Modelling chronic malnutrition in Zambia: A Bayesian distributional regression approach

Background The burden of child under-nutrition still remains a global challenge, with greater severity being faced by low- and middle-income countries, despite the strategies in the Sustainable Development Goals (SDGs). Globally, malnutrition is the one of the most important risk factors associated with illness and death, affecting hundreds of millions of pregnant women and young children. Sub-Saharan Africa is one of the regions in the world struggling with the burden of chronic malnutrition. The 2018 Zambia Demographic and Health Survey (ZDHS) report estimated that 35% of the children under five years of age are stunted. The objective of this study was to analyse the distribution, and associated factors of stunting in Zambia. Methods We analysed the relationships between socio-economic, and remote sensed characteristics and anthropometric outcomes in under five children, using Bayesian distributional regression. Georeferenced data was available for 25,852 children from two waves of the ZDHS, 31% observation were from the 2007 and 69% were from the 2013/14. We assessed the linear, non-linear and spatial effects of covariates on the height-for-age z-score. Results Stunting decreased between 2007 and 2013/14 from a mean z-score of 1.59 (credible interval (CI): -1.63; -1.55) to -1.47 (CI: -1.49; -1.44). We found a strong non-linear relationship for the education of the mother and the wealth of the household on the height-for-age z-score. Moreover, increasing levels of maternal education above the eighth grade were associated with a reduced variation of stunting. Our study finds that remote sensed covariates alone explain little of the variation of the height-for-age z-score, which highlights the importance to collect socio-economic characteristics, and to control for socio-economic characteristics of the individual and the household. Conclusions While stunting still remains unacceptably high in Zambia with remarkable regional inequalities, the decline is lagging behind goal two of the SDGs. This emphasises the need for policies that help to reduce the share of chronic malnourished children within Zambia.

Download Full-text

Giardia Duodenalis e Desnutrição Crónica em Crianças Menores de Cinco Anos de uma Região Rural da Guiné-Bissau

Acta Médica Portuguesa ◽

10.20344/amp.2091 ◽

2013 ◽

Vol 26 (6) ◽

pp. 721

Author(s):

Sónia Centeno-Lima ◽

Vítor Rosado-Marques ◽

Filipa Ferreira ◽

Ruben Rodrigues ◽

Benjamim Indeque ◽

...

Keyword(s):

Rural Community ◽

Intestinal Parasites ◽

Giardia Duodenalis ◽

Microscopic Analysis ◽

Z Score ◽

Chronic Malnutrition ◽

Under Five ◽

Detection And Identification ◽

Geographical Regions ◽

Height For Age

Introduction: Malnutrition and infections by intestinal parasites such as Giardia duodenalis coexist in the same geographical regions, reaching the highest prevalence in developing countries. The cycle of malnutrition and infection implies that both conditions can aggravate each other and compromise the growth and development of children with special relevance for under-five. The aim of this study was to investigate the association between chronic malnutrition and infection by G. duodenalis in children under five in a rural community in Guinea-Bissau.Material and Methods: A case-control study that included 109 children aged 0 to 59 months of a rural community in Guinea-Bissau was conducted. The anthropometric assessment of children in the study identified 31 cases of chronic malnutrition (z-score height for age < -2) and 78 controls (z-score height for age ≥ -2). Microscopic examination of stools was performed for detection and identification of G. duodenalis and other parasites.Results: The microscopic analysis of stool samples revealed G. duodenalis infection in 29.0% (9/31) of cases and 35.9% (28/78) of controls. No association between the infection with G. duodenalis and chronic malnutrition in children under study could be established.Discussion and Conclusion: The results reinforce the interest in designing further studies exploring this association in differentregions and epidemiological settings, while direct to the importance of the criteria for malnutrition definition which influences the subsequent analysis.

Download Full-text

Diarrhea and associated factors among under five children in sub-Saharan Africa: Evidence from demographic and health surveys of 34 sub-Saharan countries

PLoS ONE ◽

10.1371/journal.pone.0257522 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257522

Author(s):

Getu Debalkie Demissie ◽

Yigizie Yeshaw ◽

Wallelign Aleminew ◽

Yonas Akalu

Keyword(s):

Associated Factors ◽

Maternal Education ◽

Wealth Index ◽

Water Source ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Under Five ◽

Under Five Children ◽

Sub Saharan

Introduction Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. Result The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts. Conclusion This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.

