Weight-for-age malnutrition in Indonesian children, 1992-1999.
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BACKGROUND: This article measures changes over time in Indonesia in the prevalence of moderate and severe child malnutrition, and examines the factors associated with these changes. A child with a weight-for-age Z-score below -2.0 is classified as underweight and either moderately or severely malnourished. METHODS: A pooled cross-sectional dataset of 163 986 children <5 years of age from the 1992, 1995, 1998, and 1999 Indonesia Socioeconomic Household Surveys was analysed using multivariate logistic regression, and by running separate pooled regressions to calculate the effect of the each of the principal independent variables separately for each year. Robust regression techniques corrected for non-constant variance resulting from multilevel modelling. RESULTS: The overall percentage of children <5 years that are underweight decreased from 37.7% in 1992 to 28.5% in 1999. Nearly all of the gains occurred in children over one year of age. Child nutritional status improved for all major social groups in Indonesia. There was no measurable general effect of the 1997-1999 East Asian economic crisis on levels of underweight children. CONCLUSIONS: Disparities among social and economic groups have narrowed over time in Indonesia; the relatively high risk of male children compared with females has also decreased. Maternal education and economic status-as measured by quintile of adjusted per-capita household expenditures-have continued to be very strong predictors of children's nutritional outcomes. (+info)
Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial.
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OBJECTIVES: To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing. DESIGN: Cluster randomised controlled trial. SETTING: 18 clinics in three Jamaican parishes. PARTICIPANTS: 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics. INTERVENTIONS: Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials. MAIN OUTCOME MEASURES: Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires. RESULTS: Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development. CONCLUSION: Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing. (+info)
Nutritional problems in urban slum children.
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Nutritional problems like protein energy malnutrition (PEM), anemia and vitamin A deficiency continue to plague a large proportion of Indian children. The diets and nutritional status of urban slum children in India is far away from being satisfactory. The nutritional status of slum children is worst amongst all urban groups and is even poorer than the rural average. Urban migration has not provided them salvation from poverty and undernutrition. Another distressing feature is the lack of any significant improvement over the years in this population. Most common causes of malnutrition include faulty infant feeding practices, impaired utilization of nutrients due to infections and parasites, inadequate food and health security, poor environmental conditions and lack of proper child care practices. High prevalence of malnutrition among young children is also due to lack of awareness and knowledge regarding their food requirements and absence of a responsible adult care giver. With increasing urban migration in the years ahead, the problem of malnutrition in urban slums will also acquire increasing dimension unless special efforts are initiated to mitigate the health and nutrition problems of the urban poor. Improving nutritional status of urban poor requires a more direct, more focused, and more integrated strategy. (+info)
Comparison of the use of body mass index percentiles and percentage of ideal body weight to screen for malnutrition in children with cystic fibrosis.
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BACKGROUND: The Cystic Fibrosis Foundation (CFF) recommends using the percentage of ideal body weight (%IBW(CFF)) and body mass index percentiles (BMIp) to assess weight-for-height status and to screen for malnutrition. OBJECTIVE: The objective was to examine the agreement and discrepancy between the use of %IBW(CFF) and BMIp for screening malnutrition. DESIGN: Data from 13 021 children reported to the 2000 CFF Patient Registry were analyzed. RESULTS: In children of average stature (ie, height-for-age between the 25th and 75th percentiles) and aged <10 y, %IBW(CFF) corresponded closely to BMIp, and the prevalence of underweight estimated by %IBW(CFF) < 90% was similar to that by BMIp < 15th percentile. However, in children with short stature (ie, height-for-age < 25th percentile), %IBW(CFF) reflected significantly better weight-for-height status than did the BMIp, whereas the opposite trend was observed in children with tall stature (ie, height-for-age > 75th percentile). Such discrepancies averaged 8-12 percentage points when BMIp was reexpressed to the same unit and scale as %IBW(CFF). Consequently, the prevalence of underweight estimated by %IBW(CFF) < 90% was significantly lower (7.3%) than that estimated by BMIp < 15th percentile (25.7%) in children with short stature, whereas the opposite trend was found in children with tall stature (47.7% and 14.4%, respectively). Additional analyses showed that BMIp was more sensitive to, and had stronger associations with, the percentage of predicted forced expiratory volume in 1 s. CONCLUSION: Compared with BMIp, %IBW(CFF) underestimated the severity of malnutrition in children with short stature and overestimated the severity of malnutrition in children with tall stature. (+info)
Malnourished children and supplementary feeding during the war emergency in Guinea-Bissau in 1998-1999.
