By pooling the results from five previously published prospective studies the relative risks of mortality were estimated among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates along with global malnutrition prevalence data were then used to calculate the total number of young childhood deaths attributable to malnutrition in developing countries. Children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts ( > 80% of the median reference weight-for-age). The relative risk of mild-to-moderate malnutrition was 1.2-3.5 compared with the reference categories of better nourished children whose expected weight-for-age was greater than either 75% or 80% of the median value. Severely malnourished children ( < 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year in developing countries an estimated 1251280 excess deaths occur in mild-to-moderately malnourished children aged 6-60 months while 1067268 excess deaths occur in severely malnourished children: in total 2318548 deaths. These excess deaths represent 41% of all deaths in this age group or 21% of all deaths among under-5-year-olds. The relative risk of severe malnutrition ranged from 3.1 to 19.2 compared with the reference categories. A test for heterogeneity indicated that there were significant differences between the study relative risks (P <0.005). The pooled relative risk was 6.8; the overall association was highly significant (P <0.001). Child survival programs should assign greater priority to the control of childhood malnutrition.

[Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact]

In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01–2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01–2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07–0.46). A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be over-emphasized.

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The double burden of malnutrition in a rural health and demographic surveillance system site in South Africa: a study of primary schoolchildren and their mothers

Malnutrition is a considerable contributor to child mortality and morbidity. Child malnutrition further affects the country’s economic development. Child malnutrition in South Africa is persistent, continuing to be an alarming burden. The nutritional status of kids under the age of five years is a critical indicator of the country’s economic condition and health status. An understanding of the influencers of the nutritional status of children can act as a catalyst in combatting all forms of malnutrition. The purpose of this paper was to review selected studies concerning the factors that affect the nutritional status of children in South Africa. Studies were selected from electronic databases, which were PubMed, Google Scholar, Science Direct, Sabinet African Journals, and the University of Zululand library catalog. The keywords that were used to search studies and articles from the selected database were: risk factors, child nutritional status, children under the age of five years, South Africa, malnutrition, underweight, stunted, wasting, and over-nutrition. Studies and surveys published from 2010–2019 that reported on the factors influencing the nutritional status of children under the age of five years were included in this review. Twenty-seven articles met the inclusion criteria of the study. The 27 articles were made up of 21 cross-sectional articles and six longitudinal articles. The finding from this review highlights that there is a lack of studies conducted in urban areas. The results show that the nutritional status of children is affected by several factors. These include household food insecurity, low household income, illiterate caregivers, unemployment, inadequate dietary intake, low birth weight, consumption of monotonous diets, poor caregiver’s nutritional knowledge, poor access to water and sanitation, poor weaning practices, age of the caregiver, and demographic characteristics of a child (age and gender). It is critical to have an understanding of the factors that affect the nutritional status of children. Such knowledge can significantly contribute to formulating policies that can enhance nutrition security and the country’s economy. Moreover, insights into strategic interventions to eradicate all forms of malnutrition can be made.

A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa.

OBJECTIVES According to a recent survey, Pakistan was ranked as the third highest country with malnutrition and the under-five child mortality No realistic solution for this growing problem has been found despite the fact that the struggle to tackle the issue of malnutrition among young Pakistani children has been going on for the last several decades The objective of our study was to look into the relationship between parental education and malnutrition in Pakistan and to make a recommendation to improve the nutritional condition of the children METHOD We carried a case-control study among 400 mothers from February 2016 to July 2016 in a primary health care center located in a peri-urban community in Pakistan A self-constructed questionnaire comprising of 75 questions was used to collect the data RESULTS The mean age of mother was found to be 2761 ± 5130 The majority of the mothers were uneducated 168 (420%) while only 116 (290%) fathers were uneducated About 226 (565%) of the children had a normal nutritional status while 102 (255%) had first-degree malnutrition, 52 (130%) had second-degree malnutrition, and 20 (50%) had a third-degree malnutrition Higher paternal educational status (p = 0008) and maternal educational status (p = 0011) were found to be significantly associated with normal child nutritional status CONCLUSION It is recommended that the education of parents, especially females, in the rural and semi-urban areas should be promoted and given due importance The focus of all these programs should be the mother in terms of security, employment, literacy, justice, healthcare, food, shelter, and social equality

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The Role of Parents' Literacy in Malnutrition of Children Under the Age of Five Years in a Semi-Urban Community of Pakistan: A Case-Control Study.

