Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence

In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status

Quantifying the increased risk of illness in malnourished children: a global meta-analysis and propensity score matching approach

Background: Childhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity. Methods: We performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort. Results: The IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively. Conclusions: Our study revealed a correlation between specific childhood malnutrition subtypes—double-burden malnutrition and wasting—and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition

Income and education disparities in childhood malnutrition: a multi-country decomposition analysis

Introduction: Childhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition. Methods: This study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors. Results: We examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child’s age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries. Conclusion: The prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country’s specific context

Association between gender-based violence and hypertension among women in the Kyrgyzstan Republic

Background: Gender-based violence (GBV) is a significant global public health problem and the most prominent human rights violation severely impacting women’s health and wellbeing. Therefore, the aim of this study is to evaluate the association between gender-based violence and hypertension in Kyrgyzstan Republic. Methods: This study was conducted using population-based data of women from the 2018 Kyrgyzstan Demographic and Health Survey. The odds ratio was calculated to measure the association between GBV and hypertension, and p-values < 0.005 was considered statistically significant. Result: We included data of 4793 participants, and 621 (13%) of them had hypertension. Participants exposed to GBV were 24% more likely to have hypertension than unexposed participants (OR = 1.24, 95% CI: 1.03–1.48). Of all women with hypertension, 206 (33.0%) were exposed to GBV. Participants with secondary education or higher exposed to GBV were 24% more likely to be hypertensive than GBV unexposed women with the same education levels OR = 1.24, 95% CI: 1.04–1.49). Unemployed participants exposed to GBV were 45% more likely to develop hypertension than their unexposed counterparts (OR = 1.45, 95%CI: 1.15–1.81). Rural residents exposed to GBV were also 29% more likely to have hypertension than those unexposed to GBV (OR = 1.29, 95% CI: 1.04–1.59). The odds of hypertension among those exposed to GBV increase with age. Conclusion: The study revealed that GBV is a significant factor of having hypertension among Kyrgyz women

Individual and contextual factors associated with childhood malnutrition : a multilevel analysis of the double burden of childhood malnutrition in 27 countries

Background Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality. In recent times, the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual, household or population level and/or at different times in life. The objective of this study was to examine individual, neighborhood and country level factors that are associated with the double burden of childhood malnutrition. Methods We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low- and middle-income countries. We analyzed data of 138,782 children (level 1) living in 13,788 communities (level 2) from 27 countries (level 3). Results The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5% in Burundi to as high as 29.5% in Timor Leste. After adjusting for all level factors, we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey, were part of a multiple birth, were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 44.3% and 21.0% of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively. Conclusions Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors. Therefore, strategies in tackling the double burden of malnutrition must consider these shared drivers, contextual barriers and geographical clustering effects

Assessing Africa’s child survival gains and prospects for attaining SDG target on child mortality

This study assessed Africa’s child survival gains and prospects for attaining Sustainable Development Goals (SDG) target 3.2. We analysed multiple country-level secondary datasets of 54 African countries and presented spatial analysis. Results showed that only 8 out of the 54 African countries have achieved substantial reductions in under-5 mortality with an under-five mortality rate (U5MR) of 25 deaths per 1,000 live births or less. Many countries are far from achieving this target. Results of the predictions using supervised machine learning on the Bayesian network reveal that the probability of achieving the SDG target 3.2 (i.e., having U5MR of 25 deaths per 1000 live births or less) increases (from 21.6% to 100%) when the contraceptive prevalence increases from 49.8% to 78.5%; and the use of skilled birth attendants increases from 44.8% to 86.3%; and percentage of secondary school completion of female increases from 42.5 to 74.0%. Our results from Local indicator of spatial autocorrelation (LISA) cluster maps show that 7 countries (mainly in West/Central Africa) formed the high-high clusters (hotspots for U5M) and may not achieve the SDG target 3.2 unless urgent and appropriate investments are deployed. As 2030 approaches, there is a need to address the problem of limited access to quality health care, female illiteracy, limited access to safe water, and poor access to quality family planning services, particularly across many sub-Saharan African countries

