The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis

IntroductionChildhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity.MethodsWe conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results.ResultsOur network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6–66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8–34.6) and 40.9% (range 14.7–69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively.ConclusionsThe risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.

Contribution of Low Birth Weight to Childhood Malnutrition in India

Background Although Low birth weight (LBW) is an independent predictor of malnutrition, it is still a negligible public health issue in the Indian context. Where, a large number of children died due to complications from maternal and child malnutrition. Furthermore, each year, India loses its GDP due to the cost of micronutrient malnutrition which is more that the public health budget. MethodsTo conduct the study, 4th round of the National Family Health Survey (NFHS-4), a large-scale survey was used. The study used the last birth information (190,898) due to the detailed availability of maternal care information. The univariate and bivariate analysis was done to find out the percentage distribution. Further, a logistic regression was applied to examine the association between LBW and malnutrition (stunting, wasting, and underweight). The study also employed the Fairlie decomposition technique to estimate the contribution of LBW to malnutrition among Indian children. ResultsThe estimated result shows that childhood malnutrition was higher in most of the Empowered Action Group (EAG) states of India. Furthermore, the infant who was born with low birth weight was more likely to have stunted (OR=1.67; 95% CI: 1.60-1.75), wasting (OR=1.32; 95% CI: 1.26-1.39), and underweight (OR=1.44; 95% CI: 1.38-1.51) in their childhood as compared to infants with no low birth weight. The findings of the decomposition model explained 19 % of the difference in stunting, 12% in wasting, and 16% in underweight among the children born with low birth weight after controlling for background characteristics of the individuals. Other variables such as wealth status, mother’s education, height, mother’s age at birth, and sanitation facility were the significant contributors to childhood malnutrition in India. ConclusionsAlthough many nutrient-centric programmes are going on to control the nutrition status of children, the Indian government should focus more on control LBW. As LBW has a significant contribution to malnutrition, the study recommends that government should take all the necessary steps to implement and monitor some special schemes like the Kangaroo Mother Care (KMC) at the ground level to reduce the burden of LBW.

Malnutrition in children under the age of 5 years in a primary health care setting

In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.

Poverty and childhood malnutrition: Evidence-based on a nationally representative survey of Bangladesh

Background Malnutrition contributes to children’s morbidity and mortality, and the situation undermines the economic growth and development of Bangladesh. Malnutrition is associated with lower levels of education that decrease economic productivity and leads to poverty. The global burden of malnutrition continues to be unacceptably high amid social and economic growth, including in Bangladesh. Therefore, identifying the factors associated with childhood malnutrition and poverty is necessary to stop the vicious cycle of malnutrition leaded poverty. Methods The study utilized the 2017–18 Bangladesh Demographic and Health Survey (BDHS), accumulating 7,738 mother-child pairs. Associations between potential risk factors and nutritional status were determined using chi-square tests, and multivariate logistic regression models were utilized on significant risk factors to measure their odds ratio (OR) with their 95% confidence intervals (CI). Results The prevalence of moderate and severe wasting was 7.0% and 1.8%, respectively, whereas the prevalence of moderate and severe stunting was 19.2% and 8.0%, while 16.4% and 3.6% of children were moderately and severely underweight. Children from the poorest and poor households were suffering from at least one form of malnutrition. Adjusted ORs were estimated by controlling socio-economic and demographic risk factors, such as poor maternal body mass index, parents’ lower education level, use of unhygienic toilet, child age in months, and recent experience of diarrhea and fever. The pattern was almost similar for each malnutrition status (i.e., stunting, underweight, and wasting) in the poorest and poor households. Conclusion Bangladesh achieved the Millennium Development Goals, focusing primarily on health-related indicators and working to achieve the Sustainable Development Goals. Even considering this success, the prevalence of malnutrition and poverty in same household remains relatively high compared to other developing countries. Therefore, the study recommends the implementation of nationwide systematic measures to prevent poverty and malnutrition.

Malnutrition and Gut Microbiota in Children

Malnutrition continues to threaten the lives of millions across the world, with children being hardest hit. Although inadequate access to food and infectious disease are the primary causes of childhood malnutrition, the gut microbiota may also contribute. This review considers the evidence on the role of diet in modifying the gut microbiota, and how the microbiota impacts childhood malnutrition. It is widely understood that the gut microbiota of children is influenced by diet, which, in turn, can impact child nutritional status. Additionally, diarrhoea, a major contributor to malnutrition, is induced by pathogenic elements of the gut microbiota. Diarrhoea leads to malabsorption of essential nutrients and reduced energy availability resulting in weight loss, which can lead to malnutrition. Alterations in gut microbiota of severe acute malnourished (SAM) children include increased Proteobacteria and decreased Bacteroides levels. Additionally, the gut microbiota of SAM children exhibits lower relative diversity compared with healthy children. Thus, the data indicate a link between gut microbiota and malnutrition in children, suggesting that treatment of childhood malnutrition should include measures that support a healthy gut microbiota. This could be of particular relevance in sub-Saharan Africa and Asia where prevalence of malnutrition remains a major threat to the lives of millions.

Healthcare providers and caregivers’ perspectives on factors responsible for persistent malnutrition of under 5 children in Buhweju district, South Western Uganda; a phenomenological qualitative study

Background Unacceptably high levels of childhood malnutrition have been registered in all regions of Uganda over the years. Buhweju district alone contributed 46% prevalence of childhood malnutrition to the 47.8% estimated national prevalence for the whole of western Uganda in 2014. This study assessed health provider and caregiver opinions on factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Methods In this phenomenological qualitative study, we conducted two key informant interviews and six focus group discussions with Village Health Team members and care takers of under five children in Engaju and Nyakishana sub-counties respectively.to explore their opinions on the factors responsible for persistent malnutrition in Buhweju District in May 2018. Data were thematically analyzed manually and using Atals Ti 7.5. Results Historical and geographical challenges, poverty and economic occupation, parental alcoholism and domestic violence as well as inadequate childcare services were identified as factors responsible for persistent malnutrition among under five children in Engaju and Nyakishana sub counties. Conclusion Persistent malnutrition in under five children is mainly due to historical and geographical challenges and its associated factors that include poverty and economic occupation, parental alcoholism and domestic violence and inadequate childcare services. Thus literacy education for mothers and young adolescent boys and girls through engaging local leaders, local nongovernmental organizations and Companies operating in the district to contribute to social services provision would limit the domestic violence and increase sensitization on male responsibilities in the children care in Buhweju district.