Monitoring of undernutrition and parasitic infection are essential to design appropriate intervention strategies. The aim of this study was to assess the prevalence of undernutrition, intestinal parasitic infection and their associated risk factors among school children in Bahir Dar, Ethiopia. A school-based cross-sectional survey was conducted from February to June 2014 among 382 students selected from primary schools in Bahir Dar. The study subjects were selected by a systematic random sampling method. Sociodemographic data from students and their family/guardians were obtained using structured questionnaire. Height and weight of the students were measured using a standard calibrated balance. Fresh fecal samples were collected and processed using formalin-ether concentration technique. The data were analyzed using SPSS version 20.0 statistical software. The overall prevalence of undernutrition was 41.6% (18.3% stunted, 26.7% thinness and 25.9% underweight). Meal frequency ≤ 3 times a day (AOR=4.11; 95% CI: 2.23–7.59) and family monthly income <500 birr (AOR=5.87; 95% CI: 2.61–13.23) were important predictors of undernutrition. The risk of stunting was increased among students with meal frequency ≤ 3 times a day (AOR=5.56; 95% CI: 2.97–10.41) and age ranges from 9-10 years (AOR=3.02; 95% CI: 1.41–6.47). The odds of thinness was significantly increased among students with parasitic infection (AOR=1.92; 95% CI: 1.15–3.19) and family monthly income <1500 birr (AOR=2.69; 95% CI: 1.16–6.26). The likelihood of being underweight was increased among students infected with intestinal parasites (AOR=2.43; 95% CI: 1.40–4.22). The overall prevalence of intestinal parasitosis was 52.4%. The risk of parasitic infection was significantly increased among students with unclean fingernails (AOR=4.96; 95% CI: 2.79–8.82) and irregular hand washing habit (AOR=8.05; 95% CI: 4.66–13.89). This study revealed that undernutrition and intestinal parasitic infection were public health problems among school children in the study areas. These results highlight the importance for integrated efforts to address undernutrition and parasitic infection.

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Undernutrition, intestinal parasitic infection and associated risk factors among selected primary school children in Bahir Dar, Ethiopia.

Child malnutrition is a major public health concern worldwide, leading to higher morbidity and mortality. It is mostly preventable through public health and economic development. The aim of the present study was to determine socio-economic factors associated with nutritional status among children in plantation communities, Sri Lanka. A cross-sectional study was performed among preschool and school going children in three rural communities of Sri Lanka from January to August 2014. Demographic and household characteristics were documented and anthropometric measurements were collected to calculate weight-for-age (WAZ), height-for-age (HAZ) and BMI-for-age (BAZ). Anthroplus, epiinfo and SPSS versions were used for the analysis of data. A total of 547 children (aged 1–15 years, mean 7.0 ± 3.6 years, 53% female) participated in the study. 35.6%, 26.9% and 32.9% of children were underweight, stunting and wasting respectively. Undernutrition was more common in primary school children. Maternal employment, high number of siblings, high birth orders and female children were significantly associated with undernutrition among preschool children. Living in small houses, large number of family members, low monthly income and maternal employment were significantly associated with undernutrition among school children. Child undernutrition is a major public health concern in the plantation sector, Sri Lanka. Health education programs among the study population could be effective for solving the problem.

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G.L.S. Galgamuwa

Papers

Nutritional status and correlated socio-economic factors among preschool and school children in plantation communities, Sri Lanka.