Obesity burden by socioeconomic measures between 2000 and 2018 among women in sub‐Saharan Africa : a cross‐sectional analysis of demographic and health surveys

Background: The increasing global burden of obesity especially in low‐and‐middle‐income countries (LMICs) accentuates the need for critical action. In the absence of evidence‐based approaches to mitigate recent obesity trends, the likelihood of reaching global obesity targets will be almost zero. Objective: This study examined the obesity prevalence in Sub‐Sahara Africa and observed transitions on the burden of obesity prevalence over time. Methods: Data from the Demographic and Health Survey which is based on cross sessional design was used. Most recent surveys carried out in 16 sub‐Saharan Africa (SSA) between 2000 and 2018 were included in the analysis. Equiplot by the International Centre for Equity was used to display the inequities by the following socioeconomic measures: wealth index, education, and place of residence. Age‐standardized prevalence was measured across these socioeconomic measures using the WHO standard population age distribution, examined changing trends and finally assessed transition in obesity prevalence by percentage point difference of highest and lowest prevalence within each of the three socioeconomic measures. Results: A total of 496,482 women were included in the analysis. Obesity prevalence among women varied substantially, from 2% in Chad to 27% in Lesotho. Variation in obesity prevalence was observed across countries and by socioeconomic status measures. Among women in all the countries except Comoros, the burden was concentrated among the wealthiest. Out of the 16 countries included, the prevalence of obesity was concentrated among women with no education in eight countries (Benin, Burundi, Chad, Cote d'Ivoire, Guinea, Mali, Niger, Comoros) while it was concentrated in those with primary education in Congo and Lesotho and among those with secondary school education in DR Congo, Gabon, Namibia, Nigeria, and Zimbabwe. The burden of obesity was more concentrated in the urban across the 16 countries except in Comoros and Lesotho where they were higher in the rural (8.9 [7.2, 11.1] and 15.1 [13.0, 17.5] respectively) than in urban (6.6 [5.0, 8.8] and 6.8 [5.2, 8.8] respectively). Finally, the trend analysis with five countries indicated that the prevalence and gap in obesity among women increased between previous and most recent surveys except in Zimbabwe where it reduces across the three socioeconomic measures between 2011 and 2018. Conclusions: This study examined transition in obesity prevalence among women across three socioeconomic measures in selected sub‐Saharan African countries. Increasing prevalence of obesity was found in SSA but transition to women in lower socioeconomic status is already taking place in some countries

Factors influencing cervical cancer screening practice among female health workers in Nigeria: A systematic review

BACKGROUND: Cervical cancer is the most prevalent gynaecologic cancer in Nigeria. Despite being largely preventable through screening, cervical cancer is the second leading cause of cancer morbidity and mortality in Nigeria. To reduce the burden of cervical cancer in Nigeria, female health workers (FHWs) are expected to play an influential role in leading screening uptake and promoting access to cervical cancer education and screening. AIM: The aim of this systematic review is to assess the factors influencing cervical cancer screening (CCS) practice among FHWs in Nigeria. METHODS: We conducted a systematic literature search across six (6) electronic databases namely MEDLINE, Embase, Scopus, African Index Medicus, CINAHL, and Web of Science between May 2020 and October 2020. Reference list and grey literature search were conducted to complement database search. Four reviewers screened 3171 citations against the inclusion criteria and critically appraised the quality of eligible studies. Narrative synthesis was used in summarising data from included studies. RESULTS: Overall, 15 studies met the inclusion criteria and were all quantitative cross‐sectional studies. Included studies sampled a total of 3392 FHWs in Nigeria. FHWs had a high level of knowledge and positive attitude towards CCS. However, CCS uptake was poor. Predominant barriers to CCS uptake were the cost of screening, fear of positive results, lack of test awareness, reluctance to screen, low‐risk perception, and lack of time. In contrast, being married, increasing age, awareness of screening methods, and physician recommendation were the most documented facilitators. CONCLUSION: This study revealed that a complex interplay of socioeconomic, structural, and individual factors influences CCS among FHWs in Nigeria. Therefore, implementing holistic interventions targeting both health system factors such as cost of screening and infrastructure and individual factors such as low‐risk perception and fear of positive result affecting FHWs in Nigeria is critical to reducing the burden of cervical cancer