Download Full-text

A Semi-Parametric Analysis of Childhood Stunting in India: District Level Scenario

10.21203/rs.3.rs-121767/v1 ◽

2020 ◽

Author(s):

Palak Sharma ◽

Kajori Banerjee ◽

Laxmikant Dwivedi

Keyword(s):

Spatial Clustering ◽

Realistic Model ◽

District Level ◽

Parametric Models ◽

Spatial Effects ◽

Linear Association ◽

High Prevalence ◽

Non Linear ◽

Childhood Stunting ◽

Height For Age

Abstract BackgroundA growing body of literature has recognized the urgency of addressing the issue of childhood stunting (low height for age) in India and dedicated substantial resources to identifying the factors that are strongly associated with its considerable prevalence in the country. However, most of these studies have focused on parametric models with limited use of geographic information and prefixed assumption on the linear association of various factors with stunting outcomes. The present study re-investigates the non-linear association of certain covariates along with spatial effects by using a flexible Bayesian semi-parametric regression approach at the district level.MethodData is taken from the recent fourth round of the National Family Health Survey (NFHS 4, 2015-16). The analysis is based on the data from 2,24,190 children whose complete anthropometric measurements of weight and height are measured.ResultsThe paper has two major contributions. First, it challenges the pigeonholing of linear association of covariates. It identifies a non-linear association of child's age, mother's age at birth, and mother's BMI with childhood stunting. Children's height-for-age score worsens up to the age of 20 months and then stabilizes at a lower HAZ score in the states with a high prevalence of childhood stunting. Almost all high prevalence states display an inverted U association for maternal BMI suggesting that not just underweight mothers, but overweight mothers are also likely to have stunted children. Secondly, the results indicate high spatial clustering of poor performing districts in states with a high prevalence of childhood stunting. For example, the districts in the West of Bihar show significantly higher levels of childhood stunting than the ones in the East.ConclusionsThis is the first time that a flexible and realistic model has been applied to district-level data to identify regional variation and highlight the issues of pigeonholing linear association of all correlated of childhood stunting. The findings from the study is a novel attempt to rethink restrictive modeling approaches of various public health issues in a regionally diverse country such as India.

Download Full-text

Factors Associated with the Nutritional Status of Toddlers at the Limo Community Health Center, Depok City, Indonesia

International Journal of Early Childhood Special Education ◽

10.9756/int-jecse/v13i2.211110 ◽

2021 ◽

Vol 13 (2) ◽

pp. 701-706

Author(s):

Munaya Fauziah ◽

Tria Astika Endah Permatasari ◽

Dadang Herdiansyah ◽

Noor Latifah ◽

Ma’mun Murod Albarbasy ◽

...

Keyword(s):

Nutritional Status ◽

Community Health ◽

Health Center ◽

Maternal Education ◽

Family Income ◽

Community Health Center ◽

Z Score ◽

Children Under Five ◽

Under Five ◽

Nutritional Status Of Children

Undernutrition in urban areas remains a serious public health problem in Indonesia. The study aimed to find out what factors were related to the nutritional status of children under five in the working area of the Limo Community Health Center, Limo District. Depok City, Indonesia in 2019. This research was conducted in June-July 2019 using a cross-sectional study design with a sample of 118 mothers who have toddlers aged 6-59 months in the Limo Health Center work area in 2019. The sampling technique used simple random sampling. The analysis was performed using chi-square (α = 0.05). Undernutrition is defined as the condition of children under five which is determined based on the anthropometric index measurement results of body weight for age with a Z- score of -2 SD to ≤ -3 SD, while good nutrition is at a Z-score of -2 SD to 2 SD. As a result, the prevalence of undernutrition was 16.1%. As much as 50% of the respondents had high school education and mothers with low education were 32.2%. The results showed a prevalence of working mothers (13.6%), family income < Rp. 4,600,000 (52.5%), mothers with low knowledge (25.4%), male children (53.4%), poor parenting (3.4%), and mothers who did not use health services properly (3.4%). There was a significant relationship between maternal education (p = 0.004; OR: 4,813; 95% CI: 1,711-13,537), family income (p = 0.006; OR: 6.145; 95% CI: 1.68-22.43), and maternal knowledge (p = 0.007; OR: 4.389; 95% CI: 1.57-12.23) with the nutritional status of children under five in the working area of the Limo Community Health Center. The suggestion is that the Limo Community Health Center make a program to increase the knowledge capacity of mothers regarding the nutrition of their children.

