Higher maternal autonomy is associated with reduced child stunting in Malawi

AbstractChild undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < – 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93;p = 0.002). However, this association was probably mediated by other factors associated with improved child nutrition, including maternal education and family wealth, which, along with child age, were associated with stunting in the dominance analysis. Concurrent interventional programs may also have contributed to the decrease in stunting between the surveys, thus moderating the effect of maternal autonomy.

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Risk Factors of Underweight in Children Aged 6–59 Months in Ethiopia

Journal of Nutrition and Metabolism ◽

10.1155/2017/6368746 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Deneke Tosheno ◽

Yohannes Mehretie Adinew ◽

Thilagavathi Thangavel ◽

Shimelash Bitew Workie

Keyword(s):

Risk Factors ◽

Decision Making ◽

Child Nutrition ◽

Maternal Education ◽

Strong Predictor ◽

Significant Proportion ◽

Cross Sectional Study ◽

Cross Sectional ◽

Child Undernutrition ◽

Underweight Child

Background. Undernutrition in early childhood has irreversible and long-lasting implications. Hence, this study was aimed at assessing risk factors of child undernutrition.Methods. A community-based cross-sectional study was conducted on 642 households with mothers to children pairs aged 6–59 months selected by a multistage systematic random sampling method. Child anthropometric measurements on weight were recorded using standardized and calibrated weighing scales. Weight-for-age was compared to the 2007 WHO growth reference by WHO Anthro software. Data were entered using Epi-Info and analyzed using SPSS. Bivariate and multivariate logistic regression analyses were used to evaluate the association between underweight children and their predictors; both crude and adjusted odds ratios with 95% confidence interval were reported.Results. One-fourth (25%) of the children were underweight. Child age (AOR: 2.36), gender (AOR: 1.82), illness (AOR: 0.09), maternal decision making power (AOR: 0.07), maternal education (AOR: 0.19), employment/occupation (AOR: 5.29), and household income (AOR: 4.16) were found to be independent and significant predictors of underweight children.Conclusion. Significant proportion of the children were underweight. Maternal decision-making power persists as a strong predictor of children’s weight. Therefore, intervention programs focusing on improving mothers’ decision-making power on child nutrition would contribute to the efforts towards alleviating the problem.

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Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980014000275 ◽

2014 ◽

Vol 17 (11) ◽

pp. 2407-2418 ◽

Cited By ~ 16

Author(s):

Helga Bjørnøy Urke ◽

Maurice B Mittelmark ◽

Martín Valdivia

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Cross Sectional ◽

Growth Standards ◽

Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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Trends and determinants of undernutrition among young Kenyan children: Kenya Demographic and Health Survey; 1993, 1998, 2003 and 2008–2009

Public Health Nutrition ◽

10.1017/s1368980012002856 ◽

2012 ◽

Vol 15 (9) ◽

pp. 1715-1727 ◽

Cited By ~ 40

Author(s):

Peninah K Masibo ◽

Donald Makoka

Keyword(s):

Health Survey ◽

Urban Areas ◽

Child Nutrition ◽

Maternal Education ◽

Sampling Technique ◽

Household Wealth ◽

Demographic And Health Survey ◽

Demographic And Health Surveys ◽

Double Burden ◽

Percentage Points

AbstractObjectiveTo report on the trends and determinants of undernutrition among children <5 years old in Kenya.DesignData from four nationwide Kenya Demographic and Health Surveys, conducted in 1993, 1998, 2003 and 2008–2009, were analysed. The Demographic and Health Survey utilizes a multistage stratified sampling technique.SettingNationwide covering rural and urban areas in Kenya.SubjectsThe analysis included 4757, 4433, 4892 and 4958 Kenyan children aged <5 years in 1993, 1998, 2003 and 2009–2009, respectively.ResultsThe prevalence of stunting decreased by 4·6 percentage points from 39·9 % in 1993 to 35·3 % in 2008–2009, while underweight decreased by 2·7 percentage points from 18·7 % in 1993 to 16·0 % in 2008–2009. The effects of household wealth, maternal education and current maternal nutritional status on child nutrition outcomes have changed dynamically in more recent years in Kenya. Inadequate hygiene facilities increased the likelihood of chronic undernutrition in at least three of the surveys. Small size of the child at birth, childhood diarrhoea and male gender increased the likelihood of undernutrition in at least three of the surveys. Childhood undernutrition occurred concurrently with maternal overnutrition in some households.ConclusionsThe analysis reveals a slow decline of undernutrition among young children in Kenya over the last three decades. However, stunting and underweight still remain of public health significance. There is evidence of an emerging trend of a malnutrition double burden demonstrated by stunted and underweight children whose mothers are overweight.