Neighbourhood effect and inequality in access to essential health services among mother–child paired samples: a decomposition analysis of data from 58 low- and middle-income countries

Introduction: Neighbourhood effect on health outcomes is well established, but little is known about its effect on access to essential health services (EHS). Therefore, this study aimed to assess the contributing factors to access to EHS in slum versus non-slum settings. Methodology: The most recent data from 58 Demographic and Health Surveys (DHS) conducted between 2011 and 2018 were used, including a total of 157,000 pairs of currently married women aged 15–49 and their children aged 12–23 months. We used meta-analysis techniques to examine the inequality gaps in suboptimal access to EHS between mother-children pairs living in slums and non-slums. Blinder-Oaxaca decomposition technique was used to identify the factors contributing to the inequality gaps in each low- and middle-income country (LMIC) included. Result: The percentage of mother–child pairs living in slums ranged from 0.5% in Egypt to 63.7% in Congo. Meta-analysis of proportions for the pooled sample revealed that 31.2% [27.1, 35.5] of slum residents and 20.0% [15.3, 25.2] among non-slum residents had suboptimal access to EHS. We observed significant pro-slum inequalities in suboptimal access to EHS in 28 of the 52 LMICs with sufficient data. Of the 34 African countries included, 16 showed statistically significant pro-slum inequality in suboptimal access to EHS, with the highest in Egypt and Mali (2.64 [0.84–4.44] and 1.76 [1.65, 1.87] respectively). Findings from the decomposition analysis showed that, on average, household wealth, neighbourhood education level, access to media, and neighbourhood-level illiteracy contributed mostly to slum & non-slum inequality gaps in suboptimal access to EHS. Conclusion: The study showed evidence of inequality in access to EHS due to neighbourhood effects in 26 LMICs. This evidence suggests that increased focus on the urban poor might be a important for increasing access to EHS and achieving the universal health coverage (UHC) goals

A multilevel analysis of the determinants of HIV testing among men in Sub-Saharan Africa: Evidence from Demographic and Health Surveys across 10 African countries

Sub-Saharan Africa, the epicenter of the HIV epidemic, has seen significant reductions in new infections over the last decade. Although most new infections have been reported among women, particularly adolescent girls, men are still disadvantaged in accessing HIV testing, care, and treatment services. Globally, men have relatively poorer HIV testing, care, and treatment indices when compared with women. Gender norms and the associated concept of masculinity, strength, and stereotypes have been highlighted as hindering men’s acceptance of HIV counseling and testing. Therefore, men’s suboptimal uptake of HIV testing services will continue limiting efforts to achieve HIV epidemic control. Thus, this study aimed to identify individual, neighborhood, and country-level determinants of sub-optimal HIV testing among men in Sub-Saharan African countries. We analyzed demographic and health datasets from surveys conducted between 2016 and 2020 in Sub-Saharan African Countries. We conducted multivariable multilevel regression analysis on 52,641 men aged 15–49 years resident in 4,587 clusters across 10 countries. The primary outcome variable was ever tested for HIV. HIV testing services uptake among men in these ten Sub-Saharan African countries was 35.1%, with a high of 65.5% in Rwanda to a low of 10.2% in Guinea. HIV testing services uptake was more likely in men with increasing age, some form of formal education, in employment, ever married, and residents in relatively wealthier households. We also found that men who possessed health insurance, had some form of weekly media exposure, and had accessed the internet were more likely to have ever received an HIV test. Unlike those noted to be less likely to have ever received an HIV test if they had discriminatory attitudes towards HIV, comprehensive HIV knowledge, recent sexual activity, and risky sexual behavior were positive predictors of HIV testing services uptake among men. Furthermore, men in communities with high rurality and illiteracy were less likely to receive an HIV test. Individual and community-level factors influence the uptake of HIV testing among Sub-Saharan African men. There was evidence of geographical clustering in HIV testing uptake among men at the community level, with about two-thirds of the variability attributable to community-level factors. Therefore, HIV testing programs will need to design interventions that ensure equal access to HIV testing services informed by neighborhood socioeconomic conditions, peculiarities, and contexts