Download Full-text

Thirty Days Snail Biscuit Supplementation Improved Height-for-age Z-score (HAZ) of Malnourished Children in Slum Surabaya

Amerta Nutrition ◽

10.20473/amnt.v1i1.2017.31-37 ◽

2017 ◽

Vol 1 (1) ◽

pp. 31

Author(s):

Trias Mahmudiono ◽

Zeni Firginingtyas ◽

Qonita Rachmah

Keyword(s):

Control Group ◽

P Value ◽

Z Score ◽

Achatina Fulica ◽

Children Under Five ◽

Under Five ◽

Malnourished Children ◽

Score Improvement ◽

Height For Age ◽

Weight For Age

Background: Indonesia is now still suffering from malnutrition. It was reported that at least 1.39% out of 136,155 children under-five in Surabaya were severely. Severe malnutrition caused by direct factors including infectious diseases and food intake. Therefore, an alternative to overcome that problem is crucial, such as using snail flour for a weaning food. Snail is known as one of the good protein source with complete essential amino acid.Objective: This research aims to determine the effect of snail biscuit (Achatina fulica) toward z-score improvement in severely malnourished children under five according weight for age and height for age index in Ujung sub-district, Surabaya.Methods: This was an experimental research which divided into two groups; case group that given snail biscuit for a month and control group that given coconut biscuit in a same time period. Paired t-test was done to analyze the different between before and after treatment.Results: The result showed that there was no effect of snail biscuit to weight-for-age z-score (WAZ) improvement in children under five (p-value>0.05). However, a month snail biscuit intervention improved height-for-age z-score (HAZ) in children under five (p-value=0.02); while the control group did not show significant result (p-value=0.84). The strength of intervention shown by Exp(B) value=1.02 means that children under five who consume snail biscuit for a month had 1.02 higher height-for-age z-score improvement compared to those who consumed coconut biscuit.Conclusion: It can be concluded that snail biscuit give better improvement of nutritional status based on height-for-age z-score compared to coconut biscuit in malnourished children under five. It is suggested for the intervention study to expand intervention period to 90 days similar to government supplementary feeding intervention. ABSTRAK Latar belakang: Malnutrisi masih menjadi masalah gizi utama yang dialami di Indonesia. Dinas Kesehatan Kota Surabaya pada tahun 2009 melaporkan sebesar 1,888 (1.39%) dari 136,155 balita mengalami gizi buruk. Penyebab gizi buruk terdiri dari faktor langsung dan tidak langsung, dimana faktor langsung terdiri dari penyakit infeksi dan asupan makanan. Salah satu alternatif yang dapat digunakan adalah penggunaan tepung bekicot sebagai makanan pendamping. Bekicot diketahui sebagai salah satu sumber protein dengan kandungan asam amino esensial yang lengkap.Tujuan: Penelitian ini bertujuan untuk mengetahui efek pemberian biskuit bekicot (Achatina fulica) pada perbaikan z-score berat badan menurut usia dan tinggi badan menurut usia balita gizi buruk di Kelurahan Ujung, Surabaya.Metode: Penelitian ini menggunakan desain studi eksperimental dengan pembagian dua kelompok; kelompok intervensi yang diberikan biskuit bekicot selama 30 hari dan kelompok kontrol yang diberikan biskuit kelapa dalam jangka waktu yang sama. Uji statistik yang digunakan yaitu paired t-test.Hasil: Hasil analisis menunjukkan tidak ada efek pemberian biskuit bekicot selama satu bulan pada indeks status gizi berat badan menurut umur (BB/U) (P-value>0,05). Namun, intervensi pemberian biskuit bekicot secara statistik mempengaruhi perbaikan status gizi tinggi badan menurut usia (TB/U) pada balita gizi buruk, sedangkan biskuit kelapa tidak mempengaruhi TB/U balita gizi buruk (P-value=0.84). Kekuatan pengaruh intervensi berdasarkan perhitungan Exp(B)=1.02, artinya bahwa balita gizi buruk yang mengonsumsi biskuit bekicot memiliki 1.02 kali perbaikan yang lebih baik pada status gizi TB/U dibandingkan balita yang mengonsumsi biskuit kelapa.Kesimpulan: Dapat disimpulkan bahwa biskuit bekicot dapat menjadi alternatif perbaikan status gizi balita gizi buruk. Penelitian selanjutnya disarankan dapat memperpanjang durasi intervensi hingga 90 hari seperti anjuran pemerintah dalam pemberian makan tambahan.

