Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017

Abstract Background Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children’s growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration. Methods Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p]. Results In 1991–2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (− 1.0 vs − 1.2; p < 0.001) and WAZ (− 0.3 vs − 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration. Conclusions Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.

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Urbanization and the Double Burden: Trends and Inequalities in Under- and Over-nutrition by Residence and Wealth Among 1.22 Million Indian Children, Women and Men over 10 Years (P10-078-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-078-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Phuong Nguyen ◽

Samuel Scott ◽

Rasmi Avula ◽

Aishwarya Agarwal ◽

Purnima Menon ◽

...

Keyword(s):

Urban Areas ◽

Activity Levels ◽

Residential Areas ◽

Indian Children ◽

Double Burden ◽

The Past ◽

The Poor ◽

Rate Of Increase ◽

Double Burden Of Malnutrition ◽

Overweight Prevalence

Abstract Objectives We examined trends and inequities in the double burden of malnutrition among girls, boys, women and men by residence and wealth between 2006 and 2016 in India where 590 million individuals are expected to live in cities by 2030. Methods Two rounds of National Family Health Survey data collected in 2006 and 2016 (n = 276,000 children 0–59 mo; 768,000 women 15–49y; and 178,000 men 15–54y) were used. Residence was categorized as rural (RUR), urban non-slum (U-NS) and urban slum (U-SL). Multivariate regression analyses were used to examine differences and changes over time in outcomes by residential group and gender. A socioeconomic status (SES) index was created for each residential area and inequalities were assessed using concentration and slope indices. Results Children in different residential areas were born with similar height-for-age Z-scores, but growth faltering during the first two years of life was most rapid among children in RUR areas, followed by U-SL and U-NS areas. Boys and girls were equally likely to be stunted (48% in 2006 to 38% in 2016) or overweight (7–8% at both times). SES gaps were large for undernutrition, small for overnutrition, and did not change greatly in the past decade. Among adults, underweight prevalence decreased equally across residential areas (4–5%) to reach 20% on average in both men and women. Overweight prevalence increased more rapidly among those living in RUR areas (7–9%) compared to U-SL (4–6%) and U-NS (1–3%) areas, and also reached ∼20%. The SES gap for underweight was narrower in 2016 than in 2006, mainly due to improvements among the poor in all residential areas. Overweight prevalence increased in all SES quintiles in RUR and U-SL areas and increased among the poor in U-NS areas. Conclusions The double burden of malnutrition is now a reality among adults in India. Although undernutrition has been reduced in both rural and urban areas over the past decade, the rate of increase in overweight was much larger in rural compared to urban areas; and more so in slums compared to non-slum areas. A further examination of changing living conditions, food environments, and physical activity levels is needed to identify and address the causes for these rapid changes in nutrition outcomes. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by IFPRI.

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Estimating the Double Burden of Malnutrition among 595,975 Children in 65 Low- and Middle-Income Countries: A Meta-Analysis of Demographic and Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162886 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2886 ◽

Cited By ~ 3

Author(s):

Blessing J. Akombi ◽

Stanley Chitekwe ◽

Berhe W. Sahle ◽

Andre M.N. Renzaho

Keyword(s):