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BACKGROUND: Supplementary feeding programs (SFPs) are intended to mitigate the deterioration of nutritional status and the increase in mortality among malnourished children. OBJECTIVE: We investigated the effect of an SFP on malnourished children in Guinea-Bissau who were returning to their homes after having been displaced within the country because of war in 1998-1999. DESIGN: The effect of the war on the nutritional status of children aged 6-59 mo who were present in Bissau sometime from September 1998 to June 1999 was evaluated by comparing the mortality and the prevalence of malnutrition with the values expected had the war not occurred and by comparing the severity of malnutrition in malnourished children before and during the war. The quality of the SFP was also evaluated. Children with midupper arm circumference < 130 mm were provided weekly medical consultations and supplementary feeding until recovery. RESULTS: The degree of malnutrition did not increase during the war. The prevalence of malnutrition increased with the start of the war but then decreased. The mortality of malnourished children did not increase during the war. Seventy-four percent of the referred children received treatment; of those, 1% died, 67% recovered, and 32% abandoned treatment. Compliance was 89%. The recovery rate was 13.1. 1000(-1). d(-1), and the median time to recovery was 48 d. Better compliance was associated with shorter time to recovery. CONCLUSIONS: Our findings may be biased by changes in the cultural and socioeconomic background of the malnourished children. However, 3 different analyses indicated a beneficial effect of the SFP. Thus, the home-based SFP probably prevented nutritional deterioration during the war in Guinea-Bissau. (+info)
Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years.
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OBJECTIVE: Poor nutrition is thought to predispose to externalizing behavior problems, but to date there appear to have been no prospective longitudinal studies testing this hypothesis. This study assessed whether 1) poor nutrition at age 3 years predisposes to antisocial behavior at ages 8, 11, and 17 years, 2) such relationships are independent of psychosocial adversity, and 3) IQ mediates the relationship between nutrition and externalizing behavior problems. METHOD: The participants were drawn from a birth cohort (N=1,795) in whom signs of malnutrition were assessed at age 3 years, cognitive measures were assessed at ages 3 and 11 years, and antisocial, aggressive, and hyperactive behavior was assessed at ages 8, 11, and 17 years. RESULTS: In relation to comparison subjects (N=1,206), the children with malnutrition signs at age 3 years (N=353) were more aggressive or hyperactive at age 8 years, had more externalizing problems at age 11, and had greater conduct disorder and excessive motor activity at age 17. The results were independent of psychosocial adversity and were not moderated by gender. There was a dose-response relationship between degree of malnutrition and degree of externalizing behavior at ages 8 and 17. Low IQ mediated the link between malnutrition and externalizing behavior at ages 8 and 11. CONCLUSIONS: These results indicate that malnutrition predisposes to neurocognitive deficits, which in turn predispose to persistent externalizing behavior problems throughout childhood and adolescence. The findings suggest that reducing early malnutrition may help reduce later antisocial and aggressive behavior. (+info)
Methodology for estimating regional and global trends of child malnutrition.
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BACKGROUND: Child malnutrition is an important indicator for monitoring progress towards the Millennium Development Goals (MDG). This paper describes the methodology developed by the World Health Organization (WHO) to derive global and regional trends of child stunting and underweight, and reports trends in prevalence and numbers affected for 1990-2005. METHODS: National prevalence data from 139 countries were extracted from the WHO Global Database on Child Growth and Malnutrition. A total of 419 and 388 survey data points were available for underweight and stunting, respectively. To estimate trends we used linear mixed-effect models allowing for random effects at country level and for heterogeneous covariance structures. One model was fitted for each United Nation's region using the logit transform of the prevalence and results back-transformed to the original scale. Best models were selected based on explicit statistical and graphical criteria. RESULTS: During 1990-2000 global stunting and underweight prevalences declined from 34% to 27% and 27% to 22%, respectively. Large declines were achieved in Eastern and South-eastern Asia, while South-central Asia continued to suffer very high levels of malnutrition. Substantial improvements were also made in Latin America and the Caribbean, whereas in Africa numbers of stunted and underweight children increased from 40 to 45, and 25 to 31 million, respectively. CONCLUSION: Linear mixed-effect models made best use of all available information. Trends are uneven across regions, with some showing a need for more concerted and efficient interventions to meet the MDG of reducing levels of child malnutrition by half between 1990 and 2015. (+info)
Malaria and nutritional status in children living on the coast of Kenya.
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BACKGROUND: The relation between malnutrition and malaria is controversial. On the one hand, malaria may cause malnutrition, whereas on the other hand, malnutrition itself may modulate susceptibility to the disease. OBJECTIVE: The objective was to investigate the association between Plasmodium falciparum malaria and malnutrition in a cohort of Kenyan children. DESIGN: The study involved the longitudinal follow-up of children aged 0-95 [corrected] mo for clinical malaria episodes and anthropometric measurements through 4 cross-sectional surveys. We used Poisson regression analysis to investigate the association between malaria and nutritional status. RESULTS: The crude incidence rate ratios (IRRs) for malaria during the 6-mo period before assessment in children defined as malnourished on the basis of low height-for-age or low weight-for-age z scores (<-2) were 1.17 (95% CI: 0.91, 1.50; P=0.21) and 0.94 (0.71, 1.25; P=0.67), respectively, which suggests no association between malaria and the subsequent development of protein-energy malnutrition. However, we found that age acted as an effect modifier in the association between malaria episodes and malnutrition on prospective follow-up. The IRR for malaria in children aged 0-2 y, who were subsequently characterized as underweight, was 1.65 (1.10, 2.20; P=0.01), and a significant overall relation between malaria and stunting was found on regression analysis after adjustment for the interaction with age (IRR: 1.91; 1.01, 3.58; P=0.04). CONCLUSION: Although children living on the coast of Kenya continue to experience clinical episodes of uncomplicated malaria throughout the first decade of life, the effect of malaria on nutritional status appears to be greatest during the first 2 y of life. (+info)