Download Full-text

Prevalence of pneumonia and risk factors of pneumonia mortality among children under five years.

African Journal of Current Medical Research ◽

10.31191/afrijcmr.v2i2.28 ◽

2018 ◽

Vol 2 (2) ◽

Author(s):

Francis Adjei Osei ◽

Kofi Akohene Mensah ◽

Daniel Ansong ◽

Peter Agyei-Baffour ◽

Sandra Kwarteng Owusu ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Associated Factors ◽

Maternal Education ◽

Sub Saharan Africa ◽

Primary Data ◽

Categorical Variables ◽

Children Under Five ◽

Under Five ◽

Children Under 5

BackgroundPneumonia remains the foremost cause of death in children under 5 years of age especially in sub-Saharan Africa killing nearly 1 million annually.Aim Identify pneumonia prevalence, mortality rate and associated factors among children under five admitted to Komfo Anokye Teaching Hospital (KATH) in Ghana.MethodsUsing a prospective cross-sectional study method, a consecutive sample of 157 children under 5 admitted to the KATH for pneumonia from June to August 2016 was selected. A structured questionnaire was used to collect primary data from their caregivers and secondary data from the patient record using a structured data extraction form. Continuous and categorical variables were described and chi-square test employed to determine the associated factors of pneumonia mortality. Multivariate logistics regression model was used to test for the strength of the association to unearth the risk factors of pneumonia mortality.Results The study found a prevalence of pneumonia of 18.40% with a mortality rate of 12.74%. Pneumonia mortality was found to be associated with maternal education (p<0.001), occupation (p=0.01), income (p=0.02), pneumonia severity (p<0.001) and number of rooms occupied by a household (p=0.01). In multivariate regression, severe pneumonia increased the odds of pneumonia mortality (OR=18.23, 95% CI= 4.37-76.10, p<0.001). However, maternal education showed reduced likelihood of pneumonia mortality (OR=0.59, 95% CI= 0.36-0.97, p=0.039). ConclusionPneumonia places a high burden on the health of children under five years admitted to KATH. Health workers need to sensitize caregivers on the signs and symptoms of pneumonia to aid early detection and reporting which could reduce mortality.

Download Full-text

Effect of community-based food supplementation on improving growth of underweight children under five years of age in West Nusa Tenggara

Paediatrica Indonesiana ◽

10.14238/pi57.5.2017.1595 ◽

2017 ◽

Vol 57 (5) ◽

pp. 246

Author(s):

Aman Bhakti Pulungan ◽

Dini A. Mirasanti

Keyword(s):

Normal Weight ◽

Food Supplementation ◽

Z Score ◽

Community Based ◽

Normal Height ◽

Supplementary Food ◽

Under Five ◽

Height For Age ◽

Weight For Age

Background The prevalence of underweight children in West Nusa Tenggara is as high as 30%. This region had the third largest number of stunted children in the country. The local government has attempted to tackle this problem by providing supplementary food to underweight children.Objective To assess the success of the community-based food supplementation program onimproving children’s growth in West Nusa Tenggara.Methods We conducted a prospective cohort study for 10 months in Paruga District Primary Health Care Unit, Bima, West Nusa Tenggara, in year 2012. Children were given supplementary food according to the Ministry of Health’s guidelines, consisting of formula milk, high calorie biscuits, and a 60-day supply of eggs, estimated to be sufficient to normalize their weights, for their age and sex. A child’s weight and height were measured every 3 months and the results plotted on WHO growth charts for weight-for-age, height-for-age, and weight-for-height (nutritional status). Z-score <-3 SD was classified as severely underweight, severely stunted, or severely wasted, respectively; Z-score between -2 and -3 SD was classified as underweight, stunted, or wasted, respectively; and Z–score >-2 SD was classified as normal for all three categories.Results Twenty-five children under five years of age participated in this study. Subjects’ median age was 29 months. None of the subjects had normal weight-for-age Z-score at the beginning of the study. Eighty-four percent (21/25) of the subjects were severely underweight. Only 8% (2/25) of the subjects had normal height-for-age Z-score and 88% (22/25) of them were severely stunted. However, 80% (20/25) of subjects had normal nutritional status (weight-for-height). Changes in weight-for-age Z-score varied throughout the study. The highest median score was in the tenth month of follow up (-3.82). The highest median height-for-age score and weight-for-height score were also in the last month of follow up. At the end of the study, only one subject had normal weight-for-age score (4%) and none of the subjects had normal height-for-age scores. Conclusion The 10-month supplementary food program for under-five children in the Paruga District is not successful in improving body weight and height.