Health Surveys ◽

Meta Analysis ◽

Demographic And Health Surveys ◽

Double Burden ◽

Middle Income ◽

Children Under Five ◽

Under Five ◽

Middle Income Countries ◽

Double Burden Of Malnutrition ◽

Low And Middle Income

Introduction: Given the changing global nutrition landscape, the double burden of malnutrition is a major public health challenge in many developing countries. The main aim of this study is to estimate the double burden of malnutrition among children in low- and middle-income countries (LMICs). Methods: This study used cross-sectional data from Demographic and Health Surveys (2001–2016). A meta-analysis was conducted to estimate the prevalence of malnutrition indicators in 595,975 children under five years from 65 LMICs. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random-effect model was used. Sensitivity analysis was also performed, to examine the effects of outliers. Results: The pooled estimate for stunting, wasting, underweight, and overweight/obesity was 29.0%, 7.5%, 15.5%, and 5.3% respectively. Countries with the highest coexistence of undernutrition and overweight/obesity were: South Africa (stunting 27.4% (95% CI: 25.1, 29.8); overweight/obesity 13.3% (95% CI: 11.5, 15.2)), Sao Tome and Principe (stunting 29.0% (95% CI: 26.8, 31.4); overweight/obesity 10.5% (95% CI: 9.0, 12.1)), Swaziland (stunting 28.9% (95% CI: 27.3, 30.6); overweight/obesity 10.8% (95% CI: 9.7, 12.0)), Comoros (stunting 30.0% (95% CI: 28.3, 31.8); overweight/obesity 9.3% (95% CI: 8.3, 10.5)), and Equatorial Guinea (stunting 25.9% (95% CI: 23.4, 28.7); overweight/obesity 9.7% (95% CI: 8.0, 11.6)). Conclusions: There is an urgent need to strengthen existing policies on child malnutrition to integrate and scale up opportunities for innovative approaches which address the double burden of malnutrition in children under five years in LMICs.

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Socioeconomic inequalities in child growth failure in Ethiopia: findings from the 2000 and 2016 Demographic and Health Surveys

BMJ Open ◽

10.1136/bmjopen-2021-051304 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051304

Author(s):

Tolesa Bekele ◽

Patrick Rawstorne ◽

Bayzidur Rahman

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Growth Failure ◽

Wealth Quintile ◽

Child Growth ◽

Socioeconomic Inequalities ◽

Geographical Region ◽

Demographic And Health Surveys ◽

Maternal Body Mass Index ◽

Geographical Regions

ObjectiveSocioeconomic inequalities in child growth failure (CGF) remain one of the main challenges in Ethiopia. This study examined socioeconomic inequalities in CGF and determinants that contributed to these inequalities in Ethiopia.MethodsThe Ethiopia Demographic and Health Surveys 2000 and 2016 data were used in this study. A pooled unweighted sample of the two surveys yielded 21514 mother–child pairs (10873 in 2000 and 10641 in 2016). We assessed socioeconomic inequalities in CGF indicators using the concentration curve and concentration index (CI). We then decomposed the CI to identify percentage contribution of each determinant to inequalities.ResultsSocioeconomic inequalities in CGF have increased in Ethiopia between 2000 and 2016. The CI increased from −0.072 and −0.139 for stunting, −0.088 and −0.131 for underweight and −0.015 and −0.050 for wasting between 2000 and 2016, respectively. Factors that mainly contributed to inequalities in stunting included geographical region (49.43%), number of antenatal care visits (31.40%) and child age in months (22.20%) in 2000. While in 2016, inequality in stunting was contributed mainly by wealth quintile (46.16%) and geographical region (−13.70%). The main contributors to inequality in underweight were geographical regions (82.21%) and wealth quintile (27.21%) in 2000, while in 2016, wealth quintile (29.18%), handwashing (18.59%) and access to improved water facilities (−17.55%) were the main contributors. Inequality in wasting was mainly contributed to by maternal body mass index (−66.07%), wealth quintile (−45.68%), geographical region (36.88%) and paternal education (33.55%) in 2000, while in 2016, wealth quintile (52.87%) and urban areas of residence (-17.81%) were the main driving factors.ConclusionsThis study identified substantial socioeconomic inequalities in CGF, and factors that relatively contributed to the disparities. A plausible approach to tackling rising disparities may involve developing interventions on the identified predictors and prioritising actions for the most socioeconomically disadvantaged groups.

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Urban–Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991–2016

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105184 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5184

Author(s):

Wenjun Zhu ◽

Si Zhu ◽

Bruno F. Sunguya ◽

Jiayan Huang

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Demographic And Health Surveys ◽

Household Level ◽

Individual Level ◽

Child Stunting ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Urban Rural ◽

The Individual

Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas.