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Trends in the Prevalence of Overweight and Obesity and Associated Socioeconomic and Household Environmental Factors among Women in Nepal: Findings from the Nepal Demographic and Health Surveys

Obesities ◽

10.3390/obesities1020011 ◽

2021 ◽

Vol 1 (2) ◽

pp. 113-135

Author(s):

Kritika Rana ◽

Puspa Ghimire ◽

Romila Chimoriya ◽

Ritesh Chimoriya

Keyword(s):

Environmental Factors ◽

Health Surveys ◽

Wealth Index ◽

Educational Status ◽

Overweight And Obesity ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Logistic Regression Models ◽

Toilet Facility ◽

Nationally Representative

This study aimed to examine the trends in the prevalence of overweight and obesity and to determine the associated socioeconomic and household environmental factors among women in Nepal. Using nationally representative data from the 1996, 2001, 2006, 2011, and 2016 cross-sectional Nepal Demographic and Health Surveys (NDHSs) (n = 33,507), the prevalence of overweight–obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) among women aged 15–49 years were examined. From the latest NDHS 2016, non-pregnant women with recorded anthropometric measurements (n = 6165) were included in the final analyses. Multivariate logistic regression models were used to determine the socioeconomic and household environmental factors associated with BMI ≥ 25 and BMI ≥ 30. Between 1996 and 2016, the prevalence of overweight–obesity increased from 1.8% to 19.7%, while the prevalence of obesity increased from 0.2% to 4.1%. Age, marital status, wealth index, province of residence, type of cooking fuel, and household possessions—refrigerator and bicycle were significantly associated with having overweight–obesity and obesity. Similarly, educational status, religion, type of toilet facility, and household possessions—television and mobile phone were significantly associated with having overweight–obesity. Given the alarming increase in the prevalence of overweight and obesity among Nepalese women, there is an urgent need for interventions addressing these critical socioeconomic and household environmental factors.

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Hospital delivery and neonatal mortality in 37 countries in sub-Saharan Africa and South Asia: An ecological study

PLoS Medicine ◽

10.1371/journal.pmed.1003843 ◽

2021 ◽

Vol 18 (12) ◽

pp. e1003843

Author(s):

Anna D. Gage ◽

Günther Fink ◽

John E. Ataguba ◽

Margaret E. Kruk

Keyword(s):

South Asia ◽

Neonatal Mortality ◽

Ecological Study ◽

Maternal Education ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Hospital Delivery ◽

Sub Saharan ◽

Facility Births

Background Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. Methods and findings We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths (p-value < 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study’s limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. Conclusions Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality.

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Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134702 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4702

Author(s):

Sunil Rajpal ◽

Rockli Kim ◽

William Joe ◽

S.V. Subramanian

Keyword(s):

Child Nutrition ◽

Age Groups ◽

Policy Research ◽

Family Health ◽

Temporal Analysis ◽

Preschool Age ◽

Nutritional Intake ◽

Child Stunting ◽

Child Undernutrition ◽

Wealth Inequalities

Adequate nutritional intake for mothers during pregnancy and for children in the first two years of life is known to be crucial for a child’s lifelong physical and neurodevelopment. In this regard, the global nutrition community has focused on strategies for improving nutritional intake during the first 1000 day period. This is largely justified by the observed steep decline in children’s height-for-age z scores from birth to 23 months and presumed growth faltering at later ages as a reflection of earlier deprivation that is accumulated and irreversible. Empirical evidence on the age-stratified burden of child undernutrition is needed to re-evaluate the appropriate age for nutrition interventions to target among children. Using data from two successive rounds of National Family Health Surveys conducted in 2006 and 2016, the objective of this paper was to analyze intertemporal changes in the age-stratified burden of child stunting across socioeconomic groups in India. We found that child stunting in India was significantly concentrated among children entering preschool age (24 or above months). Further, the temporal reduction in stunting was relatively higher among children aged 36–47 months compared to younger groups (below 12 and 12–23 months). Greater socioeconomic inequalities persisted in stunting among children from 24 months or above age-groups, and these inequalities have increased over time. Children of preschool age (24 or above months) from economically vulnerable households experienced larger reductions in the prevalence of stunting between 2006 and 2016, suggesting that policy research and strategies beyond the first 1000 days could be critical for accelerating the pace of improvement of child nutrition in India.