Download Full-text

A Bayesian Geo-Additive Modeling of Childhood Anemia in India

10.21203/rs.3.rs-551263/v1 ◽

2021 ◽

Author(s):

Holendro Singh Chungkham ◽

STRONG P MARBANIANG ◽

Pralip Kumar Narzary

Keyword(s):

Logistic Regression ◽

Credible Interval ◽

Spatial Effect ◽

Spatial Effects ◽

Geographical Differences ◽

Wealth Status ◽

Linear Effect ◽

Northern India ◽

Continuous Covariates ◽

Non Linear

Abstract Background The geographical differences that caused anaemia can be partially explained by the variability in environmental factors, particularly nutrition and infections. The studies failed to explain the non-linear effect of the continuous covariates on childhood anaemia. The present paper aimed to investigate the risk factors of childhood anaemia in India with focus on geographical spatial effect. Methods Geo-additive logistic regression models were fitted to the data to understand fixed as well as spatial effects of childhood anaemia. Logistic regression was fitted for the categorical variable with outcomes (anaemia (Hb < 11) and no anaemia (Hb ≥ 11)). Continuous covariates were modelled by the penalized spline and spatial effects were smoothed by the two-dimensional spline. Results At 95% posterior credible interval, the influence of unobserved factors on childhood anaemia is very strong in the Northern and Central part of India. However, most of the states in North Eastern part of India showed negative spatial effects. A U-shape non-linear relationship was observed between childhood anaemia and mother’s age. This indicates that mothers of young and old ages are more likely to have children who are anaemic; in particular mothers aged 15 years to about 25 years. Then the risk of childhood anaemia starts declining after the age of 25 years and it continues till the age of around 37 years, thereafter again starts increasing. Further, the non-linear effects of duration of breastfeeding on childhood anaemia show that the risk of childhood anaemia decreases till 29 months thereafter increases. Conclusion Strong evidence of residual spatial effect to childhood anaemia in India. Government child health programme should gear up in treating childhood anaemia by focusing on known measurable factors such as mother’s education, mother’s anaemia status, family wealth status, child fever, stunting, underweight, and wasting which have been found to be significant in this study, attention should also be given to effects of unknown or unmeasured factors to childhood anaemia at the community level. Special attention to these unmeasurable factors should be focused in the states of central and northern India which have shown significant positive spatial effects.

Download Full-text

Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.

10.21203/rs.2.13778/v1 ◽

2019 ◽

Author(s):

Justice Moses K. Aheto ◽

Robert Yankson ◽

Michael Give Chipeta

Keyword(s):

Health Survey ◽

Maternal Education ◽

Demographic And Health Survey ◽

Sub Saharan Africa ◽

Multiple Births ◽

Outcome Variable ◽

Under Five ◽

Spatial Risk ◽

Increased Risk ◽

Generalised Linear Mixed Model

Abstract Background Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M was observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions can be targeted.Methods The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5,801 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results Of the total sampled under 5 children, 280 (4.83%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with AOR (9.28, 95% CI: 6.35 – 13.58) compared to singletons. Maternal education AOR (0.80, 95% CI: 0.68 – 0.93) and number of children under 5 within each household AOR (0.34, 95% CI: 0.28 – 0.41) were shown to have a protective effect. The predicted U5M risk in 2014 was at 8.3%. High altitude areas were highly associated with high U5M.Conclusion The analysis found that multiple births and high elevation are highly associated with U5M in Ghana. The high-resolution maps show areas and communities where interventions for U5M can be prioritised to have health impact.

Download Full-text