnutrition among school adolescents warrants consideration when designing policies and interventions to reduce the burden of malnutrition.

Lack of an association between dietary patterns and adiposity among primary school children in Kilimanjaro Tanzania.

INTRODUCTION: Healthy dietary habits prevent childhood overweight and obesity and the risk of non-communicable diseases (NCDs) later in life. We examined dietary patterns and their association with adiposity among primary school children in northern Tanzania. METHODS: Dietary data was collected by 24-h recall and food frequency questionnaire (FFQ) for 1170 primary school children aged 9 - 11 years from 20 primary schools in the Kilimanjaro region. Factor analysis and FFQ data were used to identify dietary patterns. Children were categorized into terciles of their adherence to each dietary pattern. Multilevel logistic regression was used to evaluate the association of dietary pattern terciles with adiposity indicators: body mass index z-scores (BMI z scores), body fat percentage by bioelectrical impedance, triceps, subscapular skinfold thicknesses, and waist circumference. RESULTS: Fifteen percent of children had BMI Z > 1.0, indicating overweight or obesity. Two dietary patterns were identified by factor analysis: a healthy pattern characterized by frequent consumption of fruits and vegetables; and a mixed dietary pattern characterized by intake of fatty snacks, sweets and sugar snacks, sugary beverages, meat and alternatives, milk, and milk products. After adjusting for potential confounders, for both models: model 1 (age and sex), and model 2 (age, sex, school type, time spent walking to school, district [urban/ rural], availability of television and electronic gadgets at home and neighbourhood playground); we found no significant associations between dietary patterns and adiposity measures. CONCLUSION: Dietary patterns were not associated with adiposity in Tanzanian primary school children, possibly because of limitations of the FFQ, which did not record information on portion sizes. Future research should focus on understanding the key foods / snacks consumed by school children, portion sizes and their long-term effects on adiposity in children.

Role of dietary quality and diversity on overweight and obesity among women of reproductive age in Tanzania.

This study aimed to examine associations of dietary quality and diversity among reproductive-aged women with overweight and obesity. We conducted a cross-sectional study in the Health and Demographic Surveillance System of the Dar es Salaam Urban Cohort Study (DUCS) in Tanzania. A random sample of 1004 non-pregnant women was selected from the DUCS population database and interviewed about dietary information using the FFQ. Women were aged 30.2 (±8.1) years; 27.8% were overweight and 22.6% were obese. All 1004 women in the study consumed starchy staple foods. Of all the women studied, 10.5%, 1.7% and 3.8% consumed vitamin A rich dark green vegetables, nuts and seeds, and beans and peas, respectively. Compared with women in the lowest quintile of Prime Dietary Quality Score (PDQS), those who were in the highest quintile were significantly less likely to be overweight or obese (Adjusted Prevalence Ratio (APR) = 0.76, 95%CI: 0.62, 0.89) (F for trend = 0.029). Dietary diversity score (DDS) was not significantly associated with overweight and obesity. Risk factors included the highest consumption of animal foods (APR = 2.81, 95% CI: 1.51-3.51) and fast food (APR = 2.57, 95% CI: 1.24-4.34). Consumption of legumes and whole grains was associated with lower risk (APR = 0.59; 95% CI: 0.38-0.2). Dietary quality is an important predictor of overweight and obesity among women of reproductive age. Nutrition interventions may be warranted to support women of reproductive age to enter pregnancy with healthier weight to prevent adverse pregnancy outcomes and future risk of chronic diseases.

Prevalence and factors associated with anaemia among pregnant women attending reproductive and child health clinics in Mbeya region, Tanzania.

Anaemia is a global public health issue, disproportionately affecting vulnerable populations such as pregnant women. The aim of this study was to assess the prevalence of anaemia and to identify factors associated with the condition among pregnant women attending antenatal clinics in the Mbeya Region of Tanzania. A cross sectional study was conducted with 420 pregnant women (<28 weeks of gestation) attending antenatal visits in the 7 districts of the Mbeya Region. A structured questionnaire was used to collect demographic information and eating habits using a 24hours dietary recall. A blood sample was collected and tested for hemoglobin content using the HemoCue 201+. Multivariate analysis was performed using standard logistic regression to explore the association between anaemia status with socio-demographic, reproductive and nutritional factors. Overall prevalence of anaemia in pregnant women was 25.5%. Out of 107 pregnant women diagnosed with anaemia and, sixty six had mild anaemia. In a multivariate logistical regression analysis anaemic women was associated with pregnant women coming from lower socio-economic status [adjusted OR = 2.40, 95%CI (1.05, 5.48)]. Moreover, anaemia was less associated with pregnant women who were living in Mbeya district council [adjusted OR = 0.28, 95%CI (0.11, 0.72)], consume at least once a day dark green leafy vegetables [adjusted OR = 0.53, 95% CI (0.30, 0.94)], and vegetable liquid cooking oil [adjusted OR = 0.56, 95% CI (0.34, 0.98)]. The prevalence of anaemia among the pregnant women falls in the category of moderate public health problem according to the WHO classification. Low socio-economic status, consumption of green leafy vegetables and vegetable liquid cooking oil were significantly and independently associated with anaemia during pregnancy. Thus, special attention should be given to pregnant women who are in lower socio-economic status and those not consuming vegetables. Interventions that integrate health and nutrition education in reproductive and child health clinics are needed to combat anaemia.

Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania.

BACKGROUND: Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania. METHODS: We conducted a cross-sectional survey among 1004 women aged 15-49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors. RESULTS: The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35-49 vs 15-24 years: PR 1.59; 95% CI: 1.30-1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07-1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63-0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03-1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61-0.99) with lower risk of overweight/obesity. CONCLUSION: Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.