Estimating the Double Burden of Malnutrition among 595,975 Children in 65 Low- and Middle-Income Countries: A Meta-Analysis of Demographic and Health Surveys

INTRODUCTION: Given the changing global nutrition landscape, the double burden of malnutrition is a major public health challenge in many developing countries. The main aim of this study is to estimate the double burden of malnutrition among children in low- and middle-income countries (LMICs). METHODS: This study used cross-sectional data from Demographic and Health Surveys (2001-2016). A meta-analysis was conducted to estimate the prevalence of malnutrition indicators in 595,975 children under five years from 65 LMICs. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random-effect model was used. Sensitivity analysis was also performed, to examine the effects of outliers. RESULTS: The pooled estimate for stunting, wasting, underweight, and overweight/obesity was 29.0%, 7.5%, 15.5%, and 5.3% respectively. Countries with the highest coexistence of undernutrition and overweight/obesity were: South Africa (stunting 27.4% (95% CI: 25.1, 29.8); overweight/obesity 13.3% (95% CI: 11.5, 15.2)), Sao Tome and Principe (stunting 29.0% (95% CI: 26.8, 31.4); overweight/obesity 10.5% (95% CI: 9.0, 12.1)), Swaziland (stunting 28.9% (95% CI: 27.3, 30.6); overweight/obesity 10.8% (95% CI: 9.7, 12.0)), Comoros (stunting 30.0% (95% CI: 28.3, 31.8); overweight/obesity 9.3% (95% CI: 8.3, 10.5)), and Equatorial Guinea (stunting 25.9% (95% CI: 23.4, 28.7); overweight/obesity 9.7% (95% CI: 8.0, 11.6)). CONCLUSIONS: There is an urgent need to strengthen existing policies on child malnutrition to integrate and scale up opportunities for innovative approaches which address the double burden of malnutrition in children under five years in LMICs

Estimating the Double Burden of Malnutrition among 595,975 Children in 65 Low- and Middle-Income Countries: A Meta-Analysis of Demographic and Health Surveys

Introduction: Given the changing global nutrition landscape, the double burden of malnutrition is a major public health challenge in many developing countries. The main aim of this study is to estimate the double burden of malnutrition among children in low- and middle-income countries (LMICs). Methods: This study used cross-sectional data from Demographic and Health Surveys (2001–2016). A meta-analysis was conducted to estimate the prevalence of malnutrition indicators in 595,975 children under five years from 65 LMICs. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random-effect model was used. Sensitivity analysis was also performed, to examine the effects of outliers. Results: The pooled estimate for stunting, wasting, underweight, and overweight/obesity was 29.0%, 7.5%, 15.5%, and 5.3% respectively. Countries with the highest coexistence of undernutrition and overweight/obesity were: South Africa (stunting 27.4% (95% CI: 25.1, 29.8); overweight/obesity 13.3% (95% CI: 11.5, 15.2)), Sao Tome and Principe (stunting 29.0% (95% CI: 26.8, 31.4); overweight/obesity 10.5% (95% CI: 9.0, 12.1)), Swaziland (stunting 28.9% (95% CI: 27.3, 30.6); overweight/obesity 10.8% (95% CI: 9.7, 12.0)), Comoros (stunting 30.0% (95% CI: 28.3, 31.8); overweight/obesity 9.3% (95% CI: 8.3, 10.5)), and Equatorial Guinea (stunting 25.9% (95% CI: 23.4, 28.7); overweight/obesity 9.7% (95% CI: 8.0, 11.6)). Conclusions: There is an urgent need to strengthen existing policies on child malnutrition to integrate and scale up opportunities for innovative approaches which address the double burden of malnutrition in children under five years in LMIC

A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level

Setting research priorities for preconception care in low- and middle-income countries: aiming to reduce maternal and child mortality and morbidity

Preconception care means providing care before pregnancy is established. Women and couples of reproductive age are generally unaware of the effects that their own health conditions and health-related behaviors may have on the fetus during pregnancy. Although antenatal care is set in the maternal, newborn, and child health (MNCH) continuum [1], it neglects the most critical time of embryonic development, which often occurs before a woman even knows she is pregnant [2]. The evidence increasingly points to earlier care before pregnancy to improve women´s health, and better pregnancy outcomes for the mother and newborn.Fil: Dean, Sohni. Aga Khan Univer​sity; PakistánFil: Rudan, Igor. University of Edinburgh; Reino UnidoFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Webb Girard, Aimee. University of Emory; Estados UnidosFil: Howson, Christopher. March of Dimes Foundation; Estados UnidosFil: Langer, Ana. Harvard University. Harvard School of Public Health; Estados UnidosFil: Lawn, Joy. Saving Newborn Lives- Save The Children; SudáfricaFil: Reeve, Mary Elizabeth. March of Dimes Foundation; Estados UnidosFil: Teela, Katherine C.. Bill and Melinda Gates Foundation; Estados UnidosFil: Toledano, Mireille. Imperial College London; Reino UnidoFil: Venkjatraman, Chandra Mouli. World Health Organization; SuizaFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Car, Josip. Imperial College London; Reino UnidoFil: Chan, Kit Yee. The University of Melbourne; AustraliaFil: Chatterjee, Subidita. Virtual Institute for Advancement of Women, Children and Young People; IndiaFil: Chitekwe, Stanley. United Nations Children's Fund; MalauiFil: Doherty, Tanya. University of the Western Cape; SudáfricaFil: Donnay, France. Bill and Melinda Gates Foundation; Estados UnidosFil: Ezzati, Majid. Imperial College London; Reino UnidoFil: Humayun, Khadija. Aga Khan Univer​sity; PakistánFil: Jack, Brian. Boston University; Estados UnidosFil: Lassi, Zohra S.. Aga Khan Univer​sity; PakistánFil: Martorelli, Reynaldo. University of Emory; Estados UnidosFil: Poortman, Ysbrand. International Genetic Alliance of parent and patient organizations and Preparing for Life; Países BajosFil: Bhutta, Zulfiqar A.. Aga Khan Univer​sity; Pakistá