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Complementary feeding practices and child growth outcomes in Haiti: an analysis of data from Demographic and Health Surveys

Maternal and Child Nutrition ◽

10.1111/mcn.12090 ◽

2013 ◽

Vol 11 (4) ◽

pp. 815-828 ◽

Cited By ~ 12

Author(s):

Rebecca A. Heidkamp ◽

Mohamed Ag Ayoya ◽

Ismael Ngnie Teta ◽

Rebecca J. Stoltzfus ◽

Joseline Pierre Marhone

Keyword(s):

Health Surveys ◽

Complementary Feeding ◽

Feeding Practices ◽

Child Growth ◽

Demographic And Health Surveys ◽

Growth Outcomes

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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 of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03457-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aaisha Amjad ◽

Abeeha Imran ◽

Nabeeha Shahram ◽

Rubeena Zakar ◽

Ahmed Usman ◽

...

Keyword(s):

Caesarean Section ◽

Urban Areas ◽

Health Surveys ◽

Secondary Data ◽

Demographic And Health Surveys ◽

Independent Variables ◽

Economic Class ◽

The Past ◽

Child Bearing ◽

Socio Demographic Factors

Abstract Background Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. Methods Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990–91, 2006–07, 2012–13 and 2017–18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). Results The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births. Conclusions The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.

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Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys

Bulletin of the World Health Organization ◽

10.2471/blt.15.152462 ◽

2016 ◽

Vol 94 (5) ◽

pp. 331-339 ◽

Cited By ~ 27

Author(s):

Jeanne Chai ◽

Günther Fink ◽

Sylvia Kaaya ◽

Goodarz Danaei ◽

Wafaie Fawzi ◽

...

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Health Surveys ◽

Intimate Partner ◽

Child Growth ◽

Demographic And Health Surveys ◽

Poor Child

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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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Socio-economic differentials in minimum dietary diversity among young children in South-East Asia: evidence from Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980018002173 ◽

2018 ◽

Vol 21 (16) ◽

pp. 3048-3057 ◽

Cited By ~ 1

Author(s):

Chloe M Harvey ◽

Marie-Louise Newell ◽

Sabu S Padmadas

Keyword(s):

Young Children ◽

Rural Areas ◽

Urban Areas ◽

Health Surveys ◽

Dietary Diversity ◽

East Asian ◽

Outcome Variable ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Minimum Dietary Diversity

AbstractObjectiveTo investigate the socio-economic differentials underlying minimum dietary diversity (MDD) among children aged 6–23 months in three economically diverse South-East Asian countries.DesignThe outcome variable MDD was defined as the proportion of children aged 6–23 months who received foods from four of the seven recommended food groups within the 24 h prior to interview. The association between socio-economic factors and MDD, adjusting for relevant characteristics, was examined using logistic regression.SettingWe used cross-sectional population data from recent Demographic and Health Surveys from Cambodia (2014), Myanmar (2015–16) and Indonesia (2012).SubjectsTotal of 8364 children aged 6–23 months.ResultsApproximately half of all children met the MDD, varying from 47·7 % in Cambodia (n1023) to 58·2 % in Indonesia (n2907) and 24·6 % in Myanmar (n301). The likelihood (adjusted OR; 95 % CI) of meeting MDD increased for children in the richest households (Cambodia: 2·4; 1·7, 3·4; Myanmar: 1·8; 1·1, 3·0; Indonesia: 2·0; 1·6, 2·5) and those residing in urban areas (Cambodia: 1·4; 1·1, 1·9; Myanmar: 1·7; 1·2, 2·4; Indonesia: 1·7; 1·5, 1·9). MDD deprivation was most severe among children from the poorest households in rural areas. The association between mother’s labour force participation and MDD was positive in all three countries but reached significance only in Indonesia (1·3; 1·1, 1·5).ConclusionsMDD deprivation among young children was significantly high in socio-economically disadvantaged families in all three study settings. MDD requirements are not being met for approximately half of young children in these three South-East Asian countries.

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