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Predictors of early childhood undernutrition in Nigeria: the role of maternal autonomy

Public Health Nutrition ◽

10.1017/s1368980019000818 ◽

2019 ◽

Vol 22 (12) ◽

pp. 2279-2289

Author(s):

Ngozichukwuka Agu ◽

Nnadozie Emechebe ◽

Korede Yusuf ◽

Oluyemisi Falope ◽

Russell S Kirby

Keyword(s):

Domestic Violence ◽

Low Power ◽

Breast Feeding ◽

Low Income ◽

Cultural Context ◽

Maternal Education ◽

Unexpected Finding ◽

Child Undernutrition ◽

Low Bmi ◽

Maternal Autonomy

AbstractObjective:To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged <2 years in Nigeria, considering the cultural context and sociodemographic factors.Design:Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling.Setting:2013 Nigerian Demographic Health Survey.Participants:Children aged between 3 and 24 months (n 7532).Results:Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity.Conclusions:Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

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Evaluation of a Package of Behaviour Change Interventions (Baduta Program) to Improve Maternal and Child Nutrition in East Java, Indonesia: Protocol for an Impact Study

JMIR Research Protocols ◽

10.2196/18521 ◽

2020 ◽

Vol 9 (9) ◽

pp. e18521 ◽

Cited By ~ 1

Author(s):

Michael John Dibley ◽

Ashraful Alam ◽

Umi Fahmida ◽

Iwan Ariawan ◽

Christiana Rialine Titaley ◽

...

Keyword(s):

Behavior Change ◽

Pregnant Women ◽

Child Nutrition ◽

Health System Strengthening ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Child Stunting ◽

Maternal And Child Nutrition ◽

Behavior Change Interventions ◽

The Impact

Background Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. Objective This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. Methods The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. Results In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. Conclusions The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia. International Registered Report Identifier (IRRID) RR1-10.2196/18521

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Higher agrobiodiversity is associated with improved dietary diversity, but not child anthropometric status, of Mayan Achí people of Guatemala

Public Health Nutrition ◽

10.1017/s1368980018000617 ◽

2018 ◽

Vol 21 (11) ◽

pp. 2128-2141 ◽

Cited By ~ 7

Author(s):

Diana V Luna-González ◽

Marten Sørensen

Keyword(s):

Species Richness ◽

Functional Diversity ◽

Rural Areas ◽

Maternal Education ◽

Dietary Diversity ◽

Local Market ◽

Crop Species ◽

Cross Sectional ◽

Child Undernutrition ◽

Anthropometric Status

AbstractObjectiveChild undernutrition remains one of the greatest challenges for public health nutrition in rural areas in developing countries. Interventions aiming to increase and conserve agrobiodiversity seem to be promising alternatives to improve child nutrition. However, the existing literature on these interventions is not conclusive about their effectiveness in combating child undernutrition. We tested the hypothesis that ‘higher agrobiodiversity is associated with greater dietary diversity and better anthropometric status’ in rural Guatemala.Design/Setting/SubjectsIn the summer of 2016, we conducted a cross-sectional study with a sample of 154 children (6–60 months). We conducted dietary recalls and structured interviews, measured children’s weight and height, and visited food production systems (Milpas, home gardens, coffee plantations). Crop species richness, nutritional functional diversity, dietary diversity scores and anthropometric status were calculated.ResultsHigher food self-sufficiency, nutritional functional diversity and dietary diversity scores were positively correlated with higher crop and animal species richness. Contrarily, remoteness to the local market was negatively correlated with dietary diversity scores. However, higher dietary diversity scores were not correlated with better child anthropometric status. Better child anthropometric status was positively correlated with improved sanitary conditions and maternal education; and negatively correlated with large household size and frequent child morbidity.ConclusionsAgricultural diversification could diversify diets, increase nutrient availability and improve child anthropometry. However, these interventions need to be accompanied by sanitation improvements, family planning, nutritional education and women’s empowerment to strengthen their positive effect on diet and nutrition.

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SDG3-related inequalities in women’s, children’s and adolescents’ health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys

BMJ Open ◽

10.1136/bmjopen-2020-047779 ◽

2021 ◽

Vol 11 (8) ◽

pp. e047779

Author(s):

Antonio Sanhueza ◽

Liliana Carvajal-Vélez ◽

Oscar J Mújica ◽

Luis Paulo Vidaletti ◽

Cesar G Victora ◽

...

Keyword(s):

Latin America ◽

Health Inequalities ◽

Rural Areas ◽

Urban Areas ◽

National Level ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

The Sustainable Development ◽

The Caribbean ◽

Nationally Representative

ObjectivesLatin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.SettingWe studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016ParticipantsThe surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.Outcome measuresFive health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.ResultsIn most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman’s age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.ConclusionsRegional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

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